International Journal of Public Health

, Volume 59, Issue 3, pp 439–448 | Cite as

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

Original Article

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.

Keywords

Mortality Old age Multilevel Germany Socioeconomic status Inequality 

Notes

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.

References

  1. 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 PubMedCentralPubMedCrossRefGoogle Scholar
  2. 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 PubMedCrossRefGoogle Scholar
  3. 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 CrossRefGoogle Scholar
  4. 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 PubMedCentralPubMedCrossRefGoogle Scholar
  5. 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 PubMedCrossRefGoogle Scholar
  6. 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 PubMedCrossRefGoogle Scholar
  7. 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 PubMedCentralPubMedCrossRefGoogle Scholar
  8. 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 PubMedCentralPubMedCrossRefGoogle Scholar
  9. FDZ-RV (2012) (Research data center of the German Federal Pension Fund). Dataset FDZ-RV-SUFRTBNRTWF02-04TDemoKibeleKreis, Rentenwegfall/-bestand 2002–2004Google Scholar
  10. Himmelreicher RK, Sewöster D, Scholz R, Schulz A (2008) Die fernere Lebenserwartung von Rentnern und Pensionären im Vergleich WSI Mitteilungen, 5:274–280Google Scholar
  11. 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 CrossRefGoogle Scholar
  12. 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
  13. 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 PubMedCrossRefGoogle Scholar
  14. Kibele EUB (2012) Regional mortality differences in Germany. Springer, DordrechtCrossRefGoogle Scholar
  15. 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 PubMedCrossRefGoogle Scholar
  16. 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 PubMedCrossRefGoogle Scholar
  17. Kroh M, Neiss H, Kroll L, Lampert T (2012) Menschen mit hohen Einkommen leben länger. DIW Wochenbericht 38:3–15Google Scholar
  18. 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 CrossRefGoogle Scholar
  19. Lantz PM, Pritchard A (2010) Socioeconomic indicators that matter for population health. Prev Chronic Dis 7:1–7Google Scholar
  20. 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 PubMedCrossRefGoogle Scholar
  21. Luy M (2006) Differentielle Sterblichkeit: die ungleiche Verteilung der Lebenserwartung in Deutschland. Rostocker Zentrum—Diskussionspapier 6Google Scholar
  22. 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 PubMedCrossRefGoogle Scholar
  23. 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 PubMedCrossRefGoogle Scholar
  24. 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 CrossRefGoogle Scholar
  25. 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 CrossRefGoogle Scholar
  26. 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 PubMedCrossRefGoogle Scholar
  27. Merlo J (2011) Contextual influences on the individual life course: building a research framework for social epidemiology. Psychosoc Interv 20:109–118CrossRefGoogle Scholar
  28. 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 PubMedCentralPubMedCrossRefGoogle Scholar
  29. 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 CrossRefGoogle Scholar
  30. 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 CrossRefGoogle Scholar
  31. Queste A (2007) Analyse kleinräumiger Mortalitätsraten in Deutschland. Landesinstitut für den Öffentlichen Gesundheitsdienst des Landes Nordrhein-Westfalen (lögd), BielefeldGoogle Scholar
  32. Rabe-Hesketh S, Skrondal A (2008) Multilevel and Longitudinal Modeling Using Stata, 2nd edn. Stata Press, College StationGoogle Scholar
  33. 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 PubMedCrossRefGoogle Scholar
  34. Regionaldatenbank Deutschland (2012) Statistische Ämter des Bundes und der Länder. Available at www.regionalstatistik.de. Accessed 9 July 2012
  35. 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 CrossRefGoogle Scholar
  36. 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 PubMedCrossRefGoogle Scholar
  37. StataCorp (2007) Stata Statistical Software: Release 10. StataCorp LP, College Station, TXGoogle Scholar
  38. 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 PubMedCrossRefGoogle Scholar
  39. 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 PubMedCrossRefGoogle Scholar
  40. 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 CrossRefGoogle Scholar
  41. 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 185–321Google Scholar
  42. 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 PubMedCrossRefGoogle Scholar
  43. 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 PubMedCentralPubMedCrossRefGoogle Scholar
  44. 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 PubMedCentralPubMedCrossRefGoogle Scholar

Copyright information

© Swiss School of Public Health 2013

Authors and Affiliations

  1. 1.Population Research Centre, Faculty of Spatial ScienceUniversity of GroningenGroningenThe Netherlands
  2. 2.Healthy Ageing: Population and Society (HAPS)University of GroningenGroningenThe Netherlands

Personalised recommendations