Life Expectancy and Total Mortality

calculated from registered data on age-spe-cific mortality and age structure.

Taken overall, life expectancy has in-creased in the European Region. Trends differ between groups of countries and age groups. Fig. 4.6 gives weighted mean life ex-pectancy figures by age for the three groups of countries. Life expectancy at birth in-creased in the 1970s and 1980s, by 4.5 years to 76.5 years in the western countries and by 1.9 years to 71.23 years in the CCEE. An in-crease was also seen in the USSR in the 1980s but, after a marked increase to 69.8 years in 1986, life expectancy at birth stag-nated or even declined at the end of the dec-ade. In the western countries, life expectancy increased at all ages after infancy. This was not the case in the CCEE, where no im-provement was seen at ages 1, 15 and 45 years; only at 65 years did life expectancy in-crease (by 1 year, in contrast to a rise of 2.1 years in the western countries). The figures for the USSR, available for the years 1981–

1990 only, indicate a decrease in life expect-ancy for all ages at the end of the decade.

Time trends for life expectancy at 15 and 45 years were further studied by sex and

Fig. 4.5: Main causes of infant mortality in the WHO European Region, 1986–1990

Life Expectancy and Total Mortality 99

country group (Fig. 4.7). For all groups of countries, life expectancy was higher in fe-males than in fe-males. On the other hand, while the increase in life expectancy was more or less similar for males and females in the western countries, the pattern in the CCEE and USSR was quite different. In the 1980s a slight increase, smaller than that served in the western countries, was ob-served for females in the CCEE and USSR,

but life expectancy for young and middle-aged males clearly decreased, from the 1980s in the CCEE and in the second half of that decade in the USSR.

In summary, life expectancy data clearly indicate that young and middle-aged males in the CCEE and USSR experienced a marked deterioration in health status in the 1980s.

Fig. 4.6: Life expectancy in the WHO European Region by age, 1970–1990

Fig. 4.7: Life expectancy in the WHO European Region by sex and age, 1970–1990

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4.5.2 All causes of mortality

The age-specific mortality of the Region’s population was used to interpret the differ-ences and changes in life expectancy be-tween the groups of countries. At the end of the 1980s, the mortality rates in the CCEE were higher than in the western European

countries in all age groups. The rates in the USSR were even higher (Fig. 4.8) except those for people aged 65 years and over. In the western countries, a downward trend in mortality was observed in all age groups and both sexes, with the most rapid improvement in younger people. In the CCEE, mortality also declined significantly in children aged

Fig. 4.8: Age-specific mortality from all causes in the WHO European Region, by sex, 1970–1990

1–14 years, but the differences in mortality between the groups of countries tended to in-crease for most of the period.

The trends in mortality differed markedly between the groups of countries in those aged 15–64 years. The most striking was the increase in total mortality in men aged 45–

64 years in the CCEE. Until the mid-1970s, this group showed similar downward trends in mortality in the CCEE and western coun-tries, with the rates in the eastern countries higher by about 23 %. The trend then changed, and the difference in rates in-creased to over 60 % of the western level at the end of the 1980s. In women aged 45–64 years, an upward trend in the rates was ob-served in the CCEE at the beginning of the 1980s; this stabilized later. With a decline in mortality in western countries, however, the difference in mortality rates increased from 14 % at the beginning of the 1970s to over 50 % at the end of the 1980s. A similar pat-tern was seen in females aged 15–44 years.

The differences in mortality resulted from a steep decline in mortality in the western countries and the stabilization of the rates in the CCEE.

In men aged 65 years and over, the levels and trends in mortality were very similar in all groups of countries until the mid-1970s.

Then the rates increased in the CCEE but the difference did not exceed 25 % of the western rates. Mortality in women aged 65 years and over was less than 10 % higher in the CCEE than in western countries in the early 1970s, but changes similar to those ob-served in men led to a 30 % difference by the mid-1980s.

A similarly detailed comparison cannot be made for the former USSR, since sequential data sets have only been available since 1986. During this period, however, age-spe-cific mortality has risen as much as or more than that in the CCEE. Only in the group aged 1–14 years have mortality rates de-creased, although they are still significantly higher than in the western countries or the CCEE.

4.5.3 Spatial patterns at the sub-national level

Mortality patterns vary not only between but also within countries. To illustrate this, the age-standardized death rates were calculated for the subnational administrative areas of the Region, using an indirect method of stan-dardization, with a common standard for males and females based on the mortality data of all Member States. The standardiz-ation was used to eliminate the impact of dif-ferences in age structure on the mortality level in the compared areas. The data for the last available year were used: 1990 for most countries, 1985 for seven European Commu-nity countries and Norway, and 1991 for the Moldavian SSR, Romania and the RSFSR.

For a few countries, only national data were available.

The age-standardized rates of mortality from all causes showed a rather consistent pattern of difference between the groups of countries (see Maps 4.1 and 4.2^a). Most of the 10 % of the male population in the Re-gion with the highest death rates lived in the RSFSR, although males in some areas of Hungary and Romania had similar death rates. Males from most of the remaining areas of the CCEE and the USSR had mor-tality rates above the median level; the excep-tions were some parts of Bulgaria. None of the areas of the western countries belonged to the upper quartile of mortality distribu-tion. Of the males in the Region with the lo-west mortality, 10 % lived in Greece, south-ern Italy and parts of Norway, Spain, Sweden and Switzerland. The pattern in fe-males showed some similarities. The highest rates were seen in Bulgaria, Hungary and Ro-mania but in a markedly smaller part of the RSFSR than for males. Relatively high fe-male mortality was also seen in Scotland and northern England. The lowest rates were found in Italy, the Netherlands, Norway, Sweden and Switzerland, and in northern Spain.

a Maps 4.1 and 4.2 will be found between Chapters 4 and 5.

Occurrence of Selected Diseases 103

4.6.1 Structure of total mortality by cause

In all countries of the European Region, the most common causes of death are cardiovas-cular diseases and cancer (Table 4.1). At the end of the 1980s, these were responsible for over 68 % of all deaths in the Region. The proportion of cardiovascular diseases in-creased in the CCEE and USSR and de-creased in western countries in the 1970s and 1980s. The proportion of cancer mortal-ity increased in all parts of the Region, par-ticularly in the western countries. The third leading cause of death – injury and poison-ing – had a relatively stable proportional mortality, while deaths due to respiratory