J Epidemiol Community Health 59:274-278 doi:10.1136/jech.2004.025510
  • Research report

Residence in mountainous compared with lowland areas in relation to total and coronary mortality. A study in rural Greece

  1. Nikos Baibas1,
  2. Antonia Trichopoulou1,
  3. Eftihios Voridis2,
  4. Dimitrios Trichopoulos3
  1. 1Department of Hygiene and Epidemiology, University of Athens, Medical School, Athens, Greece
  2. 2Euroclinic, Department of Cardiology, Athens, Greece
  3. 3Department of Epidemiology, Harvard School of Public Health, Boston, USA
  1. Correspondence to:
 Dr N Baibas
 Department of Hygiene and Epidemiology, University of Athens Medical School, 75 Mikras Asias Street, 115 27 Athens, Greece;
  • Accepted 29 September 2004


Study objective: To investigate the association of residence in mountainous or lowland areas with total and coronary mortality, in a cohort with 15 years of follow up.

Design and setting: Prospective study, based on the adult population of two lowland and one mountainous village in rural Greece. Baseline measurements on sociodemographic, lifestyle, somatometric, clinical, and biochemical variables were recorded in 1981 during a health survey and total and coronary deaths were ascertained on the basis of death certificates up to 1996.

Participants: 1198 men and women, who had participated in the 1981 survey. Analyses are based on 504 men and 646 women with complete data.

Main results: There were 150 deaths among men and 140 among women (coronary deaths: 34 and 33 respectively). In multivariate analysis with Cox regression, after adjustment for age, education, body weight, smoking, alcohol consumption, systolic blood pressure, serum total cholesterol, blood glucose, serum triglycerides, and serum uric acid, total and coronary mortality were lower for residents of the mountainous village in comparison with residents of the lowland villages (hazard ratios (95% confidence intervals) for men and women, respectively: total mortality, 0.57 (0.38 to 0.84) and 0.69 (0.47 to 1.02); coronary mortality, 0.39 (0.16 to 0.98) and 0.46 (0.20 to 1.05)).

Conclusions: Residence in mountainous areas seems to have a “protective effect” from total and coronary mortality. Increased physical activity from walking on rugged terrains under conditions of moderate hypoxia among the mountain residents could explain these findings.


  • Funding: Dr Baibas is supported from the Vassilios and Nafsika Tricha fellowship (University of Athens). The funding source had no involvement in the study design, in the collection, analysis and interpretation of data, the writing of the report and the decision to submit the paper for publication.

  • Conflicts of interest: none declared.

Responses to this article