{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T17:51:28Z","timestamp":1787507488556,"version":"build-2736575974"},"reference-count":25,"publisher":"BMJ","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Epidemiol Community Health"],"published-print":{"date-parts":[[2000,2,1]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>After unification, the gap in infant mortality rates between the two parts of Germany widened until 1996 before converging. The reasons for these changes have not, so far, been apparent.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBJECTIVES<\/jats:title>\n                    <jats:p>To investigate trends in neonatal and postneonatal mortality in the eastern (the new L\u00e4nder) and western (the old L\u00e4nder) part of Germany after unification in 1990 and to identify the scope for further improvement.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>DESIGN<\/jats:title>\n                    <jats:p>Examination of trends in birth weights, birth weight specific neonatal mortality and cause specific postneonatal mortality in the two parts of Germany from 1990 to 1996 and 1997 by analysing routinely available vital statistics data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>In both parts of Germany, neonatal mortality fell considerably, by 33 per cent in the east and 17 per cent in the west, from 4.5 and 3.5 per thousand live births in 1990 to 3.0 and 2.9 in 1997, respectively. This was attributable to an improvement in survival of infants at all birth weights but especially among those with very low birth weights, accounting for an estimated 83 to 85 per cent of the overall improvement. The birth weight distribution showed a slight worsening in the new and the old L\u00e4nder with an increase in the proportion of those under 1500 g and, in the east, a 24 per cent increase in the proportion of high birthweight infants of 4000 and more grams. Trends in postneonatal mortality revealed a worsening of about 32 per cent in the east from 1990 to 1991 followed by a decline of over 50 per cent up to 1997, leading to comparable mortality rates of 1.8 per thousand live births in the east and 2.0 in the west. While both parts experienced a decrease of 40 to 48 per cent in deaths from all diseases, the decline in deaths because of accidents and injuries was markedly higher in the new L\u00e4nder although they are still exceeding the western rate by 3.7 per 100\u2009000 live births in 1997.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Since unification, the two parts of Germany underwent a complex process that has led finally to convergence of parameters of infant health that are most likely to have been because of improvements in the quality of perinatal care. To improve infant mortality in Germany, policy measures should focus on preventive rather than curative measures as the proportion of very low birthweight babies is increasing in both parts of Germany.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/jech.54.2.84","type":"journal-article","created":{"date-parts":[[2002,7,27]],"date-time":"2002-07-27T06:33:18Z","timestamp":1027751598000},"page":"84-90","source":"Crossref","is-referenced-by-count":35,"title":["Neonatal and postneonatal mortality in Germany since unification"],"prefix":"10.1136","volume":"54","author":[{"given":"Ellen","family":"Nolte","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela","family":"Brand","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ilona","family":"Koupilov\u00e1","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"McKee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2000,2,1]]},"reference":[{"key":"2025100703193926000_54.2.84.1","first-page":"377","article-title":"Bericht 1997 \u00fcber die demographische Lage in Deutschland.","volume":"22","author":"Gr\u00fcnheid","year":"1997","journal-title":"Z Bev\u00f6lkerungswissenschaft"},{"key":"2025100703193926000_54.2.84.2","unstructured":"Bundesregierung Jahresbericht der Bundesregierung zum Stand der Deutschen Einheit 1998. Bundestags-Drucksache 13\/10823. Bonn: 1998.."},{"key":"2025100703193926000_54.2.84.3","unstructured":"ECOHOST (1998) Childhood injuries: a priority area for the transition countries of Central and Eastern Europe and the newly independent states. (LSH&TM, London)."},{"key":"2025100703193926000_54.2.84.4","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-3016.1996.tb00037.x"},{"key":"2025100703193926000_54.2.84.5","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1111\/j.1365-3016.1996.tb00037.x","article-title":"Low birthweight in Germany 1990\u201392.","volume":"10","author":"Dammann","year":"1996","journal-title":"Paediatr Perinat Epidemiol"},{"key":"2025100703193926000_54.2.84.6","unstructured":"Statistisches Bundesamt (1999) Todesursachen in Deutschland. Reihe 4. (Statistisches Bundesamt, Wiesbaden)."},{"key":"2025100703193926000_54.2.84.7","unstructured":"(1998) Health for All Data Base European Region. (World Health Organization, Regional Office for Europe, June, Copenhagen)."},{"key":"2025100703193926000_54.2.84.8","unstructured":"Ministerium f\u00fcr Gesundheitswesen der DDR (1980\u20131989) Das Gesundheitswesen der Deutschen Demokratischen Republik. (Institut f\u00fcr Medizinische Datenverarbeitung und Statistik, Berlin)."},{"key":"2025100703193926000_54.2.84.9","unstructured":"Microsoft Corporation. Microsoft Excel Version 97.."},{"key":"2025100703193926000_54.2.84.10","unstructured":"Bundesminister f\u00fcr Gesundheit (1993) Indikatoren zum Gesundheitszustand der Bev\u00f6lkerung in der ehemaligen DDR. (Nomos-Verlagsgesellschaft, Baden-Baden)."},{"key":"2025100703193926000_54.2.84.11","first-page":"232","article-title":"Eheschlie\u03b2ungen, Geburten und Sterbef\u00e4lle 1996.","volume":"3","author":"Sommer","year":"1998","journal-title":"Wirtschaft und Statistik"},{"key":"2025100703193926000_54.2.84.12","doi-asserted-by":"crossref","first-page":"1205","DOI":"10.1136\/bmj.315.7117.1205","article-title":"Why are babies getting heavier? Comparison of Scottish births from 1980 to 1992.","volume":"315","author":"Bonellie","year":"1997","journal-title":"BMJ"},{"key":"2025100703193926000_54.2.84.13","unstructured":"Casper W Wiesner G Bergmann KE , eds (10\/1995) Mortalit\u00e4t und Todesursachen in Deutschland. (RKI-Heft Berlin)."},{"key":"2025100703193926000_54.2.84.14","unstructured":"Brand A Bredeh\u00f6ft J Brand H (1999) Verbesserung der Vollst\u00e4ndigkeit und Validit\u00e4t der fl\u00e4chendeckenden Dokumentation angeborener Fehlbildungen im Rahmen der Perinatalerhebung. (L\u00d6GD, Bielefeld)."},{"key":"2025100703193926000_54.2.84.15","doi-asserted-by":"crossref","first-page":"816","DOI":"10.2105\/AJPH.88.5.816","article-title":"Decrease in infant mortality in New York City after 1989.","volume":"88","author":"Kalter","year":"1998","journal-title":"Am J Public Health"},{"key":"2025100703193926000_54.2.84.16","doi-asserted-by":"crossref","first-page":"744","DOI":"10.1016\/S0140-6736(05)63557-X","article-title":"Decline in mortality from testicular cancer in West Germany after reunification.","volume":"350","author":"Becker","year":"1997","journal-title":"Lancet"},{"key":"2025100703193926000_54.2.84.17","unstructured":"Henning A (1986) Mother and child care. in Political values and health care: the German experience. eds Light DW Schuller A (MIT Press, Cambridge, MA), pp 467\u2013486."},{"key":"2025100703193926000_54.2.84.18","doi-asserted-by":"crossref","first-page":"687","DOI":"10.1136\/bmj.305.6855.687","article-title":"Social class differences in infant mortality in Sweden: comparison with England and Wales.","volume":"305","author":"Leon","year":"1992","journal-title":"BMJ"},{"key":"2025100703193926000_54.2.84.19","first-page":"117","article-title":"Preventing sudden infant deaths - the slow diffusion of an idea.","volume":"37","author":"McKee","year":"1996","journal-title":"Health Policy"},{"key":"2025100703193926000_54.2.84.20","first-page":"40","article-title":"Verschl\u00fcsselung von Todesursachen f\u00fcr Mortalit\u00e4tsstatistiken\u2014Vergleich von Signierergebnissen in verschiedenen statistischen \u00c4mtern der Bundesrepublik Deutschland und West-Berlins.","volume":"51","author":"Giersiepen","year":"1989","journal-title":"\u00d6ffentliches Gesundheitswesen"},{"key":"2025100703193926000_54.2.84.21","first-page":"257","article-title":"Todesursachen 1990\/91 im vereinten Deutschland.","volume":"4","author":"Br\u00fcckner","year":"1993","journal-title":"Wirtschaft und Statistik"},{"key":"2025100703193926000_54.2.84.22","first-page":"773","article-title":"Trends in infant mortality attributable to birth defects\u2014United States, 1980\u20131995.","volume":"47","author":"Petrini","year":"1998","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"2025100703193926000_54.2.84.23","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(95)91327-0"},{"key":"2025100703193926000_54.2.84.24","doi-asserted-by":"crossref","first-page":"486","DOI":"10.1016\/S0140-6736(95)91327-0","article-title":"Effect of changing the stillbirth definition on evaluation of perinatal mortality rates.","volume":"346","author":"Cartlidge","year":"1995","journal-title":"Lancet"},{"key":"2025100703193926000_54.2.84.25","unstructured":"Bjerkedal T Irgens LM Daltveit AK (1997) Occurrence and survival of low birthweight births in the Nordic countries, 1980\u20131994. Health statistics in the Nordic countries. NOMESCO Report no 49. (Nordic Medico Statistical Committee, Reykjavik), pp 190\u2013215."}],"container-title":["Journal of Epidemiology and Community Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/jech.54.2.84","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,7]],"date-time":"2025-10-07T10:19:51Z","timestamp":1759832391000},"score":1,"resource":{"primary":{"URL":"https:\/\/jech.bmj.com\/lookup\/doi\/10.1136\/jech.54.2.84"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2000,2,1]]},"references-count":25,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2000,2,1]]},"published-print":{"date-parts":[[2000,2,1]]}},"alternative-id":["10.1136\/jech.54.2.84"],"URL":"https:\/\/doi.org\/10.1136\/jech.54.2.84","relation":{},"ISSN":["0143-005X","1470-2738"],"issn-type":[{"value":"0143-005X","type":"print"},{"value":"1470-2738","type":"electronic"}],"subject":[],"published":{"date-parts":[[2000,2,1]]}}}