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

For 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). ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement S.T. acknowledges support from the Australian Research Council (DP210100401). N.I. acknolwledges support from the UK National Institute for Health and Care Research (HDRUK2022.0313). The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes The raw data originated from the open access sources listed in the References. We also provide figures and tables data in separate Excel files (see the link below). Some of the Excel files contain calculations (including decomposition of life expectancy losses) and final data manipulations.