All-cause mortality trends in Switzerland since 1950. II. Geographical differences within Switzerland

Objectives: To examine regional variations in all-cause mortality in Switze rland around 1990 and trends since 1950. Special emphasis is placed on unfa vourable aspects that have been identified by comparisons with internationa l trends. Data and methods: Descriptive analysis of Swiss mortality statistics taken from individual records (1969-94) and data published by the Swiss Federal S tatistical Office (1949-68). Results: Swiss citizens aged between 15 and 79 years often show mortality r atios of 1.5 and more between the best and the worst of the 106 regions of Switzerland. In subjects aged under 50 years, relative risk ranges are even larger. However, the regional mortality patterns before and after 50 rarel y correspond. Generally, the relative risk difference between the best and the worst regions has not diminished since 1950, whereas the geographical p atterns have completely changed. Instead of an obvious rural-urban gradient in 1950, mortality rates are now highest in the largest cities and, at lea st in men, are at their lowest in the wealthy suburbs. On a larger scale (d ivision into 9 geographical units), central Switzerland has changed signifi cantly from clearly elevated mortality rates in 1950 into a decidedly favou rable position in 1990. A contrast between German and French Switzerland has existed for many decad es: in the younger and middle age groups the francophone part of Switzerlan d has a higher mortality rate than the German-speaking part, whereas at age s over 70 French Switzerland has lower rates than German Switzerland. In some urban areas of Switzerland, the turning-point from a decreasing to an increasing trend in the mortality risks of subjects aged 15-49 years was reached around 1960, occasionally resulting in age-specific rates being hi gher in 1990 than in 1950. This unfavourable partial trend has spread over most, but not all, of Switzerland since 1970. Even in subjects aged 25-34 y ears, the age group for which Switzerland has the worst relative position o n an international scale, some parts of the country do not have elevated al l-cause mortality rates, whereas for men in the largest cities mortality ri sks are more than three times as high as in Japan. The deaths from "externa l" causes (mainly accidents and suicide) show marked geographical patterns within Switzerland; however, in all parts of the country, deaths from this group are much more frequent than, for example, in Italy or the Netherlands . Conclusion: Geographical differences in mortality risks within Switzerland, as well as international disparities, suggest that there is a need for pre ventive measures in Switzerland, first and foremost concerning males aged 1 5-49 years and deaths from "external" causes.