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Folia Geographica 2026, 68/1, pp. ...

FEAST-WEST AND GENDER MORTALITY GAPS IN EUROPE’S ELDERLY POPULATION DURING THE COVID-19 PERIOD

Adéla POLAA, Klára HULÍKOVÁ TESÁRKOVÁB*, Dagmar DZÚROVÁC

Received: September 30, 2025 | Revised: November 12, 2025 | Accepted: January 2, 2026

Paper No. 26-68/1-776


A Charles University, Prague, Czechia
https://orcid.org/0000-0001-5911-4553
     adela.pola@natur.cuni.cz

B* Charles University, Prague, Czechia
https://orcid.org/0000-0003-4315-1530
     klara.hulikova@natur.cuni.cz (corresponding author)

A* Charles University, Prague, Czechia
https://orcid.org/0000-0003-0530-4997
     dagmar.dzurova@natur.cuni.cz

 

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Abstract
This study examines changes in old-age mortality in Europe during the COVID-19 pandemic period, focusing on two critical disparities: the East-West mortality gap and the gender mortality gap. Motivated by long-term variations in mortality rates across European regions and between sexes, this research aims to clarify how these inequalities changed during the pandemic. By addressing the interplay between regional and gender-based disparities, the study contributes to a deeper understanding of the pandemic’s effects on vulnerable populations, particularly the elderly. Factor and cluster analyses were employed to categorise European countries into clusters for comparison of mortality trends and to evaluate the persistence of the East-West gradient. The research on mortality gaps utilises a quantitative approach, analysing data from the Human Mortality Database and Eurostat for the years 2019–2022. Annual weighted and unweighted mean differences in life expectancy at age 65 were calculated to assess changes during the pandemic. Gender-specific differences were examined alongside regional disparities to highlight the compounded impacts of the pandemic on old-age populations. The study reveals that during the COVID-19 pandemic, the East-West mortality gap among the elderly widened. Before the pandemic, the life expectancy difference at age 65 between Eastern and Western Europe was 4.44 years for men and 3.24 years for women. By 2022, this gap widened to 6.02 years for men and 4.75 years for women. Western European countries showed signs of recovery in 2022, whereas Eastern European countries experienced prolonged declines in life expectancy. Gender disparities remained relatively stable during the pandemic, with differences of approximately 4.4 years in Eastern Europe and 3.2 years in Western Europe. The findings underscore the pandemic’s role in amplifying regional inequalities while maintaining gender disparities. This study provides novel insights into the compounded impacts of the COVID-19 pandemic on old-age mortality in Europe, emphasising the interplay between regional and gender gaps. It contributes to the literature by demonstrating how crises, such as pandemics, can exacerbate existing inequalities. The findings have significant implications for public health policies, highlighting the need for targeted interventions to address regional disparities and support ageing populations in vulnerable regions.

Key words
Life expectancy at age 65, East-West mortality gap, gender mortality gap, COVID-19, European countries.

 

REFERENCES

  1. ALLEL, K., SALUSTRI, F., HAGHPARAST-BIDGOLI, H. AND KIADALIRI, A. (2021). The contributions of public health policies and healthcare quality to gender gap and country differences in life expectancy in the UK. Population Health Metrics, 19(1), p.40.
  2. BAMBRA, C., RIORDAN, R., FORD, J. AND MATTHEWS, F. (2020). The COVID-19 pandemic and health inequalities. Journal of Epidemiology and Community Health, 74(11), pp.964–968.
  3. BOBAK, M. AND MARMOT, M. (1996). East-West mortality divide and its potential explanations: proposed research agenda. BMJ: British Medical Journal, 312(7028), pp.421–425.
  4. BEEGLE, K., DEMOMBYNES, G., DE WALQUE, D., GUBBINS, P., AND VEILLARD, J. (2024). COVID-19 increased existing gender mortality gaps in high-income more than middle-income countries. International Journal of Infectious Diseases, 148, 107167.
  5. CARRACEDO, P., DEBÓN, A., IFTIMI, A. AND MONTES, F. (2018). Detecting spatio-temporal mortality clusters of European countries by sex and age. International Journal for Equity in Health, 17(1), p.38.
  6. DAHLGREN, G. AND WHITEHEAD, M. (1991). Policies and strategies to promote social equity in health. Background document to WHO – Strategy paper for Europe. Institute for Futures Studies, Arbetsrapport, 14.
  7. DEBÓN, A., CHAVES, L., HABERMAN, S. AND VILLA, F. (2017). Characterization of between-group inequality of longevity in European Union countries. Insurance: Mathematics and Economics, 75, pp.151–165.
  8. EUROSTAT. (2024). Population on 1 January by age group and sex. 2024.
  9. HUANG, G., GUO, F., ZIMMERMANN, K.F., LIU, L., TAKSA, L., CHENG, Z., TANI, M. AND FRANKLIN, M. (2023). The effect of the COVID-19 pandemic on life expectancy in 27 countries. Scientific Reports, 13(1), p.8911.
  10. IGARI, A. (2023). Spatiotemporal inequalities of excess mortality in Europe during the first two years of the Covid-19 pandemic. Regional Statistics, 13(3), pp.510–535.
  11. JANSSEN, F. (2020). Changing contribution of smoking to the sex differences in life expectancy in Europe, 1950–2014. European Journal of Epidemiology, 35(9), pp.835–841.
  12. JASILIONIS, D., MESLÉ, F. AND VALLIN, J. (2023). Is East-West life expectancy gap narrowing in the enlarged European Union? Comparative Population Studies, 48, pp.523–552.
  13. LEÃO, T., DOETSCH, J., HENRIQUES, A. AND FRAGA, S. (2024). Is gender equality associated with a longer healthier life? Ecological evidence from 27 European countries. Journal of Public Health, 46(1), pp.136–143.
  14. LEMARCHAND, P., PAPE, M., SCHWARZ, J. (2025). Understanding sex and gender disparities in COVID-19 mortality. Biology of Sex Differences, 16, p.76.
  15. LEON, D.A. (2011). Trends in European life expectancy: a salutary view. International Journal of Epidemiology, 40(2), pp.271–277.
  16. LINK, B.G. AND PHELAN, J. (1995). Social conditions as fundamental causes of disease. Journal of Health and Social Behavior, Special Issue, pp.80–94.
  17. Max Planck Institute for Demographic Research (Germany), University of California, Berkeley (USA), and French Institute for Demographic Studies (France). Human Mortality Database.
  18. MESLÉ, F. (2004). Mortality in Central and Eastern Europe: Long-term trends and recent upturns. Demographic Research, Special Collection 2, pp.45–70.
  19. MESLÉ, F., VALLIN, J. AND ANDREYEV, Z. (2002). Mortality in Europe: The Divergence between East and West. Population (English Edition), 57(1), pp.157–197.
  20. MILLER, W.L., KOSHECHKINA, T.Y. AND GRØDELAND, Å.B. (2004). Diffuse Trust or Diffuse Analysis? The Specificity of Political Distrust in Post-Communist Europe. In: Marková, I. (ed.). Trust and Democratic Transition in Post-Communist Europe. British Academy.
  21. NINGSIH, A.P., SARI, T.B. AND INDIRWAN, D. (2024). Leave no one behind: potential solution for gender equality. Journal of Public Health, 46(3), pp.e603–e603.
  22. OECD. (2023). Health at a Glance 2023. OECD.
  23. PINHO-GOMES, A.C., VASSALLO, A., CARCEL, C., PETERS, S. AND WOODWARD, M. (2022). Gender equality and the gender gap in life expectancy in the European Union. BMJ Global Health, 7(2).
  24. PINHO-GOMES, A.C., PETERS, S.A.E., WOODWARD, M. (2023). Gender equality related to gender differences in life expectancy across the globe. PLOS Global Public Health, 3(3), e0001214.
  25. PIZZATO, M., GERLI, A.G., LA VECCHIA, C. AND ALICANDRO, G. (2024). Impact of COVID-19 on total excess mortality and geographic disparities in Europe, 2020–2023: A spatio-temporal analysis. The Lancet Regional Health – Europe, 44, 100996.
  26. SCHÖLEY, J., ABURTO, J.M., KASHNITSKY, I., KNIFFKA, M.S., ZHANG, L., JAADLA, H., DOWD, J.B. AND KASHYAP, R. (2022). Life expectancy changes since COVID-19. Nature Human Behaviour, 6(12), pp.1649–1659.
  27. SHKOLNIKOV, V.M., TIMONIN, S., JDANOV, D., MEDINA-JAUDES, N., ISLAM, N. AND LEON, D.A. (2024). East-West mortality disparities during the COVID-19 pandemic widen the historical longevity divide in Europe: an international comparative study. medRxiv preprint.
  28. TLESHOVA, U., HULÍKOVÁ TESÁRKOVÁ, K. AND DZÚROVÁ, D. (2025). Decoding life expectancy gaps: a long-term decomposition analysis of three WHO European Region country groups. Cogent Social Sciences, 11(1).
  29. United Nations, Department of Economic and Social Affairs, Population Division. (2022). World Population Prospects 2022.
  30. VÅGERÖ, D. (2010). The East–West Health Divide in Europe: Growing and Shifting Eastwards. European Review, 18(1), pp.23–34.
  31. VELKOVA, A., WOLLESWINKEL-VAN DEN BOSCH, J.H. AND MACKENBACH, J.P. (1997). The East-West life expectancy gap: differences in mortality from conditions amenable to medical intervention. International Journal of Epidemiology, 26(1), pp.75–84.
  32. YLLI, A., BURAZERI, G., WU, Y.Y. AND SENTELL, T. (2022). COVID-19 excess deaths in Eastern European countries associated with weaker regulation implementation and lower vaccination coverage. Eastern Mediterranean Health Journal, 28(10), pp.776–780.