Differences in the prevalence of physical activity and cardiovascular risk factors between people living at low (<1,001 m) compared to moderate (1,001-2,000 m) altitude.

Living at moderate altitude (up to about 2,000 m) was shown to be associated with distinct health benefits, including lower mortality from cardiovascular diseases and certain cancers. However, it remains unclear, whether those benefits are mainly due to environmental conditions (e.g., hypoxia, temperature, solar ultra-violet radiation) or differences in lifestyle behavior, including regular physical activity levels. This study aims to compare altitude-related differences in levels of physical activity and the prevalence of cardiovascular risk factors such as obesity, hypertension, hypercholesterolemia, and diabetes in an Alpine country. We interrogated the Austrian Health Interview Survey (ATHIS) 2019, a nationally representative study of persons aged over 15 years living in private Austrian households. The results confirm a higher prevalence of hypertension (24.2% vs. 16.8%) in men living at low (<1,001 m) compared to those at moderate (1,001 to 2,000 m) altitude. Women living above 1,000 m tend to have a lower prevalence of hypercholesterolemia (14.8% vs. 18.8%) and diabetes (3.2% vs. 5.6%) than their lower living peers. Both sexes have lower average body mass index (BMI) when residing at moderate altitude (men: 25.7, women: 23.9) compared to those living lower (26.6 and 25.2). Severe obesity (BMI > 40) is almost exclusively restricted to low altitude dwellers. Only men report to be more physically active on average when living higher (1,453 vs. 1,113 weekly MET minutes). These novel findings confirm some distinct benefits of moderate altitude residence on heath. Beside climate conditions, differences in lifestyle behavior, i.e., physical activity, have to be considered when interpreting those health-related divergences, and consequently also mortality data, between people residing at low and moderate altitudes.

International versus national growth charts for identifying small and large-for-gestational age newborns: A population-based study in 15 European countries.

BACKGROUND: To inform the on-going debate about the use of universal prescriptive versus national intrauterine growth charts, we compared perinatal mortality for small and large-for-gestational-age (SGA/LGA) infants according to international and national charts in Europe. METHODS: We classified singleton births from 33 to 42 weeks of gestation in 2010 and 2014 from 15 countries (N = 1,475,457) as SGA (birthweight <10th percentile) and LGA (>90th percentile) using the international Intergrowth-21st newborn standards and national charts based on the customised charts methodology. We computed sex-adjusted odds ratios (aOR) for stillbirth, neonatal and extended perinatal mortality by this classification using multilevel models. FINDINGS: SGA and LGA prevalence using national charts were near 10% in all countries, but varied according to international charts with a north to south gradient (3.0% to 10.1% and 24.9% to 8.0%, respectively). Compared with appropriate for gestational age (AGA) infants by both charts, risk of perinatal mortality was increased for SGA by both charts (aOR[95% confidence interval (CI)]=6.1 [5.6-6.7]) and infants reclassified by international charts from SGA to AGA (2.7 [2.3-3.1]), but decreased for those reclassified from AGA to LGA (0.6 [0.4-0.7]). Results were similar for stillbirth and neonatal death. INTERPRETATION: Using international instead of national charts in Europe could lead to growth restricted infants being reclassified as having normal growth, while infants with low risks of mortality could be reclassified as having excessive growth. FUNDING: InfAct Joint Action, CHAFEA Grant n°801,553 and EU/EFPIA Innovative Medicines Initiative 2 Joint Undertaking ConcePTION grant n°821,520. AH received a PhD grant from EHESP.

Moderate Altitude Residence Reduces Male Colorectal and Female Breast Cancer Mortality More Than Incidence: Therapeutic Implications?

BACKGROUND: Living at moderate altitude may be associated with health benefits, including reduced mortality from male colorectal and female breast cancer. We aimed to determine altitude-dependent incidence and mortality rates of those cancers and put them in the context of altitude-associated lifestyle differences. METHODS: Incidence cases and deaths of male colorectal cancer (n = 17,712 and 7462) and female breast cancer (n = 33,803 and 9147) from altitude categories between 250 to about 2000 m were extracted from official Austrian registries across 10 years (2008-2017). Altitude-associated differences in health determinants were derived from the Austrian Health Interview Survey (2014). RESULTS: The age-standardized incidence and mortality rates of male colorectal cancer decreased by 24.0% and 44.2%, and that of female breast cancer by 6.5% and 26.2%, respectively, from the lowest to the highest altitude level. Higher physical activity levels and lower body mass index for both sexes living at higher altitudes were found. CONCLUSIONS: Living at a moderate altitude was associated with a reduced incidence and (more pronounced) mortality from colorectal and breast cancer. Our results suggest a complex interaction between specific climate conditions and lifestyle behaviours. These observations may, in certain cases, support decision making when changing residence.

Survival of women with breast cancer in Austria by age, stage and period of diagnosis.

PURPOSE: To investigate survival of breast cancer patients by 1) age, 2) tumor stage and 3) period of diagnosis, also to determine the contribution of improvements in treatment and opportunistic mammography screening in Austria. METHODS: Survival was calculated overall and by 1) age groups (in years) < 50, 50-64, > 65; 2) stage I, II, IV, unknown 3) for 17,025 patients diagnosed 1988-92, compared with 19,284 patients diagnosed 1993-97. Odds ratios for being diagnosed as stage I in the period 1993-97 compared to 1988-92 were calculated by age group and for all ages. RESULTS: In the later period (1993-97) age-adjusted mortality rate decreased overall by 3.3% (age: < 50; 8.2%, 50-64; 5.1%, > 65; 1.6%). Overall, stage I cases increased from 46.5% to 51%. Five year relative survival rates improved significantly overall, 6.7% (p < 0.001), and within age groups (age: < 50; 4.5% (p < 0.05), 50-64; 7.2% (p < 0.05) and > 65; 7.3% (p < 0.001). This improvement is confined to patients with stage I tumors in age groups 50-64 (4.1%, p < 0.05) and > 65 (7.2%, p < 0.001) and to patients with stage II in age groups < 50 (7.7%, p < 0.01) and 50-64 (8.3%, p < 0.01). For patients younger than 50, in stage IV, diagnosed 1993-97, survival was significantly poorer (-16.9%, p < 0.05) compared to 1988-92. The odds ratio of being diagnosed as stage I in the later period was 1.19 (95% CI: 1.14, 1.24) for all ages, 1.13 (95% CI: 1.03, 1.24) and for women < 50, 1.3 (95% CI: 1.20, 1.40) 50-64 and 1.15 (95% CI: 1.09, 1.22) > 65 years old. CONCLUSION: We conclude that treatment improvements, which are accessible to all patients countrywide due to the compulsory state insurance system, had a major impact on positive trends in mortality and survival. Opportunistic screening should have contributed to some extent beginning in the early nineties.