Preschool children's health and its association with parental education and individual living conditions in East and West Germany

Within an environmental health study, dermatologic examination of 1273 pre-school-age children (5-7 years old) was carried out in selected areas of East (n = 287) and West (n = 987) Germany in spring 1991. On the basis of comparable genetic background, the influence of a different exposure to air pollutants on the manifestation of atopic diseases was investigated. Halle an der Saale (East Germany) and Duisburg (North/South) as well as Essen (West Germany) were chosen as polluted study areas, whereas the countryside town of Borken (West Germany) served as a control region. Outdoor pollution with particles and SO2 was significantly higher in Halle an der Saale. Of the total study group, 12.9% suffered from atopic eczema at the time of examination. The prevalence was highest in East Germany (17.5%; adjusted odds ratio [OR] 1.39, confidence intervals [GI] 0.77-2.52, compared to Borken). The reported frequencies of hay fever and asthma in the total study population were 2% and 1.3%, respectively, without significant differences between study sites. Some 34.7% of the children showed at least one positive skin prick test reaction; significantly (P < 0.001) higher sensitization rates were obtained in western regions (Essen, Duisburg-South) than in the control region (Borken) and East Germany. Multivariate analysis of the prevalence of atopic eczema showed associations with parental predisposition (OR 1.52, CI 1.03-2.25), sex (for boys, OR 0.63, CI 0.43-0.92), location (Duisburg-South vs Borken OR 0.52, CI 0.30-0.96), month of investigation (May vs April, and March vs February OR 0.55, CI 0.37-0.81), contact with rabbits (for girls, OR 2.90, CI 1.36-6.19), animal fur in bedrooms (2.17, 1.01-4.67), indoor use of gas without hood (1.68, 1.11-2.56), and distance of homes from a busy road (< 50 m 1.71, 1.07-2.73). Nonsignificant associations were observed for history of helminthic infections (OR 1.61, CI 0.98-2.64) and high parental education level (OR 1.83, CI 0.83-4.02). In East and West Germany, atopic eczema seems to follow a course different from that of respiratory allergic diseases and specific sensitization, a fact which underlines the need for a differentiated analysis.

BackgroundHealth and social conditions vary between West and East Germany.MethodsWe analyzed annual mortality data of all recorded deaths caused by lung, colorectal, breast and prostate cancer in Germany as they are published by the Federal Bureau of Statistics (FBS) encompassing the period 1980–2014 for former West Germany (WG) and 1990–2014 for former East Germany (EG). To compare East and West Germany we computed the ratio of the mortality rates in both parts (mortality rate ratio, MRR, <1 indicates a lower mortality in EG). Forecasting methods of time series analyses were applied (model selection based on the Box/Jenkins approach) to predict 5-year trends until 2019.ResultsLung cancer: In women mortality rose in both regions (WG: +2.8%, 1991–2014, EG: +2.2%, 1990–2014). In men mortality in WG declined between −2.1% and −1.2%, and by −2.7% (1993–2009) in EG which was followed by a plateau. Colorectal cancer: A decline was found in both WG (−3.1%, 1993–2014) and EG women (−3.8%, 1993–2008 and −2.0%, 2008–2014). A decline in EG men since 1992 (−0.9%, 1992–1997 and −2.3%, 1997–2014) mirrors the development in WG (−2.6%, 1995–2014). Breast cancer: Constant mortality decline in WG after 1996. In EG a decline (−2.4%, 1992–2007) was followed by a plateau with an MRR <1 (1990–2014). Prostate cancer: In WG a decline (−3.4%) came to a hold after 2007, while there was a constant decline of 1.5% in EG. The forecast indicated that mortality of colorectal/lung cancer in men and breast cancer reaches a plateau in future years.ConclusionCourses of mortality were similar between East and West, while existing differences are likely to remain in the near future.

Until now mortality trends of melanoma and nonmelanoma skin cancer (NMSC) in Germany have been studied only in West Germany. We were interested in comparing mortality trends of melanoma and NMSC in West and East Germany before and after the post-communist transition. By analyses of health care utilization data in West and East Germany, we explored potential reasons for mortality differences between these regions. We analyzed mortality data of skin melanoma and NMSC of West and East Germany (1980-2005). We calculated sex-specific age-standardized mortality rates using the World Standard Population. We calculated age-specific mortality rates (20-39, 40-59, 60-79, 80+ years). Age-standardized skin melanoma mortality rates tended to be lower in East Germany than West Germany before reunification. After reunification rates became very similar. Age-standardized mortality rates of NMSC were continuously higher in East than West Germany. The mortality rate differences among East and West Germans in 1996-2005 are mainly due to 2.34- and 2.24-fold higher mortality rates among men and women aged 80 years, respectively, who live in East Germany. Even 15 years after reunification, mortality of NMSC is still higher in East than West Germany, although incidence rates of squamous cell cancers of the skin are not higher in East Germany. Differences in the participation in early cancer detection and health care utilization in West and East Germany do not sufficiently explain our findings.

Infections may play a role in the etiology of sudden infant death syndrome (SIDS), with Bordetella pertussis being a potential agent. The objective was to analyze the association of SIDS and infant pertussis hospitalization rates over time, comparing a previously unvaccinated population (West Germany) versus a predominantly vaccinated population (East Germany). We calculated SIDS rates per 1000 live births per state. Live births and SIDS were available from 1980 onwards for the West German states and from 1991 onwards for the East German states. We applied interrupted time series (ITS) analyses to investigate the role of two public health interventions in 1991 (West Germany) and in 2000 (West and East Germany), respectively. Infant pertussis hospitalizations were available for five West German and three East German states between 1994 and 2019. We used multilayer and multivariate correlation analyses to determine the correlation between SIDS and pertussis hospitalization rates, including Pearson correlation test and vector autoregressive (VAR) analysis. In West Germany, the average annual SIDS rate (per 1000 live births) increased from 1.08 in 1980 to 1.68 in 1991, before declining to 1.18 in 1992 and subsequently to 0.10 in 2020. In East Germany, the average annual SIDS rate (per 1000 live births) decreased from 0.79 in 1991 to 0.12 in 2020. The results of the ITS model indicated a significant change in both level and slope at the 1991 interventions (West Germany) and in slope at the 2000 interventions (West and East Germany). The correlation coefficients between SIDS and infant pertussis hospitalization rates were 0.69 (95% CI [confidence interval]0.41, 0.85; p < 0.001) in West Germany, and 0.41 (95% CI 0.03, 0.69; p = 0.037) in East Germany. The correlation decreased during later periods (2000-2019, 2010-2019), particularly in East Germany. The results of the VAR analysis corroborated the findings of the main analyses. SIDS and infant pertussis hospitalization rates were correlated in both West and East Germany. Further studies - including improved diagnostic assessment of pertussis - seem warranted. Not applicable.

A substantial amount of literature dealing with conceptualisations of the nation has neglected the importance that gender and the politics of reproduction play in the construction of national identities. Analysing images of political campaigns and activists as well as public discourses on motherhood, abortion and childcare, I will illustrate the importance that gender and sexuality assumed in German nation-building projects before and after its unification in 1990. After 1949, East and West German ideas of nationhood were premised on opposing ideas of gender roles, in that politicians within these two German nations mobilised distinct gender identities to assert their respective political system as superior and progressive. While in East Germany, the progressiveness of the socialist project was measured along the lines of women’s integration into the labour force; in West Germany, the idea that a woman’s identity was primarily rooted in motherhood played an influential role in nationalist discourses. Once East and West Germany reunified in 1990, these opposing ideas of gender roles clashed. This became particularly visible in the context of political debates around abortion and childcare. An analysis of these debates suggests that the “new” unified German nation was premised upon a story in which the West German idea of the housewife-breadwinner model prevailed. This was diametrically opposed to what was framed as the East German “woman-worker” who had free access to abortion, and was abjected as immoral and backward. Analysing how such a national story was constructed is highly valuable, as it elucidates the ways in which gender has become a constitutive and structural element in the nation-building process of unified Germany to the present day.

Background: The major objective of the study was to assess whether the extent of health inequalities varies between East and West Germany and whether differences in social Inequalities between both parts of Germany are associated with differences in health inequalities. Methods: Data were available from a representative sample of 5,311 persons from West Germany and 2,414 persons from East Germany in the same age group (25–69 years). The study protocol was nearly identical in both studies. Socioeconomic status (SES) was assessed by household equivalent income and by educational level. Health status was assessed by perceived general health and by the number of chronic conditions. Absolute differences as well as relative differences (odds ratios) in the morbidity rates between low and high SES groups were calculated. All analyses were performed separately for men and women. Results: Income inequalities are larger in West Germany as compared with East Germany, but there are minor differences between East and West Germany concerning educational inequalities and morbidity rates. Just about all measures indicated that health inequalities favouring the upper socioeconomic groups exist in East Germany as well as in West Germany and that there are no significant differences in the extent of health inequalities between both parts of Germany. Conclusion: Using two data sets which were raised with nearly identical study protocols, it can be concluded that health inequalities are very stabile as they do not seem to differ substantially despite the fact that both parts of Germany have experienced different social systems during the past 45 years.

Trends in gender differences in health at working ages among West and East Germans

The purpose of this study is to reveal that the use of international phonetic symbols has been different in East and West Germany from World War II to the present. There has been a deviation not only in the use of IPA‐international phonetic symbols chronologically and regionally, but also in the actual language use of diphthongs and Schwa-/ə/, which was also found to be realized differentially in East and West Germany. The results are as follows. First, before World War II, German diphthongs that were written as [ae ao ɔø] in East and West Germany were written as [aɛ̯ aɔ̯ ɔoe̯] in East Germany after the division, whereas they were written as [ai͜ au͜ ɔy͜] in West Germany. Second, Schwa-/ə/ en is written as weakened or omitted [n̩] in West Germany, however it was nasalized or was written as [m̩] and as [ŋ] depending on the phonological environment in East Germany. Third, the deviation of these IPA between East and West Germany were also found in the language usage.

Objective of this re-analysis of datasets from former East and West Germany was to examine the influence of maternal education on intrauterine growth in two different political and social systems. Information on socio-demographic or lifestyle factors and pregnancy outcome was available for 3374 liveborn singletons from West Germany (1987/88) and 3070 from East Germany (1990/91). Multiple logistic regression was used to estimate the association between maternal education and the risk of delivering a small-for-gestational-age (SGA) newborn below the 10th percentile of birthweight. Women with the lowest education had a significantly elevated risk of SGA newborns compared to women with the highest education in West (odds ratio [OR] = 2.58, 95% CI : 1.17-5.67) and East Germany (OR = 2.77, 95% CI : 1.54- 5.00). The distribution of factors known to influence intrauterine growth varied with education in both states. After adjusting for these factors, women with the lowest educational level still had a higher risk of SGA birth: OR (West) = 2.02, 95% CI : 0.87-4.72; OR (East) = 1.95, 95% CI : 1.02-3.74. Our findings support the assumption that in former socialist countries health inequalities as a result of social inequalities existed.

Background Heart failure (HF) is one of the most common diseases in the adult population with a prevalence of about 4% and a steady increase due to demographic and medical developments. In Germany, it is the most common primary diagnosis for inpatient treatment. Little was known so far about regional differences. Methods We retrospectively analyzed aggregated administrative data on the number and characteristics of in-patients in Germany for the period 2000 to 2017, obtained from the German Federal Health Monitoring, an annual complete census of in-patient routine data. The number and duration of hospitalizations as well as hospital mortality with the main diagnosis “I50” (HF) were analyzed over time with a special emphasis on regional differences between the federal states. Results The number of HF-related hospitalizations in Germany increased continuously: from 239,694 in 2000 to 464,724 cases in 2017 (+94%). This increase was more pronounced in East Germany than in West Germany (119% vs. 88%) [Figure 1]. The proportion of HF-related hospitalizations in relation to the total number of hospitalizations rose from 1.4% to 2.3% (relative increase +67%) in whole Germany. Accordingly, HF was the most frequent disease-related reason for hospitalizations in Germany in 2017, again with marked differences between East and West Germany (relative increase +96% vs. +61%). Similar differences were found after age-standardization: hospitalization rate due to HF in 2017 was higher in the East than in West Germany (609 vs. 490 cases per 100,000 population), reflecting a major increase compared to year 2000 (49% vs. 36%). Despite a continuous decrease in the length of stay (from 14.3 to 10.2 days; –29%), the total number of HF-related hospital days in Germany increased by 38% (4.72 million hospital days in 2017). In East Germany, the number of hospital days increased by 51%, in West Germany by 35% [Figure 1]. The in-hospital mortality rate of HF patients remained unchanged between 2000 and 2017 at about 38,000 cases per year, corresponding to 8.2% in 2017 (East Germany 8.4%, West Germany 8.2%). With a contribution of 8.9% of all hospital deaths, HF constituted the leading cause in 2017. Again, this proportion was higher in East compared to West Germany throughout the entire observation period (2017 10.8% vs. 8.5%). The rate of HF-related in-hospital deaths was also higher in East than in West Germany (2017: 65 vs. 43 per 100,000 population) [Figure 1]. Conclusion HF continues to be the most common cause of hospitalization and hospital deaths in Germany. HF-related morbidity and mortality parameters are higher in East than in West Germany. Possible explanations for this finding are differences in the prevalence of risk factors and the structure of patient care between these regions. A more detailed understanding of these striking discrepancies 30 years after the German reunification requires further investigations. Figure 1 Funding Acknowledgement Type of funding source: None

IntroductionThe study aimed to investigate the association between the start age of non-parental Early Childhood Education and Care (ECEC) and psycho-social problems in adolescence. The similarities and differences between West and East Germany were also investigated in a natural experiment.MethodsOur sample consisted of 1022 children (621 from West Germany, 401 from East Germany) aged 3–4 years at wave 2003–2006 that were followed up to wave 2014–2017 as adolescents (mean ± SD age = 14.4 ± 0.03 years) in the KiGGS study. The psycho-social problems were measured by the parent-reported Strengths and Difficulties Questionnaire (SDQ) at wave 2014–2017. Linear regression was used to explore the relationship between ECEC-start-age and psycho-social problems in adolescence in Germany, and stratified by West and East Germany.ResultsThose who started ECEC between 2 and 3 years old (reference) had the lowest scores of psycho-social problems in the whole Germany and in West Germany in adolescence. In comparison, those who started ECEC older than 3 years old had higher scores of internalizing psycho-social problems in both West Germany (with statistically significant results) and East Germany (with a relatively larger effect size but insignificant results). Those who started ECEC younger than 1 year old had statistically significant higher scores for externalizing psycho-social problems in West Germany, even though less children started ECEC younger than 1 in West Germany compared to East Germany. This significant association was not found in East Germany. Those who started ECEC between 1 and 2 years old tended to have higher scores of externalizing psycho-social problems in both West and East Germany.ConclusionThe results suggest that if children start ECEC older than 3 years or younger than 2 years, more attention needs to be given to internalizing or externalizing psycho-social problems respectively. The regional differences for children younger than 1 year old may suggest a selection effect in West Germany where only fewer parents bring babies to ECEC, while the regional similarities for children over 3 years old indicate the importance of providing access to ECEC for children over 3 years old.

The annual number of persons killed in road-traffic accidents in Germany declined by 36% from 2001 to 2008, yet official traffic statistics still reveal a marked difference in fatalities between the federal states of the former East and West Germany twenty years after German reunification. We retrospectively analyzed data from the Trauma Registry of the German Trauma Society (Deutsche Gesellschaft für Unfallchirurgie; TR-DGU). Patients receiving primary treatment that had an Injury Severity Score (ISS) of 9 or above were analyzed separately depending on whether they were treated in the former East Germany or the former West Germany. Data were obtained from a total of 26 866 road-accident trauma cases. With Berlin excluded, 2597 cases (10.2%) were from the former East Germany (EG), and 22 966 (89.9%) were from the former West Germany (WG). The percentage of the population living in these two parts of the country is 16.7% and 83.3%, respectively. The two groups did not differ significantly in either the mortality of injuries (EG 15.8%, WG 15.7%) or in the standardized mortality rate (0.89 [EG] vs. 0.88 [WG]). Over the years 2002-2008, the mean time to arrival of the emergency medical services on the scene was 19 minutes (EG) vs. 17 minutes (WG), and the mean time to arrival in hospital was 76 minutes (EG) vs. 69 minutes (WG). Among the hospitals whose cases are included in the TR-DGU, there is no significant difference between the former East and West Germany with respect to mortality or any other clinically relevant variable. Hypothetically, the higher rate of death from road-traffic accidents in the former East Germany, as revealed by national traffic statistics, might be attributable to a difference in the quality of care received by trauma patients, but no such difference was found. Other potential reasons for it might be poorer road conditions, more initially fatal accidents, and lower accessibility of medical care in less densely populated areas.

Population trends, employment levels, economic performance, and income evolution in East and West Germany since unification

This study aimed to analyse depression-related factors. The prevalence of depression has been shown in prior surveys to vary between East and West Germany. Do these differences also appear in health insurance data? The outpatient data of a large German statutory health insurance company were analysed for regional differences in (a) the prevalence of depression diagnosis, (b) prescription rates of antidepressants and (c) risk factors of being diagnosed with depression or prescribed antidepressants. Diagnosis rates of depression in outpatient care (ICD-10 diagnosis F32/33) were analysed for the first quarter of 2004, and prescription rates of antidepressants were analysed for the first half of 2004. Odds ratios were calculated for the likelihood of being diagnosed with depression and of being prescribed antidepressants whilst considering socio-demographic and regional variables. The prevalence of depression diagnosis is up to 41% lower in East Germany than the expected mean rate and 30% above the expected mean rate in Berlin. Regional distribution rates of antidepressant prescriptions largely follow the same pattern as rates for depression diagnosis, with the exception of Berlin where prescription rates are 10% below the expected mean rate. Unemployed persons in West Germany have a higher chance of being diagnosed with depression and of being prescribed antidepressants than those unemployed in East Germany. Results correspond greatly to findings of epidemiologic surveys. However, the lower rate of depression diagnosis and prescription rates in East Germany might also be due to fewer mental health professionals practising there and possible differences in reporting style of emotional symptoms. This might contribute to the differences in diagnosis and prescription prevalence but cannot be solely responsible for this phenomenon. Probable causes of the different depression prevalence rates in East and West Germany will be discussed in this analysis. More research into factors impacting on regional differences in the prevalence of depression is needed.

Comparisons of incidence estimates of testicular cancer subtypes beyond seminoma and non-seminoma are virtually missing in the epidemiologic literature. We analysed incidence data from population-based German cancer registries to provide subtype-specific incidences of testicular cancer. We pooled data from nine cancer registries from 1998 to 2003. We estimated incidence and mortality time trends of West and East Germany. Incidence and mortality were standardized by the European standard population. The annual percentage incidence change from 1961 through 1989 was 4.9% in East Germany and 3.0% from 1970 through 2004 in Saarland. Incidence increases were the most pronounced among adolescents and young men aged 15-49 years. In 1998-2003, the seminoma incidence rate was 5.1 per 100,000; among non-seminomas, the rates were the highest for malignant teratoma (1.6 per 100,000), followed by embryonal carcinoma (1.2 per 100,000). Testicular lymphomas were rare (0.1 per 100,000). The incidence of testicular cancer among children aged 0-14 years was nearly constant from 1987 through 2004. Majority of these cancers were yolk sac tumours (0.1 per 100,000). In East and West Germany, rates of embryonal carcinoma in the early periods were considerably lower than the rates of malignant teratoma. In the most recent periods, rates of embryonal carcinoma became quite similar to the rates of malignant teratoma. The mortality decline started in West Germany roughly 12 years earlier than in East Germany. The later start of the mortality decline in East Germany may be because of a later introduction of platinum-based chemotherapy compared to West Germany.