International Journal of Epidemiology, Vol 26, 75-84, Copyright © 1997 by International Epidemiological Association
A Velkova, JH Wolleswinkel-van den Bosch and JP Mackenbach
BACKGROUND: Although mortality from conditions amenable to medical
intervention has frequently been shown to be higher in the countries of
Central and Eastern Europe (CCEE) than in the countries of Western Europe
(CWE), the contribution of these mortality differences to the East-West gap
in life expectancy is unknown. We have determined the contribution of
mortality from nine amenable causes to differences in temporary life
expectancy from birth to age 75 (TLE0-75) between 12 CCEE and the average
TLE0-75 for CWE in ca. 1988. DATA AND METHODS: Population and mortality
data were extracted from publications of the World Health Organization.
Chiang's method was used for constructing abridged life tables, and
Arriaga's method was used for decomposition by cause of death of the
differences in TLE0-75 between each of the CCEE and the average for CWE.
RESULTS: Differences in TLE0-75 between CCEE and the average for CWE ranged
between 1.25 and 6.29 years in men, and between 1.09 and 3.44 years in
women. After exclusion of early neonatal deaths, for which data were not
available in all CCEE, amenable causes accounted for between 11% and 50% of
the difference in TLE0-75 in men, and between 24% and 59% in women. The
results for countries where data on early neonatal deaths were available
show that inclusion of this category generally raises these estimates
substantially. The contribution of conditions amenable to medical
intervention to the East-West life expectancy gap is of the same order of
magnitude as that of cardiovascular diseases, and much larger than that of
neoplasms, respiratory diseases or external causes. CONCLUSION: Although
the contribution of conditions amenable to medical intervention should not
be taken as a direct estimate of the contribution of medical care to the
East-West life expectancy gap, these results suggest that reducing
differences in the effectiveness of medical care may be more important for
narrowing the life expectancy gap than has hitherto been assumed.
ARTICLES
The East-West life expectancy gap: differences in mortality from conditions amenable to medical intervention
Department of Public Health, Erasmus University Rotterdam, The Netherlands.
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