Temporal and spatial pattern of infant mortality in Germany after unification.
OBJECTIVE
After unification in 1990 the two parts of Germany underwent a complex process that has led to convergence of infant mortality. The pattern of change did, however, differ in east and west. This study investigates whether these differences conceal a complex pattern of heterogeneity at the regional level.


METHODS
Examination of routine data on infant, neonatal and postneonatal mortality. Time trends in the 16 federal states of Germany (Länder) from 1991 to 1997 were studied using a log-linear model.


RESULTS
In 1991, infant mortality was higher in almost all eastern Länder than in the west. By 1997, this east-west gap had disappeared. Over this period, infant mortality fell in all Länder but one. The decline was steepest in the east, ranging from 31% to 52%. Improvements were largely due to steep declines in both neonatal and postneonatal mortality.


CONCLUSIONS
This study shows that, at the time of unification, there was an almost complete demarcation between east and west, a pattern that disappeared by 1997. There is, however, still a substantial regional variation in infant mortality that is largely determined by postneonatal mortality.
Nolte
E
E
European Centre on Health of Societies in Transition, London School of Hygiene and Tropical Medicine.
Koupilová
I
I
McKee
M
M
D005858:Germany; D006801:Humans; D007223:Infant; D007226:Infant Mortality / Q000639:trends*; D007231:Infant, Newborn; D011057:Politics; D012922:Social Change; D012959:Socioeconomic Factors; D019371:Topography, Medical