Persistent variations in average height between countries and between socio-economic groups: an overview of 10 European countries.

PRIMARY OBJECTIVES: This paper aims to provide an overview of variations in average height between 10 European countries, and between socio-economic groups within these countries. DATA AND METHODS: Data on self-reported height of men and women aged 20-74 years were obtained from national health, level of living or multipurpose surveys for 1987-1994. Regression analyses were used to estimate height differences between educational groups and to evaluate whether the differences in average height between countries and between educational groups were smaller among younger than among older birth cohorts. RESULTS: Men and women were on average tallest in Norway, Sweden, Denmark and the Netherlands and shortest in France, Italy and Spain (range for men: 170-179 cm; range for women: 160-167 cm). The differences in average height between northern and southern European countries were not smaller among younger than among older birth cohorts. In most countries average height increased linearly with increasing birth-year (approximately 0.7-0.8 cm/5 years for men and approximately 0.4 cm/5 years for women). In all countries, lower educated men and women on average were shorter than higher educated men (range of differences: 1.6-3.0 cm) and women (range of differences: 1.2-2.2 cm). In most countries, education-related height differences were not smaller among younger than among older birth cohorts. CONCLUSIONS: The persistence of international differences in average height into the youngest birth cohorts indicates a high degree of continuity of differences between countries in childhood living conditions. Similarly, the persistence of education-related height differences indicates continuity of socio-economic differences in childhood living conditions, and also suggests that socio-economic differences in childhood living conditions will continue to contribute to socio-economic differences in health at adult ages.

Educational differences in smoking: international comparison.

OBJECTIVE: To investigate international variations in smoking associated with educational level. DESIGN: International comparison of national health, or similar, surveys. SUBJECTS: Men and women aged 20 to 44 years and 45 to 74 years. SETTING: 12 European countries, around 1990. MAIN OUTCOME MEASURES: Relative differences (odds ratios) and absolute differences in the prevalence of ever smoking and current smoking for men and women in each age group by educational level. RESULTS: In the 45 to 74 year age group, higher rates of current and ever smoking among lower educated subjects were found in some countries only. Among women this was found in Great Britain, Norway, and Sweden, whereas an opposite pattern, with higher educated women smoking more, was found in southern Europe. Among men a similar north-south pattern was found but it was less noticeable than among women. In the 20 to 44 year age group, educational differences in smoking were generally greater than in the older age group, and smoking rates were higher among lower educated people in most countries. Among younger women, a similar north-south pattern was found as among older women. Among younger men, large educational differences in smoking were found for northern European as well as for southern European countries, except for Portugal. CONCLUSIONS: These international variations in social gradients in smoking, which are likely to be related to differences between countries in their stage of the smoking epidemic, may have contributed to the socioeconomic differences in mortality from ischaemic heart disease being greater in northern European countries. The observed age patterns suggest that socioeconomic differences in diseases related to smoking will increase in the coming decades in many European countries.

Differences in self reported morbidity by educational level: a comparison of 11 western European countries.

STUDY OBJECTIVE: To assess whether there are variations between 11 Western European countries with respect to the size of differences in self reported morbidity between people with high and low educational levels. DESIGN AND METHODS: National representative data on morbidity by educational level were obtained from health interview surveys, level of living surveys or other similar surveys carried out between 1985 and 1993. Four morbidity indicators were included and a considerable effort was made to maximise the comparability of these indicators. A standardised scheme of educational levels was applied to each survey. The study included men and women aged 25 to 69 years. The size of morbidity differences was measured by means of the regression based Relative Index of Inequality. MAIN RESULTS: The size of inequalities in health was found to vary between countries. In general, there was a tendency for inequalities to be relatively large in Sweden, Norway, and Denmark and to be relatively small in Spain, Switzerland, and West Germany. Intermediate positions were observed for Finland, Great Britain, France, and Italy. The position of the Netherlands strongly varied according to sex: relatively large inequalities were found for men whereas relatively small inequalities were found for women. The relative position of some countries, for example, West Germany, varied according to the morbidity indicator. CONCLUSIONS: Because of a number of unresolved problems with the precision and the international comparability of the data, the margins of uncertainty for the inequality estimates are somewhat wide. However, these problems are unlikely to explain the overall pattern. It is remarkable that health inequalities are not necessarily smaller in countries with more egalitarian policies such as the Netherlands and the Scandinavian countries. Possible explanations are discussed.

Morbidity differences by occupational class among men in seven European countries: an application of the Erikson-Goldthorpe social class scheme.

BACKGROUND: This paper describes morbidity differences according to occupational class among men from France, Switzerland, (West) Germany, Great Britain, the Netherlands, Denmark, and Sweden. METHODS: Data were obtained from national health interview surveys or similar surveys between 1986 and 1992. Four morbidity indicators were included. For each country, individual-level data on occupation were recorded according to one standard occupational class scheme: the Erikson-Goldthorpe social class scheme. To describe the pattern of morbidity by occupational class, odds ratios (OR) were calculated for each class using the average of the population as a reference. The size of morbidity differences was summarized by the OR of two broad hierarchical classes. All OR were age-adjusted. RESULTS: For all countries, a lower than average prevalence of morbidity was found for higher and lower administrators and professionals as well as for routine nonmanual workers, whereas a higher than average prevalence was found for skilled and unskilled manual workers and agricultural workers. Self-employed men were in general healthier than the average population. The relative health of farmers differed between countries. The morbidity difference between manual workers and the class of administrators and professionals was approximately equally large in all countries. Consistently larger inequality estimates, with no or slightly overlapping confidence intervals, were only found for Sweden in comparison with Germany. CONCLUSIONS: Thanks to the use of a common social class scheme in each country, a high degree of comparability was achieved. The results suggest that morbidity differences according to occupational class among men are very similar between different European countries.

[Health for all--the last progress assessment before the year 2000]. / Gesundheit für alle--die letzte Fortschrittsmessung vor dem Jahr 2000.

In the framework of the tri-annual report to WHO of progress towards "Health for all" the specific question concerning reduction of inequity in health is addressed. Regional variations in health status represent an important aspect of that question which is of particular interest in a federal country where major public health competencies are located at the regional level (cantons in Switzerland). Health status is described by both mortality measures (main causes of death) in the population aged 0-64 years and morbidity indicators (rates of disability pensioners) in the same age group. In addition to the comparison of mortality and morbidity rates between cantons an "index of dissimilarity" (DI) was used. For both criteria, changes over a time period of 10 to 12 years were considered. Results show decreasing trends of mortality from all and main causes of death in both sexes. While this tendency goes along with decreasing dissimilarity as to male overall mortality, the corresponding female DI increases, indicating an increase in inequity between the cantons. A similar pattern is observed as to morbidity: although rates of disability pensioners went up for both sexes, this increase resulted in a lower DI-value for men but a higher one for women. The results are discussed against the background of socioeconomic differences (e.g. unemployment) between the cantons studied.

[Construction and validation of an indicator for alcohol problems in the Swiss Health Survey]. / Zur Konstruktion und Validierung eines Indikators für Alkoholprobleme in der schweizerischen Gesundheitsbefragung.

A proposed scale for alcohol problems which consisted of five items, was psychometrically examined and validated. Latent class analysis was used in addition to classic psychometric measures. The use of this scale in health surveys of the general population seems to be justified, as it offers a reliable and very economic method to measure alcohol induced problems. It is therefore proposed that this scale should continue to be used in future rounds of the Swiss Health Survey. The context of the questioning has to be taken into account when interpreting the summary score, as items showed different patterns of response in personal vs interview questionnaires.

[Why do farmers die more often from lung diseases?]. / Warum sterben Bauern häufiger an Lungenkrankheiten?

During the period 1988-1992 deaths from lung diseases were more frequent among the farming population according to Swiss mortality data. The age-standardized proportional mortality rate (PMR) is 127 for all the lung diseases (ICD-8 460-519), 140 for bronchitis and asthma (ICD-8 490-493), 137 for asthma alone (ICD-8 493) and 841 for pneumoconiosis due to organic dust (ICD-8 516.1 + .2). Stock-farmers showed a mortality pattern for chronic obstructive pulmonary disease opposite to that of vegetable farmers and wine-growers. This increased mortality among farmers is paradoxical in the light of the more frequent tolerance for aeroallergens among the children of farmers, the conservative style of housing and living as well as received ideas about working in natural and therefore healthy air. Insufficient knowledge of the multifactorial risks of natural pathogenic organic substances and of dangerous work are just as important for the pathogenesis of these diseases and deaths as the changed social and cultural values with the consequences on insurance policy. These factors affect optimal prophylaxis (limitation of air pollution, safety measures, job change and measures in order to achieve adequate social security).

A comparison of the drugs taken in fatal and nonfatal self-poisoning.

The objective of this study was a) to compare patterns of drug use in fatal and nonfatal overdoses and b) to find out if toxic drugs are overrepresented in overdoses with fatal outcome. A total of 179 cases of fatal overdoses in Switzerland (population 6.6 million) were compared with 269 medically treated self-poisoners from the agglomeration of Berne (population 301,630). Because of frequent multiple drug use, all the different compounds taken singly or in combination with other drugs were recorded and grouped according to drug types. The patterns of the frequencies of drugs used were remarkably similar in both groups. The majority of the drugs were psychotropics (81% in fatal and 68% in nonfatal overdose). Twenty-nine completed suicides were the result of drug combinations specifically recommended by EXIT. In the remaining cases benzodiazepines were used most frequently in both attempted and completed suicide, often in combination with other drugs or alcohol. Barbiturates were the only drugs recorded significantly more often in fatal overdoses (9% vs 3%). No significant difference was found for tricyclic antidepressants (13% vs 10%), or other types of drugs. The results are consistent with our assumption that drugs with higher toxicity would be overrepresented in overdoses with fatal outcome. Barbiturates, which are well known to be dangerous in overdose, were clearly associated with fatal overdoses, but not tricyclic antidepressants. This, in our view, suggests that the risk of prescribing tricyclic antidepressants should not be overestimated. The frequent use of benzodiazepines in completed suicide, however, indicates that there are no truly safe drugs in overdose.

[Overweight in Switzerland. Cross-comparison of various studies with the Heureka Study]. / Ubergewicht in der Schweiz. Ein Quervergleich verschiedener Studien mit der Heureka-Studie.

In this study the most important Swiss studies on the incidence of overweight and obesity are summarized and compared to the corresponding prevalence rates from the Heureka study. Interestingly, data on body weight indexes (mostly mass indexes) and the various prevalence rates showed good accordance for younger age groups. In the upper age classes however, phenotypic differences concerning determinants and risk factors for overweight became obvious in the different Swiss populations (i.e. from geographically different regions of Switzerland). Nevertheless, regional risk factors could not been detected because specific data were lacking. The importance of uniform weight definitions for studies as well as for daily practise is stressed.

Suicide with psychotropic drugs in Switzerland.

All suicides in Switzerland in 1990 where drugs were involved (179 persons; 12.2% of all suicides) were analyzed by examination of death certificates and direct contacts with physicians and medico-legal institutions. Nearly 50% of these people took overdoses of combinations of different drugs and in 26% of the cases alcohol was reported to have been taken with the drugs. Unexpectedly, we found 29 suicides in which persons had obviously used drug combinations recommended by EXIT, an organization advocating the freedom of the individual to decide about his own time and nature of death. In EXIT-suicides usually barbiturates and anticholinergic drugs were taken together. Interestingly, the barbiturate compound used most often had officially been withdrawn from the market the previous year. Altogether, psychotropic drugs represented 78.7% of all drugs taken, with benzodiazepines being named most often (38.9%), followed by barbiturates (16.6%) and antidepressants (13.6%). Among the benzodiazepines flunitrazepam, diazepam, and triazolam were used most often and surprisingly, benzodiazepines were named as single drugs on 27 death certificates. Among the antidepressants (taken in 20.3% of overdoses) maprotiline was the most common drug used, followed by mianserin and trimipramine. This order of frequency reflects the prescribing habits of Swiss doctors. Two suicides were recorded with neuroleptics alone.

The use of self-measured blood pressure determinations in assessing dynamics of drug compliance in a study with amlodipine once a day, morning versus evening.

OBJECTIVE: To test whether the time of administration influences the therapeutic response to a calcium antagonist taken once a day. Also, the dynamics of drug compliance and its impact on blood pressure control were investigated. DESIGN: Twenty outpatients with mild-to-moderate hypertension were included in a randomized, placebo-controlled open study. In a crossover design, all of the patients received 5 mg amlodipine, either in the morning or in the evening, during two consecutive 4-week treatment periods. METHODS: Blood pressure was taken by casual measurement, ambulatory 24-h monitoring (SpaceLabs 90202) and self-measurement at home, performed with a semi-automatic oscillometric device during the whole study period. Compliance was assessed using the Medication-Event-Monitoring System (MEMS). RESULTS: Neither casual nor ambulatory day- or night-time readings detected a significant difference between morning and evening administration. However, self-measurement documented significantly greater blood pressure reductions for morning than for evening administration. The MEMS showed different compliance on the days of ambulatory monitoring (100% with both drug regimens) compared with the whole treatment period. The number of days with missed medication was thus significantly higher for the evening dosing regimen. The difference in self-measured blood pressure between the two regimens was lost if the days with missed medication were removed from the statistical analysis. CONCLUSIONS: Time of once-a-day amlodipine administration does not influence its efficacy for 24-h blood pressure control. Furthermore, the use of self-measurement and the MEMS may provide useful additional information on the pharmacodynamic impact of different dosing patterns in hypertensive patients.

[Heureka study: prevalence of overweight and obesity in Switzerland]. / Heureka-Studie: Prävalenz des Ubergewichts und der Adipositas in der Schweiz.

Overweight and obesity as well as associated metabolic disorders belong to the most important risk factors. During the exhibition 'Heureka' in Zurich data on body weight and size as well as on other clinical and biochemical parameters were collected by a questionnaire. Age- and gender-specific prevalence rates were calculated. Between 10 and 41% of the visitors showed a body-mass index of > or = 25 kg/m2, as a function of age and gender -0.7 to 6.2% showed a body-mass index of > or = 30 kg/m2. The most important increase in body weight was found in the age groups between 20 and 40 years. The presented epidemiologic data show that overweight is common in Switzerland, too. Prevention of overweight is still one of the most rational medical strategies and should be intensified in the age group between 20 and 40.

Measurement error in alcohol consumption: the Swiss Health Survey.

It is planned to include in the Swiss Health Survey (SHS) the questions on the consumption of alcohol that have been part of the Trend Surveys of the Swiss Institute for the Prevention of Alcohol and Drug Problems (SIPA). Since both surveys use different questioning methods (SHS: telephone interview/self-administered questionnaire; SIPA Trend Surveys: personal interviews) a comparative study was carried out to test possible effects of the methods used on responses about alcohol consumption. A split-sample design was used, whereby 1097 persons were asked about their alcohol intake by personal interview, and 1154 persons completed a self-administered questionnaire with the same questions. Considerable differences were found: on an average, consumption reported by personal interview was 38.5% higher among males (including abstainers: 35.9%) and 18.0% higher among females (including abstainers: 17.4%) than that reported by self-administered questionnaire. Consumption figures as assessed by personal interview correspond better to the per capita consumption figures as estimated by sales. Preliminary conclusions concerning the design of future surveys of alcohol consumption in Switzerland are presented.

[Are home blood pressure measurements and 24-hour ambulatory recordings superior to office measurements? Comparison of 3 blood pressure recording methods in a study of cilazapril versus atenolol]. / Sind die Messung zu Hause und die ambulante 24-Std.-Blutdruckmessung der Messung in der Praxis überlegen? Ein Vergleich der drei Blutdruckmessmethoden in einer Studie Cilazapril versus Atenolol.

Self-assessment of blood pressure and ambulatory blood pressure monitoring (ABPM) are being more widely used in the diagnosis and therapy of hypertension, in addition to office blood pressure measurement. The present multicenter double-blind study compared cilazapril 2.5 to 5 mg (n = 26) to atenolol 50 to 100 mg (n = 27) over a period course of eight weeks. Office blood pressures in the morning before medication, ABPM over 24 h and self assessment of the blood pressure in the morning and evening were taken. The aim of the study was to find out if the results of ABPM and self assessment of blood pressure are similar when compared to office blood pressure measurement. After four weeks of therapy both cilazapril and atenolol achieved a significant and comparable reduction of blood pressure, which did not change significantly afterwards. Both medications showed a comparable blood pressure control over 24 h. with a once-a-day regimen. The comparison of the three techniques of blood pressure measurement demonstrates that ABPM results in significantly lower average daily values than office blood pressure measurement and that the self-assessed blood pressure values in most cases lie in-between. Although the diastolic ambulatory daily values were on the average 9 mmHg lower than the corresponding office values, it was not possible for an individual patient to accurately predict the ambulatory value obtained by to his office blood pressure value. Similar results were found for the values according to self assessment of blood pressure.(ABSTRACT TRUNCATED AT 250 WORDS)