It has been well-documented that residents of socioeconomically deprived regions die earlier than those in wealthier areas, which is also true for Germany. A research team led by the Robert Koch Institute (RKI) has now shown that the life expectancy gap between Germany’s deprived and affluent regions is wider today than it was 20 years ago—and has investigated for the first time which causes of death are behind this socioeconomic life expectancy gap. Colleagues from the Federal Institute for Population Research in Wiesbaden and the Hannover Medical School also contributed to the study. The results have been published in The Lancet Public Health (https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(24)00049-5/fulltext) and Bundesgesundheitsblatt (https://rdcu.be/dEaud).

The researchers analysed data from all German residents who died between the early 2000s and the end of 2021. They linked this data to an index developed by RKI, the "German Index of Socioeconomic Deprivation", which summarises regional information on education, employment, and income. Over the entire period of about 20 years, it was observed not only that women and men in socioeconomically more deprived areas died earlier on average and have lower levels of life expectancy than those in wealthier areas, but that these differences have also increased over time. This trend was evident before 2020 and inequalities even intensified during the COVID-19 pandemic.

Cardiovascular diseases and cancer were the most important contributors to the socioeconomic life expectancy gap in Germany, but other causes such as chronic respiratory diseases were also important. According to the researchers, the increasing inequality in life expectancy is mainly due to changes in cancer trends: although cancer mortality overall has decreased in recent decades, this trend has not been observed in more deprived regions or was much weaker than in wealthier regions. Particularly, early cancer deaths, occurring before the age of 75, contributed most to the widening socioeconomic inequalities in life expectancy. During the pandemic, COVID-19 mortality was particularly high in socioeconomically deprived regions, which further widened the life expectancy gap.

The study results highlight that creating equivalent living conditions across the country is an important area of action to improve health equity in Germany, the researchers write.

Publications:

Age-specific and cause-specific mortality contributions to the socioeconomic gap in life expectancy in Germany, 2003–21: an ecological study, Lancet Public Health (May 2, 2024): https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(24)00049-5/fulltext

Socioeconomic Deprivation and Premature Mortality in Germany 1998–2021, Bundesgesundheitsblatt (March 4, 2024): https://rdcu.be/dEaud

The study was funded by German Cancer Aid, the European Research Council, and the Federal Ministry of Health.