Excess mortality of German men and women aged 60 years and older needing long-term care 2020-2024: data from a statutory health insurance comprising more than 3 million people

INTRODUCTION: Demographic aging is increasing the demand for long-term care (LTC) in Germany. However, existing projections often rely on prevalence-based models that fail to account for age- and sex-specific trends in incidence and mortality. While dynamic approaches, such as the illness-death model, have improved projections, reliable empirical estimates of mortality rate ratios (MRR) for LTC recipients are scarce. This study addresses this gap by providing MRR estimates based on claims data. METHODS: This study analyzed anonymized, aggregated claims data from BARMER, a German statutory health insurance. The data covered individuals aged 60 years and older from 2020 to 2024. Mortality rates and MRR were calculated for individuals with and without LTC needs, stratified by age and sex. Person-time at risk was adjusted assuming mid-year deaths and MRR were derived with 95% confidence intervals. RESULTS: From 2020 to 2024, individuals with LTC need demonstrated persistently higher mortality rates compared to those without LTC need among all age groups and both sexes. The most pronounced increase in mortality disparities was observed in the 90+ age group, where the MRR rose from 6.6 in 2020 to 60.7 in 2024 among women and from 5.5 (2020) to 35.2 (2024) among men. CONCLUSION: Our analysis reveals a persistent and expanding disparity in mortality among individuals with LTC need across all age groups. The findings indicate that the MRRs have remained consistently elevated, suggesting that improvements in survival among individuals with LTC needs have been limited, thereby highlighting their underlying vulnerability.