For Whom Does Place Matter? Regional Variation in the SES-Mortality Gradient Among Retired Men in Germany

Abstract

There is mounting evidence in Germany of significant mortality inequalities associated with socioeconomic status (SES). This issue holds considerable relevance for social policy debates. However, there is a paucity of research regarding how SES-mortality inequalities differ across German regions and between urban and rural areas. This is surprising, given that existing studies suggest that SES-mortality disparities can vary systematically based on place characteristics. This paper aims to address this research gap by analysing subnational variation in the association between SES and mortality among retired men in Germany. Specifically, we investigate whether the observed SES-mortality gradients differ across subnational macro-regions and by settlement type (large cities, (other) urban, rural). For this purpose, we analyse a large administrative dataset from the German Pension Insurance (DRV), comprising 17.03 million person-years of exposure and 0.59 million recorded deaths over the period 2012–2017 among men aged 65–84 at baseline (2011). Employing a Cox proportional hazards model, we estimate relative mortality risks. To quantify the steepness of the gradients across the subregions, we use the Slope Index of Inequality and the Relative Index of Inequality. Our findings indicate that the SES-mortality association is nearly linear across a large part of the SES range in all macro-regions and settlement types, with mortality risks decreasing as SES increases. Furthermore, we observe substantial regional variation in the steepness of the mortality gradients, with large cities exhibiting the steepest gradients. Another important finding is that among individuals with high SES, regional variation in mortality risks is smallest.