Regional variations in the prevalence of eight major cardiovascular risk factors between the 16 federal states in Germany

Objective: More than 60% of cardiovascular deaths are caused by eight major risk factors. We investigated whether there are differences in the prevalence of these risk factors in the 16 German federal states that could help explain the known regional variations in cardiovascular disease prevalence and mortality in Germany.

Methods: We used pooled data from waves 2009, 2010 and 2012 of the national population-based study German Health Update (GEDA) with a total of 62,606 participants aged ≥18 years. We examined differences between the 16 German federal states in the prevalence of physical inactivity, smoking, alcohol use, low fruit and vegetable intake, obesity, and lifetime medical history of hypertension, hyperlipidemia or diabetes. The results were weighted to represent the German population on 31.12.2011.

Results: Statistically significant differences between the 16 federal were observed for all cardiovascular risk factors except for risky alcohol consumption. Diabetes had the largest regional variation between the lowest (6.7%) and highest prevalence (13.3%), followed by low fruit and vegetable intake (11.8% versus 21.0%), obesity (11.8% versus 20.6%), hypertension (22.2% versus 36.1%), current smoking (24.1% versus 35.6%), physical inactivity (31.1% versus 42.2%) and risky alcohol consumption (24.1% versus 31.6%). The smallest range was found for hyperlipidemia (26.5% versus 32.1%). Overall, the mean prevalence of each risk factor was higher in men compared to women except for diabetes. The highest proportions of men with ≥ four risk factors were found in Thüringen (21.8%), Mecklenburg-Vorpommern (21.5%) and Sachsen-Anhalt (20.4%). The highest proportions of women with ≥ four risk factors were observed in Saarland (14.9%), Mecklenburg-Vorpommern and Berlin (both 13.8%).

Conclusion: There are notable differences between German federal states in the prevalence of the eight most important cardiovascular risk factors. These observed regional variations are in line with known differences in cardiovascular morbidity and mortality between federal states in Germany and emphasize the need for benchmarking in cardiovascular prevention and health care.