• Roland Rau and Carl P Schmertmann.
• Department of Sociology and Demography, University of Rostock; Max Planck Institute forDemographic Research, Rostock.
• Dtsch Arztebl Int. 2020 Jul 20; 117 (29-30): 493499493-499.

BackgroundIdentifying regions with low life expectancy is important to policy makers, in particular for allocating resources in the health system. Life expectancy estimates for small regions are, however, often unreliable and lead to statistical uncertainties when the underlying populations are relatively small.MethodsWe combine the most recent German data available (2015-2017) with a Bayesian model that includes several methodological advances. This allows us to estimate male and female life expectancy with good precision for all 402 German districts and to quantify the uncertainty of those estimates.ResultsAcross districts, life expectancy varies between 75.8 and 81.2 years for men and from 81.8 to 85.7 years for women. The spatial pattern is similar for women and men. Rural districts in eastern Germany and some districts of the Ruhr region have relatively low life expectancy. Districts with relatively high life expectancies cluster in Baden-Wuerttemberg and southern Bavaria. Exploratory analysis shows that average income, population density, and number of physicians per 100 000 inhabitants are not strongly correlated with life expectancy at district level. In contrast, indicators that point to particularly disadvantaged segments of the population (unemployment rate, welfare benefits) are better predictors of life expectancy.ConclusionsWe do not find a consistent urban-rural gap in life expectancy. Our results suggest that policies that improve living standards for poorer segment of the population are the most likely to reduce the existing differences in life expectancy.

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