Trends in risk factors for the major “lifestyle-related diseases” in Geneva, Switzerland, 1993–2000
Introduction
Mortality rates from coronary vascular disease, stroke, and colon cancer continued to decrease in the 1980s and 1990s, while those from lung cancer and chronic obstructive pulmonary disease (women), and diabetes are currently increasing in most industrialized countries. These are the leading “lifestyle-related diseases”, accounting for almost 5.5 million annual deaths in developed regions (1). Future disease trends will depend on the progression of their major risk factors. It is therefore important to develop and maintain methods for evaluating risk factor trends in populations in a comprehensive but timely manner. Reports on trends usually rely upon periodic local or national surveys, repeated within intervals of years (2) (e.g., the MONICA, NHANES national surveys, and several local surveys have also provided data), with a few exceptions such as the BRFSS which collects monthly data in 49 US states. For example, Nelson et al from the BRFSS recently reported an increase in obesity in all US states, a stable or increasing trend in smoking in some states, a decline of physical inactivity and, finally, an increase in the use of cholesterol screening (3).
Our ongoing survey (“Bus Santé”) is community-based, uses locally-developed and validated instruments to measure the main chronic disease determinants, and is conducted continuously. We therefore are able to report 8-year quarterly data (32 time points between January 1993 and December 2000) on the evolution of behavioral and biologic health determinants through the last decade.
Section snippets
Methods
Our risk factor surveillance system has been collecting information uniformly throughout each year from independent random samples of adults aged 35 to 74 years, representative of the Geneva general population, since 1993. Through 2000, 4,228 men and 4,190 women have been interviewed and examined. Sampling methods, questionnaires, and examination techniques were standardized over the 8-year period and are described in detail elsewhere (4). Briefly, eligible subjects are identified from the list
Results
The mean±SD ages (years) of survey participants were 51.7±10.7 among men and 50.9±10.4 among women. The prevalences of hypertension decreased 15% in men and 10% in women between 1993 and 2000 (trend p's<.0001), while the prevalence of hypercholesterolemia increased 5% in men and 7% in women (trend p's<.02). Overweight and obesity also increased 10% in men and 8% in women (trend p's<.05) (Figures 1A, 1B).
Mean cholesterol increased by 0.008 mmol/l per quarter in women (trend p<.0001), and
Discussion
The indisputable decline in hypertension is encouraging. Downward trends are clear in both genders and are not associated with concurrent increases in treatment coverage. This positive evolution may be due to dietary changes, but our survey does not measure salt intakes. Overweight and obesity are steadily rising in Geneva and in other middle-aged populations 3., 6.. Contrary to what has been observed in MONICA (7), hypercholesterolemia increased consistently with the trends in obesity and in
Acknowledgements
This study was funded by the Swiss National Fund for Scientific Research (Grants No 32-31.326.91, 32-37986.93, 32-46142-95, 32-47219.96, 32-49847.96, 3200-054097.98, 32-57104.99). We thank Christoph E. Minder for comments on an earlier draft of this manuscript.
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