European Divergence and Convergence in Causes of Death

第二次世界大战后，东欧和南欧在成功抗击传染病方面迅速赶上了北方和西欧国家，预期寿命非常强劲地向更高的水平靠拢，这被认为是接近生物最大值的水平。然而，从20世纪60年代中期开始，出现了迅速的分化。当西方国家在心血管疾病领域取得惊人进展时，共产主义国家似乎在接近假定的最大值。在一些东方国家，预期寿命甚至下降，尤其是男性。多年来，INED和MPIDR开展了研究项目，以改善对死亡率和死亡原因的准确趋势和模式的不充分了解，并通过实证和理论研究更好地了解这种差异的原因。其中一个基本目标是首先重建连贯的死因时间序列，尽管疾病分类的定期修订和国家编码实践的异质性造成了统计中断。三年前，INED和MPIDR与罗斯托克大学之间的合作由于为期三年的ANR-DFG项目EDICCOD而得到了实质性的加强，主要致力于第一个主要的研究领域。新的INDICCOD项目将提供一个机会，不仅通过延长研究期和增加参与国家的数量继续朝这一方向努力，而且还将从地理差异和社会经济及文化差异的角度深入研究内部异质性，所有这些经验性研究将逐步为实现项目的最终目标提供宝贵的材料。也就是说，对两组互补的问题进行综合回答：-国家间和国家内死亡率和死亡原因趋势的差异在多大程度上符合分歧-趋同理论，以及目前东西方分歧的原因是什么？-卫生政策如何影响死亡率和死亡原因趋势，以及在改进建议方面可以得出哪些推论，特别是在东欧。

After World War Two, Eastern Europe, together with Southern Europe, quite rapidly caught up with the countries of Northern and Western Europe in their successful fight against infectious diseases, and life expectancies converged very strongly towards the higher level that was thought to be close to a biological maximum. However, from the mid 1960s, a rapid divergence was observed. The Communist countries seemed to plateau close to that supposed ma6 ximum while Western countries made spectacular progress in the field of cardiovascular diseases. In some Eastern countries life expectancy even fell down, especially among males.For many years, INED and MPIDR have undertaken research projects to both improve the insufficient knowledge of precise trends and patterns in mortality and causes of death and to better understand the reasons for such a divergence, through both empirical and theoretical studies. One of the basic objectives was first to reconstruct coherent time series of deaths by cause, despite the statistical disruptions caused by regular revisions in the classification of diseases and the heterogeneity of national coding practices.Three years ago, the collaboration between INED and MPIDR together with the University of Rostock was substantially enhanced thanks to a 3-year ANR-DFG project, EDICCOD, mainly devoted to that first major field of investigation. The new INDICCOD project will provide an opportunity not only to continue in that direction by extending the period studied and increasing the number of countries involved, but also to go deeper into the study of internal heterogeneity in terms of geographical variations and of socioeconomic and cultural differences.Step by step, all these empirical studies will provide valuable material to realize the final objective of the project, namely the production of syntheses to answer two complementary sets of questions:- To what extent do inter- and intra-national differences in mortality and cause-of-death trends fit the theory of divergence-convergence, and what are the reasons for the current East- West divergence?- How do health policies impact mortality and cause-of-death trends, and what inferences can be drawn in terms of proposals for improvement, especially in Eastern Europe.