The contribution of medical care to changing life expectancy in Germany and Poland
The contribution of medical care to changing life expectancy in Germany and Poland
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DOI：
10.1016/s0277-9536(01)00320-3
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发表时间：
2002-12-01
影响因子：
5.4
通讯作者：
McKee, M
中科院分区：
文献类型：
--
作者：
Nolte, E;Scholz, R;McKee, M
本文评估了东德和波兰政治转型前后医疗保健对死亡率变化的影响，其中包括西德进行比较。基于Rutstein的“不必要的过早死亡”概念，我们计算了1980/1983-1988年和1991/1992-1996/1997年期间，被认为对医疗保健或卫生政策有反应的条件对出生至75岁之间预期寿命变化的贡献[e((0-75))]。从出生到75岁之间的临时预期寿命，西德一直较高，东德居中，波兰最低。虽然在1980年代初至1990年代末，所有三个地区的情况都有所改善，但各国之间的变化速度不同，导致1980年代末和1990年代初，最初的贫富差距暂时扩大。在1980年代，东德50-60%的改善归因于对医疗保健有反应的疾病死亡率下降（西德：30-40%）。在波兰也观察到净的积极影响，尽管缺血性心脏病死亡率的下降抵消了这一影响。在前共产主义国家，1980年代医疗保健的改善主要是由于婴儿死亡率的下降。在20世纪90年代，他们也受益于成年人，特别是波兰35岁以上和德国55岁以上的成年人。在德国，东西之间的短期预期寿命差距持续存在，主要是由于东部可避免的疾病导致的死亡率较高，其中卫生政策导致的原因约占一半，1997年的差距为16%（男性）对24%（女性）的医疗保健。研究结果表明，在东德和波兰，与政治过渡相关的医疗保健系统的变化与预期寿命的提高有关，在较小程度上也是如此。此外，根据“不必要的过早死亡”概念评估的医疗保健质量的差异似乎造成了东西方持续存在的健康差距。特别是在波兰和前德意志民主共和国，仍有可能取得进一步进展，缩小与西方的卫生差距。(C) 2002 Elsevier Science Ltd.版权所有。
This paper assesses the impact of medical care on changes in mortality in east Germany and Poland before and after the political transition, with west Germany included for comparison. Building upon Rutstein's concept of unnecessary untimely deaths, we calculated the contribution of conditions considered responsive to medical care or health policy to changes in life expectancy between birth and age 75 [e((0-75))] for the periods 1980/1983-1988 and 1991/1992-1996/1997.Temporary life expectancy, between birth and age 75, has been consistently higher in west Germany, intermediate in east Germany and lowest in Poland. Although improving in all three regions between the early 1980s and the late 1990s, the pace of change differed between countries, resulting in a temporary widening of an initial cast-west gap by the late 1980s and early 1990s, In the 1980s, in east Germany, 50-60% of the improvement was attributable to declining mortality from conditions responsive to medical care (west Germany: 30-40%). A net positive effect was also observed in Poland, although counterbalanced by deterioration in ischaemic heart disease mortality.In the former communist countries, improvements attributable to medical care in the 1980s were due, largely, to declining infant mortality. In the 1990s, they benefited also adults, specifically those aged 35 + in Poland and 55 + in Germany. A persisting east-west gap in temporary life expectancy in Germany was due, largely, to higher mortality from avoidable conditions in the east, with causes responsive to health policy contributing about half, and medical care 16% (men) to 24% (women) to the differential in 1997.The findings indicate that changes in the health care system related to the political transition were associated with improvements in life expectancy in east Germany and, to a lesser extent, in Poland. Also, differences in the quality of medical care as assessed by the concept of 'unnecessary untimely deaths' appear to contribute to a persisting east-west health gap. Especially in Poland and the former German Democratic Republic there remains potential for further progress that would narrow the health gap with the west. (C) 2002 Elsevier Science Ltd. All rights reserved.