The German East-West Mortality Difference: Two Crossovers Driven by Smoking

Abstract

Before the fall of the Berlin Wall, mortality was considerably higher in the former East Germany than in West Germany. The gap narrowed rapidly after German reunification. The convergence was particularly strong for women, to the point that Eastern women aged 50–69 now have lower mortality despite lower incomes and worse overall living conditions. Prior research has shown that lower smoking rates among East German female cohorts born in the 1940s and 1950s were a major contributor to this crossover. However, after 1990, smoking behavior changed dramatically, with higher smoking intensity observed among women in the eastern part of Germany. We forecast the impact of this changing smoking behavior on East-West mortality differences and find that the higher smoking rates among younger East German cohorts will reverse their contemporary mortality advantage. Mortality forecasting methods that do not account for smoking would, perhaps misleadingly, forecast a growing mortality advantage for East German women. Experience from other countries shows that smoking can be effectively reduced by strict anti-smoking policies. Instead, East Germany is becoming an example warning of the consequences of weakening anti-smoking policies and changing behavioral norms.

Mortality in midlife for subgroups in Germany

“…6 Figure A4 shows only smoking related deaths by gender and region in the population of interest. We find a recent stronger increase in smoking related deaths for East compared to West German women, in line with Vogt et al (2017). For men, we find a rather stable mortality in the East, whereas West German male mortality from smoking related diseases is downward sloped.…”

“…Second, it is unclear whether smoking is mainly considered as "drug of despair". A discussion in Vogt et al (2017Vogt et al ( , second half of p. 1063 shows that evidence on the relationship between unemployment and smoking behavior is rather mixed.…”

Avoidable Cancer Mortality in Germany Since Reunification: Regional Variation and Sex Differences

“…A recent study on the future perspective in smoking-related mortality in Germany (36) argues that the east-west convergence and especially the female mortality advantage in Eastern Germany in lung cancer-related mortality is caused by women born in the 1940s and 1950s who showed a comparatively low smoking prevalence. Possibly, the contemporary mortality advantage for women in Eastern Germany will change to the opposite as younger cohorts of Eastern German women show much higher smoking rates in comparison to both, previous cohorts and the West (36, 37).…”

“…The female lung cancer epidemic affecting the younger cohorts can be approximated. For women, a greater excess mortality for lung cancer is more plausible because of the increasing dominance of higher lung cancer rates in young and middle-aged women (36–38).…”

No personality change following unemployment: A registered replication of Boyce, Wood, Daly, and Sedikides (2015)

“…The two countries experienced highly different political, societal, and economic conditions. The consequences of these differences can be still observed today (e.g., Vogt, van Raalte, Grigoriev, & Myrskylä, 2017) and result in, for example, different unemployment rates and economic conditions in the former Eastern and Western parts of Germany (e.g., Simonson, Gordo, & Kelle, 2015). Therefore, it is important to control for potential context effects of East and West Germany in the present analyses.…”