Nolte E, Shkolnikov V, McKee M
European Centre on Health of Societies in Transition, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT.
J Epidemiol Community Health. 2000 Dec;54(12):899-906. doi: 10.1136/jech.54.12.899.
To examine trends in life expectancy at birth and age and cause specific patterns of mortality in the former German Democratic Republic (GDR) and Poland during political transition and throughout the 1990s in both parts of Germany and in Poland.
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 Germany and 1991-96 data for Poland.
In both the former GDR and Poland male life expectancy at birth declined by almost one year during transition, mainly attributable to rising death rates from external causes and circulatory diseases. Female life expectancy in Poland deteriorated by 0.3 years, largely attributable to increasing circulatory mortality among the old, while in East German female rising death rates in children and young adults were nearly outbalanced by declining 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, and 1.2 years). In East Germany and Poland, the overall improvement was largely attributable to falling mortality among men aged 40-64, while those over 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 life expectancy at birth in East Germany and Poland, attributable largely to greater decreases from external causes. Among those over 40, absolute contributions 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 years in men in 1997 was largely attributable to external causes, diseases of the digestive system and circulatory diseases. Higher death rates from circulatory diseases among the elderly largely explain the female life expectancy gap of approximately one year.
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. Changes in dietary pattern and, in Germany, medical care may have been important factors in shaping post-transition mortality trends.
研究德国东部地区（前德意志民主共和国，即东德）和波兰在政治转型期间及整个20世纪90年代，出生时预期寿命、各年龄段预期寿命及死因别死亡率的变化趋势。
按年龄和死因对预期寿命进行分解。利用东德和波兰1988/89年及1990/91年的数据，研究转型期间因死因导致的预期寿命变化；利用德国1992 - 1997年的数据及波兰1991 - 1996年的数据，研究转型后预期寿命的变化。
在前东德和波兰，转型期间男性出生时预期寿命均下降了近1年，主要归因于外部原因和循环系统疾病死亡率的上升。波兰女性预期寿命下降了0.3岁，主要归因于老年人循环系统疾病死亡率的上升，而在东德，儿童和年轻人死亡率的上升几乎被70岁以上人群循环系统疾病死亡率的下降所抵消。1991/92年至1996/97年期间，前东德男性出生时预期寿命增加了2.4岁，原联邦德国增加了1.2岁，波兰增加了2.0岁（女性分别为2.3岁、0.9岁和1.2岁）。在东德和波兰，总体改善主要归因于40 - 64岁男性死亡率的下降，而65岁以上人群对女性预期寿命增加的贡献最大。15 - 39岁男性死亡人数的变化对东德和波兰出生时预期寿命的贡献为每年0.4岁，主要归因于外部原因导致的更大幅度下降。在40岁以上人群中，前东德对预期寿命变化的绝对贡献在男女两性中均大于其他两个地区，主要归因于循环系统疾病。1997年德国东西部男性预期寿命持续存在2.1岁的差距，主要归因于外部原因、消化系统疾病和循环系统疾病。老年人循环系统疾病死亡率较高在很大程度上解释了女性预期寿命约1岁的差距。
本研究进一步深入了解了政治转型对健康的影响。与波兰相比，东德转型后预期寿命和死亡率的改善更为显著。饮食模式的变化以及在德国医疗保健方面的变化可能是塑造转型后死亡率趋势的重要因素。
