Does Place Matter? Regional Variation in the SES-Mortality Gradient among Retired German Men

Georg Wenau, Max Planck Institute for Demographic Research
Pavel Grigoriev , Federal Institute for Population Research (BiB)
Sebastian Kluesener , Federal Institute for Population Research (BiB)
Roland Rau, University of Rostock
Vladimir M. Shkolnikov, Max Planck Institute for Demographic Research

There has been a long-standing debate concerning the relative importance of space and place vs. individual characteristics for mortality disparities. In this paper, we analyze the association of lifetime SES-status/income and mortality at older ages among retired German men and its variation at the sub-national level. We are particularly interested whether the income gradient in mortality differs across sub-national macro-regions and by type of settlement (big cities, other urban, rural). To answer this question, we employ a large administrative dataset of the German Pension Fund consisting of 17 Mio person-years of exposure and 585.9 thousand deaths that have occurred over the period 2012–2017 among men aged 65–84. We estimate the relative mortality risk using a Cox proportional hazard model. To quantify the steepness of the gradients and to compare them between different places of Germany, we estimate the Slope Index of Inequality and the Relative Index of Inequality. Our preliminary results suggest a linear income-mortality relationship across all macro-regions and types of settlement: the risk of dying decreases as income increases. However, the degree of inequalities between different settlements and the steepness of mortality gradients vary substantially within the country. In particular, regardless of the sub-national macro-region, big cities reveal the highest degree of disparities across income groups.

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 Presented in Session 54. Flash Session: Disparity and Variation in Mortality