Changing mortality patterns in East and West Germany and Poland. II: Short-term trends during transition and in the 1990s

Objectives-To examine trends in life expectancy at birth and age and cause specific patterns of mortality in the former German Democratic Republic (GD R) and Poland during political transition and throughout the 1990s in both parts of Germany and in Poland. Methods-Decomposition of life expectancy by age and cause of death. Changes in life expectancy during transition by cause of death were examined using data for 1988/89 and 1990/91 for the former GDR and Poland; examination of life expectancy changes after transition were based on 1992-97 data for Ge rmany and 1991-96 data for Poland. Results-In both the former GDR and Poland male life expectancy at birth dec lined by almost one year during transition, mainly attributable to rising d eath rates from external causes and circulatory diseases. Female life expec tancy in Poland deteriorated by 0.3 years, largely attributable to increasi ng circulatory mortality among the old, while in East German female rising death rates in children and young adults were nearly outbalanced by declini ng circulatory mortality among those over 70. Between 1991/92 and 1996/97, male life expectancy at birth increased by 2.4 years in the former GDR, 1.2 years in old Federal Republic, and 2.0 years in Poland (women: 2.3, 0.9, a nd 1.2 years). In East Germany and Poland, the overall improvement was larg ely attributable to falling mortality among men aged 40-64, while those ove r 65 contributed the largest proportion to life expectancy gains in women. The change in deaths among men aged 15-39 accounted for 0.4 of a year to li fe expectancy at birth in East Germany and Poland, attributable largely to greater decreases from external causes. Among those over 40, absolute contr ibutions to changing life expectancy were greater in the former GDR than in the other two entities in both sexes, largely attributable to circulatory diseases. A persisting East-west life expectancy gap in Germany of 2.1 year s in men in 1997 was largely attributable to external causes, diseases of t he digestive system and circulatory diseases. Higher death rates from circu latory diseases among the elderly largely explain the female life expectanc y gap of approximately one year. Conclusions-This study provides further insights into the health effects of political transition. Post-transition improvements in life expectancy and mortality have been much steeper in East Germany compared with Poland. Chan ges in dietary pattern and, in Germany, medical care may have been importan t factors in shaping posttransition mortality trends.