Death uses a flail to bring on the nobleman's fall. This is a clear allusion to the peasant rebellions in the 1520's. The flail (and the same bible quote) also appears in Holbein's dance of death (picture below to the right).
Death is wearing a hat that clearly marks him as of lower station in life. It's the same hat that Death is wearing before the king (letter D), the girl (letter S) and on the Holbein dagger. The same hat appears in the middle of the crowd in All men's bones.
The accompanying text for this letter goes: »Wan so der mensch wurdt sterben / nimpt er nitt alle ding / noch syn glory stygt hynab mit ym«.
This is from Psalms 49,18, which in Luther's version sounds: »Denn er wird nichts bei seinem Sterben mitnehmen, und seine Herrlichkeit wird ihm nicht nachfahren«. In English: »For when he dieth he shall carry nothing away: his glory shall not descend after him«.