[Changes in mortality in Switzerland since 1950. II. Regional differences within Switzerland]

To examine regional variations in all-cause mortality in Switzerland around 1990 and trends since 1950. Special emphasis is placed on unfavourable aspects that have been identified by comparisons with international trends.

Descriptive analysis of Swiss mortality statistics taken from individual records (1969-94) and data published by the Swiss Federal Statistical Office (1949-68).

Swiss citizens aged between 15 and 79 years often show mortality ratios of 1.5 and more between the best and the worst of the 106 regions of Switzerland. In subjects aged under 50 years, relative risk ranges are even larger. However, the regional mortality patterns before and after 50 rarely correspond. Generally, the relative risk difference between the best and the worst regions has not diminished since 1950, whereas the geographical patterns have completely changed. Instead of an obvious rural-urban gradient in 1950, mortality rates are now highest in the largest cities and, at least in men, are at their lowest in the wealthy suburbs. On a larger scale (division into 9 geographical units), central Switzerland has changed significantly from clearly elevated mortality rates in 1950 into a decidedly favourable position in 1990. A contrast between German and French Switzerland has existed for many decades: in the younger and middle age groups the francophone part of Switzerland has a higher mortality rate than the German-speaking part, whereas at ages over 70 French Switzerland has lower rates than German Switzerland. In some urban areas of Switzerland, the turning-point from a decreasing to an increasing trend in the mortality risks of subjects aged 15-49 years was reached around 1960, occasionally resulting in age-specific rates being higher in 1990 than in 1950. This unfavourable partial trend has spread over most, but not all, of Switzerland since 1970. Even in subjects aged 25-34 years, the age group for which Switzerland has the worst relative position on an international scale, some parts of the country do not have elevated all-cause mortality rates, whereas for men in the largest cities mortality risks are more than three times as high as in Japan. The deaths from "external" causes (mainly accidents and suicide) show marked geographical patterns within Switzerland; however, in all parts of the country, deaths from this group are much more frequent than, for example, in Italy or the Netherlands.

Geographical differences in mortality risks within Switzerland, as well as international disparities, suggest that there is a need for preventive measures in Switzerland, first and foremost concerning males aged 15-49 years and deaths from "external" causes.