[Increasing regional disparities in living conditions in Germany and their role in the explanation of health inequalities].
BACKGROUND
Social inequalities in Germany are on the increase. Past studies have pointed out that social inequalities and their health consequences include a regional component. This study aims at systematically describing the development of regional disparities in living conditions across Germany.


METHODS
The level of analysis was that of the 439 counties in Germany. Based on the data sets INKAR as well as Statistik regional, selected indicators of social structure (unemployment rate, employment rate, disposable income, density of statutory health insurance physicians, and proportion of females among the 18-29 year-olds) were compared for the years 1995 and 2005/2006, respectively. The results were stratified for East and West Germany to assess the development of regional disparities within these two large entities.


RESULTS
For the indicators statutory health physician density and proportion of females there is an increase in regional disparities across Germany (i. e., interquartile ranges of physician density 1995: 37 physicians per 100,000 inhabitants, 2005: 54) as well as in East and West [i. e., interquartile range of physician density 1995 (West): 42.1 physicians per 100,000 inhabitants, 2005 (West): 61.3]. Furthermore, regional disparities in the unemployment rate increased across Germany as well as within West Germany (interquartile range Germany 1995: 6.4 percentage points, 2006: 8.1; interquartile range West 1995: 3.5 percentage points, 2006: 5). Disparities between East and West increased for all the indicators.


CONCLUSIONS
This study illustrates the substantial level of regional differences in Germany as well as their temporal dynamics. Increasing regional disparities were identified across the whole of Germany as well as within the two entities East and West. Regionally diverse living conditions are linked to different capabilities and life chances. Thus, regional characteristics are relevant for an individual's social situation and ought to be, as exposures at the meso level, included in epidemiological studies.
Voigtländer
S
S
Abteilung Epidemiologie & International Public Health, Fakultät für Gesundheitswissenschaften, Universität Bielefeld. sven.voigtlaender@uni-bielefeld.de
Berger
U
U
Razum
O
O
D000293:Adolescent; D000328:Adult; D005260:Female; D005858:Germany / Q000453:epidemiology; D054624:Health Status Disparities; D006801:Humans; D040841:Resource Allocation / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D055815:Young Adult