Background: Epidemiological data of populations living at moderate altitudes between 1,000 and 2,000 m suggest healthier aging when compared to people living in lower regions. Besides social determinants of health, lifestyle and cardiovascular risk factors, environmental conditions such as ambient temperature, air pollution and aeroallergens, solar radiation and in particular hypobaric hypoxia may modify the risk of disease development and mortality. The present study was aimed at (1) evaluating altitude-dependent overall and age-specific mortality rates of the most prevalent diseases using mortality registries and (2) link them to differences in lifestyle and risk factors from a population-based survey in Austria. We analyzed altitude-dependent mortality data of the entire Austrian population over a 10-year period (2013–2022, including the COVID-19 pandemic) and the distribution of cardiovascular risk factors such as hypertension, hypercholesterolemia and diabetes, lifestyle factors such as the amount of regular physical activity and dietary habits based on a representative Austrian-wide survey from 2019. Summary: Mortality was reduced in both sexes when living between 1,000 and 2,000 m compared to those living lower: by 15% (13–18%) in men and by 22% (20–24%) in women (p < 0.05). People aged between 50 and 89 years, particularly benefited from living at higher altitudes. Women lived a healthier lifestyle than men, especially at an age of above 50 years, only women older than 74 benefited from a higher located residence regarding COVID-19 mortality. Key Messages: The present study confirms mortality benefits at moderate altitudes. We propose that besides lifestyle and other environmental conditions, episodically occurring hypoxic periods and related hypoxia conditioning effects represent major underlying mechanisms.

1.
Faeh
D
,
Gutzwiller
F
,
Bopp
M
,
Group
SNCS
.
Lower mortality from coronary heart disease and stroke at higher altitudes in Switzerland
.
Circulation
.
2009
;
120
(
6
):
495
501
.
2.
Burtscher
J
,
Millet
GP
,
Burtscher
M
.
Does living at moderate altitudes in Austria affect mortality rates of various causes? An ecological study
.
BMJ Open
.
2021
;
11
(
6
):
e048520
.
3.
Thielke
S
,
Slatore
CG
,
Banks
WA
.
Association between alzheimer dementia mortality rate and altitude in California counties
.
JAMA Psychiatry
.
2015
;
72
(
12
):
1253
4
.
4.
Tremblay
JC
,
Ainslie
PN
.
Global and country-level estimates of human population at high altitude
.
Proc Natl Acad Sci U S A
.
2021
;
118
(
18
).
5.
Burtscher
J
,
Millet
GP
,
Burtscher
M
.
Reduced mortality in cooler surroundings
.
Lancet
.
2023
;
401
(
10390
):
1771
.
6.
Burtscher
M
,
Millet
GP
,
Klimont
J
,
Burtscher
J
.
Differences in the prevalence of physical activity and cardiovascular risk factors between people living at low (<1,001 m) compared to moderate (1,001-2,000 m) altitude
.
AIMS Public Health
.
2021
;
8
(
4
):
624
35
.
7.
Burtscher
M
.
Lower mortality rates in those living at moderate altitude
.
Aging
.
2016
;
8
(
10
):
2603
4
.
8.
Sahai
H
,
Khurshid
A
.
Statistics in epidemiology: methods, techniques and applications
.
Boca Raton, New York, London, Tokyo
:
CRC press
;
1995
.
9.
Daly
LE
.
Confidence limits made easy: interval estimation using a substitution method
.
Am J Epidemiol
.
1998
;
147
(
8
):
783
90
.
10.
Klimont
J
.
Österreichische Gesundheitsbefragung 2019. Hauptergebnisse des Austrian Health Interview Survey (ATHIS) und methodische Dokumentation
.
2020
. Vienna: Bundesministerium für Soziales, Gesundheit, Pflege und Konsumentenschutz (BMSGPK).https://wwwsozialministeriumat/Themen/Gesundheit/Gesundheitssystem/Gesundheitsberichte/%C3%96sterreichische-Gesundheitsbefragung-2014-(ATHIS)html
11.
Burtscher
J
,
Kopp
M
,
Klimont
J
,
Ulmer
H
,
Strasser
B
,
Burtscher
M
.
Age- and sex-dependent associations between self-reported physical activity levels and self-reported cardiovascular risk factors: a population-based cross-sectional survey
.
BMC Public Health
.
2024
;
24
(
1
):
2843
.
12.
Kolip
P
,
Lange
C
.
Gender inequality and the gender gap in life expectancy in the European Union
.
Eur J Public Health
.
2018
;
28
(
5
):
869
72
.
13.
Ali
M
,
Wani
SUD
,
Masoodi
MH
,
Khan
NA
,
Shivakumar
HG
,
Osmani
RMA
, et al
.
Global effect of COVID-19 pandemic on cancer patients and its treatment: a systematic review
.
Clin Complement Med Pharmacol
.
2022
;
2
(
4
):
100041
.
14.
Wells
CR
,
Galvani
AP
.
Impact of the COVID-19 pandemic on cancer incidence and mortality
.
Lancet Public Health
.
2022
;
7
(
6
):
e490
91
.
15.
Bhopal
SS
,
Bhopal
R
.
Sex differential in COVID-19 mortality varies markedly by age
.
Lancet
.
2020
;
396
(
10250
):
532
3
.
16.
Ortiz-Prado
E
,
Fernandez Naranjo
RP
,
Vasconez
E
,
Simbaña-Rivera
K
,
Correa-Sancho
T
,
Lister
A
, et al
.
Analysis of excess mortality data at different altitudes during the COVID-19 outbreak in Ecuador
.
High Alt Med Biol
.
2021 12
;
22
(
4
):
406
16
.
17.
Nicolaou
L
,
Steinberg
A
,
Carrillo-Larco
RM
,
Hartinger
S
,
Lescano
AG
,
Checkley
W
.
Living at high altitude and COVID-19 mortality in Peru
.
High Alt Med Biol
.
2022
;
23
(
2
):
146
58
.
18.
Mortimer
EA
,
Monson
RR
,
MacMahon
B
.
Reduction in mortality from coronary heart disease in men residing at high altitude
.
N Engl J Med
.
1977
;
296
(
11
):
581
5
.
19.
Ezzati
M
,
Murray Horwitz
ME
,
Thomas
DS
,
Friedman
AB
,
Roach
R
,
Clark
T
, et al
.
Altitude, life expectancy and mortality from ischaemic heart disease, stroke, COPD and cancers: national population-based analysis of US counties
.
J Epidemiol Community Health
.
2012
;
66
(
7
):
e17
.
20.
Garrido
DI
,
Garrido
SM
.
Cancer risk associated with living at high altitude in Ecuadorian population from 2005 to 2014
.
Clujul Med
.
2018
;
91
(
2
):
188
96
.
21.
Ortiz-Prado
E
,
Espinosa
PS
,
Borrero
A
,
Cordovez
SP
,
Vasconez
JE
,
Barreto-Grimales
A
, et al
.
Stroke-related mortality at different altitudes: a 17-year nationwide population-based analysis from Ecuador
.
Front Physiol
.
2021
;
12
:
733928
.
22.
Felsinger
R
,
Mayer
S
,
Haidinger
G
,
Simon
J
.
Aging well? Exploring self-reported quality of life in the older Austrian population based on repeated cross-sectional data
.
J Aging Soc Pol
.
2024
:
1
17
.
23.
Kollia
N
,
Caballero
FF
,
Sánchez-Niubó
A
,
Tyrovolas
S
,
Ayuso-Mateos
JL
,
Haro
JM
, et al
.
Social determinants, health status and 10-year mortality among 10,906 older adults from the English longitudinal study of aging: the ATHLOS project
.
BMC Public Health
.
2018
;
18
(
1
):
1357
.
24.
Tenda
ED
,
Henrina
J
,
Setiadharma
A
,
Felix
I
,
Yulianti
M
,
Pitoyo
CW
, et al
.
The impact of body mass index on mortality in COPD: an updated dose-response meta-analysis
.
Eur Respir Rev
.
2024
;
33
(
174
):
230261
.
25.
Hu
G
,
Jousilahti
P
,
Barengo
NC
,
Qiao
Q
,
Lakka
TA
,
Tuomilehto
J
.
Physical activity, cardiovascular risk factors, and mortality among Finnish adults with diabetes
.
Diabetes Care
.
2005
;
28
(
4
):
799
805
.
26.
Giles
EL
,
Brennan
M
.
Trading between healthy food, alcohol and physical activity behaviours
.
BMC Public Health
.
2014
;
14
:
1231
.
27.
Wang
Y
,
Su
B
,
Alcalde-Herraiz
M
,
Barclay
NL
,
Tian
Y
,
Li
C
, et al
.
Modifiable lifestyle factors and the risk of post-COVID-19 multisystem sequelae, hospitalization, and death
.
Nat Commun
.
2024
;
15
(
1
):
6363
.
28.
Zafeiratou
S
,
Samoli
E
,
Dimakopoulou
K
,
Rodopoulou
S
,
Analitis
A
,
Gasparrini
A
, et al
.
A systematic review on the association between total and cardiopulmonary mortality/morbidity or cardiovascular risk factors with long-term exposure to increased or decreased ambient temperature
.
Sci Total Environ
.
2021
;
772
:
145383
.
29.
Schroeder
P
,
Belis
CA
,
Schnelle-Kreis
J
,
Herzig
R
,
Prevot
AS
,
Raveton
M
, et al
.
Why air quality in the Alps remains a matter of concern. The impact of organic pollutants in the alpine area
.
Environ Sci Pollut Res Int
.
2014
;
21
(
1
):
252
67
.
30.
Botteri
E
,
Støer
NC
,
Weiderpass
E
,
Pukkala
E
,
Ylikorkala
O
,
Lyytinen
H
.
Menopausal hormone therapy and risk of melanoma: a nationwide register-based study in Finland
.
Cancer Epidemiol Biomarkers Prev
.
2019
;
28
(
11
):
1857
60
.
31.
Burtscher
J
,
Samaja
M
.
Healthy aging at moderate altitudes: hypoxia and hormesis
.
Gerontology
.
2024
;
70
(
11
):
1152
60
.
32.
Janssen Daalen
JM
,
Meinders
MJ
,
Mathur
S
,
van Hees
HWH
,
Ainslie
PN
,
Thijssen
DHJ
, et al
.
Randomized controlled trial of intermittent hypoxia in Parkinson's disease: study rationale and protocol
.
BMC Neurol
.
2024
;
24
(
1
):
212
.
33.
Staub
K
,
Haeusler
M
,
Bender
N
,
Morozova
I
,
Eppenberger
P
,
Panczak
R
, et al
.
Hemoglobin concentration of young men at residential altitudes between 200 and 2000 m mirrors Switzerland's topography
.
Blood
.
2020
;
135
:
1066
9
.
34.
Aragón-Vela
J
,
Bejder
J
,
R Huertas
J
,
Plaza-Diaz
J
,
Nordsborg
NB
.
Does intermittent exposure to high altitude increase the risk of cardiovascular disease in workers? A systematic narrative review
.
BMJ Open
.
2020
;
10
(
11
):
e041532
.
35.
Lo
MY
,
Daniels
JD
,
Levine
BD
,
Burtscher
M
.
Sleeping altitude and sudden cardiac death
.
Am Heart J
.
2013
;
166
(
1
):
71
5
.
36.
Burtscher
J
,
Citherlet
T
,
Camacho-Cardenosa
A
,
Camacho-Cardenosa
M
,
Raberin
A
,
Krumm
B
, et al
.
Mechanisms underlying the health benefits of intermittent hypoxia conditioning
.
J Physiol
.
2024
;
602
(
21
):
5757
83
.
37.
Ortiz-Prado
E
,
Cordovez
SP
,
Vasconez
E
,
Viscor
G
,
Roderick
P
.
Chronic high-altitude exposure and the epidemiology of ischaemic stroke: a systematic review
.
BMJ Open
.
2022
;
12
(
4
):
e051777
.
38.
Thiersch
M
,
Swenson
ER
,
Haider
T
,
Gassmann
M
.
Reduced cancer mortality at high altitude: the role of glucose, lipids, iron and physical activity
.
Exp Cel Res
.
2017
;
356
(
2
):
209
16
.
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