Life expectancy and national income in Europe, 1900-2008: an update of Preston's analysis

Background In the past, upward shifts of the so-called Preston curve, which relates life expectancy to national income, have contributed importantly to worldwide increases in life expectancy. These shifts were due to rapid diffusion of knowledge and technology for infectious disease control from high-income to low-income countries. We assessed to what extent life expectancy growth in Europe has been accompanied by upward shifts in the relation between national income and life expectancy in later parts of the 20th century, when progress in cardiovascular disease control was the main driver of life expectancy growth. Methods Data on national income (gross domestic product per capita, in 1990 international dollars), life expectancy and cause-specific mortality covering the period 1900-2008 were extracted from international data banks. (Change in) life expectancy and age-standardized mortality was regressed on (change in) national income, and the regression parameters were used to estimate the contribution to rising life expectancy and declining mortality in Europe as a whole of changes in national income vs shifts in the relation between national income and health outcomes. Results Large upward shifts in the relation between national income and life expectancy only occurred before 1960, and were due to rapid declines in mortality from infectious diseases which were independent of rises in national income. These shifts account for between two-thirds and four-fifths of the increase in life expectancy in Europe as a whole during this period. After 1960, upward shifts in the relation between national income and life expectancy were much smaller, and contributed only between one-quarter and one-half to the increase in life expectancy in Europe as a whole. During the latter period, declines in mortality from cardiovascular disease were mainly attributable to increases in national income. Conclusions In contrast to earlier periods, recent life expectancy growth in European countries appears to have been dependent on their economic growth. More rapid diffusion of knowledge and technology for cardiovascular disease control from higher- to lower-income countries in Europe may be needed to close the East-West life expectancy gap, but it is unlikely that this can be achieved in the absence of more equal economic conditions.