Transition shocks during adulthood and health a few decades later in post-socialist Central and Eastern Europe

Comparative analysis of health status and health service utilization patterns among rural and urban elderly populations in Hungary: a study on the challenges of unhealthy aging

The demographic transition poses a significant challenge for health systems, especially in Central and Eastern European (CEE) countries, where the healthcare needs of aging populations are on the rise. This study aimed to describe and compare the health status and utilization of health services among the elderly residing in urban and rural areas of the most deprived region in Hungary. A comprehensive health survey was conducted in 2022, involving a randomly selected sample of 443 older adults (≥ 65 years) in Northeast Hungary. Multivariable logistic regression models adjusting for age, sex, education, financial status, chronic diseases, and activity limitations were used to investigate the association between type of residence and health service use. Among the study participants, 62.3% were female, 38.3% attained primary education, 12.5% reported a bad or very bad financial situation and 52.6% lived in urban areas. Overall, 24% of the elderly rated their health as very good or good (27.8% in urban and 19.7% in rural areas), while 57.8% (52.6% and 63.5% in urban and rural areas) reported limitations in daily activities. Compared to urban residents, rural residents reported lower rates of dentist visits (p = 0.006), specialist visits (p = 0.028), faecal occult blood testing (p < 0.001), colorectal cancer screening with colonoscopy (p = 0.014), and breast cancer screening (p = 0.035), and a higher rate of blood pressure measurement (p = 0.042). Multivariable models indicated that urban residence was positively associated with faecal occult blood testing (OR = 2.32, p = 0.014), but negatively associated with blood pressure (OR = 0.42, p = 0.017) and blood glucose measurements (OR = 0.48, p = 0.009). These findings highlight the influence of residence on health service utilization among older adults in Hungary. Further comprehensive studies are needed to better understand the health needs of the elderly population and to develop policies aimed at promoting healthy aging in CEE countries.

The Short-Term Effects of European Integration on Mortality Convergence: A Case Study of European Union's 2004 Enlargement

Although European integration can be expected to result in mortality convergence (reduced mortality differences), a life expectancy divide persists in the European Union (EU) between the old Member States (OMS) in the west and the new Member States (NMS) in the east. Studies investigating the impact of European integration on mortality convergence are rare and did not consider regional differences. We examine the short-term effects of the 2004 enlargement on mortality convergence at the supranational, national, and subnational levels. Using sex-specific life expectancies for 23 Member States (1990-2017) and the NUTS 2 regions in Czechia, Hungary, and Poland for 1992-2016, we examined the trend in sigma and beta mortality convergence measures at the country and regional levels using joinpoint regression. We found no compelling evidence that EU accession influenced the process of mortality convergence between OMS and NMS, or within the three NMS, over the short term. While there was overall beta and sigma convergence at the national level during 1990-2017, no regional convergence showed, and the trends in convergence did not significantly change at the time of EU accession or soon after (2004-2007). The accession in 2004 did not visibly impact the overall process of mortality convergence over the short term, likely because of the greater influence of country and region-specific policies and characteristics. The interaction of Member State and regional contexts with the mechanisms of European integration requires further study. Future enlargement procedures should emphasise tailored support to ensure more equitable gains from European integration.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10680-021-09596-y.

A Divide between the Western European and the Central and Eastern European Countries in the Peripheral Vascular Field: A Narrative Review of the Literature

Thirty years after the transition period, starting from 1989, Central and Eastern European countries (CEECs), representing one-fifth of the entire European population, share many historical, societal, political, economic, and cultural characteristics. Although accumulating data on coronary heart diseases and cerebrovascular diseases support these observations, in the case of peripheral arterial disease, data are scarce. The present review attempts to summarise the shreds of data that may highlight a divide in this field between CEECs and Western European countries. Disparities in risk factors and peripheral vascular care across Europe seem to be tangible and can be seen as a signal of existing differences. Improvements in research and development and the collection and cross-border share of scientific data are essential to initiate and facilitate convergence in this field.

Health inequalities in Eastern Europe. Does the role of the welfare regime differ from Western Europe?

When we study the impact of social policy on health inequalities, we find that most research is based on Western European countries. This study expands the geographical focus by including post-communist countries from Eastern Europe, Russia, and the Caucasus. The 2008/2009 round of the European Values Study (EVS) provides a unique opportunity for this analysis since it covers 23 post-communist countries and 20 Western European countries. The study uses multilevel cross-sectional analyses to examine the moderating role of welfare regimes on socioeconomic health inequalities. Many reviews claim that the results for welfare systems and health inequalities are inconsistent. However, since the studies selected for the reviews are mainly focused on Western Europe-only a few include Central Eastern European countries-we still need to find out how welfare regimes in post-communist countries moderate the link between socioeconomic status and health. A cluster analysis based on 13 social and economic indicators generates 4 welfare clusters within the post-communist countries which are used for further analyses. Regarding the achievements of the communist countries in compulsory secondary education, the expectation is that the educational health inequalities differ between Eastern and Western Europe. The multilevel analyses confirm that social gradients in health related to education and income exist in both Western and Eastern Europe. However, while income-related health inequalities are similar, educational health inequalities are most pronounced in the welfare cluster of the EU Member States of Central and Eastern Europe.