The underwhelming German life expectancy

Abstract

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.

Keywords: Causes of death; Divergence; Germany; High-income countries; Life expectancy.

Fig. 1

Health expenditures per capita (in USD) and life expectancy at birth in Germany and selected high-income countries, 1990–2019

Fig. 2

Trends in life expectancy at birth and at age 65 in Germany and other six selected high-income countries, 1990–2020

Fig. 3

Age-specific contributions to the total difference in life expectancy at birth (values above the bars) between Germany and each of the other selected high-income countries, 1990-99–2010-16

Fig. 4

Changes in life expectancy at birth and lifespan disparity (e-dagger) in Germany and other high-income countries, 1990–2019

Fig. 5

Cause-specific contributions to the total difference in life expectancy at birth (values above the bars) between Germany and each of the other selected high-income countries, 1990-99–2010-16