title: Italianity is associated with lower risk of prostate cancer mortality in Switzerland.
abstract: OBJECTIVE
  Different prostate cancer mortality rates observed in European countries may depend on cultural background. We aimed at exploring variation in prostate cancer mortality in the language regions of Switzerland as a function of "Italianity", a proxy for adherence to an Italian lifestyle.
  
  
  METHODS
  We used data of the Swiss National Cohort, a census-based record linkage study, consisting of census (1990 and 2000) and mortality (until 2008) data. 1,163,271 Swiss and Italian nationals 40+-year old were included. Multivariate age-standardized prostate cancer mortality rates and hazard ratios (HR) from Cox proportional hazards regression analysis were performed. Italianity was defined by an individual's nationality, place of birth and principal language, resulting in a score of 0-3 points.
  
  
  RESULTS
  Age-standardized prostate cancer mortality rates (per 100,000 person-years) were lowest in the Italian-speaking region of Switzerland (66.7 vs. 87.3 in the German-speaking region). Both Italian nationality and/or place of birth were significantly associated with lower mortality. There was a graded inverse association between mortality rates and increasing Italianity score. Individuals with the highest level of Italianity had a HR of 0.67 (95 % CI 0.59-0.76) compared to those with an Italianity score of zero. Results were similar when looking at language regions separately.
  
  
  CONCLUSIONS
  The strong and consistent association between Italianity and prostate cancer mortality suggests protective properties of an Italian lifestyle. Further research is required in order to determine which factors specific for Italian culture are responsible for the lower prostate cancer mortality.
authors.affiliation: Institute of Social and Preventive Medicine, University of Zurich, Hirschengraben 84, 8001, Zurich, Switzerland, aline.richard@ifspm.uzh.ch.
authors.forename: Aline
authors.initials: A
authors.lastname: Richard
authors.forename: David
authors.initials: D
authors.lastname: Faeh
authors.forename: Sabine
authors.initials: S
authors.lastname: Rohrmann
authors.forename: Julia
authors.initials: J
authors.lastname: Braun
authors.forename: Silvan
authors.initials: S
authors.lastname: Tarnutzer
authors.forename: Matthias
authors.initials: M
authors.lastname: Bopp
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019352:Censuses; D015331:Cohort Studies; D038441:Diet, Mediterranean; D004641:Emigration and Immigration; D006801:Humans; D015994:Incidence; D007558:Italy / Q000208:ethnology; D008297:Male; D008875:Middle Aged; D011471:Prostatic Neoplasms / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality / Q000517:prevention & control; D013557:Switzerland / Q000453:epidemiology