Estimating the contribution of mortality selection to the East-West German mortality convergence
Population Health Metrics, 15:33, 1–8 (2017)
Background: Before German reunification, old-age mortality was considerably higher in East Germany than West Germany but converged quickly afterwards. Previous studies attributed this rapid catch up to improved living conditions. We add to this discussion by quantifying for the first time the impact of mortality selection.
Method: We use a gamma-Gompertz mortality model to estimate the contribution of selection to the East-West German mortality convergence before and after reunification.
Results: We find that, compared to the West, frailer East Germans died earlier due to deteriorating mortality conditions leading to converging mortality levels for women and men above age 70 already before 1990. After 1990, the selection of frailer individuals played only a minor role in closing the East-West German mortality gap. However, our study suggests that, after reunification, old-age mortality improved so quickly because the more robust population in the East benefitted greatly from ameliorating external factors such as health care and living standards.
Conclusion: Our results from a natural experiment show that selection of frail individuals affects population level mortality dynamics. In the case of the German reunification, East German old age mortality converged already before 1990 because of stronger selection pressure.
Keywords: Germany, Germany/FRG, Germany/GDR, adult mortality, mathematical models, statistical analysis