The East-West life expectancy gap: differences in mortality from conditions amenable to medical intervention.
BACKGROUND
Although mortality from conditions amenable to medical intervention has frequently been shown to be higher in the countries of Central and Eastern Europe (CCEE) than in the countries of Western Europe (CWE), the contribution of these mortality differences to the East-West gap in life expectancy is unknown. We have determined the contribution of mortality from nine amenable causes to differences in temporary life expectancy from birth to age 75 (TLE0-75) between 12 CCEE and the average TLE0-75 for CWE in ca. 1988.


METHODS
Population and mortality data were extracted from publications of the World Health Organization. Chiang's method was used for constructing abridged life tables, and Arriaga's method was used for decomposition by cause of death of the differences in TLE0-75 between each of the CCEE and the average for CWE.


RESULTS
Differences in TLE0-75 between CCEE and the average for CWE ranged between 1.25 and 6.29 years in men, and between 1.09 and 3.44 years in women. After exclusion of early neonatal deaths, for which data were not available in all CCEE, amenable causes accounted for between 11% and 50% of the difference in TLE0-75 in men, and between 24% and 59% in women. The results for countries where data on early neonatal deaths were available show that inclusion of this category generally raises these estimates substantially. The contribution of conditions amenable to medical intervention to the East-West life expectancy gap is of the same order of magnitude as that of cardiovascular diseases, and much larger than that of neoplasms, respiratory diseases or external causes.


CONCLUSIONS
Although the contribution of conditions amenable to medical intervention should not be taken as a direct estimate of the contribution of medical care to the East-West life expectancy gap, these results suggest that reducing differences in the effectiveness of medical care may be more important for narrowing the life expectancy gap than has hitherto been assumed.
Velkova
A
A
Department of Public Health, Erasmus University Rotterdam, The Netherlands.
Wolleswinkel-van den Bosch
J H
JH
Mackenbach
J P
JP
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D005060:Europe / Q000453:epidemiology; D005061:Europe, Eastern / Q000453:epidemiology; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008017:Life Expectancy / Q000639:trends; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D009026:Mortality / Q000639:trends; D017678:Sex Distribution