East-West mortality disparities during the COVID-19 pandemic widen the historical longevity divide in Europe

Abstract

AbstractFor over half a century, life expectancy in Eastern European (former communist) countries has been appreciably lower than in Western Europe, although this difference has been narrowing since 2000. We investigated the impact of the COVID-19 pandemic on these differences. The pandemic reversed the recent convergence and widened the gap to levels observed more than two decades ago (7.9 years for males and 4.9 for females in 2021). Moreover, the trajectory of excess mortality in the pandemic differed between East and West, with the first major peaks in Eastern Europe occurring on average six months after the first peaks seen in Western countries. Despite this, the East suffered greater losses in life expectancy, especially in 2021. This was due to larger relative mortality increases in the East rather than greater frailty of the Eastern European populations as indexed by higher pre-pandemic mortality levels. East-West differences in life expectancy losses in 2021 were substantially explained by COVID-19 vaccination, which together with trust in government accounted for half the gap. We conclude that the East-West differences in life expectancy losses are associated with structural and psychosocial traits that have their roots in the communist era. This includes differences in the connectivity of populations (which drives the differences in timing), as well as profound contrasts in levels of trust in science, authorities, and their capacity to enforce lockdowns and other regulatory measures (driving the huge differences in excess mortality from autumn 2020 onwards).