District-Level Mortality Convergence in Reunified Germany: Long-Term Trends and Contextual Determinants

Document Type

Article

Publication Title

Demography

Abstract

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 con­ver-gence 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 dis-tricts. 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 mul-tinomial 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.

First Page

303

Last Page

325

DOI

10.1215/00703370-10422945

Publication Date

2-1-2023

This document is currently not available here.

Share

COinS