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      Risk factors for cardiovascular and cerebrovascular diseases among ethnic Germans from the former Soviet Union: results of a nested case-control study

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          Abstract

          Background

          Diseases of the circulatory system (CVD) are the most common causes of death in developed countries. However, the prevalence of CVD varies between countries; for example, the mortality rate in Russia is about four times higher than in Western Europe. In a recent retrospective cohort study it was unexpectedly found that CVD mortality is lower among "Aussiedler" (ethnic Germans from the former Soviet Union) compared to the German population.

          Methods

          This is a case-control study, nested into a recent cohort study of migrants from the former Soviet Union. Relatives of cases and controls themselves were interviewed by telephone using a standardized questionnaire. To estimate relative risks via the odds ratio (OR), a conditional logistic regression procedure was performed.

          Results

          Commonly known risk factors for CVD were identified as relevant to Aussiedler. The best multivariate model for CVD includes five risk factors: consumption of alcohol, smoking, diabetes, cholesterol and consumption of sweets. For alcohol consumption and smoking, OR = 3.68 (95% CI, 1.58-8.58) and OR = 3.07 (95% CI, 1.42-6.62), respectively. For diabetes mellitus and high cholesterol values, OR = 3.29 (95% CI, 1.50-7.39) and OR = 2.32 (95% CI, 1.11-4.88), respectively. The almost complete abdication of sweets is associated with a protective effect, OR = 0.34 (95% CI, 0.18-0.64). The prevalence of risk factors is somewhat different to that of the autochthon German population and partly explains the differences in CVD mortality between both groups.

          Conclusions

          The reported lower prevalences of known risk factors of CVD such as alcohol consumption, high cholesterol, diabetes and smoking (in women) could contribute to a lower risk of CVD.

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          Most cited references21

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          Socioeconomic Status and Health: What We Know and What We Don't

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            Assessment of Cardiovascular Risk by Use of Multiple-Risk-Factor Assessment Equations: A Statement for Healthcare Professionals From the American Heart Association and the American College of Cardiology

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              Huge variation in Russian mortality rates 1984-94: artefact, alcohol, or what?

              According to published data, between 1984 and 1994 mortality rates in Russia initially underwent a rapid decline followed by an even steeper increase. In 1994, male life expectancy at birth was 57.6 years, having fallen by 6.2 years since 1990. There has been concern that such striking fluctuations in mortality are an artefact, although, among other factors, alcohol consumption has been implicated. We analysed the age-specific and cause-specific patterns of mortality decrease and increase by use of data from a newly reconstructed mortality series for Russia so that we could examine the plausibility of various explanations for the mortality trends. All major causes of death, with the exception of neoplasms, showed declines in mortality between 1984 and 1987 and increases between 1987 and 1994. In relative terms, these tended to be largest for the age-group 40-50 years; surprisingly, they were of the same magnitude among women and men. The largest declines and subsequent increases in proportional terms were observed for alcohol-related deaths and accidents and violence. However, pronounced effects were also seen for deaths from infections, circulatory disease, and respiratory disease. No substantial variations were seen for neoplasms. The stability of mortality from neoplasms in contrast to other causes over the period 1984-94 largely precludes the possibility that the changes in life expectancy are mainly an artefact, particularly one due to underestimation of the population. Although factors such as nutrition and health services may be involved, the evidence is that substantial changes in alcohol consumption over the period could plausibly explain the main features of the mortality fluctuations observed. These results provide a major challenge to public health in Russia and to our understanding of the determinants of alcohol consumption and its role in explaining mortality patterns within and between many other countries.
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                Author and article information

                Journal
                BMC Public Health
                BMC Public Health
                BMC Public Health
                BioMed Central
                1471-2458
                2012
                13 March 2012
                : 12
                : 190
                Affiliations
                [1 ]Institute of Public Health, University of Heidelberg, Im Neuenheimer Feld 324, Heidelberg 69120, Germany
                Article
                1471-2458-12-190
                10.1186/1471-2458-12-190
                3317863
                22413759
                6d34c704-9974-4ba1-940d-d6a0c2d49a13
                Copyright ©2012 Kuhrs et al; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 2 November 2011
                : 13 March 2012
                Categories
                Research Article

                Public health
                aussiedler,nested case-control study,risk factors,migrants,cvd-mortality,soviet union
                Public health
                aussiedler, nested case-control study, risk factors, migrants, cvd-mortality, soviet union

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