The COVID-19 pandemic caused an increase in mortality in 2020 with a resultant decrease in life expectancy in most countries around the world. In Germany, the reduction in life expectancy at birth between 2019 and 2020 was comparatively small, at -0.20 years. The decrease was stronger among men than among women (-0.24 vs. -0.13 years) and in eastern rather than in western Germany (-0.36 vs. -0.16 years). Men in eastern Germany experienced the biggest decline in life expectancy at birth (-0.41 years). For western German men, the decline was less pronounced (-0.19 years). Among women, the decline in life expectancy at birth was also greater in eastern (-0.25 years) than in western Germany (-0.10 years). As a result of these developments, the differences in life expectancy between the two parts of Germany, and between women and men, increased compared with the previous year. Life expectancy at age 65 decreased more strongly than life expectancy at birth for both sexes and in all regions. This reflects the fact that it was mainly older age groups that were affected by the increase in mortality in 2020. This paper provides further insights into mortality changes in 2020, based on age decomposition and an analysis of lifespan inequality. We conclude that the population in eastern Germany was hit harder by the COVID-19 pandemic in 2020 than the population in the western Germany.

BACKGROUNDInternational comparisons of mortality largely depend on the quality of data. With more than 20% of deaths annually assigned to ill-defined cardiovascular conditions, the mortality level due to well-defined causes of death is under-registered in Poland. OBJECTIVEWe aim to reclassify cardiovascular garbage codes (GCs) into well-defined causes based on multiple causes of death (MCoD) data and to approximate mortality levels due to welldefined causes of death in Poland. We examine the usefulness of the MCoD approach for correcting low-quality data on causes of death. METHODSBased on the unique MCoD dataset for Poland, death counts due to cardiovascular GCs were reassigned to well-defined underlying causes in two steps: (1) manually for death records that included MCoD information constituting a logical chain of conditions leading to death and (2) with coarsened exact matching for the remaining death records. Age-specific and age-standardised death rates for large groups of causes were calculated before and after redistribution and compared to those of other Eastern European countries with relatively good data quality. RESULTSOf deaths originally assigned to cardiovascular GCs, 86,856 were reclassified, mostly to well-defined cardiovascular diseases, cancers, endocrine, nutritional and metabolic diseases, and respiratory diseases. The age-standardised death rate due to well-defined ischaemic heart diseases increased by 43%, and the rate due to cerebrovascular diseases by 22%. Cardiovascular mortality structure by large groups of causes became similar to

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We study patterns and developments in sex differences in alcohol-attributable mortality (AAM) in Poland over the years 2002-2018. Sex gap and sex-specific mortality patterns according to age, educational level and urbanrural settlements are contrasted with findings for other developed countries. Premature AAM of the population 20-64 years old is quantified with age-standardized alcohol-attributable mortality rates (AASMR) by sex and selected characteristics. For the age pattern, we study the gender gap in alcohol-attributable crude death rates for 10-year age groups. Data comes from the World Health Organization database or directly from the Polish Central Statistical Office. In 2002, in Poland, men died 9-times more often than women from causes attributable to alcohol consumption. As a result of faster growth in AASMR among women, the relative sex gap halved between 2002 and 2018. However, this relative change was accompanied by an increase in the absolute gap, resulting from a larger increase in the total number of deaths attributed to alcohol consumption among men than women. Due to the substantially higher alcohol consumption and mortality among men, differences in AAM according to age, education and place of residence, and their changes over the study years, are much more pronounced for men than women. Polish men and women are characterized by similar patterns and developments of alcohol-attributable mortality in the study years. Different from that observed for other developed countries narrowing the sex gap, we observe in Poland perseverance of male elevated AAM. An important contribution of the study is the evidence that to understand differences between men and women in AAM and their developments, we need to study both relative and absolute sex gaps.

Eurostat’s official Healthy Life Years (HLY) estimates are based on European Union Statistics on Income and Living Conditions (EU-SILC) cross-sectional data. As EU-SILC has a rotational sample design, the largest part of the samples are longitudinal, health-related attrition constituting a potential source of bias of these estimates. Bland-Altman plots assessing the agreement between pairs of HLY based on total and new rotational, representative samples demonstrated no significant, systematic attrition-related bias. However, the wide limits of agreement indicate considerable uncertainty, larger than accounted for in the confidence intervals of HLY estimates.

We propose a new summary measure of population health (SMPH), the well-being-adjusted health expectancy (WAHE). WAHE belongs to a subgroup of health-adjusted life expectancy indicators and gives the number of life years equivalent to full health. WAHE combines health and mortality information into a single indicator with weights that quantify the reduction in well-being associated with decreased health. WAHE's advantage over other SMPHs lies in its ability to differentiate between the consequences of health limitations at various levels of severity and its transparent, simple valuation function. Following the guidelines of a Committee on Summary Measures of Population Health, we discuss WAHE's validity, universality, feasibility sensitivity and ensure its reproducibility. We evaluate WAHE's performance compared to life expectancy, the most commonly used indicators of health expectancy (HE) and disability-adjusted life expectancy (DALE) in an empirical application for 29 European countries. Data on health and well-being are taken from the 2018 EU-SILC, and the life tables are from Eurostat. DALE is taken from the database of the Global Burden of Disease Programme. WAHE's sensitivity to univariate and multivariate state specifications is studied using the three Minimum European Health Module health dimensions: chronic morbidity, limitations in activities of daily living, and self-rated health. The empirical tests of the indicators’ correspondence reveal that WAHE has the strongest correlation with the other SMPHs. Moreover, WAHE estimates are in agreement with all other SMPHs. Additionally, WAHE and all other SMPHs form a group of reliable indicators for studying population health in European countries. Finally, WAHE estimates are robust, regardless of whether health is defined across one or multiple simultaneous dimensions of health. We conclude that WAHE is a useful and reliable indicator of population health and performs at least as well as other commonly used SMPHs.

Background Against the backdrop of population ageing, governments are facing the need to raise the statutory retirement age. In this context, the question arises whether these extra years added to working life would be spent in good health. As cancer represents a main contributor to premature retirement this study focuses on time trends and educational inequalities in cancer-free working life expectancy (WLE). Methods The analyses are based on the data of a large German health insurer covering annually about 2 million individuals. Cancer-free WLE is calculated based on multistate life tables and reported for three periods: 2006–2008, 2011–2013, and 2016–2018. Educational inequalities in 2011–2013 were assessed by two educational levels (8 to 11 years and 12 to 13 years of schooling). Results While labour force participation increased, cancer incidence rates decreased over time. Cancer-free WLE at age 18 increased by 2.5 years in men and 6.3 years in women (age 50: 1.3 years in men, 2.4 years in women) between the first and third period while increases in WLE after a cancer diagnosis remained limited. Furthermore, educational inequalities are substantial, with lower groups having lower cancer-free WLE. The proportion of cancer-free WLE in total WLE remained constant in women and younger men, while it decreased in men at higher working age. Conclusion The increase in WLE is accompanied by an increase in cancer-free WLE. However, the subgroups considered have not benefitted equally from this positive development. Among men at higher working age, WLE increased at a faster pace than cancer-free WLE. Particular attention should be paid to individuals with lower education and older men, as the general level and time trends in cancer-free WLE are less favourable.

Introduction:The impact of conditions that partly or indirectly contribute to drinking-related mortality is usually underestimated. We investigate all alcoholrelated multiple (underlying and contributory) causes of death and compare mortality distributions in countries with different levels and patterns of drinking. Method:Analysis of population-level mortality data for persons aged 20 and over in Austria, Czechia, Poland and Spain. Age-standardised death rates and standardised ratios of multiple to underlying cause were calculated for alcohol-related causes of death.Results: Multiple-cause mortality ranged from 20 to 58 deaths per 100,000 for men and from 5 to 16 per 100,000 for women. Liver diseases were the most common underlying and multiple causes, but mental and behavioural disorders were the second or third, depending on country and sex, most prevalent multiple mentions. Two distinct age patterns of alcohol-related mortality were observed: in Czechia and Poland an inverted-U distribution with a peak at the age of 60-64, in Austria and Spain a distribution increasing with age and then levelling off for older age groups. Discussion and Conclusion:The importance of alcohol-related conditions that indirectly impact mortality can be re-assessed with the use of contributory mentions. The multiple-cause-of-death approach provides convergent results for countries characterised by similar patterns of alcohol consumption. Multiple-cause mortality was almost double the level of mortality with alcohol as the underlying cause, except in Poland. Mental and behavioural disorders were mostly certified as contributory to other, non-alcohol-related underlying causes of death. K E Y W O R D S alcohol, causes of death, Europe, mortality, multiple causes of death Key Points• Multiple-cause mortality linked to alcohol is almost double that of mortality with alcohol as the underlying cause in Austria, Czechia and Spain, but not in Poland. • Liver diseases are the most common underlying and multiple causes of death, but the multiple causes of death approach evidences the importance of mental