Patterns of disparity in avoidable deaths - an analysis of the German burden of disease study 2017

Abstract Background Avoidable mortality captures deaths that need not have occurred. Combined with Years of Life Lost (YLL), it offers a thorough view of a population's amenable mortality burden. We aim to estimate avoidable YLL in Germany across sociodemographic and regional groups to inform prevention and healthcare strategies. Methods We merged 2017 German cause of death (COD) statistics, including previously estimated YLL, with the OECD/Eurostat reference list that defines CODs which respond to prevention (preventable) or healthcare (treatable). We calculated YLL caused by avoidable (preventable/treatable) CODs nationwide and by sex, age and spatial planning regions (SPR). We assessed avoidable YLL across SPR quintiles, categorised by the German Index of Socioeconomic Deprivation (GISD), and correlations between avoidable YLL and GISD on SPR level. Results In 2017 46% (5.3/11.6 million) of all YLL were avoidable. Two thirds (68%) of avoidable YLL were preventable, 32% were treatable. Of all YLL, 80% of those caused by injuries, 55% from communicable diseases, and 42% from non-communicable diseases were avoidable. Top three avoidable CODs were lung cancer and ischemic heart disease (both sexes), breast cancer (women), and self-harm (men). Among men, 73% of all avoidable YLL were preventable, in women 58% (p<.01). The avoidable YLL proportion in the most deprived SPR quintile was higher (52%) than in the lowest quintile (48%, p>.07). SPR with higher GISD scores correlated with increased avoidable YLL (r = .83, p<.001). Conclusions As nearly half of all YLL in 2017 in Germany were avoidable, we observed a substantial potential to reduce lifetime loss, particularly for men and socially deprived groups. Sociodemographic disparities in avoidable mortality underline the need for targeted public health interventions and tailored prevention approaches for vulnerable populations. The pre-COVID-19 estimates provide a baseline for future analyses of potential changes during the pandemic. Key messages • A notable potential to reduce lifetime loss due to avoidable causes of death was found in Germany with particularly more preventable mortality in men and socially vulnerable deprived populations. • The 2017 estimates reveal sociodemographic disparities, stressing the need for tailored public health interventions and offer a basis for future assessments of COVD-19’s impact on avoidable mortality.