Cause-Specific Mortality in France and in the Former FRG, 1950-95: Similarities and Differences

Article excerpt

Efforts to reduce mortality during the second half of the twentieth century in Europe have led to substantial gains in life expectancy. Yet the various countries of Europe have followed very different paths to achieve this result. Benoît HAUDIDIER analyses this diversity in relation to France and the former Federal Republic of Germany, two neighbouring countries with very close ties and which have recorded practically equivalent decreases in mortality.

In fact, analysis of the main causes of death shows that the reasons for this decrease are not always the same. Cardiovascular disease, and cancer among women, two series of causes whose links with lifestyle and consumption are well known, have evolved more unfavourably in the former FRG, while France comes out worse for mortality from violent causes (road traffic accidents, suicides, etc.) and from infectious diseases. The cultural differences between the two countries, taken in the broadest sense, appear to play a role, despite growing similarities in lifestyle.

By promoting a bilateral perspective, comparative studies such as the one presented here should contribute to progress in reducing mortality in either country.

Life expectancy in France and the former Federal Republic of Germany (FRG) rose substantially in the second half of the twentieth century, as it did throughout the whole of western Europe. The evolution was very similar in both countries. Between 1958 and 1997, life expectancy at birth for men increased by 7.8 years in France and by 7.9 years in the former FRG, rising respectively from 66.8 to 74.6 years and from 66.5 to 74.4 years. For women, the increase was 9.2 and 8.9 years respectively, rising from 73.1 to 82.3 years in France and from 71.6 to 80.5 years in the former FRG. Over a period of 40 years, progress in the two countries was identical, with life expectancy remaining equal for males and becoming more favourable for French women. Though life expectancies in many western European countries converge for both males and females, only in France and the former FRG has life expectancy progressed in an identical or almost identical manner since the late 1950s. The fact that the two countries belong to two contrasting cultures - Latin and Germanic - makes this similarity all the more striking.The territory of the former FRG is used here both on practical grounds (it is difficult to reconstitute homogeneous statistics for the period prior to unification), and for a more fundamental reason: the two parts of Germany have followed two very different social models. The comparison therefore concerns two countries based on a western social model: France and the former FRG. The analysis of cause- and age-specific mortality was continued until 1995 because the conditions prevailing before unification continued to shape mortality trends for several years afterwards.

Beyond the general indicator of life expectancy, which reveals identical overall trends in France and the former FRG, does the same rule apply to all aspects of mortality, notably with respect to age or cause of death? We will start by exploring the reasons for the interruption in the decline in infant mortality in the former FRG between 1968 and 1973. We will then focus on the similarities and differences in mortality from infectious diseases, violent causes and degenerative pathologies. Lastly, the differences between men and women that may appear when comparing mortality in the two countries will also be examined.

I. General observations and limitations of the study

The similarity of overall mortality trends in the two countries conceals substantial age-specific variations (Figure 1). The differences are clearly visible. Before age 45 for males and before age 30 for females, mortality has fallen more in the former FRG than in France since 1975, whereas above these ages, progress has been greater in France throughout the period.

This pattern is not surprising, since statistics for the whole of western Europe from 1950 to 1995 show that the growing convergence of life expectancies has in fact been accompanied (since 1965 at least) by a relative resistance to decline in the mortality of young people in Mediterranean Europe and of old people in northern Europe (Meslé and Vallin, 2002). …