Reversing East-West mortality difference among German women, and the role of smoking

Mikko Myrskylä, Max Planck Institute for Demographic Research
Rembrandt D. Scholz, Max Planck Institute for Demographic Research

After unification in 1990 the German East-West mortality difference narrowed rapidly, particularly for women. Here we document for the first time that for women aged 50-65 the difference has reversed and mortality is lower in the East. The reversal is surprising in the light of mortality related macro factors such as living standards and unemployment, which continue to be worse in the East. We use the indirect Preston-Glei-Wilmoth method to remove smoking-attributable deaths and find that the mortality cross-over is fully attributable to smoking: non-smoking related mortality continues to be higher in the East. The findings provide new insights into the sources of the post-unification German mortality convergence, which existing research largely attributes to converging living standards and medical care. In contrast, our findings show that the seeds for the female East-West mortality cross-over were planted before the unification in the 1960s-1980s when the women now aged 50-65 adopted their smoking behaviors.