Historical and regional particularities in the prevalence of traumatic events and posttraumatic stress disorder in East and West Germany.

BACKGROUND: Epidemiological research on the prevalence of traumatic events and PTSD has shown that there are significant differences between countries, due to their different history and socialization processes. In the case of Germany, this is particularly relevant. Germany was divided into two states from 1949 to 1990. This study examines the prevalence of traumatic events and PTSD in the formerly divided East and West Germany. METHODS: For the prevalence of traumatic events, we used data from four representative surveys (years 2005, 2007, 2008, and 2016) with a total of N = 9,200 respondents. For the analyses of PTSD prevalence, we used data from three representative surveys (years 2005, 2007, 2008) with a total of N = 6676 respondents. We compared different birth cohorts, persons living in the former West vs. East Germany, and the application of different diagnostic criteria using a chi-square test. RESULTS: The overall one-month prevalence rate for PTSD was 3.4% (3.0% for men and 3.8% for women). We found significant differences in the occurrence of traumatic events between genders, different age cohorts as well as between people who live in East and West Germany. Significant differences in the prevalence of PTSD can only be observed for different age cohorts. Most of the age effects are due to traumatic events related to World War II (WWII). Prevalence rates for PTSD were higher when the diagnostic criterions of the DSM-V were applied compared to the criterions of the DSM-IV. CONCLUSIONS: Our data suggests that socio-political factors may need to be considered when accounting for differences in occurrence rates of traumatic events, but not for prevalence rates of PTSD, between East and West Germany. People who have experienced WW II have a higher risk of suffering from PTSD. Future epidemiological trauma research should take historical and regional peculiarities of countries into account.

[Comparison of Self-Reported Childhood Maltreatment Between East and West Germany]. / Selbstberichtete Kindesmisshandlungen im Vergleich zwischen Ost- und Westdeutschland.

OBJECTIVE: The socioecological model emphasize the relevance of political, cultural and economic socialization effects for the prevalence of childhood maltreatment, which are analyzed by comparing child maltreatment between East and West German subjects who came of age before the fall of the Berlin Wall. METHODS: Using an online survey, a representative general population sample with respect to age, gender distribution and income was assessed regarding child maltreatment and current psychological distress using standardized self-report instruments. RESULTS: Of 507 study participants, 22,5% reported being born and socialized in East Germany. They reported significantly less emotional abuse than the 77,5% who grew up in the FRG. The East and West German subjects did not differ in any other form of abuse. CONCLUSION: Our findings underline the importance of socialization and enculturation effects on memory, which should be considered when interpreting the results.

Regional differences in the assessment of depressive symptoms in the former German Democratic Republic and Federal Republic of Germany.

AIM: The present study investigated regional differences in response behaviour for the Patient Health Quetionnaire-9. We tested for measurement invariance and differential item and test functioning between formerly divided East- and West-Germany: the former German Democratic Republic and Federal Republic of Germany. Diverging socialization experiences in socialist versus capitalist and collectivist versus individualist systems may affect culturally sensitive assessments of mental health. SUBJECT AND METHODS: To test this empirically, we used factor analytic and item-response-theoretic frameworks, differentiating between East- and West-Germans by birthplace and current residence based on several representative samples of the German general population (n = 3 802). RESULTS: Across all survey, we discovered slightly higher depression sum scores for East- versus West-Germans. The majority of items did not display differential item functioning-with a crucial exception in the assessment of self-harm tendencies. The scale scores were largely invariant exhibiting only small amounts of differential test functioning. Nonetheless, they made up on average about a quarter of the observed group differences in terms of effect magnitude. CONCLUSION: We explore possible causes and discuss explanations for the item-level differences. Overall, analyses of East- and West-German depressive symptom developments in the wake of reunification are feasible and statistically grounded.

[Differences in Area Specific Life Satisfaction Between East and West Germans in the Years 1991, 2006 and 2020]. / Unterschiede in der Zufriedenheit verschiedener Lebensbereiche zwischen Ost- und Westdeutschen in den Jahren 1991, 2006 und 2020.

RESEARCH: Question How did the general and area specific life satisfaction evolve between East and West Germany between 1991 and 2020? METHODS: Based on three representative surveys in the years 1991, 2006 and 2020 life satisfaction between East and West Germany was examined using mean comparison with tests of significance. The influence of relevant sociodemographic variables was calculated using Univariate Variance Analyses. RESULTS: 1991 large differences in the general life satisfaction as well as with satisfaction in the areas of living, spare time, health, finances and occupational did occur, with people in East Germany reporting to be less satisfied. These differences align during the observation time. DISCUSSION: The discrepancy in the general and area specific life satisfaction between East and West Germans did align during the last 30 years. A reason might be the improved economical living conditions in East Germany.

[Personal Resources of Adolescents in Eastern and Western Germany - Results of the KiGGS Study 15 and 25 years after the German Reunification]. / Personale Ressourcen von Jugendlichen in Ost- und Westdeutschland ­ Ergebnisse der KiGGS-Studie 15 und 25 Jahre nach der Wende.

QUESTIONS: More than 15 years after the German reunification, were there differences in the personal resources among adolescents born around 1989 between East and West? How did the differences of this generation develop? METHODS: Data from the study on the health of children, adolescents and young adults in Germany (KiGGS study) from the years 2003-2006 and 2014-2017 are used to determine the prevalence of low personal resources in 14-17-year-old adolescents in Eastern and Western Germany. Cross-sectional data at both time periods are compared between East and West, and longitudinal data are used to follow the cohort over the course of age RESULTS: Around 15 years after the German reunification, 14- to 17-year-olds from East Germany more frequently show fewer personal resources and have lower self-efficacy expectations than adolescents of the same age in West Germany. 10 years later, these differences are barely visible and have partially reversed. The east-west differences found cannot be explained by the different socio-economic situations of the families in East and West. DISCUSSION: The results show that in the 2000s, adolescents born around 1989 from families living in Eastern Germany, showed a higher risk of having fewer personal resources than adolescents from families living in Western Germany. 25 years after the German reunification this is no longer recognizable. While the differences between East and West decrease over time, the importance of the socio-economic situation of the family for the personal resources of adolescents as a whole increases, to the detriment of those with a lower socioeconomic status. The results indicate the need for targeted interventions to strengthen psychosocial resources especially for children and adolescents in phases of transformation and biographical breaks.

Individual and Work-Related Predictors of Exhaustion in East and West Germany.

Chronic exhaustion is a consequence of detrimental working conditions and demands, as well as inadequate coping techniques, potentially resulting in burnout. Previous research has studied occupational environment and individual factors as predictors of exhaustion. Although these differ between former East and West German states, the regional distinction regarding exhaustion has been neglected. To fill this gap, we used the Copenhagen Burnout Inventory in a representative German sample from 2014 to assess the burnout symptom exhaustion. Estimating ordinary least squares regressions, important burnout predictors were compared between the former East and West German states. Regional differences concerning occupational environments were related to the associations between individual factors, situational aspects of technostress and exhaustion. Associations between individual factors (e.g., female sex, lower working hours, age, partnership status, and household income) and exhaustion were stronger in East Germany, whereas technostress (strain of internet use, number of e-mails during leisure time, and social pressure to be constantly available) was more strongly associated with exhaustion in West Germany. Despite lower financial gratification and a higher social pressure to be constantly available in the East, West Germans were more afflicted by exhaustion. Individual factors and technostress should thus be considered when focusing on job-related mental health issues.

28-year incidence and time trends of childhood leukaemia in former East Germany compared to West Germany after German reunification: A study from the German Childhood Cancer Registry.

BACKGROUND: The aetiology of childhood leukaemia is largely unknown. Analyses of geographical differences may enhance aetiologic insights. The reunification of Germany in 1990 provides a unique opportunity to evaluate incidence patterns and time trends in two merging countries with substantial lifestyle, social and socioeconomic differences. With this study we provide an extensive assessment of 28-year incidence patterns and temporal trends after the German reunification. METHODS: We identified all children diagnosed with a lymphoid leukaemia (LL) or acute myeloid leukaemia (AML) before the age of 15 years between 1991 and 2018 using the German Childhood Cancer Registry (N = 14,922), and evaluated the incidence pattern and temporal trends in former East Germany compared to West Germany by subtype, age at diagnosis and sex. RESULTS: Incidence rates of LL were substantially lower (around 20 %) in Eastern Germany compared to Western Germany at the time of reunification. This was followed by a remarkable increase in Eastern Germany across both sexes and age groups until around 2000, when incidence rates reached the same levels as those in Western German federal states. Thereafter, incidence rates remained rather stable with some indications of a slightly decreasing tendency in both Eastern and Western Germany (estimated annual percentage changes (EAPC) 2005-2018: East Germany = -0.8 %; West Germany = -0.4 %), driven by the 0- to 4-year olds. Overall, AML incidence rates were stable over time in Western Germany, while EAPC for Eastern Germany indicated an increasing tendency (EAPC 1991-2018 = 1.3 %) driven by the older children, mostly during the early 2000s and in most recent years. CONCLUSION: The underlying mechanisms driving the childhood leukaemia rates remain inconclusive. Linkage studies including individual and clinical data would be valuable in evaluating the impact of a population's social, socioeconomic and lifestyle changes on the risk of childhood leukaemia and disease aetiology overall.

Predicting adaptive and maladaptive responses to the Coronavirus (COVID-19) outbreak: A prospective longitudinal study / Predicción de respuestas adaptativas y desadaptativas durante el brote de Coronavirus (COVID-19): estudio longitudinal prospectivo

BACKGROUND/OBJECTIVE: The outbreak of COVID-19 and the lack of vaccine made extraordinary actions such as social distancing necessary. While some individuals experience the restrictions on daily life as a heavy burden, others adapt to the situation and try to make the best of it. The present longitudinal study investigated the extent and predictors of the burden induced by the outbreak of COVID-19 in Germany. METHOD: Data were assessed in October 2019 using the DASS-21 and the PMH-Scale, and in March 2020 adding a six-item measure of burden and a 2-item rating of sense of control. RESULTS: In a sample of 436 participants, about 28% stayed in self-quarantine, 22 persons had relevant symptoms and one person was positively tested for COVID-19. Most participants experienced medium to high levels of burden but tried to make the best of it. Stress symptoms in 2019 predicted a higher level of burden and PMH predicted a lower level of burden in March 2020. Remarkably, depression and anxiety symptoms did not significantly predict burden. The protective effect of PMH and the negative impact of stress symptoms were mediated by perceived sense of control. CONCLUSIONS: The results emphasize the protective effect of PMH in extraordinary situations such as the current outbreak of COVID-19

ANTECEDENTES/OBJETIVO: El brote COVID-19 y la falta de vacuna hicieron necesarias acciones extraordinarias como la distancia social. Algunas personas experimentan las restricciones en la vida diaria como sobrecarga emocional y otras se adaptan a la situación, tratando de sacar lo mejor de ella. Se investigó el alcance y predictores de sobrecarga emocional inducida por el COVID-19 en Alemania. MÉTODO: Se evaluaron niveles de estrés y salud mental positiva en octubre de 2019 con DASS-21 y Escala-PMH, y en marzo de 2020, agregando medidas de sobrecarga emocional y percepción de control. RESULTADOS: En una muestra de 436 participantes, el 28% permaneció en cuarentena, 22 personas tuvieron síntomas relevantes y una dio positivo en COVID-19. La mayoría experimentaron niveles de sobrecarga emocional medio-alto, aunque trataron de sobrellevar la situación lo mejor posible. Los síntomas de estrés en octubre 2019 predijeron un nivel de sobrecarga más elevado en marzo 2020 y, contrariamente, los niveles de salud mental positiva en octubre 2019 predijeron un menor nivel de sobrecarga emocional en marzo 2020. Sorprendentemente, los síntomas de depresión y ansiedad no predijeron la sensación de sobrecarga posterior. El efecto protector de la salud mental positiva y el impacto negativo de los síntomas de estrés fueron mediados por la percepción de control. CONCLUSIONES: Se resalta el efecto protector de la salud mental positiva en situaciones extraordinarias como el brote COVID-19

Do smoking, nutrition, alcohol use, and physical activity vary between regions in Germany? - results of a cross-sectional study.

BACKGROUND: Previous studies on lifestyle risk factors mainly focused on age- or gender-specific differences. However, lifestyle risk factors also vary across regions. Aim of the present study was to examine the extent to which prevalence rates of SNAP (smoking, nutrition, alcohol consumption, physical activity) vary between East and West Germany or North and South Germany. METHODS: Data came from the population-representative 2015 Epidemiological Survey of Substance Abuse (ESA) comprising 9204 subjects aged 18 to 64 years. To assess an east-west or south-north gradient, two binary logistic regression models were carried out for each SNAP factor. RESULTS: The logistic regression models revealed statistically significant differences with higher rates of at-risk alcohol consumption and lower rates of unhealthy nutrition in East Germany compared to West Germany. Significant differences between North and South Germany were found for at-risk alcohol consumption with higher rates of at-risk alcohol consumption in South Germany. Daily smoking and low physical activity were equally distributed across regions. CONCLUSIONS: The implementation of measures reducing at-risk alcohol consumption in Germany should take the identified east-west and south-north gradient into account. Since the prevalence of unhealthy nutrition was generally high, prevention and intervention measures should focus on Germany as a whole instead of specific regions.

Changes in the epidemiology and aetiology of dental traumatic injuries in permanent teeth in children before and after German unification.

AIM: To evaluate the longitudinal occurrence of traumatic dental injuries in permanent teeth comparing recent data from 2014 to 2016 in Greifswald after German unification with a historic sample from socialist times (1974-1989). MATERIALS AND METHODS: In this retrospective study, traumatic dental injury parameters as type, date, location, and cause of injury as well as tooth affected were extracted from the trauma records of patients from 1974 to 1989 and 2014-2016. RESULTS: The descriptive analysis of 444 teeth in 245 patients revealed that the recent and historic samples had a very similar pattern of dental trauma (201/243 teeth in 117/128 patients, respectively): Maxillary permanent central incisors were affected in 70.7% and 68.3%, respectively. Enamel-dentine fractures were the most prevalent fracture injury in both recent and historic samples (64% and 43.1%, respectively) followed by enamel fractures (20.7% and 36.9%, respectively). Subluxations were the most common luxation traumatic dental injury (44.7%) followed by lateral luxation (39.8%) as reported in the historic sample while in the recent sample subluxation constituted 42.9% of luxation injuries followed by concussion (36.2%). CONCLUSION: This study detected a very stable pattern of dental traumatic injuries over 40 years, even after the change from a socialistic society to a market economy.

Trends in alcohol-related mortality in East and West Germany, 1980-2014: age, period and cohort variations.

BACKGROUND AND AIMS: Several indicators suggest that the extent and trends of alcohol-related mortality differ between East and West Germany. Regional drinking patterns and differences in health-care systems are assumed to affect the risk of dying from an alcohol-induced disease. The study addresses two questions: (1) what are the unbiased and independent age, period and cohort effects on alcohol-related mortality trends in Germany; and (2) do these trends differ between East and West Germany? METHODS: Data on alcohol-related mortality for East and West Germany came from the national causes of death register for the years 1980-2014. Analyses included all deaths fully attributable to alcohol based on the International Classification of Diseases (ICD-9 and ICD-10). Gender-stratified age-period-cohort analyses were conducted using the intrinsic estimator model. RESULTS: Age effects showed a concave pattern with a peak at ages 55-64 years in both regions. Incidence rate ratios (IRR) in East Germany were highest in the years 1990-1994 (men and women: IRR = 1.52) and declined thereafter. In West Germany, IRR were lowest in 1980-1984 (men: IRR = 0.81, women: IRR = 0.75) and stabilized at approximately 1.10 since 1995-1999. Cohort effects showed continuously lower IRR for those born after 1955-1959 in the East and those born after 1945-1949 in the West. Patterns for males and females were comparable. CONCLUSIONS: The results suggest that alcohol-related mortality showed different trends in East and West Germany, which can be explained partly by different drinking patterns before and changes in the health-care system after the reunification.

The German East-West Mortality Difference: Two Crossovers Driven by Smoking.

Before the fall of the Berlin Wall, mortality was considerably higher in the former East Germany than in West Germany. The gap narrowed rapidly after German reunification. The convergence was particularly strong for women, to the point that Eastern women aged 50-69 now have lower mortality despite lower incomes and worse overall living conditions. Prior research has shown that lower smoking rates among East German female cohorts born in the 1940s and 1950s were a major contributor to this crossover. However, after 1990, smoking behavior changed dramatically, with higher smoking intensity observed among women in the eastern part of Germany. We forecast the impact of this changing smoking behavior on East-West mortality differences and find that the higher smoking rates among younger East German cohorts will reverse their contemporary mortality advantage. Mortality forecasting methods that do not account for smoking would, perhaps misleadingly, forecast a growing mortality advantage for East German women. Experience from other countries shows that smoking can be effectively reduced by strict anti-smoking policies. Instead, East Germany is becoming an example warning of the consequences of weakening anti-smoking policies and changing behavioral norms.

Cancer mortality in former East and West Germany: a story of unification?

BACKGROUND: Health and social conditions vary between West and East Germany. METHODS: We 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. RESULTS: Lung 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. CONCLUSION: Courses of mortality were similar between East and West, while existing differences are likely to remain in the near future.

Antimicrobial resistance of Neisseria gonorrhoeae isolates in south-west Germany, 2004 to 2015: increasing minimal inhibitory concentrations of tetracycline but no resistance to third-generation cephalosporins.

Increasing antimicrobial resistance of Neisseria gonorrhoeae, particularly to third-generation cephalosporins, has been reported in many countries. We examined the susceptibility (determined by Etest and evaluated using the breakpoints of the European Committee on Antimicrobial Susceptibility Testing) of 434 N. gonorrhoeae isolates collected from 107 female and 327 male patients in Stuttgart, south-west Germany, between 2004 and 2015. During the study period, high proportions of isolates were resistant to ciprofloxacin (70.3%), tetracycline (48.4%; increasing from 27.5% in 2004/2005 to 57.7% in 2014/2015; p = 0.0002) and penicillin (25.6%). The proportion of isolates resistant to azithromycin was low (5.5%) but tended to increase (p = 0.08). No resistance and stable minimum inhibitory concentrations were found for cefixime, ceftriaxone, and spectinomycin. High-level resistance was found for ciprofloxacin (39.6%) and tetracycline (20.0%) but not for azithromycin; 16.3% of the isolates produced betalactamase. Thus, cephalosporins can still be used for the treatment of gonorrhoea in the study area. To avoid further increasing resistance to azithromycin, its usage should be limited to patients allergic to cephalosporins, or (in combination with cephalosporins) to patients for whom no susceptibility testing could be performed or those co-infected with chlamydiae.

Mortality of Testicular Cancer in East and West Germany 20 Years after Reunification: A Gap Not Closed Yet.

BACKGROUND: The decline of testicular cancer mortality in East Germany began in the 1980s, about 10 years later than that recorded in West Germany. We aimed at providing up-to-date time trends of testicular cancer mortality rates in Germany. MATERIAL AND METHODS: Mortality data from East Germany (1971-2010) and West Germany (1954-2010) were provided by the Federal Bureau of Statistics. We estimated age-specific and age-standardized mortality rates using the World Standard Population. RESULTS: Despite the declining trend in the 2000s, the mortality rates of testicular cancer remained higher in East than in West Germany. These rates were 5.5 and 2.6 per million person-years in 2010, respectively. Age-specific mortality trends by period and birth cohort showed that the mortality decline was larger among younger (15-44 years) than elderly men. CONCLUSION: The mortality of testicular cancer is still higher in East than West Germany. Despite very similar densities of hospital beds, urologists and oncologist per million male population in both parts of Germany, we hypothesized that a paucity of centers of expertise for treating testicular cancers in the East could account for this particular pattern.

[Neonaticide: A classification of female perpetrators in an east-west comparison]. / Neonatizid : Täterinnentypologie und Ost-West-Vergleich.

BACKGROUND: The term neonaticide describes the act of killing a newborn child by a parent (mostly by the mother) within 24 h after birth. The aim of this study was to establish a classification of female perpetrators using psychopathological, mental, social and biographical characteristics and to make a comparison of the frequency between the old and new federal states in Germany. MATERIAL AND METHODS: In this study a total of 63 female German perpetrators who killed at least one newborn between 1986 and 2009 are portrayed and classified by epidemiological and psychopathological characteristics and personality profiles. After obtaining consent from the public prosecutors responsible, data were collected from forensic psychiatric expert opinions and legally valid court verdicts. A questionnaire was established to answer the questions on the psychopathological, e.g. do the women suffer from a mental disease when killing their newborn(s), mental, e.g. can personality accentuations be elicited, social, e.g. are the women unemployed and biographical characteristics of the women, e.g. how old are the women? Finally, an investigation was carried out using significance tests to find out if there was a significant statistical difference in the frequency of neonaticide between the eastern and western federal states. RESULTS: A cluster analysis based on the descriptive analysis was developed. The cluster analysis provided a foundation for a dichotomous classification of the perpetrators depending on five criteria. The first category contained 32 perpetrators who were on average 21 years old, who were primiparous and who hid, ignored or did not perceive their pregnancy. Most of them still lived with their parents. The perpetrators either did not have a mental disease or suffered from an acute stress disorder. The second category contained 31 perpetrators who were on average 25 years old, who were pluriparous, who hid their pregnancy and who lived with their partner. These women either did not have a mental disease or suffer from a personality disorder. A statistically significant higher incidence was found in the eastern federal states of Germany. CONCLUSION: The presented categorization of female perpetrators into two groups, where the features only show a small degree of overlap, should be taken into consideration in the assessment of the reasons for neonaticide. The typology of female perpetrators is more heterogeneous than previously assumed. The presented typologies and knowledge of conditional constellations involved in neonaticide achieve better prerequisites to be able to recognize persons at risk earlier and to instigate preventive measures.

[Infant mortality in Germany (2008-2012)--lower in the former German Democratic Republic?]. / Säuglingssterblichkeit in Deutschland (2008-2012)--niedriger im Osten?

BACKGROUND: German infant mortality is ranked near the median of European countries. In Germany infant mortality is significantly higher in the German Federal Republic compared with the former German Democratic Republic. This is often used as reason for a call for structural requirements and minimum caseload for the care for very low birth weight infants. METHOD: Neonatal and infant mortality were calculated for the 16 German federal states with data from the German statistical federal office for the years 2008-2012. RESULTS: Considerable variations were found for the neonatal (1.34-3.61‰, total Germany 2.31‰) and the infant (2.38-5.20‰, 3.47‰) mortality. The rate of stillborn infants was 3.56‰. A lower neonatal mortality in the former German Democratic Republic (1.62‰ vs. 2.44‰, p<0.0001, Chi-squared test) could not be confirmed for preterm infants with birth weight less than 1 500 g. In the former German Democratic Republic stillbirth was significantly more frequent in preterm infants with birth weight 500-999 g (p<0.0001). Combined stillbirth and neonatal mortality showed no difference between the German Federal Republic and former German Democratic Republic (5.45‰ and 5.29‰, respectively, n.s.; infants less than 500 g birth weight were excluded). The average number of preterm infants per perinatal centre and federal state had no influence on state specific neonatal mortality. CONCLUSION: If stillborn infants were accounted for no difference was found between the German Federal Republic and the former German Democratic Republic regarding mortality. Comparing infant mortality of different countries has to account for stillborn infants. Considerable variation of neonatal mortality is persisting throughout Germany despite structural requirements and introduction of a minimum caseload since 2005. A lower infant mortality in the former German Democratic Republic and implications drawn from are not supported by the presented nationwide data from the German statistical federal office.

Survival from childhood acute lymphoblastic leukaemia in West Germany: does socio-demographic background matter?

BACKGROUND: Sex, age, immunophenotype and white blood cell count at diagnosis are well accepted predictors of survival from acute lymphoblastic leukaemia (ALL) in children. Less is known about the relationship between socio-economic determinants and survival from paediatric ALL, studied here for the first time in German children. METHODS: ALL cases were diagnosed between 1992 and 1994 and their parents interviewed during a previous nationwide case-control study. Children were followed-up for 10 years after diagnosis by the German Childhood Cancer Registry. Cox proportional hazards models estimating hazard ratios (HRs) were calculated to assess the impact of selected socio-demographic characteristics on overall and event-free survival. RESULTS: Overall survival was 82.5%, with a higher proportion of girls than boys surviving (85% versus 81%). We found a non-linear relationship between age at diagnosis and survival, with poorer survival in infants and children aged >5 years. There was no association between socio-economic factors and survival or risk of relapse. For five levels of increasing family income, all HRs were close to one. No relationship was seen with parental educational level. CONCLUSION: Socio-economic determinants did not affect ALL survival in West German children, in contrast to studies from some other countries. Dissimilarities in social welfare systems, including access to health care, lifestyle and differences in treatment may contribute to these differences in findings. Our observation of no social inequalities in paediatric ALL survival is reassuring, but needs continued monitoring to assess the potential impact of evolvement of treatment options and changes in paediatric health service.

Regional variations in German mesothelioma mortality rates: 2000­2010.

PURPOSE: Germany has one of the highest age-adjusted mesothelioma mortality rates worldwide. As mesothelioma occurs ≥ 30 years after asbestos exposure, contemporary rates likely reflect exposures in the 1960-1970s. During this period, political division between West and East Germany led to differences regarding the import and consumption of asbestos. It is unclear whether mesothelioma rates also differ between these formerly separate countries which are now served by similar health and mortality reporting systems, thereby facilitating regional comparisons. METHODS: We examined regional, temporal, and sex variations in mesothelioma mortality rates in Germany in 2000-2010, collapsing the federal states into West Germany, East Germany, and Berlin. We calculated truncated (≥ 40 years) age-standardized mesothelioma mortality rates (ASRs(40+)) per 100,000 person-years, estimated sex-stratified mortality rate ratios (MRRs) (95 % confidence intervals (CIs)), adjusted for age and calendar year from Poisson models, and fitted age-period-cohort models. RESULTS: There were 12,854 mesothelioma deaths at ages ≥ 40 years in Germany during 2000-2010. ASRs(40+) were higher in West (males 4.4; females 0.8) than East (males 1.7; females 0.6) Germany. MRRs for West versus East Germany were 2.68 (95 % CI 2.48-2.88) among males and 1.42 (95 % CI 1.27-1.59) among females. In both regions, mortality rates increased for birth cohorts until the mid 1940s and subsequently declined. The country's peak mesothelioma burden is predicted to occur by 2020. CONCLUSIONS: Geographical differences in mesothelioma mortality rates are consistent with heterogeneous historical asbestos exposures. Differences may exist for other asbestos-related cancers and should be investigated in analytic studies with individual asbestos exposure information.