Background: 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. This study examines how age- and cause-specific mortality contributions to the socioeconomic gap in life expectancy have changed in Germany over time.

Methods: Official German population and cause-of-death statistics from 2003 to 2021 were linked to the district-level German Index of Socioeconomic Deprivation. Life-table and decomposition methods were applied to calculate life expectancy by deprivation quintile and decompose the life expectancy gap (ΔLE) between the most and least deprived quintiles into age- and cause-specific mortality contributions.

Findings: From 2003 to 2019, the ΔLE between the most and least deprived quintiles of districts increased from 1.1 to 1.8 years among women and from 3.0 to 3.1 years among men. Thereafter, in the COVID-19 pandemic, it increased more rapidly to 2.2 and 3.5 years respectively in 2021. The causes of death contributing most to the ΔLE were cardiovascular diseases (CVD) and cancer, with declining contributions of CVD deaths at age 70 and above and increasing contributions of cancer deaths at ages 40–74 over time. COVID-19 mortality at ages 45+ was the strongest contributor to the increase in ΔLE after 2019.

Interpretation: To reduce the socioeconomic gap in life expectancy, effective efforts are needed to prevent early deaths from CVD and cancer in deprived populations, with cancer prevention and control becoming an increasingly important field of action in this respect.