Why did life expectancy in Central and Eastern Europe suddenly improve in the 1990s? An analysis by cause of death.
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.


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.
Department of Public Health, Erasmus MC, The Netherlands j.mackenbach@erasmusmc.nl.
Johan P
JP
Mackenbach
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.
Marina
M
Karanikolos
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.
Jamie
J
Lopez Bernal
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.
Martin
M
Mckee
D000063:Accidents, Traffic / Q000517:prevention & control; D000368:Aged; D000369:Aged, 80 and over; D000428:Alcohol Drinking / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000517:prevention & control; D002423:Cause of Death / Q000639:trends; D005060:Europe / Q000453:epidemiology; D005061:Europe, Eastern / Q000453:epidemiology; D005260:Female; D006801:Humans; D008017:Life Expectancy / Q000639:trends*; D008297:Male
Bulgaria; Czech Republic; Hungary; Life expectancy; Poland; Romania; Slovakia; cardiovascular disease; mortality; politics