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Widening income inequalities in life expectancy? Analysing time trends based on German health insurance data
  1. Fabian Tetzlaff1,
  2. Jelena Epping2,
  3. Stefanie Sperlich2,
  4. Juliane Tetzlaff2
  1. 1Institute for General Practice, Hannover Medical School, Hanover, Germany
  2. 2Medical Sociology Unit, Hannover Medical School, Hanover, Germany
  1. Correspondence to Fabian Tetzlaff, Institute for General Practice, Hannover Medical School, Hanover, 30625, Germany; tetzlaff.fabian{at}


Background While social disparities in mortality have been shown in the majority of high-income countries, research on inequalities in the German population is still limited. This applies especially to studies investigating time trends in social inequalities with respect to life expectancy. The aim of this study is to examine income inequalities in life expectancy and whether inequalities have narrowed or widened over time.

Methods The analyses are based on the claims data of a large German health insurance provider, which facilitates the combining of information on individual income and mortality. Life expectancy is calculated separately for three income groups (<60%, 60% to 80% and ≥80% of the average income in Germany) and for sex by applying period life table analyses. Trends are assessed by comparing the time periods 2005–2008 (N = 1 773 122), 2009–2012 (N=1 792 735) and 2013–2016 (N = 1 987 114).

Results Trends in life expectancy differed by sex, age and income group. Especially among elderly men, the gap between low- and high-income groups widened over time, disadvantaging men with low incomes. Among women, a slight reduction in inequalities was observed, which was driven by the increases in life expectancy in low-income groups.

Conclusion Our study shows that not all population subgroups benefitted equally from the continuing rise in life expectancy. The persisting inequalities emphasise the importance of public health efforts concentrating on reducing mortality risks among individuals in lower socioeconomic positions. Special attention should be paid to elderly men with low incomes. Further research is needed on the mechanisms underlying increasing health inequalities over time.

  • life expectancy
  • time trend
  • income inequalities
  • Germany

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  • Contributors FT and JT developed the idea and research questions of the study. FT analysed the data and wrote the first draft of the manuscript. JE and JT were major contributors to the final manuscript. JE, SSp and JT contributed to the conception and discussion of the study and reviewed the work critically. All authors read and approved the final version of the manuscript.

  • Funding The work done by JT was funded by the AOKN (Statutory Local Health Insurance of Lower Saxony) as part of a project on morbidity compression.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Our study is based on claims data, that is, on routinely collected data. The use of this sort of data for scientific purposes is regulated by federal law, and the data protection officer of the Statutory Local Health Insurance of Lower Saxony (AOKN) has approved its use.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement The datasets generated and analysed during the current study are not publicly available due to protection of data privacy of the insured individuals by the Statutory Local Health Insurance of Lower Saxony (AOKN).