[Years of life lost: known methods and a refined approach using the example of the most frequent causes of death in Germany]. / Verlorene Lebensjahre: Bekanntes und Neues zur Methodik am Beispiel der häufigsten Todesursachen in Deutschland.

BACKGROUND: Years of life lost (YLL) is a meaningful indicator of the relevance of causes of death, although it is rarely used in Germany. Numerous methods have been developed to calculate YLL. OBJECTIVE: Prototypical methods for calculating YLL are presented and critically appraised. An improved method is proposed that is based on cause-elimination life tables (CELTs). METHODS: The different methods are applied to deaths in Germany in 2018. Changes in comparison to 1998 are presented using the modified method. RESULTS: While in 2018 cardiovascular diseases were the leading cause of death by number of cases, cancer was responsible for most YLL. Different methods of calculating YLL lead to divergent ranks for less frequent causes of death. YLL on the basis of general life tables underestimate CELT-based YLL by up to 18.4% (cardiovascular diseases). Measured by CELT-based YLL, cardiovascular diseases were the most important cause of death in 1998. CONCLUSION: The calculation of YLL on the basis of CELTs avoids inconsistencies of established methods and leads to relevantly different results. Characteristics of the proposed method (violation of the egalitarian principle, lack of additivity) do not affect its usefulness as a tool for health planning.

Small-area analysis on socioeconomic inequalities in cancer survival for 25 cancer sites in Germany.

Socioeconomic inequalities in cancer survival have been reported in various countries but it is uncertain to what extent they persist in countries with relatively comprehensive health insurance coverage such as Germany. We investigated the association between area-based socioeconomic deprivation on municipality level and cancer survival for 25 cancer sites in Germany. We used data from seven population-based cancer registries (covering 32 million inhabitants). Patients diagnosed in 1998 to 2014 with one of 25 most common cancer sites were included. Area-based socioeconomic deprivation was assessed using the categorized German Index of Multiple Deprivation (GIMD) on municipality level. We estimated 3-month, 1-year, 5-year and 5-year conditional on 1-year age-standardized relative survival using period approach for 2012 to 2014. Trend analyses were conducted for periods between 2003-2005 and 2012-2014. Model-based period analysis was used to calculate relative excess risks (RER) adjusted for age and stage. In total, 2 333 547 cases were included. For all cancers combined, 5-year survival rates by GIMD quintile were 61.6% in Q1 (least deprived), 61.2% in Q2, 60.4% in Q3, 59.9% in Q4 and 59.0% in Q5 (most deprived). For most cancer sites, the most deprived quintile had lower 5-year survival compared to the least deprived quintile even after adjusting for stage (all cancer sites combined, RER 1.16, 95% confidence interval 1.14-1.19). For some cancer sites, this association was stronger during short-term follow-up. Trend analyses showed improved survival from earlier to recent periods but persisting deprivation differences. The underlying reasons for these persisting survival inequalities and strategies to overcome them should be further investigated.