All-cause mortality trends in Switzerland since 1950. I. Differences in sex, age, and nationality in comparison with European trends

Background: All-cause mortality is an important criterion for assessing the health status and the living conditions of a population, thus indicating p ossible preventive measures. Data and methods: Descriptive analyses of Swiss mortality records and a com parison with the WHO mortality data bank for the period since 1950. Results: Age-specific mortality trends in Switzerland are traced back to 19 50 and compared with the situation in other European countries. At the begi nning of the 1950s Swiss all-cause mortality rates were about the European average; now they are among the lowest worldwide. In most age classes, rate s declined by more than one third between 1951/54 and 1990/94, in females e ven by more than 50%. This rather optimistic overall picture conceals less favourable partial trends. The decline in mortality rates in men aged 20-49 and women aged 20-34 years did not continue after 1970, and for males aged 20-44 and females aged 25-34 mortality risks have even increased in recent years. In both males and females, mortality rates from injury and poisonin g (mainly accidents and suicide) exceed those of European low-incidence cou ntries by 100%. On an international scale Swiss subjects aged between 15 an d 44 years are at much higher risk, even when deaths from injury and poison ing, the most important cause of death in these ages, are excluded. When co mpared with their Swedish contemporaries, Swiss males aged 25-34 pears have almost twice the risk of dying from a "natural" as well as from an "extern al" cause. As a rule, male/female sex ratios of mortality continued to incr ease, except in subjects aged 45-64 years. Conclusion: In spite of low overall mortality risks, international age-spec ific rates suggest considerable potential for preventive measures in Switze rland. There is some evidence of substantial under-registration of the mort ality risks of foreigners living in Switzerland. As foreigners represent a substantial part of the total population - with a maximum of 30% of men age d 25-34 years - figures for Switzerland as a whole may be biased seriously. Therefore, for mortality analyses and comparisons with international data, we suggest the study be restricted to Swiss citizens. When assessing morta lity risks for foreigners in Switzerland, alternative data sources and meth ods should be taken into account.