Article
The social gradient of “deaths of despair” in Germany: Evidence from the German National Cohort (NAKO) mortality follow-up
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Authors
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Ronny Westerman
- Bundesinstitut für Bevölkerungsforschung, Wiesbaden, Germany
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Andrea Werdecker
- Bundesinstitut für Bevölkerungsforschung, Wiesbaden, Germany
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Ulrich Mueller
- Bundesinstitut für Bevölkerungsforschung, Wiesbaden, Germany
| Published: | September 6, 2024 |
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Outline
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Introduction: In some countries, notably the United Kingdom and the United States, an increase in 'deaths of despair' (deaths from suicide, harmful alcohol consumption and harmful drug use) has been observed in the middle-aged population since the early 2000s. The question is whether this is a country-specific phenomenon confined to the US and the UK. As is well known, Germany is a special case of economic and social transformation between East and West Germany in the course of reunification and is still characterised by relatively large social inequalities and inequalities in mortality risks. The impact of social inequalities on “deaths of despair” in Germany has not been well studied.
Methods: We analysed cause-specific mortality data from the German National Cohort (NAKO) between 2014 and 2021, using socioeconomic status (SES), education, income and last place of residence as additional covariates. Deaths were then categorised according to the underlying cause of death as alcohol, drug or suicide according to the International Classification of Diseases, 10th Revision (ICD-10) code for deaths of despair as drug-related (F11-F16, F18-F19, X40-X44, X85*, Y10-Y14), suicides (X60-X85, Y10-Y34, Y87. 0, Y87.2) and alcohol-related (F10, K70, K73, X45,G31.2, G62.1, I42.6, K29.2, K74.0-K74.2, K74.6, K86.0). We compared the means, proportions and estimated odds ratios (ORs) from univariate logistic regression for each covariate in all (N = 2,833) participants who died of despair (N = 258) or other causes (N = 2,575) with those who were alive (N = 202,220) from 1 September 2014 to 31 December 2021. Logistic lasso (penalised) regression was used to account for correlations between selected covariates.
Results: The main finding confirmed that people with low SES were more likely to die from 'deaths of despair', regardless of whether they lived in eastern or western Germany.
Conclusions: This highlights the importance of social inequalities for 'deaths of despair' in Germany and needs to be further considered in public health research.
The authors declare that they have no competing interests.
The authors declare that an ethics committee vote is not required.
References
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