Injury mortality in East Germany

OBJECTIVES: This study determined the effects of social changes in East Germany since 1989 on patterns of injury mortality. METHODS: Death certificate data regarding injuries from 1980 through 1995 and police data regarding traffic injuries in East Germany from 1980 through 1998 were compared with similar data from West Germany. RESULTS: The number of motor vehicle-related injuries and deaths in East Germany increased dramatically between 1989 and 1991, whereas those in West Germany declined slightly. The increased mortality in the more rural East has especially involved young men driving automobiles on rural roads and has persisted since reunification of East and West Germany. Falls, other accidents, and suicides have shown no such effect. Homicide among East German men has increased but remains uncommon. CONCLUSIONS: Recent social changes in East Germany, including increased access to motor vehicles and decreased restrictions on personal freedom, have been associated with increased motor vehicle crashes and mortality, especially among young men and on rural roads.     

Determinants of avoidable deaths from ischemic heart disease in East and West Germany

Objective  

Within Germany, a significant decrease in avoidable mortality from ischemic heart disease (IHD) has been observed since the early 1990s. The objective of this paper is to identify the specific reasons that have led to the decrease in the number of avoidable deaths from IHD in West and East Germany from 1996 to 2004.     

Berliners' models of heart disease causation

Following the collapse of socialism and subsequent German reunification, cardiac mortality rose unexpectedly in the former East Germany; although rates improved by mid-decade, a West/East health gradient persisted. Psychosocial stress from regime change, postsocialism, was one hypothesis proposed to explain the health transition. Absent from the scholarly conversation were individuals' own assessments of their illness experiences in this time of social upheaval. I hypothesized that such data might illuminate processes linking illness and social change. I analyzed illness narratives of East and West Berliners with heart disease, attending to subjective notions of causation. Both groups cited nonmodifiable and modifiable risk factors; half of the East Berliners incorporated additional material that referenced processes associated with postsocialism. I propose that ethnographic investigations of illness experiences can contribute to the development of more culturally relevant, comprehensive hypotheses of nonbiologic risk factors for cardiovascular disease.     

The influence of the geographic, demographic and socio-economic factors on the mortality from ischaemic heart disease in Switzerland (author's transl)

The age-standardized mortality rate of Swiss men from ischaemic heart disease (ICD 8th revision, codes 410-414) can be placed between the higher mortality rate of the Federal Republic of Germany and the lower one of France. A geographical gradient is also found within Switzerland: the German speaking areas register higher rates than the French speaking areas, and this difference is more pronounced for comparisons of large cities than for rural locations. These mortality rates are not biased by the other diseases of the heart (ICD codes 420-429). In addition to this geographical gradient, the socio-economic classes, marital status and the number of children are the best demographic and social indicators to discriminate in multivariate form the deaths from ischaemic heart disease among all deaths of men aged 45 to 64 years: the relative risk of dying from ischaemic heart disease is higher among men in non-manual professions (especially in non-independent situations) and among married men with two or none children. The results confirm the importance of the psycho-socio-cultural factors in the etiology of ischaemic heart disease.     

Estimating the contribution of mortality selection to the East–West German mortality convergence

Background

Before German reunification, old-age mortality was considerably higher in East Germany than West Germany but converged quickly afterward. Previous studies attributed this rapid catch-up to improved living conditions. We add to this discussion by quantifying for the first time the impact of mortality selection.

Methods

We use a gamma-Gompertz mortality model to estimate the contribution of selection to the East–West German mortality convergence before and after reunification.

Results

We find that, compared to the West, frailer East Germans died earlier due to deteriorating mortality conditions leading to converging mortality rates for women and men already over age 70 before 1990. After 1990, the selection of frailer individuals played only a minor role in closing the East–west German mortality gap. However, our study suggests that, after reunification, old-age mortality improved quickly because the more robust population in the East benefitted greatly from ameliorating external factors such as health care and better living standards.

Conclusion

Our results from a natural experiment show that selection of frail individuals plays an important role in population-level mortality dynamics. In the case of the German reunification, East German old-age mortality already converged before 1990 because of stronger selection pressure.

     

Violence and fear of violence in East and West Germany

The purpose of this research was to assess the effect of major social changes in Germany since 1989 on mortality due to intentional injury. Mechanisms and types of fatal intentional injury in East and West Germany between 1970 and 1995 were determined from death certificates and compared with judicial data on violent crime convictions and recent public survey data on citizen fear of crime. The number of homicides among East German males increased between 1989 and 1991, and the homicide rate remains high when compared with West German males (although lower than that of American males). Homicide among German females is less common, presently about equally likely in East and West. Violent crime in general has become more frequent in Germany, and citizen fear of crime has increased markedly, especially in the East. Non-citizens are convicted for an increasing number of homicides and assaults. Rates of suicide were declining in East and West before reunification, and these rates have continued to decline. Social changes in Europe since 1989 have led to noticeable increases in violence and homicide in Germany, which in turn have reduced feelings of security among German citizens, especially in the East. Suicide rates have not been affected.     

Time trends in exposure to environmental tobacco smoke and parental educational level for 6-year-old children in Germany

The aim of the study was to investigate the association between exposure to environmental tobacco smoke of 6-year-old children and parental educational level in Germany under the changing socioeconomic conditions after reunification. Logistic regression was used to examine the relationship between tobacco smoke exposure of children (current environmental tobacco smoke, maternal smoking during pregnancy, environmental tobacco smoke during the first 3 years of the child’s life) and the determinants parental educational level, time and region. In Germany, the risk of environmental tobacco smoke exposure among 6-year-old children was strongly associated with parental educational level (odds ratio: ≥2 ‘low’/‘middle’ versus ‘high’ parental educational level). In West Germany, environmental tobacco smoke exposure generally exhibited a decreasing trend of about 20%. In contrast, in East Germany the environmental tobacco smoke exposure was only decreasing for children of parents with higher education. The gap between low and high parental educational level with respect to current children’s tobacco smoke exposure has increased from 1991 to 2000 in East Germany. A considerable fresh increase of maternal smoking during pregnancy could be observed around 1991 in both parts of Germany. In East Germany, the transition from a socialist economic system to a market economy after reunification might in part explain the increased gap of tobacco smoke exposure between children of parents with lower and higher educational levels.     

Entwicklung der Herz-Kreislauf-Morbidität und -Mortalität in Ostdeutschland nach der politisch-ökonomischen Wende

Cardiovascular mortality decreased in the GDR between 1980 and 1989 in men by 14 % and in women by 18 %. In 1990, however, among men as well as women the rates increased considerably, particularly for the age group 25-44 (18 % and 17 %, respectively), but also for the age group 45-64 (7 % for both sexes). Compared with the mortality rates of 1989 this increase resulted in an excess-mortality of approximately 1120 cardiovascular deaths in this age range in East Germany during the year of the reunification. The re-arrangement of the coding practice in this year is obviously not an explaination for this phenomenon. There were, on the other hand, very similar trends of the cardiovascular mortality and the myocardial infarction and stroke morbidity in the years before and after the reunification. The stroke morbidity developed quite parallel with the hypertension prevalence rates. But we observed no relationship between the trends in hypercholesterolemia and smoking, on the one hand, and the myocardial infarction attack rates, on the other hand. However, the prevalence of psychosocial risk factors (social network, job stress, life events) increased considerably. This fact seems to play an important role particularly in the increase of the incidence of myocardial infarctions after the political change. Cardiovascular mortality droped after the reunification to a faster rate than before the reunification especially in the age range below 65 years. Nevertheless, cardiovascular mortality is still currently much higher in East than in West Germany. Therefore, in order to bring the East German rates in line with the West German rates it will probably still take a long time.     

Pertussis in Germany: regional differences in management and vaccination status of hospitalized cases

The incidence of pertussis requiring hospitalization in children younger than 16 years was estimated by the use of an active surveillance-system. Of special interest were differences between West and East Germany following different vaccination strategies before reunification. In 1997 and 1998, 754 pertussis cases required a total of 11,151 hospital inpatient days. The incidence of hospitalized pertussis was 2.68/100,000 person years and this was significantly higher in East than in West Germany. In East Germany an unusually high percentage of hospitalized cases was found in children aged 6-15 years (45% versus 13% in West Germany). The difference between the regions may be due either to a different perception of the disease or to an increased immunity induced by prior disease or vaccination. In East Germany, pertussis was rare until reunification but it has increased significantly since then. Older children may thus represent a population at risk of pertussis having not had previous exposure to pertussis antigens.     

Food and nutrient intake in East and West Germany, 8 years after the reunification--The German Nutrition Survey 1998

OBJECTIVE: To explore differences in food and nutrient intake as well as cardiovascular risk factors between the eastern and western parts of Germany in 1998 and to compare food consumption information between 1991 and 1998. DESIGN AND SUBJECTS: In all, 4030 people, aged 18-79 y, sampled from the East and West parts of Germany participated in the German Nutrition Survey (1998) by completing dietary histories and being assessed for cardiovascular risk factors. In a separate analysis, two food frequency data sets were compared from National Health Surveys conducted in 1991 (n = 7466) and in 1998 (n = 4556). RESULTS: In 1998, East Germans consumed more bread, fruit, fish, sausage, offal, and men additionally more cakes/cookies, beer and soft drinks than West Germans. They consumed less cereals, pasta, sweets, leafy vegetables, tea and drinking water, and men less vegetables and wine and women less pastry/crackers, potatoes and animal fat compared with their counterparts in West Germany. East Germans had a higher intake of total vitamin A, retinol, vitamin D, vitamin B12 and chloride, and in addition men of alcohol, and women of monosaccharides. They had a lower intake of total water, vitamin K, calcium, magnesium and manganese, and men of linoleic acid, and women of vitamin E than their West German counterparts. In East Germany, higher mean systolic blood pressure, and total and high-density lipoprotein cholesterol concentrations were found in men, and a lower mean total serum cholesterol concentration found in women compared with West Germany. CONCLUSION: Differences in food intake between the eastern and western parts of Germany still existed in 1998, although these differences were smaller than those observed 1 y after the reunification.     

The influence of large-scale airborne particle decline and traffic-related exposure on children's lung function

Between 1991 and 2000, ambient air pollution in East Germany changed to resemble West German pollution levels: The concentration of total suspended particles (TSPs) decreased on a broad scale while traffic increased. During that time, we analyzed total lung capacity (TLC) and airway resistance (R(aw)) of East and West German children. We tested children 5-7 years of age (n = 2,574) with cooperation-independent body plethysmography in repeated cross sections. We used random-effect models to determine the mutually adjusted association between lung function and short-term and chronic particle exposure and its interaction with living near a busy road. Annual averages of TSPs declined from 77 to 44 microg/m2; averages on the day of investigation declined from 133 to 30 microg/m2. Differences in lung function between East and West German children vanished during the investigation time. The association of TSPs with R(aw) and TLC was stronger in children living > 50 m away from busy roads. East German children from this group had an R(aw) 2.5% higher [95% confidence interval (CI), 0.0-5.1%] per 40-microg/m2 increase of daily TSP averages. TLC decreased by 6.2% (95% CI, 0.04-11.6%) per 40-microg/m2 increase in annual mean TSPs, and this effect was equally pronounced in East and West Germany. TSP exposure decreased on a broad scale between 1991 and 2000. Lower concentrations of TSPs were associated with better measures of lung function in 6-year-old children. For children living near busy roads, this effect was diminished.     

Lebenserwartung, vorzeitig verlorene Lebensjahre und vermeidbare Sterblichkeit im Ost-West-Vergleich

The dynamics of convergence between East and West Germany in the life-prolonging process continued undiminished from 1990 until 2001. The regional differences in premature and avoidable mortality were clearly reduced, both between East and West and between the individual federal states. In the East and in the West there was an increase in life expectancy in all age groups and for both sexes, whereby the increase in life expectancy was considerably greater in East Germany and in all of the East German federal states. Also, the standardized potential years of life lost before the age of 65 decreased more intensively in East Germany. The women in East Germany achieved a lower premature mortality due to illness in the year 2001 than those in West Germany. In the initial year of 1990, the years of life lost were 27.2% greater. Unnatural premature mortality (especially due to accidents) was also relatively high in East Germany in the year 2001, but it is clearly being reduced. The avoidable mortality has been more than cut in half in all East German federal states since 1990. An almost complete alignment between East and West in regard to avoidable mortality was achieved in the year 2001. The phase of economic stagnation that can be observed in East Germany since 1997 has up to now not led to a worsening in the constitutive health references presented above.     

The impact of maternal education on intrauterine growth: a comparison of former West and East Germany

BACKGROUND: Objective of this re-analysis of datasets from former East and West Germany was to examine the influence of maternal education on intrauterine growth in two different political and social systems. METHODS: Information on socio-demographic or lifestyle factors and pregnancy outcome was available for 3374 liveborn singletons from West Germany (1987/88) and 3070 from East Germany (1990/91). Multiple logistic regression was used to estimate the association between maternal education and the risk of delivering a small-for-gestational-age (SGA) newborn below the 10th percentile of birthweight. RESULTS: Women with the lowest education had a significantly elevated risk of SGA newborns compared to women with the highest education in West (odds ratio [OR] = 2.58, 95% CI : 1.17-5.67) and East Germany (OR = 2.77, 95% CI : 1.54- 5.00). The distribution of factors known to influence intrauterine growth varied with education in both states. After adjusting for these factors, women with the lowest educational level still had a higher risk of SGA birth: OR (West) = 2.02, 95% CI : 0.87-4.72; OR (East) = 1.95, 95% CI : 1.02-3.74. CONCLUSIONS: Our findings support the assumption that in former socialist countries health inequalities as a result of social inequalities existed.     

Individual risk factors, health behaviour and mortality developments in Germany from 1984 to 1998

The aim of the study is to investigate the contribution by the risk factors smoking, overweight, high blood pressure, physical inactivity and regular alcohol consumption to the total mortality development of the general population in Germany. Data are a mortality follow-up conducted by the Federal Institute for Population Research during 1984 - 1998 in West Germany and 1991-1998 in East Germany. 8474 persons participated at baseline in West Germany in the age group 31-69 years, and 1546 persons participated at baseline in East Germany in the age-group 40-79 years. The vital status in the year 1998 could be determined in West Germany for 86.5% and in East Germany for 97.0%. In the observation period 1986-1998 for West Germany 17.2% of the males died and 8.6% of the females. In East Germany between 1991-1998 9.6% of the males died and 6.7% of the females. The statistical analysis, based on the Cox regression showed for West Germany except for overweight in males throughout a significant contribution of the risk factor load on total mortality. The highest relative risks were found for strong smokers (males: RR = 3.47, p < 0.001, females: RR = 3.62, p < 0.001). The relative mortality risk for persons with three and more risk factors yielded in males 4.88 (p < 0.001) and in females 5.05 (p < 0.001). These findings clearly demonstrate that already a few risk markers of the individual health behaviour have a strong impact on the total mortality development in Germany. The mortality risk is about five times higher for persons with three and more risk factors. This indicates the need for preventive measures targeting high-risk population groups.     

Diet in residents of East and West Germany in 1991–1992 as ascertained by a retrospective food frequency questionnaire

In this study, we compared dietary habits of residents in East (N=76) and West Germany (N=266) using results obtained in 1992–1993 from a retrospective semi-quantitative food frequency questionnaire referring to 1991–1992. Nutrient intakes were calculated based on the German Federal Food Code. Univariate and multivariate logistic regression was used to determine whether dietary intakes varied according to residence in East and West Germany. At the food level, East German subjects reported a higher consumption of bread, spreadable fat, and sausage, whereas West German participants reported a higher intake of fruit, vegetables, and pasta and rice. At the macronutrient level, energy intake did not differ significantly between groups, nor did the percent contribution of protein, carbohydrate, fat, and alcohol to total energy intake. East German participants had a lower total water and fibre intake, the latter significant only after adjustment for confounders. At the micronutrient level, East German participants had a higher intake of cobalamin, retinol and retinol-equivalents (but not of beta-carotene). There were no differences in the intake of vitamins C, D, and E between groups. Less salt and more potassium, calcium, magnesium and zinc were consumed by West than by East German subjects. Overall, both groups showed disadvantageous dietary patterns. The results are discussed in the context of an overview of other dietary surveys performed in the two parts of Germany before and after reunification. In general our results are consistent with other observations showing that dietary habits in East Germany rapidly approached those in West Germany after reunification, although some residual differences seemed to persist.     

Mortality from all causes and circulatory disease by country of birth in England and Wales 2001-2003

BACKGROUND: Differences in mortality by country of birth in England and Wales in people under 70 years of age have been demonstrated previously. Changes in age distribution of migrants and in migration patterns have occurred subsequently. METHODS: All-cause and circulatory disease mortality for people aged 20 years and over in England and Wales by country of birth were examined using population data from the 2001 Census and mortality data for 2001-2003. Indirect standardization was used to estimate sex-specific standardized mortality ratios (SMRs) and 95% confidence intervals (CI) in comparison to mortality for England and Wales as a whole. RESULTS: SMRs for all-cause mortality were statistically significantly higher than the national average for people born in Ireland, Scotland, East Africa and West Africa and lower for people born in China and Hong Kong. SMRs for circulatory disease were highest among people born in Bangladesh and lowest among people born in China and Hong Kong. Patterns of ischaemic heart disease and cerebrovascular disease mortality differed by country of birth. CONCLUSIONS: Mortality, particularly due to ischaemic heart disease and stroke, differs markedly by country of birth in all age groups including the > or =70-year-old group.     

Weight gain in two adult cohorts in East and West Germany reunification

BACKGROUND: Several epidemiological studies have shown consistently higher prevalence rates of obesity and overweight in East German adults compared to West German adults before German reunification in 1990. If different lifestyle factors after German division contribute to these differences, one might speculate that trends of obesity and overweight in the East and West after German reunification in 1990 would be similar. OBJECTIVE: To examine weight gain in East and West German adult cohorts in the decade after German reunification. METHODS: The study population includes 554 individuals with complete data aged 20 - 47 years in 1990-92 participating in the ten year follow-up of the European Community Respiratory Health Survey (ECRHS) in the German centres Hamburg (West) and Erfurt (East). Age and occupation-adjusted prevalence and incidence rates, stratified for gender and centre, were calculated for the Erfurt and Hamburg cohorts. RESULTS: The prevalence of overweight increased in males and females in both cities, and was statistically significant for Hamburg males (32.7% to 44.9%), Hamburg females (12.3% to 25.4%) and Erfurt females (18.5% to 31.2%). The increase in the prevalence of obesity was statistically significant for males (Hamburg: 3.7% to 7.9%; Erfurt: 5.2% to 10.8%) and for females only in Hamburg (6.4% to 14.2%). The increase in the prevalence of overweight and obesity were larger in Hamburg than in Erfurt. Moreover, the incidence rates of obesity were higher in Hamburg for both sexes, but were not statistically significant CONCLUSION: Our findings indicate different patterns of weight gain in 2 study sites in East- and West-Germany. These results might reflect a convergence of initially higher prevalences of overweight and obesity in the East with initially lower prevalences in the West.     

Airway diseases and allergies in East and West German children during the first 5 years after reunification: time trends and the impact of sulphur dioxide and total suspended particles

BACKGROUND: East-West comparison studies in Europe find higher prevalences of infectious airway diseases and lower prevalences of allergies in eastern areas. Pollution from sulphur dioxide (SO2) or total suspended particles (TSP) are discussed as causes of this difference. METHODS: In four differently polluted areas of East Germany where pollution decreased dramatically between 1989 and 1995 cross-sectional studies in about 7-year-old children were repeated every year between 1991 and 1995. In two differently polluted areas of West Germany studies with the same design were done in 1991 and 1994. In all, 19090 children participated in the study. Thirteen different questions about airway diseases and allergies were evaluated. Logistic regression was used to adjust for confounding. RESULTS: With the exception of pneumonia, all infectious airway diseases and irritations of the airways show a steeper temporal decrease in East than in West Germany or are positively associated with either SO2 or TSP in East Germany. For allergies and related symptoms no differences in time trends could be detected or no association with SO2 or TSP could be seen in East Germany. CONCLUSION: Most airway diseases were more frequent in East than in West Germany in 1991 and were associated with SO2 or TSP. The decrease in these pollutants between 1991 and 1995 has already had a favourable effect. An effect of SO2 or TSP pollution on allergies and related symptoms could not be detected. This pollution does not protect against the development of allergies.     

Social inequities in cardiovascular disease risk factors in East and West Germany.

Social class related differences in prevalence of cardiovascular disease risk factors in Germany were investigated with special emphasis on comparisons between East and West Germany and on time trends. Databases for West Germany are the first and second National Health Survey (survey 1: N = 4794, survey 2: N = 5315), carried out in the framework of the German Cardiovascular Prevention Study, and for East Germany the first GDR-MONICA project (N = 6125). Different social class indices were applied to evaluate social inequities for hypertension, hypercholesterolemia, cigarette smoking, obesity and predicted cardiovascular disease mortality. As a main result, it was found that very similar patterns in the relation between social class characteristics and cardiovascular disease risk factor prevalence occurred for both parts of Germany. Social class gradients were strongest for obesity and weakest for hypercholesterolemia. Analysis of time trends for the period from 1984 to 1988 (for West Germany only) revealed an increase in social inequalities for hypertension in males and cigarette smoking in females. These findings point to the need to focus more on social disadvantaged segments in the population when community based health promotion and disease prevention programs are brought into action.