Skip to main content

Advertisement

SpringerLink
Log in

Individual- and area-level effects on mortality risk in Germany, both East and West, among male Germans aged 65+

  • Original Article
  • Published:
International Journal of Public Health

Abstract

Objectives

This study investigates whether mortality inequalities based on individual- and area-level deprivation exist at older ages in Germany, and whether there are differences between eastern and western Germany.

Methods

Data on population and death counts according to the individual-level socioeconomic status of male German pensioners aged 65+ years in Germany in 2002–2004 were obtained from the German Federal Pension Fund. Area-level characteristics for the 439 German districts were incorporated. Multilevel Poisson models were fitted.

Results

Individual-level socioeconomic mortality inequalities exist among elderly men in Germany. After controlling for differential population composition in the districts, we found that district-level factors contribute to the explanation of mortality inequalities in (western) Germany. The analysis further indicated that mortality and mortality inequalities tend to be higher in more economically deprived districts, and that minor mortality differences attributable to regional conditions exist in eastern Germany.

Conclusions

The results showed that regional conditions have moderate effects on health inequalities at older ages in (western) Germany, when the differential population composition in the districts is controlled for.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  • Breckenkamp J, Mielck A, Razum O (2007) Health inequalities in Germany: do regional-level variables explain differentials in cardiovascular risk? BMC Public Health 7:132. doi:10.1186/1471-2458-7-132

    Article  PubMed Central  PubMed  Google Scholar 

  • Brzoska P, Razum O (2008) Indebtedness and mortality: analysis at county and city levels in Germany. Gesundheitswesen 70:387–392. doi:10.1055/s-2008-1080935

    Article  CAS  PubMed  Google Scholar 

  • Chaix B, Rosvall M, Merlo J (2007) Assessment of the magnitude of geographical variations and socioeconomic contextual effects on ischaemic heart disease mortality: a multilevel survival analysis of a large Swedish cohort. J Epidemiol Commun H 61:349–355. doi:10.1136/jech.2006.047597

    Article  Google Scholar 

  • Christensen K, Doblhammer G, Rau R, Vaupel JW (2009) Ageing populations: the challenges ahead. Lancet 374:1196–1208. doi:10.1016/j.bbr.2011.03.031

    Article  PubMed Central  PubMed  Google Scholar 

  • Cummins S, Curtis S, Diez-Roux AV, Macintyre S (2007) Understanding and representing ‘place’ in health research: a relational approach. Soc Sci Med 65:1825–1838. doi:10.1016/j.socscimed.2007.05.036

    Article  PubMed  Google Scholar 

  • Diehl K, Schneider S (2011) How relevant are district characteristics in explaining subjective health in Germany?: a multilevel analysis. Soc Sci Med 72:1205–1210. doi:10.1016/j.socscimed.2011.02.013

    Article  PubMed  Google Scholar 

  • Diez Roux AV (2001) Investigating neighborhood and area effects on health. Am J Public Health 91:1783–1789. doi:10.2105/AJPH.91.11.1783

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  • Dragano N, Bobak M, Wege N, Peasey A, Verde PE, Kubinova R, Weyers S, Moebus S, Möhlenkamp S, Stang A, Erbel R, Jöckel K-H, Siegrist J, Pikart H (2007) Neighbourhood socioeconomic status and cardiovascular risk factors: a multilevel analysis of nine cities in the Czech Republic and Germany. BMC Public Health 7:255. doi:10.1186/1471-2458-7-255

    Article  PubMed Central  PubMed  Google Scholar 

  • FDZ-RV (2012) (Research data center of the German Federal Pension Fund). Dataset FDZ-RV-SUFRTBNRTWF02-04TDemoKibeleKreis, Rentenwegfall/-bestand 2002–2004

  • Himmelreicher RK, Sewöster D, Scholz R, Schulz A (2008) Die fernere Lebenserwartung von Rentnern und Pensionären im Vergleich WSI Mitteilungen, 5:274–280

  • Huisman M, Kunst AE, Andersen O, Bopp M, Borgan J-K, Borrell C, Costa G, Deboosere P, Desplanques G, Donkin A, Gadeyne S, Minder C, Regidor E, Spadea T, Valkonen T, Mackenbach JP (2004) Socioeconomic inequalities in mortality among elderly people in 11 European populations. J Epidemiol Commun H 58:468–475. doi:10.1136/jech.2003.010496

    Article  CAS  Google Scholar 

  • Human Mortality Database (2012) University of California, Berkeley (USA), and Max Planck Institute for Demographic Research (Germany). Available at www.mortality.org or www.humanmortality.org. Accessed 24 September 2012

  • Kemptner D, Wildner M, Abu-Omar K, Caselmann WH, Kerscher G, Reitmeir P, Mielck A, Rütten A (2008) Regional differences in health behaviour in Bavaria—a multilevel analysis of a representative population questionnaire in combination with socioeconomic structural data. Gesundheitswesen 70:28–37. doi:10.1055/s-2007-1022523

    Article  CAS  PubMed  Google Scholar 

  • Kibele EUB (2012) Regional mortality differences in Germany. Springer, Dordrecht

    Book  Google Scholar 

  • Klein J, Vonneilich N, Baumeister SE, Kohlmann T, von dem Knesebeck O (2012) Do social relations explain health inequalities? Evidence from a longitudinal survey in a changing eastern German region. Int J Public Health 57:619–627. doi:10.1007/s00038-012-0356-y

    Article  PubMed  Google Scholar 

  • Kreft D, Doblhammer G (2012) Contextual and individual determinants of health among Aussiedler and native Germans. Health Place 18:1046–1055. doi:10.1016/j.healthplace.2012.05.008

    Article  PubMed  Google Scholar 

  • Kroh M, Neiss H, Kroll L, Lampert T (2012) Menschen mit hohen Einkommen leben länger. DIW Wochenbericht 38:3–15

    Google Scholar 

  • Kunst AE, Bos V, Santana P, Valkonen T, Mackenbach JP, Andersen O, Cardano M, Costa G, Harding S, Hemström Ö, Layte R, Regidor E, Reid A (2004) Monitoring of trends in socioeconomic inequalities in mortality. Experiences from a European project. Demogr Res Special Collect 2:229–254. doi:10.4054/DemRes.2004.S2.9

    Article  Google Scholar 

  • Lantz PM, Pritchard A (2010) Socioeconomic indicators that matter for population health. Prev Chronic Dis 7:1–7

    Google Scholar 

  • Latzitis N, Sundmacher L, Busse R (2011) Regional differences in life expectancy in Germany at county levels and their possible determinants. Gesundheitswesen 73:217–228. doi:10.1055/s-0030-1252035

    Article  CAS  PubMed  Google Scholar 

  • Luy M (2006) Differentielle Sterblichkeit: die ungleiche Verteilung der Lebenserwartung in Deutschland. Rostocker Zentrum—Diskussionspapier 6

  • Mackenbach JP, Stirbu I, Roskam A-JR, Schaap MM, Menvielle G, Leinsalu M, Kunst AE, For the European Union Working Group on Socioeconomic Inequalities in Health (2008) Socioeconomic inequalities in health in 22 European countries. N Engl J Med 358:2468–2481. doi:10.1056/NEJMsa0707519

    Article  CAS  PubMed  Google Scholar 

  • Maier W, Fairburn J, Mielck A (2012) Regional deprivation and mortality in Bavaria. Development of a community-based index of multiple deprivation. Gesundheitswesen 74:416–425. doi:10.1055/s-0031-1280846

    Article  CAS  PubMed  Google Scholar 

  • Majer IM, Nusselder WJ, Mackenbach JP, Kunst AE (2011) Socioeconomic inequalities in life and health expectancies around official retirement age in 10 Western-European countries. J Epidemiol Commun H 65:972–979. doi:10.1136/jech.2010.111492

    Article  CAS  Google Scholar 

  • Martikainen P, Kauppinen TM, Valkonen T (2003) Effects of the characteristics of neighbourhoods and the characteristics of people on cause specific mortality: a register based follow up study of 252,000 men. J Epidemiol Commun H 57:210–217. doi:10.1136/jech.57.3.210

    Article  CAS  Google Scholar 

  • Meijer M, Röhl J, Bloomfield K, Grittner U (2012) Do neighborhoods affect individual mortality? A systematic review and meta-analysis of multilevel studies. Soc Sci Med 74:1204–1212. doi:10.1016/j.socscimed.2011.11.034

    Article  PubMed  Google Scholar 

  • Merlo J (2011) Contextual influences on the individual life course: building a research framework for social epidemiology. Psychosoc Interv 20:109–118

    Article  Google Scholar 

  • Mohnen SM, Volker B, Flap H, Groenewegen PP (2012) Health-related behavior as a mechanism behind the relationship between neighborhood social capital and individual health: a multilevel analysis. BMC Public Health 12:116. doi:10.1186/1471-2458-12-116

    Article  PubMed Central  PubMed  Google Scholar 

  • Nolte E, Shkolnikov V, McKee M (2000) Changing mortality patterns in East and West Germany and Poland. II: short-term trends during transition and in the 1990s. J Epidemiol Commun H 54:899–906. doi:10.1136/jech.54.12.899

    Article  CAS  Google Scholar 

  • Pickett KE, Pearl M (2001) Multilevel analyses of neighbourhood socioeconomic context and health outcomes: a critical review. J Epidemiol Commun H 55:111–122. doi:10.1136/jech.55.2.111

    Article  CAS  Google Scholar 

  • Queste A (2007) Analyse kleinräumiger Mortalitätsraten in Deutschland. Landesinstitut für den Öffentlichen Gesundheitsdienst des Landes Nordrhein-Westfalen (lögd), Bielefeld

  • Rabe-Hesketh S, Skrondal A (2008) Multilevel and Longitudinal Modeling Using Stata, 2nd edn. Stata Press, College Station

    Google Scholar 

  • Razum O, Altenhöner T, Breckenkamp J, Voigtländer S (2008) Social epidemiology after the German reunification: east vs. west or poor vs. rich? Int J Public Health 53:13–22. doi:10.1007/s00038-007-6116-8

    Article  PubMed  Google Scholar 

  • Regionaldatenbank Deutschland (2012) Statistische Ämter des Bundes und der Länder. Available at www.regionalstatistik.de. Accessed 9 July 2012

  • Riva M, Gauvin L, Barnett TA (2007) Toward the next generation of research into small area effects on health: a synthesis of multilevel investigations published since July 1998. J Epidemiol Commun H 61:853–861. doi:10.1136/jech.2006.050740

    Article  Google Scholar 

  • Shkolnikov VM, Scholz R, Jdanov DA, Stegmann M, von Gaudecker H-M (2008) Length of life and the pensions of five million retired German men. Eur J Public Health 18:264–269. doi:10.1093/eurpub/ckm102

    Article  PubMed  Google Scholar 

  • StataCorp (2007) Stata Statistical Software: Release 10. StataCorp LP, College Station, TX

  • Strohmeier KP, Schultz A, Bardehle D, Annuss R, Lenz A (2007) Health indicator-based cluster analysis of districts and urban districts in North Rhine-Westphalia. Gesundheitswesen 69:26–33. doi:10.1055/s-2007-960491

    Article  CAS  PubMed  Google Scholar 

  • Tarkiainen L, Martikainen P, Laaksonen M, Leyland AH (2010) Comparing the effects of neighbourhood characteristics on all-cause mortality using two hierarchical areal units in the capital region of Helsinki. Health Place 16:409–412. doi:10.1016/j.healthplace.2009.10.008

    Article  PubMed  Google Scholar 

  • Turrell G, Kavanagh A, Draper G, Subramanian SV (2007) Do places affect the probability of death in Australia? A multilevel study of area-level disadvantage, individual-level socioeconomic position and all-cause mortality, 1998–2000. J Epidemiol Commun H 61:13–19. doi:10.1136/jech.2006.046094

    Article  Google Scholar 

  • Valkonen T (2001) Trends in differential mortality in European countries. In: Vallin J, Meslé, F, Valkonen T (eds) Trends in mortality and differential mortality (Population Studies, No. 36), Council of Europe, pp 185–321

  • Voigtländer S, Berger U, Razum O (2010a) Increasing regional disparities in living conditions in Germany and their role in the explanation of health inequalities. Gesundheitswesen 72:301–308. doi:10.1055/s-0029-1233487

    Article  PubMed  Google Scholar 

  • Voigtländer S, Berger U, Razum O (2010b) The impact of regional and neighbourhood deprivation on physical health in Germany: a multilevel study. BMC Public Health 10:403. doi:10.1186/1471-2458-10-403

    Article  PubMed Central  PubMed  Google Scholar 

  • Yen IH, Michael YL, Perdue L (2009) Neighborhood environment in studies of health of older adults: a systematic review. Am J Prev Med 37:455–463. doi:10.1016/j.amepre.2009.06.022

    Article  PubMed Central  PubMed  Google Scholar 

Download references

Acknowledgments

The author thanks the organizers and participants of the workshop “Explaining Health Inequalities: The Role of Space and Time” (June 25-27, 2012; Bielefeld, Germany), and in particular Sven Voigtländer for helpful comments on this study. Support from the staff of the research data center of the German Federal Pension Fund Support and from Miriam Hils in language editing is gratefully acknowledged.

Author information

Authors and Affiliations

  1. Population Research Centre, Faculty of Spatial Science, University of Groningen, PO Box 800, 9700 AV, Groningen, The Netherlands

    Eva U. B. Kibele

  2. Healthy Ageing: Population and Society (HAPS), University of Groningen, Groningen, The Netherlands

    Eva U. B. Kibele

Authors
  1. Eva U. B. Kibele
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Eva U. B. Kibele.

Additional information

This article is part of the special issue “Explaining Health Inequalities: The Role of Space and Time”.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kibele, E.U.B. Individual- and area-level effects on mortality risk in Germany, both East and West, among male Germans aged 65+. Int J Public Health 59, 439–448 (2014). https://doi.org/10.1007/s00038-013-0480-3

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00038-013-0480-3

Keywords

Search

Navigation