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The unification of Germany in 1990 brought about substantial social and economic changes in its eastern part, with new uncertainties and, despite increasing overall income, rising inequality. This paper explores the potential impact on health of these changes during the 1990s, looking specifically at income-related health inequalities in east and west Germany and its modulation by psychosocial factors. We used data from the German Socio-Economic Panel (GSOEP) for the years 1992 and 1997, including individuals aged 25+. We investigated changes in self-perceived health in the two parts of Germany and its socio-economic and psychosocial determinants. Analyses estimated odds ratios of less than good health using logistic regression. In 1992, 47% of east Germans rated their health worse than good compared with 54% in the west. By 1997, the east-west gap in self-rated health had disappeared, with the prevalence of poor health increasing to 56% in both parts. Income and education were important determinants of health in east and west, with, in the age-sex-adjusted model, those having available less than 60% of median equivalent income being at increased risk of poor health in 1992 (OR(east) 2.39, 1.45-3.94; OR(west) 2.04, 1.65-2.52). Addition of education reduced the strength of this relationship only slightly. In the west, income-related health inequalities widened between 1992 and 1997 yet the initially stronger gradient declined in the east, despite an overall increase in income inequality (OR(east) 1.63, 1.04-2.56; OR(west) 2.65, 2.19-3.21). The impact of education remained stable. Psychosocial variables were important determinants, mediating the effects of income, with leisure-cultural social involvement exerting the strongest effect in both east and west.The results show that, unlike in the west, the overall increase in income inequality in east Germany between 1992 and 1997 was not accompanied by a simultaneous increase in income-related health inequalities. This suggests that mechanisms involved in the association of socio-economic factors and health possibly behave differently in east and west.

There is emerging awareness of alcohol as a cause of the persisting health divide between east and west Germany. This study quantifies the burden of alcohol attributable mortality in the two parts of Germany in the 1990s, taking account of both adverse and beneficial effects of alcohol. We used an epidemiological approach that applies cause-specific alcohol attributable fractions derived from published relative risks and data on the distribution of alcohol consumption in east and west Germany in 1990/1992 and 1998 to mortality data for the two regions in 1992 and 1997, thus producing an estimate of the number of alcohol attributable deaths 'caused' or 'prevented'. Including the cardio-protective effect of alcohol, there were about 1.4% more deaths among men aged 20+ in 1992 in Germany than would have been expected in a non-drinking population, while there were 0.1% fewer deaths among women. By 1997, this had increased to 1.8% excess male deaths and 0.1% excess female deaths. In 1997, alcohol 'caused' 9.0% of all deaths in east German men compared with 5.6% in the west (women east: 2.5%; women west: 2.2%). At the same time, alcohol 'prevented' 5.2% deaths in east German men compared with 4.3% in the west, while there were 2.9% and 2.0% fewer deaths in women. This resulted in a net excess of deaths due to alcohol, except east German women, where 0.3% deaths were estimated to have been averted by alcohol. Although by 1997 net deaths 'caused' by alcohol had increased in the west and declined in the east, the burden of mortality due to alcohol among men remained highest in the east whereas in women the order had reversed.Mortality attributable to alcohol contributes considerably to overall mortality and to the east-west gap in Germany. This study points to the need for comprehensive policies on alcohol in Germany to close the persisting east-west health gap.

Earlier findings have shown that after unification with the Federal Republic of Germany (FRG) in October 1990 the proportion of very-low-birthweight infants in the former German Democratic Republic (GDR) increased. This study seeks to explore this observation in more detail at the regional level. The analysis of aggregate data of live births in Germany between 1991 and 1997 shows an increasing proportion of very-low-birthweight infants as well as a general trend towards heavier babies in both east and west. The growing proportion of live born infants at very low birthweights in the east, however, seems to be due, in part, to increased registration, most likely reflecting the introduction of the more comprehensive (western) definition of a live birth with unification in October 1990. A fairly distinct east-west pattern in the birthweight distribution present in 1991 had almost disappeared by 1997 and given way to a north-south one.

After the fall of the Berlin Wall in 1989 the former communist countries of central and eastern Europe underwent substantial social and economic changes that had a major impact on health. The situation of the former German Democratic Republic was unique in that its existing institutions were replaced rapidly and it was quickly integrated economically with the West. This study describes recent trends in morbidity and mortality from infectious diseases in East and West Germany before and after unification using routine data from 1980 onwards. Substantial differences in morbidity and mortality resulting from infectious diseases were observed between East and West Germany. These seem to be the complex result of societal and health system differences in both parts of Germany before unification, differing population dynamics and health behaviours, and an increasing westernisation in the eastern part of Germany during recent years.

Objectives: To examine the long term evolution of mortality in the former German Democratic Republic (GDR) in the period from 1960 and its specific position in health terms compared with the Federal Republic (FRG) in the west and Poland in the east., Methods: Decomposition of life expectancy by age and cause of death. Differences in life expectancy at birth between the former GDR and the old FRG were decomposed by age using data on all cause mortality for the period 1960 to 1997. Changes in life expectancy over time by cause of death were examined using data for 1974 and 1989 for both parts of Germany and for 1974 and 1988 for Poland., Results: Male life expectancy in the two parts of Germany diverged twice, in the mid-1960s, favouring the GDR, and in the mid-1970s, giving increasing advantage to the FRG, while female life expectancy remained similar until the mid-1970s and began to diverge thereafter. The initial advantage of the GDR was mainly attributable to an improving mortality rate among children compared with that in the west in both sexes. During the 1980s, mortality among men over 15 and women over 40 steadily worsened relative to their western counterparts, although men were doing considerably better than those in Poland who actually experienced deterioration. In the FRG, falling death rates among adults of all ages have contributed substantially to the improvement in life expectancy between 1974 and 1989, largely attributable to falling deaths from cardiovascular disease and from injuries at younger adult ages. In Poland, death rates among male adults have risen at all ages over 35, mostly attributable to worsening death rates from cardiovascular disease and neoplasms while women experienced stagnation. The GDR showed a small worsening among men under 60, counterbalanced by improvements among those over 60, and some improvement in women, attributable to falling deaths from cardiovascular disease among the middle aged and elderly., Conclusions: This study provides further evidence for the complexity of the east-west mortality differential emerging in the 1960s in Europe, highlighting the intermediate position in health terms the former GDR occupied during much of the communist period. Further research is required to assess the underlying causes for the specific position of the former GDR between east and west.

Objectives: To examine trends in life expectancy at birth and age and cause specific patterns of mortality in the former German Democratic Republic (GDR) and Poland during political transition and throughout the 1990s in both parts of Germany and in Poland., Methods: Decomposition of life expectancy by age and cause of death. Changes in life expectancy during transition by cause of death were examined using data for 1988/89 and 1990/91 for the former GDR and Poland; examination of life expectancy changes after transition were based on 1992-97 data for Germany and 1991-96 data for Poland., Results: In both the former GDR and Poland male life expectancy at birth declined by almost one year during transition, mainly attributable to rising death rates from external causes and circulatory diseases. Female life expectancy in Poland deteriorated by 0.3 years, largely attributable to increasing circulatory mortality among the old, while in East German female rising death rates in children and young adults were nearly outbalanced by declining circulatory mortality among those over 70. Between 1991/92 and 1996/97, male life expectancy at birth increased by 2.4 years in the former GDR, 1.2 years in old Federal Republic, and 2.0 years in Poland (women: 2.3, 0.9, and 1.2 years). In East Germany and Poland, the overall improvement was largely attributable to falling mortality among men aged 40-64, while those over 65 contributed the largest proportion to life expectancy gains in women. The change in deaths among men aged 15-39 accounted for 0.4 of a year to life expectancy at birth in East Germany and Poland, attributable largely to greater decreases from external causes. Among those over 40, absolute contributions to changing life expectancy were greater in the former GDR than in the other two entities in both sexes, largely attributable to circulatory diseases. A persisting East-west life expectancy gap in Germany of 2.1 years in men in 1997 was largely attributable to external causes, diseases of the digestive system and circulatory diseases. Higher death rates from circulatory diseases among the elderly largely explain the female life expectancy gap of approximately one year., Conclusions: This study provides further insights into the health effects of political transition. Post-transition improvements in life expectancy and mortality have been much steeper in East Germany compared with Poland. Changes in dietary pattern and, in Germany, medical care may have been important factors in shaping post-transition mortality trends.