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Quantifying the contribution of smoking to regional mortality disparities in Germany

Pavel Grigoriev, Federal Institute for Population Research (BiB), Germany
Alyson A. Van Raalte, Max Planck Institute for Demographic Research (MPIDR)

Understanding factors responsible for regional mortality differentials are crucial for developing adequate policy responses. The aim of this paper is to quantify the impact of smoking on regional mortality disparities in Germany and their changes over the last four decades. We use regional all-cause and cause-specific mortality data for the period 1980–2017, and perform our analysis across five geographical areas of Germany. We estimate smoking-attributable mortality using the Preston-Glei-Wilmoth method, which relies on mortality from lung cancer as a proxy of past smoking behavior. We measure the impact of smoking by computing complete life tables before and after eliminating smoking-attributable deaths. As expected, smoking-attributable mortality has been declining among males and increasing among females. This rise among females has been accompanied by rapidly growing regional divergence in lung cancer mortality determined by births cohorts 1940–1950. Our estimates suggest that in 2017, the elimination of smoking-attributable deaths would halve the female all-cause mortality gap with the vanguard region (South). East Germany with the lowest female smoking-attributable mortality stands out as a notable exception. However, soon the impact of smoking should grow in East Germany, which may eventually contribute to widening regional disparities in mortality.

Keywords: Mortality, Population geography, Inequality, Spatial analysis/regression

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  Presented in Session 100. Socioeconomic Inequality and Mortality Differentials