Does the Mortality of Individuals with Severe Disabilities Contribute to the Persistent East–West Mortality Gap Among German Men?

Abstract

After three decades since reunification male life expectancy in East Germany still lags behind that of West Germany. Unlike most of the prior studies focusing on the role of socioeconomic factors, this study aims at assessing the contribution of the population with severe disabilities to the persistent East–West male mortality gap. Our analysis is mainly based on the German Pension Fund data. It is restricted to men aged 30–59 receiving disability pension (DP). We estimate mortality indicators and compare trends among populations with or without DP. We use decomposition method to quantify the effects of changes in mortality and compositional changed in the prevalence of receiving DP on the East–West mortality difference. The analysis covers the period 1995–2013. The German Socioeconomic Panel data and Cox proportional hazard models are used to evaluate the regional differences in the risk of receiving DP. Our results suggest that both the higher prevalence of receiving DP in the East and the higher mortality level among men not receiving DP in the East explain the East–West gap. The mortality difference among those receiving DP is negligible and does not contribute much to it. The observed higher prevalence in receiving DP in the East is very likely to reflect the reality as we found no regional differences in the risk of transitioning to receiving DP. The disadvantageous position of the East can be explained by the post-reunification crisis which particularly hit young men in the 1990s, selective migration from East to West after reunification, and the higher proportion of the healthier foreign population living in the West.

The socioeconomic gap in life expectancy in Germany: a decomposition of age- and cause-specific mortality contributions, 2003–2021

“…The sharp decline in CVD mortality is one of the most important factors behind the increase in life expectancy in recent decades [9, 21]. However, large regional and socioeconomic differences in the overall level and in the pace of declines were reported for CVD mortality [9, 17, 21]. Jasilionis et al have suggested that the stagnation in CVD mortality and these large regional and socioeconomic inequalities in mortality, which increased over time, may be the driving forces behind the current stagnation in life expectancy [2].…”

“…In addition, a north-south divide was reported with lower cancer mortality in the less deprived districts in southern Germany [18]. The currently still remaining gap in life expectancy of about 1 year in 2017 between eastern and western German men was mainly due to the less favourable development of cancer and cardiovascular mortality in the eastern parts of Germany [9, 18, 21]. For women it was mainly the sharp decline in differences in cardiovascular mortality during the transformation process that led to the disappearance of differences in life expectancy between eastern and western Germany [9].…”

Quantifying the contribution of smoking to regional mortality disparities in Germany: a cross-sectional study

“…It has been suggested that in addition to the differences in socioeconomic conditions, a substantially higher proportion of men with severe health problems in the East could explain the disadvantageous position of the East. 26 …”

“…Our results suggest that past smoking behaviour does not explain the persistent health disadvantage of Eastern men that has been observed during the last two decades. It has been suggested that in addition to the differences in socioeconomic conditions, a substantially higher proportion of men with severe health problems in the East could explain the disadvantageous position of the East 26…”

“…It has been suggested that in addition to the differences in socioeconomic conditions, a substantially higher proportion of men with severe health problems in the East could explain the disadvantageous position of the East. 26 Among women, the elimination of smoking-attributable deaths within Western German regions would halve the current life expectancy gap with the vanguard region South. The elimination of smoking-attributable deaths had little effect on the gap between the regions East and South until the late 1990s.…”