Convergence and divergence of life expectancy in Europe: a centennial view.

It has been noted that national life expectancies have diverged in Europe in recent decades, but it is unknown how these recent trends compare to longer term developments. Data on life expectancy, cause-specific mortality and determinants of mortality were extracted from harmonized international data-bases. Variation was quantified with the inter-quartile range, and the contribution of changing economic conditions was analyzed by comparing observed life expectancy variations with those expected on the basis of changes in levels of national income and/or changes in the relation between national income and life expectancy. During the first decades of the 20th century, variation in life expectancy in Europe increased to reach peak values around 1920, then decreased to reach its lowest values in 1960 (among men) and 1970 (among women), and finally increased strongly again. The first widening was due to less rapid decline in mortality in Southern and Central and Eastern Europe, particularly from infectious diseases, and coincided with an increasing strength of the national income-life expectancy relation. The second widening was due to stagnating or increasing mortality in Central and Eastern Europe, particularly from cardiovascular diseases, and coincided with a very strong rise of between-country differences in national income. Despite some similarities, differences between both episodes of widening differences in life expectancy cast doubt on the idea that the current episode of widening represents a simple delay of epidemiological transitions. Instead, it is an alarming phenomenon that should be a main focus of European policy making.