Changing patterns of mortality in 25 European countries and their economic and political correlates, 1955-1989.
OBJECTIVE
We investigated trends in mortality in European countries by cause of death in the period 1955-1989, and studied the role of economic and political conditions.


METHODS
We extracted data on age-standardised mortality by country (n = 25), sex, cause of death (n = 17) and calendar year from an internationally harmonised dataset. We analysed changes in dispersion of mortality as well as changes in the association of mortality with average income and levels of democracy.


RESULTS
After 1960, dispersion in all-cause mortality in Europe as a whole increased due to diverging trends for many specific causes of death, particularly for cerebrovascular disease. This coincided with widening disparities in average income, and strengthening of the association between levels of democracy and mortality. Divergence in Central and Eastern Europe could largely be explained from stagnating trends in average income and an increasing mortality disadvantage related to its democratic deficit.


CONCLUSIONS
Although this was a politically stable period, mortality patterns were highly dynamic, and prefigured the more dramatic mortality trends after 1990. Economic and political stagnation probably explains the diverging trends in Central and Eastern Europe.
Department of Public Health, Erasmus MC, P.O. Box 2040, 3000 CA, Rotterdam, Netherlands, j.mackenbach@erasmusmc.nl.
Johan P
JP
Mackenbach
Caspar W N
CW
Looman
D002423:Cause of Death; D002561:Cerebrovascular Disorders / Q000401:mortality; D003709:Democracy; D004467:Economics / Q000266:history; D005060:Europe / Q000453:epidemiology; D005061:Europe, Eastern / Q000453:epidemiology; D005260:Female; D059066:Gross Domestic Product / Q000706:statistics & numerical data; D054624:Health Status Disparities; D049673:History, 20th Century; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D008297:Male; D009026:Mortality / Q000266:history; D011057:Politics