OBJECTIVES: We investigated whether social gradient in all-cause mortality in the Czech Republic changed during the postcommunist transition by comparing two cohorts, recruited before and after the political changes in 1989. METHODS: Participants (aged 25-64 years) in two population surveys (n=2530 in 1985, n=2294 in 1992) were followed up for mortality for 15 years (291 and 281 deaths, respectively). Education was classified into attainment categories and years of schooling (both continuous and in tertiles). Cox regression was used to estimate HR of death by educational indices in each cohort over a 15-year follow-up. RESULTS: All three educational variables were significantly associated with reduced risk of death in both cohorts when men and women were combined; for example, the adjusted HRs of death in the highest versus lowest tertile of years of schooling were 0.65 (95% CI 0.47 to 0.89) in 1985 and 0.67 (95% CI 0.48 to 0.93) in 1992. Adjustment for covariates attenuated the gradients. In sex-specific analysis, the gradient was more pronounced and statistically significant in men. There were no significant interactions between cohort and educational indices. CONCLUSIONS: The educational gradient in mortality did not differ between the two cohorts (1985 vs 1992), suggesting no major increase in educational inequality during the early stage of postcommunist transition. Further research is needed to understand trends in health inequalities during socioeconomic transitions.

• Keywords
• aging, education, health inequalities, mortality,
• MeSH
• Cohort Studies MeSH
• Humans MeSH
• Cause of Death * MeSH
• Socioeconomic Factors MeSH
• Educational Status MeSH
• Check Tag
• Humans MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Geographicals
• Czech Republic epidemiology   MeSH

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.

• Keywords
• Causes of death, Convergence, East and West Germany, Mortality, Reunification,
• Publication type
• Journal Article MeSH

OBJECTIVE: To study the association between own education, adult and parental circumstances and the risk of myocardial infarction in a former communist country. DESIGN: Population based case-control study. SETTING: General population of five districts of the Czech Republic in the age group 25-64 years. PARTICIPANTS: Random sample of population (938 men and 1048 women, response rate 77%) served as controls to 282 male and 80 female cases of non-fatal first myocardial infarctions. MAIN OUTCOME MEASURES: Myocardial infarction was defined by the WHO MONICA criteria based on ECG, enzymes and symptoms. The following socioeconomic indicators were studied: own education, crowded housing conditions (more than one person per room), car ownership, and education and occupation of mother and father. RESULTS: There was a weak correlation between education and car ownership, and a strong association between own education and parental education and occupation. Crowding was not related to other socioeconomic factors. The risk of myocardial infarction was inversely related to education, and was unrelated to material conditions and parental education and occupation. The age-sex-district adjusted odds ratios for apprenticeship, secondary, and university education, compared with primary education, were 0.87, 0.74 and 0.46, respectively (p for trend 0.009); odds ratios for car ownership and crowding were 1.01 (95% confidence intervals 0.77, 1.34) and 0.92 (0.76, 1.12), respectively. Further adjustment for parental circumstances and adult height did not change these estimates but adjustment for coronary risk factors reduced the gradient. Increased height seemed, anomalously, to confer a small increased risk. CONCLUSIONS: In this population, the social gradient in non-fatal myocardial infarction is only apparent for own education. Materialist explanations for this gradient seem unlikely but behaviours seem responsible for a part of the gradient.

• MeSH
• Adult MeSH
• Myocardial Infarction epidemiology   MeSH
• Middle Aged MeSH
• Humans MeSH
• Risk Factors MeSH
• Socioeconomic Factors MeSH
• Case-Control Studies MeSH
• Educational Status MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Geographicals
• Czech Republic epidemiology   MeSH

OBJECTIVES: This study investigated social variation in birth outcome in the Czech Republic after the political changes of 1989. METHODS: Routinely collected records on singleton live births in 1989, 1990, and 1991 (n = 380,633) and 1994, 1995, and 1996 (n = 286,907) were individually linked to death records. RESULTS: Mean birthweight fell from 3,323 g to 3,292 g (P < .001) between 1989 and 1991 and then increased to 3,353 g by 1996. The gap in mean birthweight between mothers with a primary education and those with a university education, adjusted for age, parity, and sex of infants, widened from 182 g (95% confidence interval [CI] = 169, 19) in 1989 to 256 g (95% CI = 240, 272) in 1996. Similar trends were found for preterm births. Postneonatal mortality declined most among the better educated and the married. The odds ratio for postneonatal death for infants of mothers with a primary (vs university) education, adjusted for birthweight, increased from 1.99 (95% CI = 1.52, 2.60) in 1989 through 1991 to 2.39 (95% CI = 1.55, 3.70) in 1994 through 1995. CONCLUSIONS: Despite general improvement in the indices of fetal growth and infant survival in the most recent years, social variation in birth outcome in the Czech Republic has increased.

• MeSH
• Adult MeSH
• Fertility MeSH
• Infant Mortality trends   MeSH
• Humans MeSH
• Marital Status MeSH
• Infant, Newborn MeSH
• Odds Ratio MeSH
• Birth Weight * MeSH
• Reproducibility of Results MeSH
• Data Collection MeSH
• Social Class MeSH
• Educational Status MeSH
• Population Surveillance MeSH
• Pregnancy MeSH
• Pregnancy Outcome epidemiology   MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Male MeSH
• Infant, Newborn MeSH
• Pregnancy MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Geographicals
• Czech Republic epidemiology   MeSH