Declining regional disparities in mortality in the context of persisting large inequalities in economic conditions: the case of Germany.

Alyson A Van Raalte,Anna Oksuzyan,Pavel Grigoriev,Sebastian Klüsener

doi:10.1093/ije/dyz265

Abstract

BackgroundSubnational regional mortality inequalities are large and appear to be mostly increasing within industrialized countries, although comparative studies across high-income countries are scarce. Germany is an important country to examine because it continues to experience considerable economic disparities between its federal states, in part resulting from its former division.MethodsWe analyse state-level mortality in Germany utilizing data from a newly constructed regional database based on the methodology of the Human Mortality Database. We compare time trends (1991–2015) in the German state-level standard deviation in life expectancy to that of other large, wealthy countries and examine the association between mortality and economic inequalities at the regional level. Finally, using contour-decomposition methods, we investigate the degree to which age patterns of mortality are converging across German federal states.ResultsRegional inequalities in life expectancy in Germany are comparatively low internationally, particularly among women, despite high state-level inequalities in economic conditions. These low regional mortality inequalities emerged 5–10 years after reunification. Mortality is converging over most ages between the longest- and shortest-living German state populations and across the former East–West political border, with the exception of an emerging East–West divergence in mortality among working-aged men.ConclusionsThe German example shows that large regional economic inequalities are not necessarily paralleled with large regional mortality disparities. Future research should investigate the factors that fostered the emergence of this unusual pattern in Germany.

Highlights

What belongs together, will grow together (Willy Brandt).Following the collapse of the Berlin Wall, Brandt’s famous quote aspired to a convergence of living conditions in what 1 year later would become a unified Germany
Regional inequalities in per-capita GDP and regional inequalities in life expectancy we found that regional per-capita GDP levels were associated with regional life-expectancy levels within large European nations, which is consistent with existing findings on the relationship between mortality and economic conditions at the national[40] and subnational regional levels,[11,31] we did not find any association between inequalities in GDP and inequalities in life expectancy across subnational regions within these same countries
This concords with findings at the individual level showing that the relationship between income inequality and inequalities in life expectancy is weaker in countries guided by a more extensive state-welfare system compared with the USA or the UK.[40]

Summary

Introduction

Will grow together (Willy Brandt).Following the collapse of the Berlin Wall, Brandt’s famous quote aspired to a convergence of living conditions in what 1 year later would become a unified Germany. We compare time trends (1991–2015) in the German state-level standard deviation in life expectancy to that of other large, wealthy countries and examine the association between mortality and economic inequalities at the regional level. Using contourdecomposition methods, we investigate the degree to which age patterns of mortality are converging across German federal states. Results: Regional inequalities in life expectancy in Germany are comparatively low internationally, among women, despite high state-level inequalities in economic conditions. These low regional mortality inequalities emerged 5–10 years after reunification. Future research should investigate the factors that fostered the emergence of this unusual pattern in Germany

Results

Discussion

Conclusion