European Journal of Epidemiology

, Volume 26, Issue 8, pp 595–608 | Cite as

Determinants of 40-year all-cause mortality in the European cohorts of the Seven Countries Study

  • Paolo Emilio Puddu
  • Alessandro Menotti
  • Hanna Tolonen
  • Srecko Nedeljkovic
  • Anthony George Kafatos
MORTALITY

Abstract

If a few risk factors had predictive power for all-cause mortality in different geographical-cultural areas, then preventive efforts might be concentrated on these. Thirteen potential risk factors were measured in 6,554 men aged 40–59 around 1960 in Northern, Southern and Eastern European areas of the Seven Countries Study. In 40 years 85.3% of men died in the pooled areas (87.9, 81.8 and 87.9% in Northern, Southern and Eastern Europe, respectively). Six risk factors were significant predictors of events in all three areas: directly for age, smoking habits, mean blood pressure, heart rate and ECG abnormalities; inversely for forced expiratory volume. In a pooled model also father and mother life status, socio-economic status, and arm circumference (the last one in an inverse way) had significant coefficients that were not heterogeneous across areas (except for socio-economic status). Serum cholesterol was around significance. ROC curves had values of 0.833, 0.806 and 0.819 respectively in Northern, Southern and Eastern Europe, and 0.827 in the pooled areas. Correlation coefficients between observed and expected cases in deciles of estimated risk were between 0.98 and 0.99. Survivors after 40 years in the lower half of the estimated risk were 10.7, 23.6 and 13.3% in Northern, Southern and Eastern Europe, respectively. Under- or over-estimate of cross-applying risk functions did not exceed 15%. All-cause mortality and survival in middle aged men during 40 years were strongly associated with a few, mainly cardiovascular, risk factors, whose predictive power was similar in different cultures across Europe.

Keywords

Risk factors All-cause mortality Prediction Epidemiology Seven Countries Study 

References

  1. 1.
    Anderson KM, Castelli WP, Levy D. Cholesterol and mortality. 30 years of follow-up from the Framingham study. JAMA. 1987;257:2176–80.PubMedCrossRefGoogle Scholar
  2. 2.
    Inskip H, Beral V, McDowall M. Mortality of Shipham residents: 40-year follow-up. Lancet. 1982;1:896–9.PubMedCrossRefGoogle Scholar
  3. 3.
    Rossow I, Amundsen A. Alcohol abuse and mortality: a 40-year prospective study of Norwegian conscripts. Soc Sci Med. 1997;44:261–7.PubMedCrossRefGoogle Scholar
  4. 4.
    Goto A, Yasumura S, Nishise Y, Sakihara S. Association of health behavior and social role with total mortality among Japanese elders in Okinawa, Japan. Aging Clin Exp Res. 2003;15:443–50.PubMedGoogle Scholar
  5. 5.
    Peeters A, Barendregt JJ, Willekens F, Mackenbach JP, Al Mamun A, Bonneux L. NEDCOM, the Netherlands epidemiology and demography compression of morbidity research group. Obesity in adulthood and its consequences for life expectancy: a life-table analysis. Ann Intern Med. 2003;138:24–32.PubMedGoogle Scholar
  6. 6.
    Degrave E, Autier P, Grivegnée AR, Zizi M. All-cause mortality among Belgian military radar operators: a 40-year controlled longitudinal study. Eur J Epidemiol. 2005;20:677–81.PubMedCrossRefGoogle Scholar
  7. 7.
    Frostad A, Søyseth V, Andersen A, Gulsvik A. Respiratory symptoms as predictors of all-cause mortality in an urban community: a 30-year follow-up. J Intern Med. 2006;259:520–9.PubMedCrossRefGoogle Scholar
  8. 8.
    Imanishi R, Seto S, Ichimaru S, Nakashima E, Yano K, Akahoshi M. Prognostic significance of incident complete left bundle branch block observed over a 40-year period. Am J Cardiol. 2006;98:644–8.PubMedCrossRefGoogle Scholar
  9. 9.
    Meisinger C, Wölke G, Brasche S, Strube G, Heinrich J. Postload plasma glucose and 30-year mortality among nondiabetic middle-aged men from the general population: the ERFORT study. Ann Epidemiol. 2006;16:534–9.PubMedCrossRefGoogle Scholar
  10. 10.
    Brummett BH, Helms MJ, Dahlstrom WG, Siegler IC. Prediction of all-cause mortality by the Minnesota Multiphasic Personality Inventory Optimism-Pessimism scale scores: study of a college sample during a 40-year follow-up period. Mayo Clin Proc. 2006;81:1541–4.PubMedCrossRefGoogle Scholar
  11. 11.
    Ruggiero C, Metter EJ, Melenovsky V, Cherubini A, Najjar SS, Ble A, et al. High basal metabolic rate is a risk factor for mortality: the Baltimore longitudinal study of aging. J Gerontol A Biol Sci Med Sci. 2008;63:698–706.PubMedGoogle Scholar
  12. 12.
    Ferrie JE, Singh-Manoux A, Kivimäki M, Mindell J, Breeze E, Smith GD, et al. Cardiorespiratory risk factors as predictors of 40-year mortality in women and men. Heart. 2009;95:1250–7.PubMedCrossRefGoogle Scholar
  13. 13.
    He J, McGee D, Niu X, Choi W. Examining the dynamic association of BMI and mortality in the Framingham Heart Study. Int J Environ Res Public Health. 2009;6:3115–26.PubMedCrossRefGoogle Scholar
  14. 14.
    Holtermann A, Mortensen OS, Burr H, Søgaard K, Gyntelberg F, Suadicani P. Physical work demands, hypertension status and risk of ischemic heart disease and all-cause mortality in the Copenhagen Male Study. Scand J Work Environ Health. 2010;36:466–72.PubMedCrossRefGoogle Scholar
  15. 15.
    Panagiotakos DB, Chrysohoou C, Pitsavos C, Menotti A, Dontas A, Skoumas J, et al. Corfu Cohort from the Seven Countries Study. Forty-years (1961–2001) of all-cause and coronary heart disease mortality and its determinants: the Corfu cohort from the Seven Countries Study. Int J Cardiol. 2003;90:73–9.PubMedCrossRefGoogle Scholar
  16. 16.
    Moschandreas J, Kafatos A, Aravanis C, Dontas A, Menotti A, Kromhout D. Long-term predictors of survival for the Seven Countries Study cohort from Crete: from 1960 to 2000. Int J Cardiol. 2005;100:85–91.PubMedCrossRefGoogle Scholar
  17. 17.
    Menotti A, Kromhout D, Blackburn H, Jacobs D, Lanti M. Forty-year mortality from cardiovascular diseases and all causes of death in the US Railroad cohort of the Seven Countries Study. Eur J Epidemiol. 2004;19:417–24.PubMedCrossRefGoogle Scholar
  18. 18.
    Menotti A, Lanti M, Maiani G, Kromhout D. Determinants of longevity and all-cause mortality among middle-aged men. Role of 48 personal characteristics in a 40-year follow-up of Italian Rural Areas in the Seven Countries Study. Aging Clin Exp Res. 2006;18:394–406.PubMedGoogle Scholar
  19. 19.
    Pelkonen M, Tukiainen H, Tervahauta M, Notkola IL, Kivelä SL, Salorinne Y, et al. Pulmonary function, smoking cessation and 30 year mortality in middle aged Finnish men. Thorax. 2000;55:746–50.PubMedCrossRefGoogle Scholar
  20. 20.
    Pelkonen M, Notkola IL, Nissinen A, Tukiainen H, Koskela H. Thirty-year cumulative incidence of chronic bronchitis and COPD in relation to 30-year pulmonary function and 40-year mortality: a follow-up in middle-aged rural men. Chest. 2006;130:1129–37.PubMedCrossRefGoogle Scholar
  21. 21.
    Keys A (ed), Blackburn H, Menotti A, Buzina R, Mohacek I, Karvonen MJ, et al. Coronary heart disease in seven countries. Circulation 1970;41(suppl 1):1–211.Google Scholar
  22. 22.
    Keys A (ed), Aravanis C, Blackburn H, Buzina R, Djordjevic BS, Dontas AS et al. Seven Countries Study. A multivariate analysis of death and coronary heart disease. Cambridge: Harvard Univ Press; 1980. pp 1–381.Google Scholar
  23. 23.
    Morris JN. Uses of epidemiology, vol. 3. London: Edinburgh; 1975. p. 1–318.Google Scholar
  24. 24.
    Rose G, Blackburn H. Cardiovascular survey methods. World Health Organization: Geneva; 1968. p. 1–188.Google Scholar
  25. 25.
    Anderson JT, Keys A. Cholesterol in serum and lipoprotein fractions: its measurement and stability. Clin Chem. 1956;2:145–59.PubMedGoogle Scholar
  26. 26.
    Menotti A, Blackburn H, Kromhout D, Nissinen A, Adachi H, Lanti M. Cardiovascular risk factors as determinants of 25-year all-cause mortality in the seven countries study. Eur J Epidemiol. 2001;17:337–46.PubMedCrossRefGoogle Scholar
  27. 27.
    Dyer AR. A method for combining results from several prospective epidemiological studies. Stat Med. 1986;5:303–17.PubMedCrossRefGoogle Scholar
  28. 28.
    Lanti M, Menotti A, Nedeljkovic S, Nissinen A, Kafatos A, Kromhout D. Long-term trends in major cardiovascular risk factors in cohorts of aging men in the European cohorts of the Seven Countries Study. Aging Clin Exp Res. 2005;17:306–15.PubMedGoogle Scholar
  29. 29.
    May M. Commentary: improved coronary risk prediction using neural networks. Int J Epidemiol. 2002;31:1262–3.CrossRefGoogle Scholar
  30. 30.
    Buijsse B, Feskens EJ, Moschandreas J, Jansen EH, Jacobs DR Jr, Kafatos A, et al. Oxidative stress, and iron and antioxidant status in elderly men: differences between the Mediterranean south (Crete) and northern Europe (Zutphen). Eur J Cardiovasc Prev Rehabil. 2007;14:495–500.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2011

Authors and Affiliations

  • Paolo Emilio Puddu
    • 1
  • Alessandro Menotti
    • 2
  • Hanna Tolonen
    • 3
  • Srecko Nedeljkovic
    • 4
  • Anthony George Kafatos
    • 5
  1. 1.Department of Cardiovascular Pathophysiology, Anaesthesiology and Surgery, Laboratory of Biotechnologies Applied to Cardiovascular DiseasesSapienza UniversityRomeItaly
  2. 2.Associazione per le Ricerca CardiologicaRomeItaly
  3. 3.National Institute for Health and WelfareHelsinkiFinland
  4. 4.Institute of Cardiovascular Diseases, Clinical Center of SerbiaBelgradeSerbia
  5. 5.School of Public Health, Department of Social Medicine and NutritionUniversity of CreteHeraklionGreece

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