The underwhelming German life expectancy

Abstract

This article contributes to the discussion on the determinants of diverging life expectancy in high-income countries, with a focus on Germany. To date, much of this discourse has centered around the social determinants of health, issues of healthcare equity, poverty and income inequality, and new epidemics of opioids and violence. Yet despite doing well on all of these metrics and having numerous advantages such as comparatively strong economic performance, generous social security, and an equitable and well-resourced health care system, Germany has been a long-time life expectancy laggard among the high-income countries. Using aggregated population-level mortality data for Germany and selected six high-income countries (Switzerland, France, Japan, Spain, the United Kingdom, and the United States) from the Human Mortality Database and WHO Mortality Database, we find that the German longevity shortfall is mainly explained by a longstanding disadvantage in survival among older adults and adults nearing statutory retirement age, which mainly stems from sustained excess cardiovascular disease mortality, even when compared to other laggard countries such as the US and the UK. Patchy contextual data suggests that the unfavorable pattern of cardiovascular mortality may be driven by underperforming primary care and disease prevention. More systematic and representative data on risk factors are needed to strengthen the evidence base on the determinants of the controversial and long-standing health gap between more successful countries and Germany. The German example calls for broader narratives of population health that embed the variety of epidemiological challenges populations face around the globe.

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

“…First results on the impact of the COVID-19 pandemic on life expectancy have reported substantial decreases in life expectancy in almost all high-income countries [2-6], which is supported by our study for Germany. In addition, our findings show that COVID-19 as a new cause of death has not only increased mortality overall, but was also accompanied by widening socioeconomic inequalities in life expectancy during the pandemic.…”

“…Compared to other high-income countries, Germany also shows a less favourable development in mortality between the ages of 50 and 79 years, but also in the age groups above. Almost half of the difference between these countries and Germany is explained by the mortality in age groups 50-79 and 80+ [2]. In our study, we were able to show that the mortality inequalities in these age groups drive socioeconomic inequalities in life expectancy and may also contribute to explaining the currently stagnating trends in life expectancy in Germany.…”

“…in the US and the UK) [2]. During the COVID-19 pandemic, life expectancy decreased substantially in almost all high-income countries [2-6]. Since German reunification in 1990, life expectancy (at birth) in Germany increased by 0.27 years annually until 2010, but slowed down thereafter, peaking in 2019 at 78.7 years for men and 83.5 years for women.…”

“…However, there are considerable regional variations in mortality levels and trends, even within German federal states [5, 8]. The reasons for these differences could be differences in economic prosperity as well as differences in population composition by socioeconomic position, exacerbated by selective migration, factors considered to be related to health-related behaviours, and health infrastructures in the regions [2, 5, 8, 9]. In general, however, the differences between the districts decreased from 1997 to 2016 due to the strong decline in mortality in the eastern parts of Germany [8].…”

“…Jasilionis et al have suggested that, in addition to regional inequalities, widening socioeconomic inequalities in health may be the driving forces behind the current developments in life expectancy in Germany [2]. Numerous international studies have reported higher mortality among people with lower socioeconomic position (e.g.…”