BACKGROUND Subnational regional mortality inequalities are large and appear to be mostly increasing within industrialized countries, although comparative studies across high-income countries are scarce. Germany is an important country to examine because it continues to experience considerable economic disparities between its federal states, in part resulting from its former division. METHODS We analyse state-level mortality in Germany utilizing data from a newly constructed regional database based on the methodology of the Human Mortality Database. We compare time trends (1991-2015) in the German state-level standard deviation in life expectancy to that of other large, wealthy countries and examine the association between mortality and economic inequalities at the regional level. Finally, using contour-decomposition methods, we investigate the degree to which age patterns of mortality are converging across German federal states. RESULTS Regional inequalities in life expectancy in Germany are comparatively low internationally, particularly among women, despite high state-level inequalities in economic conditions. These low regional mortality inequalities emerged 5-10 years after reunification. Mortality is converging over most ages between the longest- and shortest-living German state populations and across the former East-West political border, with the exception of an emerging East-West divergence in mortality among working-aged men. CONCLUSIONS The German example shows that large regional economic inequalities are not necessarily paralleled with large regional mortality disparities. Future research should investigate the factors that fostered the emergence of this unusual pattern in Germany.

中文翻译：

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在经济状况持续严重不平等的背景下，死亡率的区域差异正在缩小：德国。

背景技术尽管缺乏对高收入国家的比较研究，但次地区的区域死亡率不平等现象很大，并且在工业化国家中似乎主要在加剧。德国是一个需要审查的重要国家，因为德国继续在其联邦州之间经历相当大的经济差异，部分原因是其前任分裂。方法我们根据人类死亡率数据库的方法，使用来自新建区域数据库的数据来分析德国的州级死亡率。我们将德国预期寿命与其他大型富裕国家的标准水平的标准偏差的时间趋势（1991-2015年）进行了比较，并研究了区域水平上死亡率与经济不平等之间的关联。最后，使用轮廓分解方法，我们调查了德国联邦各州的死亡率年龄模式趋同的程度。结果尽管经济状况在国家层面存在严重不平等现象，但国际上，德国的预期寿命区域不平等现象相对较低，尤其是女性。统一后的5-10年出现了这些低的区域死亡率不平等现象。在大多数年龄段，死亡率都在最高和最低寿的德国各州人口之间以及整个前东西方政治边界之间汇合，除了在工作年龄的男子中出现的东西方死亡率差异之外。结论德国的例子表明，区域经济不平等现象未必与区域死亡率差异大并存。