Health convergence between East and West Germany as reflected in long-term cause-specific mortality trends: how much was due to reunification?

Pavel Grigoriev, Max-Planck Institute for Demographic Research
Marketa Pechholdova, University of Economics, Prague (VSE)

Past political and socioeconomic developments have had a strong impact on recent mortality trends in Germany. A notable mortality gap between the German Democratic Republic (East Germany) and the pre-unified Federal Republic of Germany (West Germany) began to narrow rapidly right after the unification of the two states. It has been suggested that health progress in East Germany is likely to be explained by the reduction of causes of death amenable to health interventions, predominantly cardiovascular diseases. Despite extensive research, the factors underlying the remarkable improvement in East Germany are still not fully understood. One of the reasons for that is a number of significant changes in the classification of causes of death as well as the changes in coding practices taking place in East Germany shortly after reunification. These latter changes, which happen to coincide in time with profound socioeconomic transformation of East Germany, have particularly complicated the interpretation of mortality trends and made the international comparisons difficult. In this paper, we report the initial results of the project on the reconstruction mortality trends in East Germany which are mainly focused on methodological problems related to the transition to Western coding practices in October 1990. We propose an upward correction of cancer mortality as well as the corrections accounting for obvious inter-exchanges between the items within the chapter of circulatory diseases. Afterwards, we perform the comparative analysis of the adjusted mortality trends, and discuss mechanisms that have been driving the process of mortality convergence in Germany.