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

Area of Science:

• Public Health
• Epidemiology
• Demography

Background:

• Mortality rates in East Germany were historically higher than in West Germany before reunification.
• German reunification led to a rapid narrowing of the mortality gap, particularly for women aged 50-69.
• Lower smoking rates among older East German female cohorts were a key factor in their improved mortality outcomes.

Purpose of the Study:

• To forecast the impact of changing smoking behaviors on East-West mortality differences in Germany.
• To analyze how shifts in smoking intensity among East German women may affect future mortality trends.
• To evaluate the implications of altered smoking patterns for public health policy and behavioral norms.

Main Methods:

• Utilizing mortality data and forecasting models to project future trends.
• Analyzing cohort-specific smoking behaviors in East and West Germany post-reunification.
• Comparing mortality trends between East and West German women, considering socioeconomic factors and smoking prevalence.

Main Results:

• The historical mortality advantage for East German women is expected to reverse due to increasing smoking rates in younger cohorts.
• Higher smoking intensity among younger East German women is identified as a significant factor that will likely negate their current mortality advantage.
• Forecasting models that do not incorporate smoking data may inaccurately predict a continued mortality advantage for East German women.

Conclusions:

• Weakening anti-smoking policies and changing behavioral norms in East Germany are contributing to increased smoking rates among women.
• East Germany's experience serves as a cautionary example regarding the public health consequences of reduced smoking cessation efforts.
• Effective anti-smoking policies, as demonstrated in other countries, are crucial for mitigating the adverse health impacts of smoking.