There are regional differences in life expectancy in Germany. This becomes particularly visible in a lower life expectancy in the eastern and northern parts of Germany. Consequently, in the northeastern-most state of Mecklenburg-Vorpommern (MV) life expectancy is lower than in most other German federal states, also in comparison to its western neighbouring country Schleswig-Holstein (SH). These differences were especially marked at the time of German reunification, have however enormously decreased since then. Did urban and rural regions profit to the same extent from this development? Where are still differences between the two federal states according to sex, region and cause of death? By the means of standardised death rates based on the official German cause of death statistics from 1990 to 2011, this paper shows that the mortality decline was greater in MV than in SH and that the mortality rate of the urban areas of MV are meanwhile on the same level as the urban areas of SH for men, for women even lower. In the rural areas of MV and in the region of Vorpommern, however, mortality is still considerably higher than in any region of SH. Since these differences are especially related to cardiovascular diseases, socio-economic and risk-relevant factors as well as selective migration and the worse accessibility of medical care in the rural parts of MV are possible causes. At these points, there is still need for action.