Johan P Mackenbach1, Marina Karanikolos2, Jamie Lopez Bernal2, Martin Mckee2. 1. Department of Public Health, Erasmus MC, The Netherlands j.mackenbach@erasmusmc.nl. 2. European Observatory on Health Systems and Policies, London School of Hygiene and Tropical Medicine, UK ECOHOST: The Centre for Health and Social Change, London School of Hygiene and Tropical Medicine, UK.
Abstract
BACKGROUND: The upturn of life expectancy in Central and Eastern Europe in the 1990s, after a period of stagnation or even decline, is one of the main events in European population history of the late 20th century, but has not been satisfactorily explained. DATA AND METHODS: Turning points in total and cause-specific mortality in the Czech Republic, Bulgaria, Hungary, Poland, Romania and Slovakia were determined using joinpoint regression. Changes in life expectancy in the 10 years following country-specific turning points were decomposed by age and cause of death using Arriaga's method. RESULTS: Among men, the turning points for all-cause mortality coincided with those for ischaemic heart disease in all six countries, and sometimes also with those for liver cirrhosis, road traffic accidents and lung cancer. Among women, the pattern was more diffuse. In the 10 years since the turning point for all-cause mortality, life expectancy increased by around four years for men and three years for women in most countries. Declines in mortality from cardiovascular disease explain between a third and a half of the increase in life expectancy in all countries, but beyond this the contributing causes of death often varied considerably. CONCLUSIONS: Although the upturn of life expectancy in Central and Eastern Europe started at different points in time, improvements in prevention and/or treatment of ischaemic heart disease appear to have played a role in all six countries. Other factors, such as changes in alcohol consumption and road traffic safety, have, however, also made important contributions in some countries.
BACKGROUND: The upturn of life expectancy in Central and Eastern Europe in the 1990s, after a period of stagnation or even decline, is one of the main events in European population history of the late 20th century, but has not been satisfactorily explained. DATA AND METHODS: Turning points in total and cause-specific mortality in the Czech Republic, Bulgaria, Hungary, Poland, Romania and Slovakia were determined using joinpoint regression. Changes in life expectancy in the 10 years following country-specific turning points were decomposed by age and cause of death using Arriaga's method. RESULTS: Among men, the turning points for all-cause mortality coincided with those for ischaemic heart disease in all six countries, and sometimes also with those for liver cirrhosis, road traffic accidents and lung cancer. Among women, the pattern was more diffuse. In the 10 years since the turning point for all-cause mortality, life expectancy increased by around four years for men and three years for women in most countries. Declines in mortality from cardiovascular disease explain between a third and a half of the increase in life expectancy in all countries, but beyond this the contributing causes of death often varied considerably. CONCLUSIONS: Although the upturn of life expectancy in Central and Eastern Europe started at different points in time, improvements in prevention and/or treatment of ischaemic heart disease appear to have played a role in all six countries. Other factors, such as changes in alcohol consumption and road traffic safety, have, however, also made important contributions in some countries.
Authors: Johan P Mackenbach; José Rubio Valverde; Barbara Artnik; Matthias Bopp; Henrik Brønnum-Hansen; Patrick Deboosere; Ramune Kalediene; Katalin Kovács; Mall Leinsalu; Pekka Martikainen; Gwenn Menvielle; Enrique Regidor; Jitka Rychtaříková; Maica Rodriguez-Sanz; Paolo Vineis; Chris White; Bogdan Wojtyniak; Yannan Hu; Wilma J Nusselder Journal: Proc Natl Acad Sci U S A Date: 2018-06-04 Impact factor: 11.205
Authors: João Vasco Santos; Mariana Lobo; Rui Manuel Neiva; João Viana; Júlio Souza; Cláudia Camila Dias; Jonathan Cylus; Walter Ricciardi; Alberto Freitas Journal: Int J Public Health Date: 2020-02-17 Impact factor: 3.380
Authors: Anna Sagan; Marina Karanikolos; Małgorzata Gałązka-Sobotka; Martin McKee; Monika Rozkrut; Iwona Kowalska-Bobko Journal: Int J Environ Res Public Health Date: 2022-03-31 Impact factor: 3.390