Markéta Pechholdová

Introduction: The Czechia is facing population aging. The number of people with dementia is increasing. Conflicting conclusions of European studies confirm the difficulties of quantifying the disease. Aims: We aim to estimate the number of people with dementia in Czechia until 2050: a) projecting dementia prevalence using prevalence rates from EURODEM and EuroCoDe studies, b) projecting dementia based on mortality tables of individuals living with dementia. Comparing both approaches to dementia estimation. Methods: We conducted a literature review. The projection is based on socio-demographic and health variables; construction of life tables for people with dementia. Results: According to the results a) projecting the prevalence of dementia; over 300,000 seniors aged 60+ will suffer from dementia by 2050; b) estimating the number of individuals living with dementia: The number of men and women with dementia aged 65+ was estimated at over 120 thousand. Conclusions: Czech society is not prepared for this intense increase in the number of individuals living with dementia. We argue early diagnosis as well as appropriate health and social care are urgent.

Introduction and Aims.Globally, Czechia and Lithuania are among the top‐ranking countries in terms of high alcohol consumption. This study highlights notable contrasts in temporal trends in alcohol‐related mortality and identifies country‐specific patterns in educational differences.Design and Methods.The study uses harmonised cause‐of‐death series from the Human Cause of Death Database. Mortality disparities by education were assessed using census‐linked mortality data. Directly standardised death rates were used to estimate levels of national and group‐specific mortality. Relative and absolute mortality differences by education were assessed by range‐type measures (Poisson regression mortality ratios and rate differences) and Gini‐type measures.Results.Between 1994–1995 and 2016, the absolute difference between Czechia and Lithuania in terms of alcohol‐related age‐standardised death rates (per 1 000 000) decreased from 450 for males and 130 for females to 76 in males and 11 in females. In both countries, alcohol‐related mortality was markedly higher among persons of lower education levels. Lithuanian males experienced the highest absolute inequalities measured by rate difference between the low and high educated (740 per million), while Lithuanian females showed the most pronounced relative inequalities (6.70‐fold difference between low and high educated). The corresponding figures were less than half for Czechia.Discussion and Conclusions.Reducing educational disparities in alcohol‐related mortality within both countries would have a substantial impact on overall levels. Policies aimed at targeting the lowest priced and illegal alcohols and reducing levels of harmful drinking should be a priority, especially in Lithuania.

Every time the classification of causes of death is changed, time series of deaths by cause are disrupted in more or less profound ways. When changes involve only the merging of several items or splitting a single item into several new categories, the problems caused by these ruptures are not too difficult to solve. A more or less severe imbroglio occurs, however, each time a new item results from recombining portions of different split items. Sometimes, but very rarely, some countries proceed to a bridge coding during the year of transition, which can help reconstruct coherent time series. This article first summarizes the general principles of the method developed for France by Meslé and Vallin to reconstruct complete series for France from 1925 to 1999 in the detailed list of the 9th WHO International Classification of Diseases (ICD), doing so by successively bridging a posteriori the five versions of the ICD that were in use during that period. Second, it reports on several methodological improvements that have been developed with the aim to reconstruct and analyze mortality trends by cause in sixteen industrialized countries.

The sizeable mortality gap between the German Democratic Republic (East Germany) and the pre-unified Federal Republic of Germany (West Germany) narrowed rapidly after the two states were unified. Despite extensive research, the mechanisms underlying the convergence process are still not fully understood. Significant changes to coding practices and the system of data collection introduced in East Germany shortly after reunification have further complicated the ability of researchers to interpret mortality trends. Our aim is to assess the role of German reunification in the convergence process in light of the evolution of long-term mortality trends by causes of death. Compared to previous studies, we rely on much more detailed mortality data, which we first adjust for notable distortions. We propose an upward correction of cancer mortality, as well as corrections that account for obvious changes in the items selected within the ICD chapter of circulatory diseases. We identify three distinct processes that took place in East Germany around the time of reunification: (1) a sustained reduction in mortality that started before reunification; (2) a temporary increase in mortality in 1990–1991 that was related to the abrupt social transition, as reflected by socially sensitive causes such as accidents, alcohol-related diseases, and acute myocardial infarction; and (3) a reunification-driven process of convergence that was mostly caused by the accelerated decline in mortality from cerebrovascular and chronic heart diseases. Mortality improvements observed in the GDR starting in the 1980s might be interpreted as the first signs of a cardiovascular revolution. Shifts in individual behaviour likely started before reunification, whereas the real progress in medical care occurred later with the implementation of the Western system of health care. We therefore conclude that German reunification per se did not initiate the convergence process, but rather reinforced and accelerated trends that were already apparent.

After several decades of stagnation, mortality in most Central European countries started to decrease after 1989. The Czech Republic and Poland were the first former Communist countries in this region to experience a rapid and sustained increase in life expectancy. This study focuses on the trends in cause-of-death mortality that have contributed to the recent progress in these two countries. The analysis is based on the cause-of-death time series (1968–2013) reconstructed in accordance with the 10th ICD revision, which makes the data fully comparable over the full period under study. Actual trends in cause-specific mortality are presented, and age, sex and causes of death components of life expectancy changes are disentangled. In both countries, the reduction in cardiovascular mortality at adult and old ages was crucial for the increase in life expectancy after 1991. Results are discussed in the context of institutional changes that occurred after the fall of Communism, such as the reorientation of health policies and the emergence of non-governmental organizations. Changes in health-related attitudes and behaviours as well as structural changes in societies, notably the rising share of persons with tertiary education, are also discussed.

The health situation in Russia has often been characterized as a long‐running crisis. From the 1960s until the beginning of the 2000s, the declining life expectancy trend was substantially interrupted only twice: once in the mid‐1980s as a result of Gorbachev's anti‐alcohol campaign, and again at the end of the 1990s as a result of the “rebound” effect following the dramatic rise in mortality associated with the acute socioeconomic crisis. In both cases, the progress made proved to be short‐lived. A third mortality decline in Russia began in 2003 and is still ongoing. We investigate the components and driving forces of this new development, in particular the role played by cardiovascular diseases. Using cause‐specific mortality data, we identify the main features of the recent improvements and compare these features with those observed in selected European countries, specifically France, Poland, and Estonia. Our aim is to gauge whether the features of the improvements in these countries are similar to those of the recent advancements made in Russia. Although the recent improvements in Russia have features in common with initial stages of prior mortality declines in other countries and may support optimism about the future, a return to mortality stagnation cannot be ruled out.

Though many countries have been collecting cause-of-death information from death certificates for more than a century, these valuable data sources remain underexplored. This is certainly due in part to the frequent revisions of the International Classification of Diseases (ICD), which have caused breaks in data continuity. This paper describes the methodological background and the results of the transition between the eighth and the ninth revision of ICD for the territory of former West Germany. Using practical examples, we examine the difficulties encountered and discuss the solutions applied.