Department of International Health, Care and Public Health Research Institute - CAPHRI, Maastricht University, Maastricht, the Netherlands.
International Max Planck Research School for Population, Health and Data Science, Max Planck Institute for Demographic Research, Rostock, Germany.
Demography. 2023 Feb 1;60(1):303-325. doi: 10.1215/00703370-10422945.
The mortality gap between former East and West Germany decreased rapidly in the decade following the reunification of the country in 1990. However, because no previous study has estimated life expectancy (e0) over time for all German districts, the extent of mortality convergence across districts and its determinants are largely unknown. We used a novel relational Bayesian model to estimate district e0 in Germany during 1997-2016, examined mortality convergence using a novel convergence groups approach, and explored the role of selected district characteristics in the process. Differences in e0 between German districts decreased for both sexes during 1997-2016, mainly driven by rapid mortality improvements in eastern German districts. However, considerable heterogeneity in district-level e0 trajectories within federal states was evident. For example, district clusters in northwestern Germany showed increasing e0 disadvantage, which led to a north-south divergence in mortality. A multinomial regression analysis showed a robust association between the e0 trajectory and the district-level tax base and long-term unemployment but not with hospital density. Thus, an equitable "leveling up" of health seems possible with policies investing in places and the people who inhabit them.
东德和西德在统一后的十年里，死亡率差距迅速缩小。然而，由于之前没有研究估计过德国所有地区的预期寿命(e0)，因此死亡率趋同的程度及其决定因素在很大程度上是未知的。我们使用一种新颖的关系贝叶斯模型来估计德国在 1997 年至 2016 年期间的地区 e0，使用一种新的趋同群体方法来检查死亡率趋同情况，并探讨了选定地区特征在这一过程中的作用。1997-2016 年间，德国男女的 e0 差异都在缩小，这主要是由于东德地区的死亡率迅速改善。然而，在联邦州内，地区一级 e0 轨迹存在相当大的异质性。例如，德国西北部的地区集群显示出 e0 劣势的增加，这导致了死亡率的南北分歧。多项回归分析显示，e0 轨迹与地区一级的税收基础和长期失业之间存在稳健的关联，但与医院密度无关。因此，通过投资于地方和居住在那里的人民的政策，实现健康的公平“提升”似乎是可能的。
