THE EAST-WEST LIFE EXPECTANCY GAP - DIFFERENCES IN MORTALITY FROM CONDITIONS AMENABLE TO MEDICAL INTERVENTION

Background. Although mortality from conditions amenable to medical int ervention has frequently been shown to be higher in the countries of C entral and Eastern Europe (CCEE) than in the countries of Western Euro pe (CWE), the contribution of these mortality differences to the East- West gap in life expectancy is unknown. We have determined the contrib ution of mortality from nine amenable causes to differences in tempora ry life expectancy from birth to age 75 (TLE(0-75)) between 12 CCEE an d the average TLE(0-75) for CWE in ca. 1988. Data and methods. Populat ion and mortality data were extracted from publications of the World H ealth Organization. Chiang's method was used for constructing abridged life tables, and Arriaga's method was used for decomposition by cause of death of the differences in TLE(0-75) between each of the CCEE and the average for CWE. Results. Differences in TLE(0-75) between CCEE a nd the average for CWE ranged between 1.25 and 6.29 years in men, and between 1.09 and 3.44 years in women. After exclusion of early neonata l deaths, for which data were not available in all CCEE, amenable caus es accounted for between 11% and 50% of the difference in TLE(0-75) in men, and between 24% and 59% in women. The results for countries wher e data on early neonatal deaths were available show that inclusion of this category generally raises these estimates substantially. The cont ribution of conditions amenable to medical intervention to the East-We st life expectancy gap is of the same order of magnitude as that of ca rdiovascular diseases, and much larger than that of neoplasms, respira tory diseases or external causes. Conclusion. Although the contributio n of conditions amenable to medical intervention should not be taken a s a direct estimate of the contribution of medical care to the East-We st life expectancy gap, these results suggest that reducing difference s in the effectiveness of medical care may be more important for narro wing the life expectancy gap than has hitherto been assumed.