[Indebtedness and mortality: analysis at county and city levels in Germany]

Little is known about the influence of individual debts on health inequalities in Germany. Studies from English-language countries have shown that indebtedness is a great burden in every-day life that leads to mental stress and is related to negative health outcomes. Our paper, for the first time, analyses the role of indebtedness on mortality in Germany.

Using ecological level data of Germany's 439 administrative districts, we assessed the role of unemployment, income, educational level, population density, regional prosperity, number of hospital beds and of the independent effect of indebtedness on mortality. The variance explained by indebtedness was determined by means of multiple linear regression models. Data were provided by the Federal Statistical Office of Germany and Schufa Holding AG.

Indebtedness and unemployment are moderately correlated. Even so, a significant independent effect of indebtedness on mortality can be shown. Indebtedness contributes to the explanation of health inequalities and, together with other socioeconomic factors and the federal state, explains 59% of the variance in age-standardised district level mortality. Indebtedness explains 6% of variance.

For the first time in Germany, this study shows that indebtedness not only influences population health as a result of low income or unemployment but also has an independent, albeit rather small, effect. Studies focussing on social inequity and health should further examine the role of indebtedness and also include an analysis on the individual level.