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      Social differences in mortality and life expectancy in Germany. Current situation and trends

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          Abstract

          Social differences in mortality and life expectancy are a clear demonstration of the social and health-related inequalities that exist within a particular population. According to data from the Socio-Economic Panel (SOEP) for the period ranging from 1992 to 2016, 13% of women and 27% of men in the lowest income group died before the age of 65; the same can be said for just 8% of women and 14% of men in the highest income group. The difference between mean life expectancy at birth among the lowest and highest income groups is 4.4 years for women and 8.6 years for men. Substantial differences also exist between income groups regarding further life expectancy at the age of 65: women in the lowest income group have a 3.7-year shorter life expectancy than women in the highest income group. Similarly, men in the lowest income group have a 6.6-year shorter life expectancy than men in the highest income group. Finally, results from the trend analyses suggest that social differences in life expectancy have remained relatively stable over the last 25 years.

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          Socioeconomic Inequalities in Health in 22 European Countries

          Comparisons among countries can help to identify opportunities for the reduction of inequalities in health. We compared the magnitude of inequalities in mortality and self-assessed health among 22 countries in all parts of Europe. We obtained data on mortality according to education level and occupational class from census-based mortality studies. Deaths were classified according to cause, including common causes, such as cardiovascular disease and cancer; causes related to smoking; causes related to alcohol use; and causes amenable to medical intervention, such as tuberculosis and hypertension. Data on self-assessed health, smoking, and obesity according to education and income were obtained from health or multipurpose surveys. For each country, the association between socioeconomic status and health outcomes was measured with the use of regression-based inequality indexes. In almost all countries, the rates of death and poorer self-assessments of health were substantially higher in groups of lower socioeconomic status, but the magnitude of the inequalities between groups of higher and lower socioeconomic status was much larger in some countries than in others. Inequalities in mortality were small in some southern European countries and very large in most countries in the eastern and Baltic regions. These variations among countries appeared to be attributable in part to causes of death related to smoking or alcohol use or amenable to medical intervention. The magnitude of inequalities in self-assessed health also varied substantially among countries, but in a different pattern. We observed variation across Europe in the magnitude of inequalities in health associated with socioeconomic status. These inequalities might be reduced by improving educational opportunities, income distribution, health-related behavior, or access to health care. Copyright 2008 Massachusetts Medical Society.
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            The German Socio-Economic Panel (SOEP)

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              Income inequality and socioeconomic gradients in mortality.

              We investigated whether the processes underlying the association between income inequality and population health are related to those responsible for the socioeconomic gradient in health and whether health disparities are smaller when income differences are narrower. We used multilevel models in a regression analysis of 10 age- and cause-specific US county mortality rates on county median household incomes and on state income inequality. We assessed whether mortality rates more closely related to county income were also more closely related to state income inequality. We also compared mortality gradients in more- and less-equal states. Mortality rates more strongly associated with county income were more strongly associated with state income inequality: across all mortality rates, r= -0.81; P=.004. The effect of state income inequality on the socioeconomic gradient in health varied by cause of death, but greater equality usually benefited both wealthier and poorer counties. Although mortality rates with steep socioeconomic gradients were more sensitive to income distribution than were rates with flatter gradients, narrower income differences benefit people in both wealthy and poor areas and may, paradoxically, do little to reduce health disparities.
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                Author and article information

                Journal
                J Health Monit
                J Health Monit
                JoHM
                Journal of Health Monitoring
                Robert Koch Institute (Nordufer 20 13353 Berlin, Germany )
                2511-2708
                14 March 2019
                March 2019
                : 4
                : 1
                : 3-14
                Affiliations
                [1 ] Robert Koch Institute , Berlin Department of Epidemiology and Health Monitoring
                [2 ] Formerly Robert Koch Institute , Berlin Department of Epidemiology and Health Monitoring
                Author notes
                Corresponding author PD Dr Thomas Lampert, Robert Koch Institute, Department of Epidemiology and Health Monitoring, General-Pape-Str. 62–66, D-12101 Berlin, Germany, E-mail: LampertT@ 123456rki.de
                Article
                10.25646/5872
                8848850
                35586309
                2174cab7-4a40-4721-add5-53c7a8479cd6
                © Robert Koch Institute. All rights reserved unless explicitly granted.

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                History
                : 21 December 2018
                : 23 January 2019
                Page count
                Figures: 5, Tables: 1, Equations: 0, References: 31, Pages: 12
                Funding
                The analyses presented here were carried out using own funds.
                Categories
                Focus

                social inequality,socioeconomic status,income,mortality,life expectancy

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