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This document is a response to a letter to the editor regarding a previously published article titled "The underwhelming German life expectancy." The authors address three issues raised in the letter: the impact of cause-of-death statistics, the choice of comparison countries and outcomes, and the relevance of non-healthcare-related factors affecting life expectancy. They argue that cause-of-death data comparability is an important issue, but the claim that using large groups of causes of death produces incomparable results is not widely shared. They also state that their study did not claim that cardiovascular disease (CVD) mortality levels predict life expectancy levels, but rather aimed to determine the major contributors to the life expectancy gap between Germany and other countries. The authors provide evidence supporting the importance of CVD for Germany's underwhelming life expectancy, including long-term excess cardiovascular mortality and a systematic German disadvantage in CVD-related metrics. They defend their choice of mortality as an outcome measure and discuss the limitations of health indicators based on subjective measures. They acknowledge the relevance of non-healthcare-related factors affecting life expectancy but note the lack of nationally representative and internationally comparable data to precisely identify these factors. The authors conclude that reducing CVD mortality requires better data for monitoring and joint efforts from policymakers, researchers, and caregivers. They also emphasize the importance of understanding both medical and non-medical determinants of population health in Germany. [Extracted from the article]

Background Intra-annual excess mortality is the most reliable measure of losses of lives due to short-term risk factors. The objectives of our study are (i) to estimate excess mortality across German states in the course of the coronavirus disease 2019 (COVID-19) pandemic years 2020 and 2021 and (ii) to identify possible regional-level determinants of spatial inequality in pandemic-related excess mortality. Methods We use weekly mortality data series for the calculation of weekly death rates, standardized by age for each federal state of Germany. We estimate the expected level of mortality as state-specific mortality trends and excess mortality in 2020 and 2021. We explore ecological statistical relationships between excess mortality, COVID-19 morbidity, and selected regional socioeconomic indicators using fixed-effects regression models. Results Our study shows that during the first pandemic year, there was South-to-North gradient in excess mortality in Germany, with excess mortality being higher in the South. Over the course of the second pandemic year 2021, this gradient changed to become an East-to-West gradient, with excess mortality being higher in the East. The results of the study show stronger effects of COVID-19 morbidity on excess mortality in East Germany. State-level indicators reflecting economic activity, employment, and capacity of intensive care units show significant correlations with excess mortality across the states. Conclusions The results show pronounced state-level differences in the magnitude of excess mortality during the COVID-19 pandemic in Germany. Economic activity, employment and capacity of intensive care units were the most important state-level characteristics associated with the observed spatial variations in excess mortality. [ABSTRACT FROM AUTHOR]

This article contributes to the discussion on the determinants of diverging life expectancy in high-income countries, with a focus on Germany. To date, much of this discourse has centered around the social determinants of health, issues of healthcare equity, poverty and income inequality, and new epidemics of opioids and violence. Yet despite doing well on all of these metrics and having numerous advantages such as comparatively strong economic performance, generous social security, and an equitable and well-resourced health care system, Germany has been a long-time life expectancy laggard among the high-income countries. Using aggregated population-level mortality data for Germany and selected six high-income countries (Switzerland, France, Japan, Spain, the United Kingdom, and the United States) from the Human Mortality Database and WHO Mortality Database, we find that the German longevity shortfall is mainly explained by a longstanding disadvantage in survival among older adults and adults nearing statutory retirement age, which mainly stems from sustained excess cardiovascular disease mortality, even when compared to other laggard countries such as the US and the UK. Patchy contextual data suggests that the unfavorable pattern of cardiovascular mortality may be driven by underperforming primary care and disease prevention. More systematic and representative data on risk factors are needed to strengthen the evidence base on the determinants of the controversial and long-standing health gap between more successful countries and Germany. The German example calls for broader narratives of population health that embed the variety of epidemiological challenges populations face around the globe. [ABSTRACT FROM AUTHOR]

Background The article examines gender differences in happy life expectancy at age 50 (LE50) and computes the age-specific contributions of mortality and happiness effects to gender differences in happy LE50 in 16 European countries. Methods Abridged life tables and happy LE50 were calculated using conventional life tables and Sullivan's method. Age-specific death rates were calculated from deaths and population exposures in the Human Mortality Database. Happiness prevalence was estimated using the 2010–11 Survey of Health, Ageing and Retirement in Europe. Happiness was defined using a single question about life satisfaction on a scale of 0–10. A decomposition algorithm was applied to estimate the exact contributions of the differences in mortality and happiness to the overall gender gap in happy LE50. Results Gender differences in happy LE50 favour women in all countries except Portugal (0.43 years in Italy and 3.55 years in Slovenia). Generally, the contribution of the gender gap in happiness prevalence is smaller than the one in mortality. The male advantage in the prevalence of happiness partially offsets the effects of the female advantage in mortality on the total gender gap in happy LE50. Gender differences in unhappy life years make up the greatest share of the gender gap in total LE50 in all countries except Denmark, Germany, Netherlands, Slovenia and Sweden. Conclusion Countries with the largest gender gap in LE are not necessarily the countries with larger differences in happy LE50. The remaining years of life of women are expected to be spent not only in unhealthy but also in unhappy state. [ABSTRACT FROM AUTHOR]

Background Although socioeconomic mortality differences in Germany are well documented, trends ingroup-specific mortality and differences between the eastern and the western parts of the country remain unexplored. Methods Population and death counts by level of lifetime earnings (1995–1996 to 2007–2008) and broad occupational groups (1995–1996 to 2003–2004) for men aged 65 years and older were obtained from the German Federal Pension Fund. Directly standardised mortality rates and life expectancy at age 65 were used as mortality measures. Results Mortality declined in all socioeconomic groups in eastern and western Germany and these declines tended to be larger in higher status groups. Relative socioeconomic differences in age-standardised mortality rates and in life expectancy at age 65 widened over time. Absolute differences widened over the majority of time periods. The widening was more pronounced in eastern Germany. Conclusions Widening socioeconomic mortality differences in Germany, especially in eastern Germany, show that population groups did not benefit equally from the improvements in survival. The results suggest that special efforts have to be taken in order to reduce mortality among people with lower socioeconomic status, especially in eastern Germany. Health equity should be considered a priority when planning policies, practices, and changes in the healthcare system and related sectors. [ABSTRACT FROM AUTHOR]

Competing Interests: Competing interests: None declared.

Background and Aim: Due to its strong economy and a well-developed healthcare system, Germany is well positioned to achieve above-average reductions in mortality. Nevertheless, in terms of life expectancy, Germany is increasingly falling behind Western Europe. We compare mortality trends in Germany with other Western European countries, covering the period from 1960 to 2019. The focus is on long-term trends in Germany's ranking in international mortality trends. In addition, we conduct a detailed mortality analysis by age., Methods: Our analysis is mostly based on mortality data from the Human Mortality Database (HMD). Cause-specific mortality data originate from the database of the World Health Organization (WHO). For the international comparison of mortality trends, we use conventional mortality indicators (age-standardized mortality rate, period life expectancy)., Results: Compared to other Western European countries, Germany has higher mortality in the middle and older age groups. Germany's life expectancy gap compared to Western Europe has grown during the past 20 years. In 2000, Germany was 0.73 years behind for men and 0.74 years behind for women. By 2019, these figures had risen to 1.43 and 1.34 years, respectively. This is mainly due to mortality from non-communicable diseases., Conclusion: For Germany to catch up with other Western European countries, a stronger focus on further reducing mortality at ages 50+ is crucial. This also requires further research to understand the factors behind Germany's disadvantageous position., (© 2024. The Author(s).)