Abstract
Objectives: the study was set up to explore regional disparities in France in the annual prevalence of cardiovascular risk factors (hypertension, high lipids, obesity, diabetes and tobacco consumption) and protective factors (alcohol intake) in members of the GAZEL Cohort and to determine which, if any, risk factors followed the same north-south gradient as the one known for cardiovascular mortality. Methods: the population studied comprised 18,070 subjects aged from 35 to 50 years, employed by the French national gas and electricity company. Every year from 1989 to 1993 they received a self-administered questionnaire by mail. From the replies, differences in risk factor prevalence were evaluated by an odds ratio adjusted for sex and age, using a marginal model. Results: a regional effect was found (p < 0.001) for arterial hypertension, with high odds ratios in northern France and low ratios in the south east, for high lipids, with high odds ratios in Champagne, the Loire region and Upper Normandy and low ratios in the south east and the Paris area, and for obesity, with high odds ratios in the north and north east and low ratios in the south, south east and west. Conclusion: these results show a gradient between the north and south east for hypertension, obesity, and to a lesser degree high lipids. This gradient corresponds to the known regional disparities for cardiovascular mortality.
Similar content being viewed by others
References
WHO MONICA Project. Myocardial infarction and coronary deaths in the World Health Organization MONICA Project (registration procedures, event rates, and case-fatality rates in 38 populations from 21 countries in four continents). Circulation 1994; 90: 583–612.
WHO MONICA Project: Risk factors. Int J Epidemiol 1989; 18(Suppl.1): S46–S55.
Ducimetière P, Richard JL. Dietary lipids and coronary heart disease: Is there a French paradox? Nutr Metab Cardiovasc Dis 1992; 2: 195–201.
Michel E. Disparités régionales de la mortalité en France. Situation en 1990. Solidarité Santé — Etudes statistiques 1993; 1: 77–91.
Douste-Blazy Ph, Ruidavets JB, Arveiller D, et al. Facteurs de risque cardiovasculaire dans la population de deux régions couvertes par les registres MONICA-FRANCE: Strasbourg et Toulouse. Rev Epidémiol Santé Publique 1988; 36: 342–349.
Simon C, Nuttens MC, Ruidavets JB, et al. Blood pressure and dietary intake in a French population sample from three regions. Rev Epidémiol Santé Publique 1990; 38: 531–538.
Mesbah M, Chwalow AJ, Balkau B, Costagliola D, et al. Prevalence of non-insulin dependent diabetes as perceived by general practitioners in France. Rev Epidémiol Santé Publique 1995; 43: 225–230.
Goldberg M, Leclerc A, Chastang JF, et al. Mise en place d'unc cohorte épidémiologique à Electricité de France-Gaz de France. Recrutement des volontaires. Rev Epidémiol Santé Publique 1990; 38: 265–368.
Goldberg M, Leclere A, Chastang JF, et al. Mise en place d'une cohorte épidémiologique à Electricité de France-Gaz de France. Principales caractéristiques de l'échantillon. Rev Epidémiol Santé Publique. 1990; 38: 378–380.
Dang Tran P, Leclere A, Chastang JF, et al. Prévalence des problèmes de santé dans la cohorte Gazel(EDF-GDF): Répartition et disparités regionales. Rev Epidémiol Santé Publique 1994; 42: 285–300.
Manson JE, Tosteson H, Ridker PM, et al. The primary prevention of myocardial infarction. N Engl J Med 1992; 326: 1406–1416.
Rich-Edwards JW, Manson JE, Hennekens CH, et al. The primary prevention of coronary heart disease in women. N Engl J Med 1995; 332: 1758–1766.
Verschuren WMM, Jacobs DR, Bloemberg BPM, et al. Serum total cholesterol and long-term coronary heart disease mortality in different cultures. Twenty-five-year follow-up of the Seven Country Study. JAMA 1995; 274: 131–136.
Austin AM. Plasma triglyceride as a risk factor for coronary heart disease. The epidemiologic evidence and beyond. Am J Epidemiol 1989; 129: 249–259.
Criqui MH, Heiss G, Cohn R, et al. Plasma triglyceride level and mortality from coronary heart disease. N Engl J Med 1993; 328: 1220–1225.
Stampfer MJ, Rimm EB, Chapmann Walsh D. Commentary: Alcohol, the Heart, and Public Policy. Am J Public Health 1993; 83: 801–804.
Bray GA. The Syndromes of Obesity: An Endocrine Approach. In: DeGroot LJ, et al. (eds), Endocrinology, 3rd ed. Philadelphia: W B Saunders Company, 1995: 2624–2662.
Zeger SL, Liang K-Y. Longitudinal data analysis for dicrete and continuous outcomes. Biometrics 1986; 42: 121–130.
Engelman L. Stepwise Logistic Regression. In: Dixon WJ (ed), BMDP Statistical Software Manual. Berkeley: University of California Press, 1990; 1013–1046.
SAS/IML and SAS/GRAPH Software, version 6 ed. Cary, NC: SAS Institute Inc, 1990.
Groemping U. Gee: A SAS Macro for Longitudinal Data Analysis (version — 2.02). Universität Dortmund, Germany, 1994.
Niedhammer I, Goldberg M, Leclerc A, et al. Psychosocial work environment and cardiovascular risk factors in an occupational cohort in France. J Epidemiol Community Health 1998; 52: 93–100.
Rolland-Cachera MF, Cole TJ, Sempé M, et al. Body Mass Index variations: Centiles from birth to 87 years. Eur J Clin Nutr 1991; 45: 13–21.
Michel E, Jougla E. Disparités régionales de la mortalité et de l'offre sanitaire en France. Rev Epidemiol Santé Publique 1993; 41: 256–259.
Marmot MG. Geography of blood pressure and hypertension. Br Med Bulletin 1984; 40: 380–386.
Bertrand M. Consommation et lieu d'achat des produits alimentaires en 1991. INSEE Résultats. Ed INSEE, 1993: 262–263.
Trevisan M, Krogh V, Freudenheim J, et al. Consumption of olive oil, butter, and vegetable oils and coronary heart disease risk factors. JAMA 1990; 263: 688–692.
Jacotot B. L'huile d'olive et la prévention des maladies cardiovasculaires. In: L'huile d'olive, de la gastronomie à la santé. Paris: Ed Artulen, 1993: 107–136.
Elford J, Phillips A, Thompson AG, et al. Migration and geographic variations in blood pressure in Britain. BMJ 1990; 300: 291–295.
Knuiman JT, West CE, Burema J. Serum total and high density lipoprotein cholesterol concentrations and body mass index in adult men from 13 countries. Am J Epidemiol 1982; 116: 631–642.
Castelli WP, Cooper GR, Doyle GT, et al. Distribution of triglyceride and total, LDL and HDL cholesterol in several populations: A cooperative lipoprotein phenotyping study. J Chron Dis 1977; 30: 147–169.
International Collaborative Study Group. Metabolic epidemiology of plasma cholesterol. Mechanisms of variation of plasma cholesterol within populations and between populations. Lancet 1986; 991–995.
Pearson TA. Therapeutic management of triglycerides: an international perspective. Am J Cardiol 1992; 70: 26H–31H.
Craig WY, Palomaki GE, Haddow JE. Cigarette smoking and serum lipid and lipoprotein concentrations: An analysis of published data. BMJ 1989; 298: 784–788.
Gaziano JM, Buring JE, Breslow JL, et al. Moderate alcohol intake, increased levels of high-density lipoprotein and its subfraction, and decreased risk of myocar dial infarction. N Engl J Med 1993; 329: 1829–1834.
Kromhout D, Menotti A, Bloemberg B, et al. Dietary saturated and trans fatty acid and cholesterol and 25-year mortality from coronary heart disease: The Seven Country Study. Prev Med 1995; 24: 308–315.
Jenkins DJA, Wolever TMS, Rao AV, et al. Effect on blood lipids of very high intakes of fiber in diets low in saturated fat and cholesterol. N Engl J Med 1993; 329: 21–26.
Foster DW. Eating disorders: Obesity, anorexia nervosa, and bulimia nervosa. In: Wilson JD, Foster DW (eds), Williams textbook of endocrinology. Philadelphia: WB Saunders Company, 1992; 1335–1365.
Laurier D, Guiget M, Chau NP, et al. Prevalence of obesity: A comparative survey in France, the United Kingdom and the United States. Int J Obes 1992; 16: 565–572.
Taylor CB, Jatulis DE, Winkleby MA, et al. Effects of Life-Style on Body Mass Index Change. Epidemiology 1994; 5: 599–603.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Dang Tran, P., Leclerc, A., Chastang, J.F. et al. Regional disparities in cardiovascular risk factors in France: A five-year analysis of the GAZEL cohort. Eur J Epidemiol 14, 535–543 (1998). https://doi.org/10.1023/A:1007437517370
Issue Date:
DOI: https://doi.org/10.1023/A:1007437517370