Trends in gender differences in health at working ages among West and East Germans.
ABSTRACT: Before 1990, Germany was divided for more than 40 years. While divided, significant mortality disparities between the populations of East and West Germany emerged. In the years following reunification, East German mortality improved considerably, eventually converging with West German levels. In this study, we explore changes in the gender differences in health at ages 20-59 across the eastern and western regions of Germany using data from the German Socio-Economic Panel (SOEP) for the 1990-2013 period. We apply random-effects linear regressions to the SOEP data to identify trends in health, measured as self-assessed health satisfaction, after German reunification. The findings indicate that women were substantially less satisfied with their health than men in both West and East Germany, but that the gender gap was larger in East Germany than in West Germany. Furthermore, the results show that respondents' satisfaction with their health decreased over time, and that the decline was steeper among men - and particularly among East German men - than among women. Thus, the initial male advantage in health in East and West Germany in the years immediately after reunification diminished over time, and even reversed to become a female advantage in East Germany. One interpretation of this finding is that stress-inducing post-reunification changes in the political and social landscape of East Germany had lasting damaging consequences for men's health. Ongoing risky health behaviors and high levels of economic insecurity due to unemployment could have had long-lasting effects on the health of the working-aged population. A partial explanation for our finding that health declined more sharply among East German men than among their female counterparts could be that women have better compensatory mechanisms than men for dealing with psychosocial stress.
Project description:Before the fall of the Berlin Wall, mortality was considerably higher in the former East Germany than in West Germany. The gap narrowed rapidly after German reunification. The convergence was particularly strong for women, to the point that Eastern women aged 50-69 now have lower mortality despite lower incomes and worse overall living conditions. Prior research has shown that lower smoking rates among East German female cohorts born in the 1940s and 1950s were a major contributor to this crossover. However, after 1990, smoking behavior changed dramatically, with higher smoking intensity observed among women in the eastern part of Germany. We forecast the impact of this changing smoking behavior on East-West mortality differences and find that the higher smoking rates among younger East German cohorts will reverse their contemporary mortality advantage. Mortality forecasting methods that do not account for smoking would, perhaps misleadingly, forecast a growing mortality advantage for East German women. Experience from other countries shows that smoking can be effectively reduced by strict anti-smoking policies. Instead, East Germany is becoming an example warning of the consequences of weakening anti-smoking policies and changing behavioral norms.
Project description:The sizeable mortality gap between the German Democratic Republic (East Germany) and the pre-unified Federal Republic of Germany (West Germany) narrowed rapidly after the two states were unified. Despite extensive research, the mechanisms underlying the convergence process are still not fully understood. Significant changes to coding practices and the system of data collection introduced in East Germany shortly after reunification have further complicated the ability of researchers to interpret mortality trends. Our aim is to assess the role of German reunification in the convergence process in light of the evolution of long-term mortality trends by causes of death. Compared to previous studies, we rely on much more detailed mortality data, which we first adjust for notable distortions. We propose an upward correction of cancer mortality, as well as corrections that account for obvious changes in the items selected within the ICD chapter of circulatory diseases. We identify three distinct processes that took place in East Germany around the time of reunification: (1) a sustained reduction in mortality that started before reunification; (2) a temporary increase in mortality in 1990-1991 that was related to the abrupt social transition, as reflected by socially sensitive causes such as accidents, alcohol-related diseases, and acute myocardial infarction; and (3) a reunification-driven process of convergence that was mostly caused by the accelerated decline in mortality from cerebrovascular and chronic heart diseases. Mortality improvements observed in the GDR starting in the 1980s might be interpreted as the first signs of a cardiovascular revolution. Shifts in individual behaviour likely started before reunification, whereas the real progress in medical care occurred later with the implementation of the Western system of health care. We therefore conclude that German reunification per se did not initiate the convergence process, but rather reinforced and accelerated trends that were already apparent.
Project description:BACKGROUND:Subnational regional mortality inequalities are large and appear to be mostly increasing within industrialized countries, although comparative studies across high-income countries are scarce. Germany is an important country to examine because it continues to experience considerable economic disparities between its federal states, in part resulting from its former division. METHODS:We analyse state-level mortality in Germany utilizing data from a newly constructed regional database based on the methodology of the Human Mortality Database. We compare time trends (1991-2015) in the German state-level standard deviation in life expectancy to that of other large, wealthy countries and examine the association between mortality and economic inequalities at the regional level. Finally, using contour-decomposition methods, we investigate the degree to which age patterns of mortality are converging across German federal states. RESULTS:Regional inequalities in life expectancy in Germany are comparatively low internationally, particularly among women, despite high state-level inequalities in economic conditions. These low regional mortality inequalities emerged 5-10?years after reunification. Mortality is converging over most ages between the longest- and shortest-living German state populations and across the former East-West political border, with the exception of an emerging East-West divergence in mortality among working-aged men. CONCLUSIONS:The German example shows that large regional economic inequalities are not necessarily paralleled with large regional mortality disparities. Future research should investigate the factors that fostered the emergence of this unusual pattern in Germany.
Project description:Since unification in 1990, living conditions in Germany's "New Länder" have slowly converged to the conditions in the "Old Länder". One can assume, however, that West-East differences persist more strongly in remote rural areas neglected by economic development. Therefore, this paper aims to investigate and compare the living conditions of older adults in rural areas in East and West Germany with respect to personal and environmental resources which are important preconditions for autonomy and well-being in old age. These conditions were examined in a survey conducted in urban and rural regions of five European countries in 2000. The German rural study was carried out in the districts of Jerichow (Saxony-Anhalt) and Vogelsberg (Hesse), and included 762 men and women aged 55 years or older, randomly chosen in villages of at most 5,000 inhabitants. East-West comparison showed both similarities and differences. Similarities arose in human conditions such as subjective health, parenthood and network variety, and in environmental conditions such as home-ownership, attachment to one's home, length of residence in the same neighbourhood, and satisfaction with mobility options. Differences were found in socio-demographic conditions (e.g. education, income, household composition), basic neighbourhood features, and patterns of social and leisure activities. Regression analysis showed the differing impact of single predictor variables on life satisfaction in the East and West: satisfaction with financial situation and functional health contributes far more to older people's life satisfaction in the West German rural area, whereas mobility-related aspects affect elders' life satisfaction more strongly in the East German countryside. The findings reflect, on the one hand, continuing structural East-West differences and, on the other, diverging socio-cultural habits.
Project description:Introduction The legal status of abortion has changed in the regions of former East Germany after reunification due to the adoption of restrictive West German abortion policies. The aim of this study was to evaluate the impact on attitudes towards abortion and the associated health care implications in Western and Eastern Germany. Materials and Methods Nationally representative data on public support for legally restricting abortion access were taken from the German General Social Survey and included the surveys 1992, 1996, 2000, 2006 and 2012 (N?=?14?459). Two indicators of barriers to access to abortion care were calculated for each federal state, based on the number of abortion facilities and the proportion of women seeking abortion outside their state of residency. Data were analysed using latent class analysis. Results Results suggested that abortion attitudes could be classified into three distinct subgroups: 1) support for abortion access independent of women's reason; 2) support on the basis of maternal or foetal health reasons but not for socio-economic reasons (e.g. financial restrictions); and 3) no support. The size of subgroups in favour of partial or complete restriction on abortion access increased in both regions over the study period and this trend could not be explained by changes in socio-demographic characteristics. Respondents living in a federal state with more barriers to access to abortion care were more likely to hold restrictive abortion attitudes. Conclusion Negative attitudes towards abortion have increased in Western and Eastern Germany during the two decades following reunification and may harm women by limiting acceptability and accessibility of abortion care. Abortion policies, public discourse and provision of abortion care should be informed by international guidelines protecting women's health and rights.
Project description:Narcissism scores are higher in individualistic cultures compared with more collectivistic cultures. However, the impact of sociocultural factors on narcissism and self-esteem has not been well described. Germany was formerly divided into two different social systems, each with distinct economic, political and national cultures, and was reunified in 1989/90. Between 1949 and 1989/90, West Germany had an individualistic culture, whereas East Germany had a more collectivistic culture. The German reunification provides an exceptional opportunity to investigate the impact of sociocultural and generational differences on narcissism and self-esteem. In this study, we used an anonymous online survey to assess grandiose narcissism with the Narcissistic Personality Inventory (NPI) and the Pathological Narcissism Inventory (PNI) to assess grandiose and vulnerable aspects of narcissism, and self-esteem with the Rosenberg Self-Esteem Scale (RSE) in 1,025 German individuals. Data were analyzed according to age and place of birth. Our results showed that grandiose narcissism was higher and self-esteem was lower in individuals who grew up in former West Germany compared with former East Germany. Further analyses indicated no significant differences in grandiose narcissism, vulnerable narcissism or self-esteem in individuals that entered school after the German reunification (? 5 years of age in 1989). In the middle age cohort (6-18 years of age in 1989), significant differences in vulnerable narcissism, grandiose narcissism and self-esteem were observed. In the oldest age cohort (> 19 years of age in 1989), significant differences were only found in one of the two scales assessing grandiose narcissism (NPI). Our data provides empirical evidence that sociocultural factors are associated with differences in narcissism and self-esteem.
Project description:OBJECTIVES:To assess disparities in mortality by socioeconomic status in Germany. DESIGN AND PARTICIPANTS:We analyse a large administrative dataset of the German Pension Fund (DRV), including 27?million person-years of exposure and 42 000 deaths in 2013. The data cover the economically active population, stratified by sex and by East and West. OUTCOME MEASURES:Age-standardised mortality rates and Poisson regression mortality rate ratios (MRRs). RESULTS:The risk of dying increases with decreasing income: the MRRs of the lowest to the highest income quintile are 4.66 (95% CI 4.48 to 4.85) among men and 3.06 (95% CI 2.90 to 3.23) among women. The impact of income attenuates after controlling for education and other explanatory variables, especially for females. In the fully controlled model for females, individual income is a weaker predictor of mortality, but there is a clear educational mortality gradient. In the fully controlled model, the MRRs of the unemployed to the employed are 2.09 (95% CI 2.03 to 2.15) among men and 2.01 (95% CI 1.92 to 2.10) among women. The risk of dying is around half as high among foreigners as among German citizens. The socioeconomic disparities are greater among East than West German men. CONCLUSIONS:Low socioeconomic status is a major determinant of excess adult mortality in Germany. The persisting East-West differences in male adult mortality can be explained by the higher socioeconomic status of men living in the West, rather than by contextual differences between East and West. These differences can be further monitored using DRV data.
Project description:Long-term studies of land system change can help providing insights into the relative importance of underlying drivers of change. Here, we analyze land system change in Germany for the period 1883-2007 to trace the effect of drastic socio-economic and institutional changes on land system dynamics. Germany is an especially interesting case study due to fundamentally changing economic and institutional conditions: the two World Wars, the separation into East and West Germany, the accession to the European Union, and Germany's reunification. We employed the Human Appropriation of Net Primary Production (HANPP) framework to comprehensively study long-term land system dynamics in the context of these events. HANPP quantifies biomass harvests and land-use-related changes in ecosystem productivity. By comparing these flows to the potential productivity of ecosystems, HANPP allows to consistently assess land cover changes as well as changes in land use intensity. Our results show that biomass harvest steadily increased while productivity losses declined from 1883 to 2007, leading to a decline in HANPP from around 75%-65% of the potential productivity. At the same time, decreasing agricultural areas allowed for forest regrowth. Overall, land system change in Germany was surprisingly gradual, indicating high resilience to the drastic socio-economic and institutional shifts that occurred during the last 125 years. We found strikingly similar land system trajectories in East and West Germany during the time of separation (1945-1989), despite the contrasting institutional settings and economic paradigms. Conversely, the German reunification sparked a fundamental and rapid shift in former East Germany's land system, leading to altered levels of production, land use intensity and land use efficiency. Gradual and continuous land use intensification, a result of industrialization and economic optimization of land use, was the dominant trend throughout the observed period, apparently overruling socio-economic framework conditions and land use policies.
Project description:In post-unification Germany, lingering conflicts between East and West Germans have found some unusual outlets, including a debate of the relative superiority of East and West German 'Ampelmännchen' pedestrian traffic signs. In our study, we probed the visual efficacy of East and West German Ampelmännchen signs with a Stroop-like conflict task. We found that the distinctive East German man-with-hat figures were more resistant to conflicting information, and in turn produced greater interference when used as distractors. These findings demonstrate Stroop-like effects for real-life objects, such as traffic signs, and underline the practical utility of an East German icon.
Project description:The consequences of political reunification for health and mortality have the unique character of a 'natural experiment'. This is particularly true for the formerly divided German Baltic Sea region due to its cultural and geographic commonalities. This paper ascertains the changes and differences in premature mortality at ages 0-74 in urban and rural areas of the German states of Mecklenburg-Vorpommern (MV) and Schleswig-Holstein (SH) since reunification and the contribution made by 'avoidable' mortality. Using official cause-of-death data, the effectiveness of health care and health policies was measured based on the concept of avoidable mortality in terms of both amenable and preventable conditions. Methods of decomposition and standardisation were employed in order to erase the compositional effect from the mortality trend. As a result, mortality differences relate primarily to men and the rural areas of the German Baltic Sea region. Whereas the mortality levels in the urban areas of MV and SH have converged, the rural areas of MV still show higher levels of preventable and amenable mortality. The results show that the accessibility and quality of medical care in the thinly populated areas of MV and the effectiveness of inter-sectoral health policies through primary prevention, particularly with regard to men, have room for improvement.