The Social Grandient and the 'Deaths of Despair' in Germany: Findings from the German National Cohort (NAKO)

Ronny Westerman , Federal Institute for Population Research (BiB), Germany
Andrea Werdecker, Federal Institute for Population Research (BiB)
Ulrich Mueller, University of Marburg

Background: ‘Deaths of despair' have extensively researched, particularly in the United Kingdom and the United States, but this phenomenon is not limited to these countries. Germany, which experienced significant social inequalities during the economic transition of German reunification, continues to face specific social disparities in health and mortality. Nevertheless, the impact of the social gradient on the 'deaths of despair' in Germany has not received much attention. Methodology: We used cause-specific mortality data from the German National Cohort (NAKO) for the period 2014–2023. A total of 2,820 deaths were considered for which complete information on the causes of death was available. A multiple-causes of death analysis was performed considering the complete death certificate information and additional medical records. The social gradient was derived from employment status, the European Socio-Economic Classification (ESeC), education (ISCED 11) and relative income position based on the NAKO baseline questionnaires. Logistic regression models were used for statistical analysis, providing odds and relative risk ratios for the analyses of the 'deaths of despair' categories. Results: The major outcome indicated that individuals with a low socioeconomic status were at a higher risk for the deaths of despair'. Those who had been unemployed for a long time and those with the lowest income levels were disproportionately affected. Surprisingly, educational attainment and occupational status had no significant influence on the risk for the 'deaths of despair'. Conclusion: The social gradient is a significant predictor of the risk of the 'deaths of despair' in Germany.

See paper

 Presented in Session P6. Health, Mortality, and Ageing 2