Association between race/color and incidence of hypertension in the ELSA-Brasil population: investigating the mediation of racial discrimination and socioeconomic position.

OBJECTIVE: To investigate the mediation effect of socioeconomic position and racial discrimination in the association between race/color and incidence of hypertension in 4-years follow up. METHODS: We included 8,370 participants of the Longitudinal Study of Adult Health (ELSA-Brasil). A latent variable was constructed to represent socioeconomic position (SEP). The perception of discrimination was measured through an adaptation of the Lifetime Major Events Scale; and hypertension was defined using standard criteria. We investigated Body Mass Index (BMI) due to its role in proximal risk for hypertension. To investigate the mediating role of SEP and racial discrimination, we used structural equation modeling. RESULTS: SEP had a direct and negative effect on HT incidence (HT incidence increased in worse SEP categories), while the effect of BMI on HT was direct and positive. We did not find significant direct effects of race/color and racial discrimination on HT. As for indirect effects, we observed associations between race/color and HT only through SEP mediation. CONCLUSION: According to our results, race/color is indirectly related to HT incidence, mediated by SEP. Racial discrimination was not a mediator in the relationship between race/color and HT in the follow-up period.

Association between dietary patterns and renal function in a cross-sectional study using baseline data from the ELSA-Brasil cohort.

Previous analyses of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) identified four main dietary patterns (DP). The aim of this study was to explore the association between the previously defined DP and renal function (RF). A cross-sectional study using the ELSA-Brasil baseline data was carried out. DP ("traditional", "fruits and vegetables", "bakery", and "low sugar/low fat), metabolic syndrome (MS) using the Joint Interim Statement criteria, microalbuminuria (MA), and glomerular filtration rate (eGFR) through the CKD-EPI equation were evaluated. Abnormal RF was defined as eGFR<60 mL·min-1·(1.73 m2)-1 and MA≥3.0 mg/dL. Factors associated with RF were determined and mediation analysis was performed to investigate the association between DP, MS, and RF. A total of 15,105 participants were recruited, with a mean age of 52±9 years; 8,134 participants (54%) were females. The mediation analysis identified indirect associations between "bakery" and "fruits and vegetables", and both were associated with decreased eGFR and albuminuria in both genders, compared with "traditional" and "low sugar/low fat" patterns in the general population. There was a direct association of the "bakery" pattern with MA in men (OR: 1.17, 95%CI: 1.92-1.48). The "fruits and vegetables" pattern also showed a direct association with reduced eGFR in women (OR: 1.65, 95%CI: 1.28-2.12), although there was no significance after adjustment. The "fruits and vegetables" and "bakery" DPs were associated with renal dysfunction. The only independent, direct association was between "bakery" DP and MA in men, raising concerns about DP and renal damage in men.

Biopsychosocial factors associated with a current depressive episode in diabetes: the ELSA-Brasil study.

AIMS: Depression is more prevalent in people with diabetes, and is associated with worse diabetes outcomes. Depression in diabetes is more treatment resistant, and as underlying mechanisms are unknown, development of more effective treatment strategies is complicated. A biopsychosocial model may improve our understanding of the pathophysiology, and therewith help improving treatment options. METHODS: Diabetes was diagnosed according to American Diabetes Association (ADA) criteria and a current depressive episode according to the International Classification of Diseases (ICD-10), based on the Clinical Interview Schedule Revised (CIS-R). From the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil), we included 455 participants without diabetes with a current depressive episode and 10 900 without either diabetes or a current depressive episode. Furthermore, 2183 participants had diabetes alone and 106 had both diabetes and a current depressive episode. Variable selection was based on their relationship with depression and/or diabetes. Multinomial multivariate logistic regression was used to determine how the models differed between participants with and without diabetes. RESULTS: A current depressive episode in diabetes was related to being older and female, having poorer education, financial problems, experiencing discrimination at work, home and school, higher waist circumference, albumin to creatinine ratio and insulin resistance, and the presence of hypertension and cardiovascular disease. In non-diabetes, a current depressive disorder was related to being female, not being black, low income, psychological and social factors, non-current alcohol use, lower HDL cholesterol, higher insulin resistance and the presence of cardiovascular disease. CONCLUSIONS: A current depressive episode in the presence compared with the absence of diabetes was related more to biological than to psychosocial factors.

Adherence to the Dietary Approaches to Stop Hypertension (DASH) and hypertension risk: results of the Longitudinal Study of Adult Health (ELSA-Brasil).

We investigated whether high adherence to the Dietary Approaches to Stop Hypertension (DASH) diet was independently associated with lower risk of incident hypertension. Participants included 5632 adults, without hypertension at the baseline (2008-2010) of the Longitudinal Study of Adult Health, who took part in the second follow-up visit (2012-2014). Adherence to the DASH diet was estimated at baseline using a score based on eight food items (final scores from 8 to 40 points) and was categorised as high adherence (≥30 points, or ≥75 %) and low adherence (<75 %; reference). Hypertension was defined as systolic blood pressure (BP) ≥140 mmHg or diastolic BP ≥90 mmHg, or use of antihypertensive drugs. The association between adherence to the DASH diet and the risk of incident hypertension was estimated using Cox regression models adjusted by covariates. In total, 780 new cases of hypertension (13·8 %) were identified in about 3·8-year follow-up. Participants with high adherence to the DASH diet had 26 % lower risk of hypertension (hazard ratio (HR) 0·74; 95 % CI 0·57, 0·95) after adjustment for socio-demographic characteristics, health-related behaviours, diabetes and family history of hypertension. The HR reduced to 0·81 (95 % CI 0·63, 1·04) and was of borderline statistical significance after adjustment for BMI, suggesting that lower body weight explains about 10 % of the association between high adherence to the DASH diet and hypertension risk reduction. The results indicate that high adherence to the DASH diet lowered the risk of hypertension by one-fourth over a relatively short follow-up period.

Association between dietary patterns and renal function in a cross-sectional study using baseline data from the ELSA-Brasil cohort

Previous analyses of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) identified four main dietary patterns (DP). The aim of this study was to explore the association between the previously defined DP and renal function (RF). A cross-sectional study using the ELSA-Brasil baseline data was carried out. DP ("traditional", "fruits and vegetables", "bakery", and "low sugar/low fat), metabolic syndrome (MS) using the Joint Interim Statement criteria, microalbuminuria (MA), and glomerular filtration rate (eGFR) through the CKD-EPI equation were evaluated. Abnormal RF was defined as eGFR<60 mL·min-1·(1.73 m2)-1 and MA≥3.0 mg/dL. Factors associated with RF were determined and mediation analysis was performed to investigate the association between DP, MS, and RF. A total of 15,105 participants were recruited, with a mean age of 52±9 years; 8,134 participants (54%) were females. The mediation analysis identified indirect associations between "bakery" and "fruits and vegetables", and both were associated with decreased eGFR and albuminuria in both genders, compared with "traditional" and "low sugar/low fat" patterns in the general population. There was a direct association of the "bakery" pattern with MA in men (OR: 1.17, 95%CI: 1.92-1.48). The "fruits and vegetables" pattern also showed a direct association with reduced eGFR in women (OR: 1.65, 95%CI: 1.28-2.12), although there was no significance after adjustment. The "fruits and vegetables" and "bakery" DPs were associated with renal dysfunction. The only independent, direct association was between "bakery" DP and MA in men, raising concerns about DP and renal damage in men.

Job stress is associated with migraine in current workers: the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).

BACKGROUND: Migraine is an important source of social burden and work-related costs. Studies addressing the association of migraine with job stress are rare. OBJECTIVES: The aim of this paper was to study the association of job stress components and migraine using structured, validated questionnaires that were part of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). METHODS: The ELSA-Brasil is a multicentre cohort of 15,105 civil servants (12,096 current workers) in Brazil. Job strain was assessed using the 17-item Brazilian version of the Swedish Demand-Control-Support Questionnaire. Headache episodes in the preceding 12 months were assessed using a questionnaire based on the International Headache Society criteria. We analysed the association between job stress domains and migraine in men and women using adjusted logistic regression and interaction models. RESULTS: We included 3113 individuals without headache and 3259 migraineurs. Low job control [odds ratio (OR) 1.30; 95% confidence interval (95% CI) 1.10-1.53], high job demands (OR 1.37; 95% CI 1.18-1.59) and low social support (OR 1.49; 95% CI 1.29-1.71) were associated with migraine. Job control was more strongly associated with migraine in women (p for interaction = 0.02). High-strain (high demand and low control) jobs were associated with migraine in both men (OR 1.48; 95% CI 1.11-1.97) and women (OR 1.51; 95% CI 1.17-1.95). CONCLUSIONS: We observed a strong association between high-strain jobs and migraine. Job control was a stronger migraine-related factor for women. Low social support was associated with migraine in both sexes.

Association between routine visits for dental checkup and self-perceived oral health in an adult population in Rio de Janeiro: the Pró-Saúde Study.

OBJECTIVE: To investigate the association between routine visits for dental checkup and self-perceived oral health. METHODS: Cross-sectional data from a study of university employees in Rio de Janeiro - The Pró-Saúde Study. Self-perceived oral health and the reported pattern and frequency of visits to the dentist were obtained through a multidimensional self-administered questionnaire. RESULTS: Data were obtained from 3252 participants. When compared with individuals who reported self-perceived oral health as good ('very good', 'good' or 'fair') individuals who reported self-perceived oral health as bad ('bad' or 'very bad') were significantly more likely to be older, male, less educated, poorer; they also reported more frequently to have lost more teeth and not visiting the dentist for routine dental 'checkup'. Among those who reported visiting for dental checks at least annually, 3% reported bad oral health, as opposed to 15% among those who reported visiting the dentist only when in trouble. Compared with those who reported visiting the dentist at least annually, odds ratio of bad oral health was 3.9 (95% CI, 2.68-5.67) for subjects who reported visiting only when in trouble, 2.6 (95% CI, 1.51-4.62) who reported visiting for dental checks less frequently than once every 2 years, and 1.4 (95% CI, 0.77-2.52) for subjects who reported visiting for dental checks once every 2 years, after controlling for sex, age, education, income and tooth loss. CONCLUSIONS: Not visiting the dentist for a routine dental check increased the chance of reporting one's own oral health as bad. In any case, the habit of visiting for dental 'checkup, once per year or once every 2 years was associated with nearly all the individuals perceiving his/her oral health positively. However, in order to gather more solid scientific data to guide public policies it is necessary to perform longitudinal studies, especially experiments in different populations focused mainly on the socioeconomic characteristics and dental clinical conditions.

[Social network and social support measures from the Pró-Saúde Study: pre-tests and pilot study]. / Medidas de rede e apoio social no Estudo Pró-Saúde: pré-testes e estudo piloto.

We describe methodological steps in the selection of questions on social networks and support for a cohort study of 4,030 employees from a public university in Rio de Janeiro. First, group discussions with volunteers were conducted to explore the adequacy of related concepts. Next, questions in the Medical Outcomes Study questionnaire were submitted to standard "forward-" and "back-translation" procedures. The questions were subsequently evaluated through five stages of pre-tests and a pilot study. No question had a proportion of non-response greater than 5%. Pearson correlation coefficients between questions were distant from both zero and unity; correlation between all items and their dimension score was higher than 0.80 in most cases. Finally, Cronbach Alpha coefficients were above 0.70 within each dimension. Results suggest that social networks and support will be adequately measured and will allow for the investigation of their associations with health outcomes in a Brazilian population.

Blood pressure levels in Xavánte adults from the Pimentel Barbosa Indian Reservation, Mato Grosso, Brazil.

OBJECTIVE: To study blood pressure (BP) levels in the Xavánte Indians of Central Brazil. METHODS: 93 subjects > or = 15 years old were included. Systolic (SBP) and diastolic (DBP) blood pressure readings were taken to the nearest mm Hg at Korotkoff phases 1 and 5 using a mercury sphygmomanometer. Height and weight measurements were taken, as well as general information on demographic, dietary, and social factors, including use of tobacco and alcohol. RESULTS: 5.3% of the adult men and 7.7% of the adult women (> or = 18 years old) were classified as hypertensive (SBP > or = 140 mm Hg and/or DBP > or = 90 mm Hg). No patients were classified as stage 3 hypertensive (SBP > or = 180 mm Hg or DBP > or = 110 mm Hg). Men had higher mean body weight and height than women. There was no major difference in mean BMI (body mass index) for men and women. SBP showed a positive and statistically significant correlation with age in both men (P = .056) and women (P = .040). Among men, DBP showed a negative correlation with height (P = .032). Among women, weight and BMI showed a positive correlation with DBP (P = .013 and P = .005, respectively). Diastolic pressure did not show statistically significant correlation with age for either sex (P>.05). CONCLUSION: The prevalence of hypertension has increased among the Xavánte over the years, which is probably related to behavioral, social, and economic alterations deriving from increased interaction with Brazilian national society.

Factors associated with vaginal birth after cesarean in a maternity hospital of Rio de Janeiro.

OBJECTIVES: Identifying characteristics associated with vaginal birth after cesarean. STUDY DESIGN: Case-control study based on medical records. STUDY POPULATION: women with previous cesarean, who had delivered in a public Rio de Janeiro maternity hospital between 1992 and 1996. SAMPLE: 141 cases (vaginal births after cesarean) and 304 controls (a new cesarean after other(s)). Multivariate analysis with logistic regression was carried out. RESULTS: The following characteristics were associated with greater probability of vaginal birth (IC=95%): only one previous cesarean (OR=19.05; IC=6.88-52.76); cervical dilatation at admission above 3 cm (OR=8.86; IC=4.93-15.94); gestational age below 37 weeks (OR=3.01; IC=1.40-6.46); history of at least one previous vaginal birth (OR=2.12; IC=1.18-3.82); level of education below high school (OR=1.94; IC=1.02-3.69). Chronic hypertension reduced the chances of vaginal birth (OR=0.44; IC=0.22-0.88). CONCLUSIONS: Among the factors that can be modified to reduce the number of repeated cesareans are: trial of labor promotion, reducing admission of women at early stages of labor and adequate hypertension management during pregnancy. CONDENSATION: Among the factors that can be modified to reduce the number of repeated cesareans are: the trial of labor promotion for women who present previous cesarean, reducing admission of women at early stages of labor and adequate hypertension management during pregnancy.

Reliability of the information about the history of diagnosis and treatment of hypertension. Differences in regard to sex, age, and educational level. The Pró-Saúde study.

OBJECTIVE: To assess the intraobserver reliability of the information about the history of diagnosis and treatment of hypertension. METHODS: A multidimensional health questionnaire, which was filled out by the interviewees, was applied twice with an interval of 2 weeks, in July '99, to 192 employees of the University of the State of Rio de Janeiro (UERJ), stratified by sex, age, and educational level. The intraobserver reliability of the answers provided was estimated by the kappa statistic and by the coefficient of intraclass correlation (CICC). RESULTS: The general kappa (k) statistic was 0.75 (95% CI=0.73-0.77). Reliability was higher among females (k=0.88, 95% CI=0.85-0.91) than among males (k=0.62, 95% CI=0.59-0.65). The reliability was higher among individuals 40 years of age or older (k=0.79; 95% CI=0.73-0.84) than those from 18 to 39 years (k=0.52; 95% CI=0.45-0.57). Finally, the kappa statistic was higher among individuals with a university educational level (k=0.86; 95% CI=0.81-0.91) than among those with high school educational level (k=0.61; 95% CI=0.53-0.70) or those with middle school educational level (k=0.68; 95% CI=0.64-0.72). The coefficient of intraclass correlation estimated by the intraobserver agreement in regard to age at the time of the diagnosis of hypertension was 0.74. A perfect agreement between the 2 answers (k=1.00) was observed for 22 interviewees who reported prior prescription of antihypertensive medication. CONCLUSION: In the population studied, estimates of the reliability of the history of medical diagnosis of hypertension and its treatment ranged from substantial to almost perfect reliability.

[An epidemiological approach to health promotion: the ideas of Geoffrey Rose]. / Um enfoque epidemiológico da promoção da saúde: as idéias de Geoffrey Rose.

In this paper, we discuss some of the ideas developed by Geoffrey Rose, which are seldom explicitly expressed in the contemporary debate on health promotion. The following notions are emphasized: many health exposures and outcomes are expressed in a continuum, and do not follow the dichotomy exposed/non-exposed or diseased/ non-diseased; there is a linear relationship between certain exposures and their effects along the range of exposure levels; thus, many individuals exposed to low risk may generate more cases of a disease than few individuals exposed to high risk. In addition, there is a strong relationship between average behaviors and the occurrence of deviance, as a result of the balance between biological and social forces favoring diversity or uniformity. Thus, risk differences between defined populations involve differences in the population distributions as a whole, rather than in the proportion of individuals with high risk. Overall, these concepts favor emphasis on strategies aiming the general population, and not only the individuals considered to be at high risk of disease.

Reliability of self-reported weight and height among state bank employees.

INTRODUCTION: Self-reported weight and height were compared with direct measurements in order to evaluate the agreement between the two sources. METHODS: Data were obtained from a cross-sectional study on health status from a probabilistic sample of 1,183 employees of a bank, in Rio de Janeiro State, Brazil. Direct measurements were made of 322 employees. Differences between the two sources were evaluated using mean differences, limits of agreement and intraclass correlation coefficient (ICC). RESULTS AND CONCLUSION: Men and women tended to underestimate their weight while differences between self-reported and measured height were insignificant. Body mass index (BMI) mean differences were smaller than those observed for weight. ICC was over 0.98 for weight and 0.95 for BMI, expressing close agreement. Combining a graphical method with ICC may be useful in pilot studies to detect populational groups capable of providing reliable information on weight and height, thus minimizing resources needed for field work.

[Public health and behavior modification: a contemporary issue]. / Saúde pública e mudanças de comportamento: uma questão contemporânea.

Most cardiovascular disease risk factors can be modified through life-style changes. Choices of habits and behavior are in fact heavily influenced by concepts of normality and social values. However, social influences fail to fully explain these choices, insofar as health-related habits are also shaped by personal experience. The main limitations of public health practice can probably be found at this subjective level. This article emphasizes the need to consider determinants of human behavior at different levels, increasingly important for strategies to promote health and prevent disease, or at least delay its onset. The primary focus is to influence rules and laws aimed at protecting life. The article also discusses possible strategies for translating scientific knowledge into public health action, avoiding the restriction to the "healthy life" regulatory role. Finally, participation by public health professionals is suggested in places where population groups share life experiences, such as workplaces, schools, and churches, developing approaches which include those experiences as well as fears and hopes related to health. Scientific facts might thus be transformed into more familiar elements of everyday life.

[Eating habits among employees of a state-owned bank: food consumption profile]. / Hábitos alimentares entre funcionários de banco estatal: padrão de consumo alimentar.

In order to investigate the health conditions of current employees in a government-owned bank in the State of Rio de Janeiro, we performed a cross-sectional study in two departments where systematic sampling was applied. Among the health conditions, we focused on the employees' eating habit profile using a questionnaire on frequency of food group consumption analyzed through a summary measure (eating score). Although the majority of the study population display good eating habits, the results confirmed a major difference between genders. Some 60% of men had scores higher than the population mean (51.2), as compared to only 45% of women. In addition, we observed that men, and particularly younger men, consumed more foodstuffs that were rich in saturated fat, salt, and sugar as compared to women. The findings indicate that quality of one's diet along with changes in other habits and behaviors (like smoking and sedentary life style) should be part of programs to promote health in the workplace, with a view towards controlling cardiovascular and other diseases.

[Anthropometric profile of employees from a government bank in the state of Rio de Janeiro, Brazil. 1 Body mass index and sociodemographic factors]. / Perfil antropométrico de funcionários de banco estatal no Estado do Rio de Janeiro/Brasil: 1: índice de massa corporal e fatores sócio demográficos.

This study first describes the anthropometric profile of employees at Banco do Brasil and then compares these results to those of the Brazilian National Health and Nutritional Survey, PNSN/1989, for the Southeastern region of the country. It is a cross-sectional study with a sample comprising 647 bank clerks. Weight and height informed by respondents were used to compute the body mass index (BMI). Among bank clerks, 8.8% were underweight, 27.8% were overweight and 6.4% were obese. Overweight increased with age and was about 3 times greater in men than in women. Among social and demographic variables, sex, age, and schooling best explained BMI variance. For men, proportion of overweight was higher in bank clerks than in the PNSN population, while for women, PNSN showed higher frequencies of overweight as compared to female bank clerks. High prevalence of overweight in the general population, as well as in specific groups like bank clerks, highlights the urgent need for definition and development of prevention and control policies capable of impacting risk factors and ultimately leading to a decrease in social cost due to mortality from chronic diseases.

[High blood pressure among bank employees in Rio de Janeiro. Life-style and treatment]. / Hipertensão arterial entre funcionários de banco estatal no Rio de Janeiro. Hábitos de vida e tratamento.

PURPOSE: This study estimates the frequency of treatment of high blood pressure and compares life-styles among hypertensives and non-hypertensives. METHODS: Cross-sectional study in a systematic sample of 1183 employees in a government-owned bank in the State of Rio de Janeiro, through a self-administered questionnaire. Direct measurements of arterial pressure, weight and height were also taken in a sub-sample. Those who had been informed more than once as having high blood pressure, by a health professional, were classified as hypertensives. RESULTS: There were no important differences among hypertensives and non-hypertensives with respect to the prevalence of smoking, alcohol and physical activities. Dieting was more frequent among overweight/obese hypertensives than overweight/obese non-hypertensives. Only 44.7% were under treatment. Subjects with high level of education were more likely to be treated as were those who quit smoking, presented overweight/obesity or family history of cerebrovascular diseases. CONCLUSION: Access to information and health care was not sufficient to guarantee high blood pressure treatment or a healthy life-style which contributes to hypertension control.

[Cigarette smoking among bank employees]. / Tabagismo entre trabalhadores de empresa bancária.

OBJECTIVE: To describe the prevalence of cigarette smoking and its association with other risk factors for chronic diseases among active workers of communication and data processing centers of a Bank. METHODS: Cross-sectional study in a simple random sample of 647 active workers of the bank. The data were collected in the work environment, through self-administered questionnaires. RESULTS: The prevalence of cigarette smoking was 29.5% (95% Confidence Interval (CI): 27.5%-31.5%), 31.1% (95% CI: 26.2%-35.8%) among men and 27.8% (95% CI: 22.6%-32.9%) among women. On average, males started smoking at the age of 17.6 years and women at the age of 19.4. High prevalence of heavy smokers was observed among men and women (53% and 42%, respectively, smoked more than 20 cigarettes per day). Smokers were older, more likely to be divorced, separated and widowed, to have high blood pressure, to drink alcoholic beverages more often, and to exercise less often than to non-smokers. Those who gave up smoking were older, drank more alcoholic beverages, and were more often overweight. CONCLUSION: The considerable frequency of smoking and other risk factors for chronic diseases among those workers may be an indication of the need for new strategies for health interventions. Opportunities for preventive actions, which are more effective and less costly, may have been lost.

[Cardiovascular diseases. Comments on early mortality in Brazil]. / Doenças cardiovasculares. Comentários sobre a mortalidade precoce no Brasil.

PURPOSE: To compare age specific mortality rates from acute myocardial infarction and cerebrovascular diseases in Brazilian cities with equivalent death rates in other countries. METHODS: Data on Brazilian deaths were obtained from the Health Ministry's Mortality Information System. Data for other countries were obtained from a World Health Organization specialized publication. RESULTS: Nearly 50% of ischemic heart disease deaths among males occurred in men under 65. The equivalent proportion in other countries was 25%. The acute myocardial infarction death rate among men aged 35-44 was 3 times greater than in North America. The Brazilian cardiovascular disease death rates were also higher then in other countries. CONCLUSION: Contrary to what is usually believed, it is not only among old people that cardiovascular diseases are an important cause of death. This suggests that there is a need for specifically designed investigations that take account of the peculiarities of the Brazilian situation, as well as for urgent implementation of targetted risk factor control programs.

[Mortality differentials in men and women in the southeastern region, Brazil--1960, 1970 and 1980]. / Diferencial de mortalidade em homens e mulheres em localidade da região sudeste, Brasil--1960, 1970 e 1980.

Male and female mortality rates in the city of Rio de Janeiro in 1960, 1970 and 1980 are studied with a view to analysing the different risks to which men and women are subject by age group. Mortality differentials by sex and cause were studied by means of male/female mortality ratios, relative and absolute differences among rates, and standardized rates. An analysis of differentials by selected groups of cause for 1980 was undertaken. Male mortality rates were higher than the female rates in all age groups in the three years studied, with an increase of the male/female mortality ratio for the 15-34 age group over this period. The excess of male death was mainly due to the increase of deaths from violent causes among young men, a dramatic circumstance that can hardly be changed by "technical" procedures. As regards deaths from other causes, biological determinants and the different risks for men and women should be considered in order better to understand this situation.