Swiss study reveals mortality ‘röstigraben’

People in French and Italian-speaking Switzerland are more likely to die from alcohol-related liver diseases than their countrymen in German-speaking cantons, according to a new study.

Swiss study reveals mortality ‘röstigraben’
Photo: Leonid Mamchenkov

The Swiss Mortality Atlas, led by Frédérique Chammartin for the Swiss Tropical and Public Health Institute (Swiss TPH) in Basel, examined data from around 60,000 death certificates between 2008 and 2012.

Researchers analyzed the geographical distribution of the major causes of death in Switzerland, including cancers, cardiovascular diseases and Alzheimer’s, showing some stark divides.

The majority of deaths from liver disease, lung cancer, flu and Alzheimer’s occurred in French and Italian-speaking Switzerland, while more people in German-speaking cantons died from cardiovascular diseases – Switzerland’s leading cause of death – and diabetes.

This ‘Röstigraben’ divide when it comes to liver disease is no surprise to experts, reported Sunday paper Sonntags Zeitung.

“The difference is clearly due to higher alcohol consumption in Western Switzerland,” Gerhard Gmel, a researcher at Lausanne hospital CHUV, told the paper.

“We know that alcohol is responsible for nearly all liver damage,” he added.

Figures from Addiction Monitoring in Switzerland for 2014 – the latest available – show that people in the Italian-speaking canton of Ticino are the heaviest drinkers in the country, with 20.8 percent of the population there drinking every day.

In French-speaking Switzerland 14.7 percent admit to drinking daily, while in German-speaking cantons only 8.2 percent quaff alcohol on a daily basis.

The Swiss Mortality Atlas also pointed to the link between lung cancer and smoking, both of which were more prevalent in French-speaking areas.

“The most important risk factor for lung cancer is tobacco consumption,” said the report, quoting another study that shows “a significantly higher prevalence in smoking in the French-speaking part of Switzerland than in the German-speaking part, especially among women.”

The research has annoyed some.

Jean-Felix Savary, general secretary of addiction study group GREA, based in Lausanne, told daily Le Matin that this type of study only serves to stigmatize.

“What does it seek to show? That we have risky behaviour that increases the cost of healthcare?” he said.

“The non-problematic consumption of alcohol is actually larger in French-speaking Switzerland, particularly for cultural reasons,” he added.

“By contrast, regional differences are less obvious when it comes to heavy drinkers.”

According to the report authors, a mortality atlas is important “because it provides insight for underlying risk factors that can be environmental, sociocultural or health systems related.”

“From a public health perspective, it enables areas (e.g. municipalities) to be identified where interventions, preventive measures and modifying behaviour might be warranted, and hence will assist in health resource allocation.”

Life expectancy in Switzerland remains among the highest in the world at 80.4 years for men and 85.4 years for women, according to the World Health Organization.

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IN NUMBERS: Reasons to be optimistic about the coronavirus situation in Switzerland

Data from the Federal Office of Public Health (FOPH) shows that the rate of contaminations is declining, especially in the hardest-hit Swiss cantons.

IN NUMBERS: Reasons to be optimistic about the coronavirus situation in Switzerland
Measures such as make in and outdoors helped bring infection rates down. Photo by AFP

According to FOPH, after peaking in early November, infections are slowing down in most of the country. Between the first and second week of November, the number of cases dropped by 23.4 percent. 

During the month of October, the positivity rate per 100,000 people was 2101. For the past two weeks, that number fell to 849,2. 

This improvement is most marked in French-speaking Switzerland, where various restrictions were put in place at the end of October to curb record-high numbers of infections. The biggest decrease is in the canton of Jura, which recorded 42 percent less cases. Next are Fribourg (-38 percent), Valais (-36 percent) and Neuchâtel (-35 percent).

READ MORE: Covid-19 in Switzerland: Five reasons to be optimistic 

On the other hand, infection rates in some German-speaking cantons, which have been relatively unaffected by the pandemic, are on the rise.

In Basel City, for instance, increasing infection rates prompted local officials to introduce stricter coronavirus measures from Monday. 

Basel City along with Basel Country, Obwalden and Uri are the only Swiss-German cantons where infections are currently rising.

The R-rate

Another indication that infections are declining is the latest R number— a way of rating the speed at which the disease spreads.

Only two weeks ago, the R rate in Switzerland was 1.05. If this value is greater than 1, the daily number of cases increases exponentially. But if it is lower, they decrease.

Now the nationwide average is 0.78. Experts say that if Switzerland can maintain this rate, the daily number of new infections will be halved every 14 days. 

“This looks like a trend reversal”, said FOPH’s director Anne Lévy. 

“I am confident that we are going in the right direction”, she added.

Hospital admissions and deaths

The number of hospital admissions is also slowly dropping, though it still remains high.

According to FOPH, the rate of hospitalisations was 243 per 100,000 people on November 11th. That number dropped to 13 cases per 100,000 on the 19th. 

The number of coronavirus-related deaths is also declining, although the numbers are still high.

From 95 cases per 100,000 on November 12th, the number fell to 37 on November 19th. 

Authorities say there is approximately a three-week delay between the time a patient is admitted to a hospital and their death. So, the latest numbers are likely still related to patients who were hospitalised before the infection rates dropped.