La Vecchia C, Levi F, Lucchini F, Negri E
Istituto di Ricerche Farmacologiche Mario Negri, Milano, Italy.
Eur J Epidemiol. 1998 Jan;14(1):1-8. doi: 10.1023/a:1007440201137.
Trends in age-standardized death certification rates from all causes, coronary heart disease (CHD), cerebrovascular diseases, all neoplasms and lung cancer were analysed over the period 1980-1993 in 20 major European countries. There were steady and substantial declines of overall mortality in all western European countries for both sexes, although appreciable geographic differences persisted. These favourable trends reflect a decline in CHD mortality in most western countries, besides a persisting fall in cerebrovascular disease, and a substantial stability (with some decline in a few northern and central European countries) in cancer mortality. In contrast, in eastern European countries appreciable rises were registered in mortality from major causes of death considered for males. For females, only moderate declines were observed in Eastern Europe. In the early 1990s, overall mortality was 30 to 100% higher for males and 20 to 100% higher for females as compared to Western Europe. As indicated by the trends in lung cancer death rates, this reflects a major impact of the tobacco-related disease epidemic in subsequent cohorts, as well as more unfavourable lifestyle factors (i.e. aspects of diet, other environmental factors), and a delayed control of hypertension in Eastern Europe, together with a substantial excess of suicides, (road) accidents, homicides and alcohol-related diseases, and the delayed introduction of rational treatment for some conditions. An indication of reversal of mortality trends was evident in the early 1990s only in Poland. In conclusion, there is ample scope for intervention on avoidable mortality in eastern European countries.
对1980 - 1993年期间20个欧洲主要国家的全因、冠心病（CHD）、脑血管疾病、所有肿瘤和肺癌的年龄标准化死亡认证率趋势进行了分析。所有西欧国家的男女总体死亡率都持续且大幅下降，尽管明显的地理差异依然存在。这些有利趋势反映出除了脑血管疾病死亡率持续下降外，大多数西方国家的冠心病死亡率也在下降，癌症死亡率基本稳定（在一些北欧和中欧国家略有下降）。相比之下，东欧国家男性主要死因的死亡率明显上升。对于女性，东欧仅观察到适度下降。在20世纪90年代初，与西欧相比，男性总体死亡率高30%至100%，女性高20%至100%。正如肺癌死亡率趋势所示，这反映出烟草相关疾病流行对后续人群的重大影响，以及更不利的生活方式因素（即饮食方面、其他环境因素），东欧高血压控制延迟，同时自杀、（道路）事故、凶杀和酒精相关疾病大量增加，以及一些疾病合理治疗的引入延迟。死亡率趋势的逆转迹象仅在20世纪90年代初的波兰明显。总之，东欧国家在可避免死亡率方面有很大的干预空间。
