The Impact of Living at Moderate Altitude on Healthy Aging in Austria: Epidemiological Findings and Potential Underlying Mechanisms.

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.