Holland is falling behind many of its European neighbours for life expectancy, and smoking seems to be the reason, says a study of mortality by the Netherlands National Institute of Public Health and the Environment (RIVM). The trend is particularly striking among Dutch women, who also have one of the highest rates of smoking in Europe.
In 1970, the average life expectancy of Dutch women was 76, the third highest in Europe, with only Swedish and Norwegian women living longer. But by 1997 their position had fallen, relative to other countries, to below the average in the European Union, just over 80. Women in France and Spain had overtaken their Dutch counterparts, with life expectancies of 83 and 82 respectively.
The Netherlands seems to be following a trend set by Denmark, which also has high rates of smoking among women. One recent study (Lancet 2000;357:871-2) suggested that the Danish increase could be associated with the accession to the Danish throne of Queen Margarethe II, a popular monarch, who is known to enjoy smoking cigarettes.
The RIVM research "Lang leve Nederland!" (www.rivm.nl) was ordered by the Ministry of Health after the World Health Organization's World Health Report 2000 ranked the Netherlands as only the 17th most healthy country. Specific problems highlighted in that report included stagnating life expectancy. The RIVM study of age specific death rates showed that although death rates were generally falling, mortality among Dutch men aged 65 and over and women aged 45 to 70 was higher than the average in the European Union. Dutch people had better age specific rates for heart disease, stroke, and accidental falls but worse for breast, colorectal, and prostate cancers; pneumonia; and lung cancer and asthma. Though determinants are complex, says the study, smoking is the most dominant risk factor for the last two causes.
Figures for 1997 showed 40% of Dutch men and 30% of women smoke. In the United Kingdom, 29% of men and 28% of women smoke. Only Spanish men (42%) and Danish women (33%) smoke more than the Dutch. Dutch men who do not smoke can expect to live seven years longer than those who do (life expectancy 70 v 77 years); women can expect to live six years longer (76 v 82 years).
The study, led by Peter Kramers, concludes: "the stagnation of increasing life expectancy can be attributed to the single factor, smoking."