Regional trends in cerebrovascular mortality in Germany after unification (1990-1999)

Background and Purpose: After the unification in 1990 two different health and political systems merged in Germany. Our aim was to analyze trends in mortality from cerebrovascular diseases in the formerly divided western and eastern parts of Germany since the unification. Methods: Trends in mortality were determined by analyzing age-adjusted vital statistics data obtained from the Federal Statistics Office. ICD-9 was used from 1990 to 1997 and ICD-10 in 1998 and 1999. Results: Cerebrovascular mortality declined in Germany between 1991 and 1999 from 104.4 to 72.3 per 100,000 men and from 82.2 to 55.5 per 100,000 women. Mortality rates from cerebrovascular diseases in East Germany were continuously above West German rates: in 1991 the overall rate ratio in East compared to West Germany was 1.6 and in 1999 it was 1.5 in both men and women. This regional variation is mainly due to a higher rate of cerebrovascular diseases being defined as ‘Other’ (ICD-9 437, now ICD-10 I67) in East compared to West Germany. Conclusion: Nearly 10 years after the unification, cerebrovascular mortality is still markedly higher in East compared to the West Germany. Further investigation is needed to determine the causes for the regional variation in cerebrovascular mortality and to improve preventive strategies.