East-West mortality disparities during the COVID-19 pandemic widen the historical longevity divide in Europe: an international comparative study

Introduction For over half a century, life expectancy in the former communist countries of Eastern Europe has been noticeably lower than in Western Europe. Since 2000 this gap has narrowed. We examined the impact of the COVID-19 pandemic on these long-term mortality trends and differences. Methods Nationally reported mortality data were used to estimate East-West differences in excess mortality and life expectancy losses. Regression and decomposition methods were employed to examine the contribution of vaccination, trust in government, regulatory enforcement, and air connectivity between populations to these differences. Results During the pandemic, the East-West life expectancy gap widened to its highest level in more than two decades. Moreover, the trajectory of excess mortality during the pandemic differed between East and West, with levels of excess mortality in the East being minimal until autumn 2020. Cumulative excess mortality in weeks 10-18 of 2020 was correlated with an index of air connectivity, which was appreciably lower in Eastern compared to Western European countries in the immediate pre-pandemic period. From October 2020 onwards, the East suffered greater losses in life expectancy, especially in 2021. This could not be explained by greater frailty of the Eastern European populations, as indicated by higher pre-pandemic mortality levels. Half of the difference between East and West in 2021 was jointly explained by COVID-19 vaccination levels and trust in government. Conclusions East-West contrasts in the timing and magnitude of life expectancy losses during the COVID-19 pandemic appear to have their ultimate origins in differences between societies that were established during the Cold War. These include differences in the connectivity of populations, levels of trust in science and authorities and the related capacity of Eastern countries to mount effective vaccination campaigns. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement S.T. acknowledges support from the Australian Research Council (DP210100401). N.I. acknowledges 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 (). Some of the Excel files contain calculations (including decomposition of life expectancy losses) and final data manipulations.