New Article in “The Lancet Public Health” • 01.05.2024Socioeconomic Gap in Life Expectancy in Germany

Earlier death among people in socioeconomically deprived circumstances has been found internationally and for various causes of death, resulting in a considerable life-expectancy gap between socioeconomic groups. For this study, Fabian Tetzlaff from the Robert Koch Institute (RKI) along with Markus Sauerberg, Pavel Grigoriev and Michael Mühlichen from our REDIM team and other researchers from RKI and Hannover Medical School, examined how age-specific and cause-specific mortality contributions to the socioeconomic gap in life expectancy have changed at the area level in Germany over time.

In this ecological study, official German population and cause-of-death statistics provided by the Federal Statistical Office of Germany for the period Jan 1, 2003, to Dec 31, 2021, were linked to district-level data of the German Index of Socioeconomic Deprivation. Life-table and decomposition methods were applied to calculate life expectancy by area-level deprivation quintile and decompose the life-expectancy gap between the most and least deprived quintiles into age-specific and cause-specific mortality contributions.

The authors found that the gap in life expectancy between the most and least deprived quintiles of districts increased by 0.7 years among females (from 1.1 to 1.8 years) and by 0.1 years among males (from 3.0 to 3.1 years) between 2003 and 2019. Thereafter, during the COVID-19 pandemic, the gap increased more rapidly to 2.2 years in females and 3.5 years in males in 2021. Between 2003 and 2021, the causes of death that contributed the most to the life-expectancy gap were cardiovascular diseases and cancer, with declining contributions of cardiovascular disease deaths among those aged 70 years and older and increasing contributions of cancer deaths among those aged 40–74 years over this period. COVID-19 mortality among individuals aged 45 years and older was the strongest contributor to the increase in life-expectancy gap after 2019.

The authors conclude that, in order to reduce the socioeconomic gap in life expectancy, effective efforts are needed to prevent early deaths from cardiovascular disease and cancer in socioeconomically deprived populations, with cancer prevention and control becoming an increasingly important field of action in this respect.

Tetzlaff, Fabian; Sauerberg, Markus; Grigoriev, Pavel; Tetzlaff, Juliane; Mühlichen, Michael; Baumert, Jens; Michalski, Niels; Wengler, Annelena; Nowossadeck, Enno; Hoebel, Jens (2024): Age-specific and cause-specific mortality contributions to the socioeconomic gap in life expectancy in Germany, 2003–21: an ecological study. The Lancet Public Health 9(5): 295–305.