Spatial patterns in long-term care in Germany and how they are linked to socioeconomic factors. A study based on the concept of disability-free life expectancy

Daniel Kreft, University of Rostock

The ongoing rise in life expectancy means that the number of people who will be at increased risk of experiencing a severe loss of physical functioning and mobility at advanced ages will also rise, which could in turn lead to increased demand for long-term assistance and care services. This study explores spatial disparities in long-term care in Germany using the following indicators: disability-free life expectancy (DFLE), life expectancy with disability, and the health ratio, the proportion of DFLE to life expectancy. These indicators are combined measures of mortality and morbidity. Disability is defined as receiving benefits from the statutory long-term care (SLTC) insurance system. Data from the official census of all beneficiaries, the German SLTC census 2009, are combined with county-level lifetable estimates. In addition, socioeconomic indicators from the regional database of the German NSO are analyzed as determinants of disability disparities. Based on the health ratios observed, it is clear that there are pronounced spatial clusters which extend beyond the borders of federal states and are linked to the socioeconomic conditions in the respective counties. Results from meta-regression suggest there is a significant relationship between a county’s health ratio and the county’s socioeconomic performance, socioeconomic composition, level of urbanization, and health structure. A high household income per capita, a low long-term unemployment rate, a high population density, and a low level of premature mortality in a county are significantly linked to a high health ratio. This is the first study that shows the existence of spatial differentials in care need and the linkages of these differentials to the socioeconomic structure and performance of the county.