Independent at heart: persistent association of altitude with ischaemic heart disease mortality after consideration of climate, topography and built environment
BackgroundLiving at higher altitude was dose-dependently associated with lower risk of ischaemic heart disease (IHD). Higher altitudes have different climatic, topographic and built environment properties than lowland regions. It is unclear whether these environmental factors mediate/confound the as...
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| Veröffentlicht in: | Journal of epidemiology and community health (1979) 2016-08, Vol.70 (8), p.798-806 |
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| creator | Faeh, David Moser, André Panczak, Radoslaw Bopp, Matthias Röösli, Martin Spoerri, Adrian |
| description | BackgroundLiving at higher altitude was dose-dependently associated with lower risk of ischaemic heart disease (IHD). Higher altitudes have different climatic, topographic and built environment properties than lowland regions. It is unclear whether these environmental factors mediate/confound the association between altitude and IHD. We examined how much of the altitude-IHD association is explained by variations in exposure at place of residence to sunshine, temperature, precipitation, aspect, slope and distance to main road.MethodsWe included 4.2 million individuals aged 40–84 at baseline living in Switzerland at altitudes 195–2971 m above sea level (ie, full range of residence), providing 77 127 IHD deaths. Mortality data 2000–2008, sociodemographic/economic information and coordinates of residence were obtained from the Swiss National Cohort, a longitudinal, census-based record linkage study. Environment information was modelled to residence level using Weibull regression models.ResultsIn the model not adjusted for other environmental factors, IHD mortality linearly decreased with increasing altitude resulting in a lower risk (HR, 95% CI 0.67, 0.60 to 0.74) for those living >1500 m (vs |
| doi_str_mv | 10.1136/jech-2015-206210 |
| format | Article |
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Higher altitudes have different climatic, topographic and built environment properties than lowland regions. It is unclear whether these environmental factors mediate/confound the association between altitude and IHD. We examined how much of the altitude-IHD association is explained by variations in exposure at place of residence to sunshine, temperature, precipitation, aspect, slope and distance to main road.MethodsWe included 4.2 million individuals aged 40–84 at baseline living in Switzerland at altitudes 195–2971 m above sea level (ie, full range of residence), providing 77 127 IHD deaths. Mortality data 2000–2008, sociodemographic/economic information and coordinates of residence were obtained from the Swiss National Cohort, a longitudinal, census-based record linkage study. Environment information was modelled to residence level using Weibull regression models.ResultsIn the model not adjusted for other environmental factors, IHD mortality linearly decreased with increasing altitude resulting in a lower risk (HR, 95% CI 0.67, 0.60 to 0.74) for those living >1500 m (vs<600 m). This association remained after adjustment for all other environmental factors 0.74 (0.66 to 0.82).ConclusionsThe benefit of living at higher altitude was only partially confounded by variations in climate, topography and built environment. Rather, physical environment factors appear to have an independent effect and may impact on cardiovascular health in a cumulative way. Inclusion of additional modifiable factors as well as individual information on traditional IHD risk factors in our combined environmental model could help to identify strategies for the reduction of inequalities in IHD mortality.</description><identifier>ISSN: 0143-005X</identifier><identifier>EISSN: 1470-2738</identifier><identifier>DOI: 10.1136/jech-2015-206210</identifier><identifier>PMID: 26791518</identifier><identifier>CODEN: JECHDR</identifier><language>eng</language><publisher>England: BMJ Publishing Group Ltd</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Air pollution ; Altitude ; Arterial highways ; Built environment ; Built environments ; Cardiovascular disease ; Cardiovascular diseases ; Censuses ; Community health ; Coronary Artery Disease ; Environment Design ; Environmental factors ; Environmental modeling ; Female ; Households ; Humans ; Ischemia ; Male ; Marital status ; Middle Aged ; Mortality ; Mortality rates ; Myocardial ischemia ; Myocardial Ischemia - mortality ; Place of residence ; Precipitation ; Risk Factors ; Socioeconomic factors ; Switzerland ; Topographical aspect ; Topography ; Urban environments ; Variables</subject><ispartof>Journal of epidemiology and community health (1979), 2016-08, Vol.70 (8), p.798-806</ispartof><rights>Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing</rights><rights>2016 BMJ Publishing Group</rights><rights>Copyright: 2016 Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-b413t-12f4fdfea6119722ec8452fde51ba7642b531cc8ea9018a892a43e03c76afcdd3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://jech.bmj.com/content/70/8/798.full.pdf$$EPDF$$P50$$Gbmj$$H</linktopdf><linktohtml>$$Uhttps://jech.bmj.com/content/70/8/798.full$$EHTML$$P50$$Gbmj$$H</linktohtml><link.rule.ids>114,115,314,776,780,799,3183,23550,27901,27902,57992,58225,77342,77373</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26791518$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Faeh, David</creatorcontrib><creatorcontrib>Moser, André</creatorcontrib><creatorcontrib>Panczak, Radoslaw</creatorcontrib><creatorcontrib>Bopp, Matthias</creatorcontrib><creatorcontrib>Röösli, Martin</creatorcontrib><creatorcontrib>Spoerri, Adrian</creatorcontrib><creatorcontrib>Swiss National Cohort Study Group</creatorcontrib><creatorcontrib>for the Swiss National Cohort Study Group</creatorcontrib><title>Independent at heart: persistent association of altitude with ischaemic heart disease mortality after consideration of climate, topography and built environment</title><title>Journal of epidemiology and community health (1979)</title><addtitle>J Epidemiol Community Health</addtitle><description>BackgroundLiving at higher altitude was dose-dependently associated with lower risk of ischaemic heart disease (IHD). Higher altitudes have different climatic, topographic and built environment properties than lowland regions. It is unclear whether these environmental factors mediate/confound the association between altitude and IHD. We examined how much of the altitude-IHD association is explained by variations in exposure at place of residence to sunshine, temperature, precipitation, aspect, slope and distance to main road.MethodsWe included 4.2 million individuals aged 40–84 at baseline living in Switzerland at altitudes 195–2971 m above sea level (ie, full range of residence), providing 77 127 IHD deaths. Mortality data 2000–2008, sociodemographic/economic information and coordinates of residence were obtained from the Swiss National Cohort, a longitudinal, census-based record linkage study. Environment information was modelled to residence level using Weibull regression models.ResultsIn the model not adjusted for other environmental factors, IHD mortality linearly decreased with increasing altitude resulting in a lower risk (HR, 95% CI 0.67, 0.60 to 0.74) for those living >1500 m (vs<600 m). This association remained after adjustment for all other environmental factors 0.74 (0.66 to 0.82).ConclusionsThe benefit of living at higher altitude was only partially confounded by variations in climate, topography and built environment. Rather, physical environment factors appear to have an independent effect and may impact on cardiovascular health in a cumulative way. Inclusion of additional modifiable factors as well as individual information on traditional IHD risk factors in our combined environmental model could help to identify strategies for the reduction of inequalities in IHD mortality.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Air pollution</subject><subject>Altitude</subject><subject>Arterial highways</subject><subject>Built environment</subject><subject>Built environments</subject><subject>Cardiovascular disease</subject><subject>Cardiovascular diseases</subject><subject>Censuses</subject><subject>Community health</subject><subject>Coronary Artery Disease</subject><subject>Environment Design</subject><subject>Environmental factors</subject><subject>Environmental modeling</subject><subject>Female</subject><subject>Households</subject><subject>Humans</subject><subject>Ischemia</subject><subject>Male</subject><subject>Marital status</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Mortality rates</subject><subject>Myocardial ischemia</subject><subject>Myocardial Ischemia - mortality</subject><subject>Place of residence</subject><subject>Precipitation</subject><subject>Risk Factors</subject><subject>Socioeconomic factors</subject><subject>Switzerland</subject><subject>Topographical aspect</subject><subject>Topography</subject><subject>Urban environments</subject><subject>Variables</subject><issn>0143-005X</issn><issn>1470-2738</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNqNkU-L1TAUxYMoznN070YJuBG0mpumbTo7GfwzMOBGwV1Jkxub0jY1SZX5Nn5U8-z4Fm50cxNyf_dcTg4hj4G9Aijr1yPqoeAMqlxqDuwOOYBoWMGbUt4lBwaiLBirvpyRBzGOLF8b3t4nZ7xuWqhAHsjPq8XgirksiapEB1QhXdAVQ3Qx_X6M0WunkvML9ZaqKbm0GaQ_XBqoi3pQODu9D1LjIqqIdPYhqcmlG6pswkC1X6IzGE4yenKzSviSJr_6r0GtQ0YXQ_vNTYni8t0Fv8x5_0Nyz6op4qPb85x8fvf20-WH4vrj-6vLN9dFL6BMBXArrLGoaoC24Ry1FBW3BivoVVML3lclaC1RtQykki1XokRW6qZWVhtTnpPnu-4a_LcNY-rmbA6nSS3ot9iBZLJuOGvhf1DBGWtbntFnf6Gj38KSjWSqZjKHVVaZYjulg48xoO3WkL8n3HTAumPQ3THo7hh0twedR57eCm_9jOY08CfZDDzZgTEmH059IRg0kh1NvNj7_Tz-e90vbfK-uQ</recordid><startdate>20160801</startdate><enddate>20160801</enddate><creator>Faeh, David</creator><creator>Moser, André</creator><creator>Panczak, Radoslaw</creator><creator>Bopp, Matthias</creator><creator>Röösli, Martin</creator><creator>Spoerri, Adrian</creator><general>BMJ Publishing Group Ltd</general><general>BMJ Publishing Group LTD</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88G</scope><scope>88I</scope><scope>8AF</scope><scope>8C1</scope><scope>8FE</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AEUYN</scope><scope>AFKRA</scope><scope>AN0</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB0</scope><scope>LK8</scope><scope>M0S</scope><scope>M1P</scope><scope>M2M</scope><scope>M2P</scope><scope>M7P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PSYQQ</scope><scope>Q9U</scope><scope>7X8</scope><scope>7T2</scope><scope>7U2</scope><scope>C1K</scope></search><sort><creationdate>20160801</creationdate><title>Independent at heart: persistent association of altitude with ischaemic heart disease mortality after consideration of climate, topography and built environment</title><author>Faeh, David ; Moser, André ; Panczak, Radoslaw ; Bopp, Matthias ; Röösli, Martin ; Spoerri, Adrian</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b413t-12f4fdfea6119722ec8452fde51ba7642b531cc8ea9018a892a43e03c76afcdd3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Air pollution</topic><topic>Altitude</topic><topic>Arterial highways</topic><topic>Built environment</topic><topic>Built environments</topic><topic>Cardiovascular disease</topic><topic>Cardiovascular diseases</topic><topic>Censuses</topic><topic>Community health</topic><topic>Coronary Artery Disease</topic><topic>Environment Design</topic><topic>Environmental factors</topic><topic>Environmental modeling</topic><topic>Female</topic><topic>Households</topic><topic>Humans</topic><topic>Ischemia</topic><topic>Male</topic><topic>Marital status</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Mortality rates</topic><topic>Myocardial ischemia</topic><topic>Myocardial Ischemia - mortality</topic><topic>Place of residence</topic><topic>Precipitation</topic><topic>Risk Factors</topic><topic>Socioeconomic factors</topic><topic>Switzerland</topic><topic>Topographical aspect</topic><topic>Topography</topic><topic>Urban environments</topic><topic>Variables</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Faeh, David</creatorcontrib><creatorcontrib>Moser, André</creatorcontrib><creatorcontrib>Panczak, Radoslaw</creatorcontrib><creatorcontrib>Bopp, Matthias</creatorcontrib><creatorcontrib>Röösli, Martin</creatorcontrib><creatorcontrib>Spoerri, Adrian</creatorcontrib><creatorcontrib>Swiss National Cohort Study Group</creatorcontrib><creatorcontrib>for the Swiss National Cohort Study Group</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>ProQuest Nursing and Allied Health Journals</collection><collection>Health & Medical Collection (Proquest)</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Psychology Database (Alumni)</collection><collection>Science Database (Alumni Edition)</collection><collection>STEM Database</collection><collection>ProQuest Public Health Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest One Sustainability</collection><collection>ProQuest Central UK/Ireland</collection><collection>British Nursing Database</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>ProQuest Natural Science Collection</collection><collection>BMJ Journals</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>ProQuest Biological Science Collection</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Psychology Database (ProQuest)</collection><collection>ProQuest Science Journals</collection><collection>Biological Science Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest One Psychology</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><collection>Health and Safety Science Abstracts (Full archive)</collection><collection>Safety Science and Risk</collection><collection>Environmental Sciences and Pollution Management</collection><jtitle>Journal of epidemiology and community health (1979)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Faeh, David</au><au>Moser, André</au><au>Panczak, Radoslaw</au><au>Bopp, Matthias</au><au>Röösli, Martin</au><au>Spoerri, Adrian</au><aucorp>Swiss National Cohort Study Group</aucorp><aucorp>for the Swiss National Cohort Study Group</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Independent at heart: persistent association of altitude with ischaemic heart disease mortality after consideration of climate, topography and built environment</atitle><jtitle>Journal of epidemiology and community health (1979)</jtitle><addtitle>J Epidemiol Community Health</addtitle><date>2016-08-01</date><risdate>2016</risdate><volume>70</volume><issue>8</issue><spage>798</spage><epage>806</epage><pages>798-806</pages><issn>0143-005X</issn><eissn>1470-2738</eissn><coden>JECHDR</coden><abstract>BackgroundLiving at higher altitude was dose-dependently associated with lower risk of ischaemic heart disease (IHD). Higher altitudes have different climatic, topographic and built environment properties than lowland regions. It is unclear whether these environmental factors mediate/confound the association between altitude and IHD. We examined how much of the altitude-IHD association is explained by variations in exposure at place of residence to sunshine, temperature, precipitation, aspect, slope and distance to main road.MethodsWe included 4.2 million individuals aged 40–84 at baseline living in Switzerland at altitudes 195–2971 m above sea level (ie, full range of residence), providing 77 127 IHD deaths. Mortality data 2000–2008, sociodemographic/economic information and coordinates of residence were obtained from the Swiss National Cohort, a longitudinal, census-based record linkage study. Environment information was modelled to residence level using Weibull regression models.ResultsIn the model not adjusted for other environmental factors, IHD mortality linearly decreased with increasing altitude resulting in a lower risk (HR, 95% CI 0.67, 0.60 to 0.74) for those living >1500 m (vs<600 m). This association remained after adjustment for all other environmental factors 0.74 (0.66 to 0.82).ConclusionsThe benefit of living at higher altitude was only partially confounded by variations in climate, topography and built environment. Rather, physical environment factors appear to have an independent effect and may impact on cardiovascular health in a cumulative way. Inclusion of additional modifiable factors as well as individual information on traditional IHD risk factors in our combined environmental model could help to identify strategies for the reduction of inequalities in IHD mortality.</abstract><cop>England</cop><pub>BMJ Publishing Group Ltd</pub><pmid>26791518</pmid><doi>10.1136/jech-2015-206210</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Journal of epidemiology and community health (1979), 2016-08, Vol.70 (8), p.798-806 |
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| subjects | Adult Aged Aged, 80 and over Air pollution Altitude Arterial highways Built environment Built environments Cardiovascular disease Cardiovascular diseases Censuses Community health Coronary Artery Disease Environment Design Environmental factors Environmental modeling Female Households Humans Ischemia Male Marital status Middle Aged Mortality Mortality rates Myocardial ischemia Myocardial Ischemia - mortality Place of residence Precipitation Risk Factors Socioeconomic factors Switzerland Topographical aspect Topography Urban environments Variables |
| title | Independent at heart: persistent association of altitude with ischaemic heart disease mortality after consideration of climate, topography and built environment |
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