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Jansen L, Schwettmann L, Behr C, Eberle A, Holleczek B, Justenhoven C, Kajüter H, Manz K, Peters F, Pritzkuleit R, Schmidt-Pokrzywniak A, Sirri E, Tetzlaff F, Voigtländer S, Arndt V. Trends in cancer incidence by socioeconomic deprivation in Germany in 2007 to 2018: An ecological registry-based study. Int J Cancer 2023; 153:1784-1796. [PMID: 37539757 DOI: 10.1002/ijc.34662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 06/23/2023] [Accepted: 06/27/2023] [Indexed: 08/05/2023]
Abstract
Age-standardized cancer incidence has decreased over the last years for many cancer sites in developed countries. Whether these trends led to narrowing or widening socioeconomic inequalities in cancer incidence is unknown. Using cancer registry data covering 48 million inhabitants in Germany, the ecological association between age-standardized total and site specific (colorectal, lung, prostate and breast) cancer incidence in 2007 to 2018 and a deprivation index on district level (aggregated to quintiles) was investigated. Incidence in the most and least deprived districts were compared using Poisson models. Average annual percentage changes (AAPCs) and differences in AAPCs between deprivation quintiles were assessed using Joinpoint regression analyses. Age-standardized incidence decreased strongly between 2007 and 2018 for total cancer and all cancer sites (except female lung cancer), irrespective of the level of deprivation. However, differences in the magnitude of trends across deprivation quintiles resulted in increasing inequalities over time for total cancer, colorectal and lung cancer. For total cancer, the incidence rate ratio between the most and least deprived quintile increased from 1.07 (95% confidence interval: 1.01-1.12) to 1.23 (1.12-1.32) in men and from 1.07 (1.01-1.13) to 1.20 (1.14-1.26) in women. Largest inequalities were observed for lung cancer with 82% (men) and 88% (women) higher incidence in the most vs the least deprived regions in 2018. The observed increase in inequalities in cancer incidence is in alignment with trends in inequalities in risk factor prevalence and partly utilization of screening. Intervention programs targeted at socioeconomically deprived and urban regions are highly needed.
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Affiliation(s)
- Lina Jansen
- Epidemiological Cancer Registry Baden-Württemberg, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Lars Schwettmann
- Division for Health Economics, Department of Health Services Research, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Christian Behr
- Cancer Registry Rheinland-Palatinate gGmbH, Mainz, Germany
| | - Andrea Eberle
- Bremen Cancer Registry, Leibniz-Institute for Prevention Research and Epidemiology: BIPS, Bremen, Germany
| | | | | | | | - Kirsi Manz
- Cancer Registry Mecklenburg-Western Pomerania, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | | | - Ron Pritzkuleit
- Institute for Cancer Epidemiology, University Lübeck, Cancer Registry Schleswig-Holstein, Lübeck, Germany
| | | | - Eunice Sirri
- Epidemiological Cancer Registry Lower Saxony, Registerstelle, Oldenburg, Germany
| | - Fabian Tetzlaff
- Division of Social Determinants of Health, Robert Koch-Institute, Berlin, Germany
| | - Sven Voigtländer
- Bavarian Cancer Registry, Bavarian Health and Food Safety Authority, Nürnberg, Germany
| | - Volker Arndt
- Epidemiological Cancer Registry Baden-Württemberg, German Cancer Research Center (DKFZ), Heidelberg, Germany
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Khand A, Brankin-Frisby T, Gornall M, Hatherley J, Raj R, Campbell M, Salmon T, Yang YH, Grainger R. Independent Predictors of Repeat Emergency Room Presentations: Insights from a Cohort of 1066 Consecutive Patients with Non-Cardiac Chest Pain Generating 4770 Repeat Presentations. J Clin Med 2023; 12:5290. [PMID: 37629331 PMCID: PMC10455527 DOI: 10.3390/jcm12165290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 07/08/2023] [Accepted: 07/19/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND AND IMPORTANCE Chest pain (CP) is one of the most frequent presentations to the emergency department (ED), a large proportion of which is non-cardiac chest pain (NCCP). Repeat attendances to ED are common and impose considerable burden to overstretched departments. OBJECTIVE Our aim was to determine drivers for repeat ED presentations using NCCP as the primary cause of index presentation. DESIGN, SETTING AND PARTICIPANTS This was a retrospective cohort study of 1066 consecutive presentations with NCCP to a major urban hospital ED in North England. Index of Multiple Deprivation (IMD), a postcode-derived validated index of deprivation, was computed. Charlson comorbidity index (CCI) was determined by reference to known comorbidity variables. Repeat presentation to ED to any national hospital was determined by a national linked database (population 53.5 million). Independent predictors of ED representation were computed using logistic regression analysis. RESULTS Median age was 43 (IQR 28-59), and 50.8% were male. Furthermore, 27.8%, 8.1% and 3.8% suffered from chronic obstructive pulmonary disease (COPD), hypertension and diabetes mellitus, respectively. The most frequent diagnoses, using ICD-10 coding, were non-cardiac chest pain (55.1%), followed by respiratory conditions (14.7%). One-year incidence of adjudicated myocardial infarction, urgent or emergency coronary revascularisation and all-cause death was 0.6%, 2% and 5.3%, respectively. There was a total of 4770 ED repeat presentations 1 year prior to or following index presentation with NCCP in this cohort. Independent (multivariate) predictors for frequent re-presentation (defined as ≥2 representations) were a history of COPD (OR [odds ratio] 2.06, p = 0.001), previous MI (OR3.6, p = 0.020) and a Charlson comorbidity index ≥1 (OR 1.51, p = 0.030). The frequency of previous MI was low as only 3% had sustained a previous MI. CONCLUSIONS This analysis indicates that COPD and complex health care needs (represented by high CCI), but not socio-economic deprivation, should be health policy targets for lessening repeat ED presentations. What is already known on this topic: Repeat presentations with non-ischaemic chest pain are common, placing a considerable burden on emergency departments. WHAT THIS STUDY ADDS COPD and complex health care needs, denoted by Charlson comorbidity index, are implicated as drivers for repeat presentation to accident and emergency department. Socio-economic deprivation was not an independent predictor of re-presentation. How might this study affect research, practice, or policy: Community-based support for COPD and complex health care needs may reduce frequency of ED attendance.
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Affiliation(s)
- Aleem Khand
- Liverpool University Hospitals NHS Foundation Trust, Liverpool L9 7AL, UK (T.S.); (Y.-h.Y.)
- Liverpool Heart and Chest Hospital, Liverpool L14 3PE, UK
- Department of Ageing and Chronic Diseases, University of Liverpool, Liverpool L69 3BX, UK
| | - Thomas Brankin-Frisby
- Liverpool University Hospitals NHS Foundation Trust, Liverpool L9 7AL, UK (T.S.); (Y.-h.Y.)
| | - Matthew Gornall
- Clinical Trials Unit, University of Liverpool, Liverpool L69 3BX, UK
| | - James Hatherley
- Liverpool University Hospitals NHS Foundation Trust, Liverpool L9 7AL, UK (T.S.); (Y.-h.Y.)
| | - Ray Raj
- Liverpool University Hospitals NHS Foundation Trust, Liverpool L9 7AL, UK (T.S.); (Y.-h.Y.)
| | - Michael Campbell
- Liverpool University Hospitals NHS Foundation Trust, Liverpool L9 7AL, UK (T.S.); (Y.-h.Y.)
| | - Thomas Salmon
- Liverpool University Hospitals NHS Foundation Trust, Liverpool L9 7AL, UK (T.S.); (Y.-h.Y.)
| | - Yi-han Yang
- Liverpool University Hospitals NHS Foundation Trust, Liverpool L9 7AL, UK (T.S.); (Y.-h.Y.)
| | - Ruth Grainger
- North-West Coast Academic Science Network, Cheshire WA4 4AB, UK
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Engelhardt M, Brioli A, von Lilienfeld-Toal M. [Differences due to socio-economic status, genetic background and sex in cancer and precision medicine - An intersectional approach to close the care gap for marginalized groups]. Dtsch Med Wochenschr 2023; 148:528-538. [PMID: 37094588 DOI: 10.1055/a-1892-4833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Abstract
Malignant tumor diseases constitute the 2nd most common cause of death and due to our extended life expectancy cancer per se has substantially increased, being highly prevalent after cardiovascular diseases. Evidence also generated from the COVID-19 pandemic, that defined gender differences exist in symptom and disease courses, and have advocated the need to assess gender, ethnic/racial and minority differences in cancer care and treatment more meticulously. It is becoming increasingly evident that in novel cancer care/precision oncology, representation of minorities, elderly and frail patients in clinical trials remains largely unbalanced, thus distribution of cancer success is iniquitous. This article focusses on these aspects and suggests solutions, how this can be improved.
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Qi X, Jia Y, Pan C, Li C, Wen Y, Hao J, Liu L, Cheng B, Cheng S, Yao Y, Zhang F. Index of multiple deprivation contributed to common psychiatric disorders: A systematic review and comprehensive analysis. Neurosci Biobehav Rev 2022; 140:104806. [PMID: 35926729 DOI: 10.1016/j.neubiorev.2022.104806] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 04/08/2022] [Accepted: 07/31/2022] [Indexed: 10/16/2022]
Abstract
BACKGROUND Limited studies have been conducted to explore the interaction effects of social environmental and genetic factors on the risks of common psychiatric disorders. METHODS 56,613-106,695 individuals were collected from the UK Biobank cohort. Logistic or liner regression models were first used to evaluate the associations of index of multiple deprivation (IMD) with bipolar disorder (BD), depression and anxiety in UK Biobank cohort. Then, for the significant IMD associated with BD, depression and anxiety, genome-wide gene-environment interaction study (GWEIS) was performed by PLINK 2.0. RESULT Totally, the higher levels of IMD were significantly associated with higher risks of BD, depression and anxiety. For BD, GWEIS identified multiple significant SNPs interacting with IMD, such as rs75182167 for income and rs111841503 for education. For depression and anxiety, GWEIS found significant SNPs interacting with income and education, such as rs147013419 for income and rs142366753 for education. CONCLUSION Social environmental deprivations contributed to the risks of psychiatric disorders. Besides, we reported multiple candidate genetic loci interacting with IMD, providing novel insights into the biological mechanism.
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Affiliation(s)
- Xin Qi
- Precision Medicine Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yumeng Jia
- Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, China
| | - Chuyu Pan
- Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, China
| | - Chune Li
- Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, China
| | - Yan Wen
- Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, China
| | - Jingcan Hao
- Cancer Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Li Liu
- Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, China
| | - Bolun Cheng
- Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, China
| | - Shiqiang Cheng
- Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, China
| | - Yao Yao
- Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, China
| | - Feng Zhang
- Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, China.
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Marijic P, Schwarzkopf L, Maier W, Trudzinski F, Kreuter M, Schwettmann L. Comparing outcomes of ILD patients managed in specialised versus non-specialised centres. Respir Res 2022; 23:220. [PMID: 36030227 PMCID: PMC9420269 DOI: 10.1186/s12931-022-02143-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 08/11/2022] [Indexed: 12/05/2022] Open
Abstract
Background Early appropriate diagnosis and treatment of interstitial lung diseases (ILD) is crucial to slow disease progression and improve survival. Yet it is unknown whether initial management in an expert centre is associated with improved outcomes. Therefore, we assessed mortality, hospitalisations and health care costs of ILD patients initially diagnosed and managed in specialised ILD centres versus non-specialised centres and explored differences in pharmaceutical treatment patterns. Methods An epidemiological claims data analysis was performed, including patients with different ILD subtypes in Germany between 2013 and 2018. Classification of specialised centres was based on the number of ILD patients managed and procedures performed, as defined by the European Network on Rare Lung Diseases. Inverse probability of treatment weighting was used to adjust for covariates. Mortality and hospitalisations were examined via weighted Cox models, cost differences by weighted gamma regression models and differences in treatment patterns with weighted logistic regressions. Results We compared 2022 patients managed in seven specialised ILD centres with 28,771 patients managed in 1156 non-specialised centres. Specialised ILD centre management was associated with lower mortality (HR: 0.87, 95% CI 0.78; 0.96), lower all-cause hospitalisation (HR: 0.93, 95% CI 0.87; 0.98) and higher respiratory-related costs (€669, 95% CI €219; €1156). Although risk of respiratory-related hospitalisations (HR: 1.00, 95% CI 0.92; 1.10) and overall costs (€− 872, 95% CI €− 75; €1817) did not differ significantly, differences in treatment patterns were observed. Conclusion Initial management in specialised ILD centres is associated with improved mortality and lower all-cause hospitalisations, potentially due to more differentiated diagnostic approaches linked with more appropriate ILD subtype-adjusted therapy. Supplementary Information The online version contains supplementary material available at 10.1186/s12931-022-02143-1.
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Affiliation(s)
- Pavo Marijic
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München - German Research Centre for Environmental Health (GmbH), Neuherberg, Germany.,Pettenkofer School of Public Health, Munich, Germany.,Institute for Medical Information Processing, Biometry and Epidemiology, IBE, LMU Munich, Munich, Germany
| | - Larissa Schwarzkopf
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München - German Research Centre for Environmental Health (GmbH), Neuherberg, Germany.,Pettenkofer School of Public Health, Munich, Germany.,Comprehensive Pneumology Centre Munich (CPC-M), Member of the German Centre for Lung Research (DZL), Munich, Germany.,IFT-Institut Fuer Therapieforschung, Munich, Germany
| | - Werner Maier
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München - German Research Centre for Environmental Health (GmbH), Neuherberg, Germany
| | - Franziska Trudzinski
- Centre for Interstitial and Rare Lung Diseases, Pneumology and Respiratory Critical Care Medicine, Thoraxklinik, University of Heidelberg, German Centre for Lung Research (DZL), Röntgenstr. 1, 69126, Heidelberg, Germany
| | - Michael Kreuter
- Centre for Interstitial and Rare Lung Diseases, Pneumology and Respiratory Critical Care Medicine, Thoraxklinik, University of Heidelberg, German Centre for Lung Research (DZL), Röntgenstr. 1, 69126, Heidelberg, Germany.
| | - Lars Schwettmann
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München - German Research Centre for Environmental Health (GmbH), Neuherberg, Germany.,Department of Economics, Martin Luther University Halle-Wittenberg, Halle, Germany
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[Spatio-temporal distribution of COVID-19 in Cologne and associated socio-economic factors in the period from February 2020 to October 2021]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2022; 65:853-862. [PMID: 35920847 PMCID: PMC9362610 DOI: 10.1007/s00103-022-03573-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 07/20/2022] [Indexed: 11/05/2022]
Abstract
Hintergrund und Ziele Schon in der frühen Phase der global sehr verschieden verlaufenden COVID-19-Pandemie zeigten sich Hinweise auf den Einfluss sozioökonomischer Faktoren auf die Ausbreitungsdynamik der Erkrankung, die vor allem ab der zweiten Phase (September 2020) Menschen mit geringerem sozioökonomischen Status stärker betraf. Solche Effekte können sich auch innerhalb einer Großstadt zeigen. Die vorliegende Studie visualisiert und untersucht die zeitlich-räumliche Verbreitung aller in Köln gemeldeten COVID-19-Fälle (Februar 2020–Oktober 2021) auf Stadtteilebene und deren mögliche Assoziation mit sozioökonomischen Faktoren. Methoden Pseudonymisierte Daten aller in Köln gemeldeten COVID-19-Fälle wurden geocodiert, deren Verteilung altersstandardisiert auf Stadtteilebene über 4 Zeiträume kartiert und mit der Verteilung von sozialen Faktoren verglichen. Der mögliche Einfluss der ausgewählten Faktoren wird zudem in einer Regressionsanalyse in einem Modell mit Fallzuwachsraten betrachtet. Ergebnisse Das kleinräumige lokale Infektionsgeschehen ändert sich im Pandemieverlauf. Stadtteile mit schwächeren sozioökonomischen Indizes weisen über einen großen Teil des pandemischen Verlaufs höhere Inzidenzzahlen auf, wobei eine positive Korrelation zwischen den Armutsrisikofaktoren und der altersstandardisierten Inzidenz besteht. Die Stärke dieser Korrelation ändert sich im zeitlichen Verlauf. Schlussfolgerung Die zeitnahe Beobachtung und Analyse der lokalen Ausbreitungsdynamik lassen auch auf der Ebene einer Großstadt die positive Korrelation von nachteiligen sozioökonomischen Faktoren auf die Inzidenzrate von COVID-19 erkennen und können dazu beitragen, lokale Eindämmungsmaßnahmen zielgerecht zu steuern. Zusatzmaterial online Zusätzliche Informationen sind in der Online-Version dieses Artikels (10.1007/s00103-022-03573-4) enthalten.
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Manz KM, Schwettmann L, Mansmann U, Maier W. Area Deprivation and COVID-19 Incidence and Mortality in Bavaria, Germany: A Bayesian Geographical Analysis. Front Public Health 2022; 10:927658. [PMID: 35910894 PMCID: PMC9334899 DOI: 10.3389/fpubh.2022.927658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 06/23/2022] [Indexed: 11/13/2022] Open
Abstract
Background Area deprivation has been shown to be associated with various adverse health outcomes including communicable as well as non-communicable diseases. Our objective was to assess potential associations between area deprivation and COVID-19 standardized incidence and mortality ratios in Bavaria over a period of nearly 2 years. Bavaria is the federal state with the highest infection dynamics in Germany and demographically comparable to several other European countries. Methods In this retrospective, observational ecological study, we estimated the strength of associations between area deprivation and standardized COVID-19 incidence and mortality ratios (SIR and SMR) in Bavaria, Germany. We used official SARS-CoV-2 reporting data aggregated in monthly periods between March 1, 2020 and December 31, 2021. Area deprivation was assessed using the quintiles of the 2015 version of the Bavarian Index of Multiple Deprivation (BIMD 2015) at district level, analyzing the overall index as well as its single domains. Results Deprived districts showed higher SIR and SMR than less deprived districts. Aggregated over the whole period, the SIR increased by 1.04 (95% confidence interval (95% CI): 1.01 to 1.07, p = 0.002), and the SMR by 1.11 (95% CI: 1.07 to 1.16, p < 0.001) per BIMD quintile. This represents a maximum difference of 41% between districts in the most and least deprived quintiles in the SIR and 110% in the SMR. Looking at individual months revealed clear linear association between the BIMD quintiles and the SIR and SMR in the first, second and last quarter of 2021. In the summers of 2020 and 2021, infection activity was low. Conclusions In more deprived areas in Bavaria, Germany, higher incidence and mortality ratios were observed during the COVID-19 pandemic with particularly strong associations during infection waves 3 and 4 in 2020/2021. Only high infection levels reveal the effect of risk factors and socioeconomic inequalities. There may be confounding between the highly deprived areas and border regions in the north and east of Bavaria, making the relationship between area deprivation and infection burden more complex. Vaccination appeared to balance incidence and mortality rates between the most and least deprived districts. Vaccination makes an important contribution to health equality.
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Affiliation(s)
- Kirsi Marjaana Manz
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Ludwig-Maximilians-Universität (LMU), Munich, Germany
- *Correspondence: Kirsi Marjaana Manz
| | - Lars Schwettmann
- Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Neuherberg, Germany
- Department of Economics, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Ulrich Mansmann
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Ludwig-Maximilians-Universität (LMU), Munich, Germany
- Pettenkofer School of Public Health, Ludwig-Maximilians-Universität (LMU), Munich, Germany
| | - Werner Maier
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Ludwig-Maximilians-Universität (LMU), Munich, Germany
- Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Neuherberg, Germany
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Erdmann S, Biddle L, Kieser M, Bozorgmehr K. Using independent cross-sectional survey data to predict post-migration health trajectories among refugees by estimating transition probabilities and their variances. Biom J 2022; 64:964-983. [PMID: 35187684 DOI: 10.1002/bimj.202100045] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 12/07/2021] [Accepted: 01/12/2021] [Indexed: 11/10/2022]
Abstract
Health research is often concerned with the transition of health conditions and their relation with given exposures, therefore requiring longitudinal data. However, such data is not always available and resource-intensive to collect. Our aim is to use a pseudo-panel of independent cross-sectional data (e.g., data of T 0 $T_0$ and T 1 $T_1$ ) to extrapolate and approximate longitudinal health trajectories ( T 0 $T_0$ - T 1 $T_1$ ). Methods will be illustrated by examples of studying contextual effects on health among refugees by calculating transition probabilities with associated variances. The data consist of two cross-sectional health surveys among randomly selected refugee samples in reception ( T 0 $T_0$ ) and accommodation centers ( T 1 $T_1$ ) located in Germany's third-largest federal state. Self-reported measures of physical and mental health, health-related quality of life, health care access, and unmet medical needs of 560 refugees were collected. Missing data were imputed by multiple imputation. For each imputed data set, transition probabilities were calculated based on (i) probabilistic discrete event systems with Moore-Penrose generalized inverse matrix method (PDES-MP) and (ii) propensity score matching (PSM). By application of sampling approaches, exploiting the fact that status membership is multinomially distributed, results of both methods were pooled by Rubin's Rule, accounting for within and between-imputation variance. Most of the analyzed estimates of the transition probabilities and their variances are comparable between both methods. However, it seems that they handle sparse cells differently: either assigning an average value for the transition probability for all states with high certainty (i) or assigning a more extreme value for the transition probability with large variance estimate (ii).
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Affiliation(s)
- Stella Erdmann
- Institute of Medical Biometry, University of Heidelberg, Heidelberg, Germany
| | - Louise Biddle
- Section for Health Equity Studies and Migration, Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Meinhard Kieser
- Institute of Medical Biometry, University of Heidelberg, Heidelberg, Germany
| | - Kayvan Bozorgmehr
- Section for Health Equity Studies and Migration, Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany.,Department of Population Medicine and Health Services Research, School of Public Health, Bielefeld University, Bielefeld, Germany
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Peters M, Zeeb H. Availability of open data for spatial public health research. GERMAN MEDICAL SCIENCE : GMS E-JOURNAL 2022; 20:Doc01. [PMID: 35465641 PMCID: PMC9006316 DOI: 10.3205/000303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 11/11/2021] [Indexed: 11/08/2022]
Abstract
Background: Preventive and health-promoting policies can guide (place- and space-specific) factors influencing human health, such as the physical and social environment. Required is data that can lead to a more nuanced decision-making process and identify both existing and future challenges. Along with the rise of new technologies, and thus the multiple opportunities to use and process data, new options have emerged to measure and monitor factors that affect health. Thus, in recent years, several gateways for open data (including governmental and geospatial data) have become available. At present, an increasing number of research institutions as well as (state and private) companies and citizens' initiatives are providing data. However, there is a lack of overviews covering the range of such offerings regarding health. In particular, for geographically differentiated analyses, there are challenges related to data availability at different spatial levels and the growing number of data providers. Objectives: This paper aims to provide an overview of open data resources available in the context of space and health to date. It also describes the technical and legal conditions for using open data. Results: An up-to-date summary of results including information on relevant data access and terms of use is provided along with a web visualization. All data is available for further use under an open license.
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Affiliation(s)
- Manuela Peters
- Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany,Faculty 11 – Human and Health Sciences, University of Bremen, Germany,*To whom correspondence should be addressed: Manuela Peters, Leibniz Institute for Prevention Research and Epidemiology – BIPS, Achterstraße 30, 28215 Bremen, Germany, Phone: +49 421 218-56924, E-mail:
| | - Hajo Zeeb
- Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany,Faculty 11 – Human and Health Sciences, University of Bremen, Germany
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De Nicola G, Schneble M, Kauermann G, Berger U. Regional now- and forecasting for data reported with delay: toward surveillance of COVID-19 infections. ADVANCES IN STATISTICAL ANALYSIS : ASTA : A JOURNAL OF THE GERMAN STATISTICAL SOCIETY 2022; 106:407-426. [PMID: 35069920 PMCID: PMC8764329 DOI: 10.1007/s10182-021-00433-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 12/17/2021] [Indexed: 12/20/2022]
Abstract
Governments around the world continue to act to contain and mitigate the spread of COVID-19. The rapidly evolving situation compels officials and executives to continuously adapt policies and social distancing measures depending on the current state of the spread of the disease. In this context, it is crucial for policymakers to have a firm grasp on what the current state of the pandemic is, and to envision how the number of infections is going to evolve over the next days. However, as in many other situations involving compulsory registration of sensitive data, cases are reported with delay to a central register, with this delay deferring an up-to-date view of the state of things. We provide a stable tool for monitoring current infection levels as well as predicting infection numbers in the immediate future at the regional level. We accomplish this through nowcasting of cases that have not yet been reported as well as through predictions of future infections. We apply our model to German data, for which our focus lies in predicting and explain infectious behavior by district.
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Affiliation(s)
- Giacomo De Nicola
- Department of Statistics, Ludwig-Maximillians-Universität München, Munich, Germany
| | - Marc Schneble
- Department of Statistics, Ludwig-Maximillians-Universität München, Munich, Germany
| | - Göran Kauermann
- Department of Statistics, Ludwig-Maximillians-Universität München, Munich, Germany
| | - Ursula Berger
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximillians-Universität München, Munich, Germany
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Berger J, Engelhardt M, Möller MD, Radeloff K, Seltmann A, von Lilienfeld-Toal M. Sozioökonomische Benachteiligung als Risikofaktor für Krebserkrankungen – „closing the care gap“. FORUM 2022. [PMCID: PMC9362474 DOI: 10.1007/s12312-022-01113-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Armut ist ein Risikofaktor für Krebs. Menschen aus sozioökonomisch benachteiligten Gesellschaftsschichten erkranken häufiger und früher an Krebs, haben nach Diagnosestellung oftmals eine kürzere Lebenserwartung und profitieren hinsichtlich des Gesamtüberlebens weniger von der Therapie. Diese Beobachtung hat sich im Zuge der COVID-19-Pandemie weiter verschärft. Im vorliegenden Beitrag stellen wir zusammengefasst Ergebnisse für Deutschland dar, die diesen Zusammenhang illustrieren. Methodisch greifen wir dazu auf Erkenntnisse zurück, die sich auf individuelle Marker wie das individuelle Einkommen oder auf regionale Indizes sozialer Deprivation wie den German Index of Multiple Deprivation (GIMD) konzentrieren. Das Konzept der Klassenmedizin hinterfragt strukturelle Bedingungen, die dazu führen, dass das Versorgungssystem und die Behandler*innen selbst bestehende Unterschiede weiter fördern, anstatt diese auszugleichen. Faktoren der Ungleichheit in der Versorgung von Menschen gerade mit onkologischen Erkrankungen, seien sie sozioökonomischer, geschlechtsspezifischer oder ethnischer Art, müssen besser erfasst werden, um eine gerechte und gleichwertige Behandlung aller Menschen zu gewährleisten.
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Affiliation(s)
- Johannes Berger
- Charité Comprehensive Cancer Center, Charitéplatz 1, 10117 Berlin, Deutschland
| | - Monika Engelhardt
- Hämatologie und Onkologie, Interdisziplinäres Tumorzentrum, Universitätsklinik Freiburg, Hugstetterstr. 53, 79106 Freiburg, Deutschland
| | - Mandy-Deborah Möller
- Hämatologie und Onkologie, Interdisziplinäres Tumorzentrum, Universitätsklinik Freiburg, Hugstetterstr. 53, 79106 Freiburg, Deutschland
| | - Katrin Radeloff
- Universitätsklinik für Hals-Nasen-Ohren-Heilkunde, Evangelischen Krankenhaus Oldenburg, Steinweg 13–17, 26122 Oldenburg, Deutschland
| | - Alexander Seltmann
- MediNetz Jena e. V. c/o Anonymer Krankenschein Thüringen e. V., Westbahnhofstr. 2, 07743 Jena, Deutschland
| | - Marie von Lilienfeld-Toal
- Abteilung für Hämatologie und internistische Onkologie, Klinik für Innere Medizin II, Universitätsklinikum Jena, Am Klinikum 1, 07747 Jena, Deutschland
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12
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Auzanneau M, Rosenbauer J, Maier W, von Sengbusch S, Hamann J, Kapellen T, Freckmann G, Schmidt S, Lilienthal E, Holl RW. Heterogeneity of Access to Diabetes Technology Depending on Area Deprivation and Demographics Between 2016 and 2019 in Germany. J Diabetes Sci Technol 2021; 15:1059-1068. [PMID: 34253084 PMCID: PMC8442190 DOI: 10.1177/19322968211028608] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Despite increasing use of technology in type 1 diabetes, persistent ethnic and socio-economic disparities have been reported. We analyzed how the use of insulin pump therapy and continuous glucose monitoring (CGM) evolved over the years in Germany depending on demographics and area deprivation. METHOD We investigated the use of insulin pump and CGM between 2016 and 2019 in 37,798 patients with type 1 diabetes aged < 26 years from the German Prospective Follow-up Registry (DPV). Associations with federal state, area-deprivation quintile (German Index of Multiple Deprivation 2010 on district level), gender, and migration background were investigated over time using multiple logistic regression. RESULTS Between 2016 and 2019, the regional distribution of insulin pump use did not change substantially and the association with area deprivation remained non-linear and statistically non-significant. The effect of area deprivation on CGM use decreased continuously and disappeared in 2019 (OR [95%-CI] Q1 vs Q5: 1.85 [1.63-2.10] in 2016; 0.97 [0.88-1.08] in 2019). The effect of migration background on the use of either technology decreased over the years but remained significant in 2019. Girls had constantly higher odds of using an insulin pump than boys (OR: 1.25 [1.18-1.31] in 2019), whereas no gender difference was identified for CGM use. CONCLUSIONS Although disparities decreased in Germany, access to diabetes technology still depends on migration background in 2019, and gender differences in pump use persist. As technological advances are made, further research is needed to understand the reasons for these persistent disparities.
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Affiliation(s)
- Marie Auzanneau
- Institute of Epidemiology and Medical
Biometry, ZIBMT, University of Ulm, Ulm, Baden-Württemberg, Germany
- German Center for Diabetes Research
(DZD), Neuherberg, Germany
- Marie Auzanneau, MPH, Institute of
Epidemiology and Medical Biometry, ZIBMT, University of Ulm,
Albert-Einstein-Allee 41, Ulm, Baden-Württemberg D-89081, Germany.
| | - Joachim Rosenbauer
- German Center for Diabetes Research
(DZD), Neuherberg, Germany
- Institute for Biometrics and
Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at
Heinrich Heine University, Düsseldorf, North Rhine-Westphalia, Germany
| | - Werner Maier
- German Center for Diabetes Research
(DZD), Neuherberg, Germany
- Institute of Health Economics and
Health Care Management, Helmholtz Zentrum München, German Research Center for
Environmental Health (GmbH), Neuherberg, Bayern, Germany
| | - Simone von Sengbusch
- Department of Pediatrics and Adolescent
Medicine, Division of Pediatric Endocrinology and Diabetes, University of Lübeck,
Lübeck, Schleswig-Holstein, Germany
| | - Johannes Hamann
- Department of Pediatrics, St. Marien
Hospital Landshut, Landshut, Germany
| | - Thomas Kapellen
- Department of Women and Child Health,
Hospital for Children and Adolescents, University of Leipzig, Leipzig, Sachsen,
Germany
| | - Guido Freckmann
- Institut für Diabetes-Technologie,
Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm,
Baden-Württemberg, Ulm, Germany
| | - Silke Schmidt
- Department of Paediatrics and
Adolescent Medicine, Klinikum Dritter Orden, Munich, Bavaria, Germany
| | - Eggert Lilienthal
- Department of Pediatrics, St.
Josef-Hospital, Ruhr-University Bochum, Bochum, Nordrhein-Westfalen, Germany
| | - Reinhard W. Holl
- Institute of Epidemiology and Medical
Biometry, ZIBMT, University of Ulm, Ulm, Baden-Württemberg, Germany
- German Center for Diabetes Research
(DZD), Neuherberg, Germany
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13
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Grau AJ, Dienlin S, Bartig D, Maier W, Buggle F, Becher H. Regional Deprivation, Stroke Incidence, and Stroke Care. DEUTSCHES ARZTEBLATT INTERNATIONAL 2021; 118:397-402. [PMID: 34304754 DOI: 10.3238/arztebl.m2021.0149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 12/07/2020] [Accepted: 02/04/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Regional deprivation can increase the risk of illness and adversely affect care outcomes. In this study, we investigated for the German state of Rhineland-Palatinate whether spatial-structural disadvantages are associated with an increased frequency of ischemic stroke and with less favorable care outcomes. METHODS We compared billing data from DRG statistics (2008-2017) and quality assurance data (2017) for acute ischemic stroke with the German Index of Multiple Deprivation 2010 (GIMD 2010) for the 36 districts (Landkreise) and independent cities (i.e., cities not belonging to a district) in Rhineland-Palatinate using correlation analyses, a Poisson regression analysis, and logistic regression analyses. RESULTS The age-standardized stroke rates (ASR) ranged from 122 to 209 per 100 000 inhabitants, while the GIMD 2010 ranged from 4.6 to 47.5; the two values were positively correlated (Spearman's ρ = 0.47; 95% confidence interval [0.16; 0.85]). In 2017, mechanical thrombectomies were performed more commonly (5.7%) in the first GIMD 2010 quartile of the regional areas (i.e., in the least deprived areas) than in the remaining quartiles (4.2-4.6%). The intravenous thrombolysis rates showed no differences from one GIMD 2010 quartile to another. Severe neurological deficits (National Institutes of Health Stroke Scale ≥ 5) on admission to the hospital were slightly more common in the fourth quartile (i.e., in the most deprived areas), while antiplatelet drugs and statins were somewhat less commonly ordered on discharge in those areas than in the first quartile. CONCLUSION These findings document a relationship between regional deprivation and the occurrence of acute ischemic stroke. Poorer GIMD 2010 scores were associated with worse care outcomes in a number of variables, but the absolute differences were small.
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Affiliation(s)
- Armin J Grau
- Department of Neurology, Ludwigshafen Hospital, Ludwigshafen; Quality Assurance Agency of Rhineland-Palatinate, Mainz; DRG Market, Osnabrück; Helmholtz Center Munich - German Research Center for Health and the Environment (Ltd), Institute for Health Economics and Management in Healthcare, Neuherberg; Oberwallis Hospital Center, Visp, Switzerland; Institute for Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg
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14
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Finke I, Behrens G, Maier W, Schwettmann L, Pritzkuleit R, Holleczek B, Kajüter H, Gerken M, Mattutat J, Emrich K, Jansen L, Brenner H. Small-area analysis on socioeconomic inequalities in cancer survival for 25 cancer sites in Germany. Int J Cancer 2021; 149:561-572. [PMID: 33751564 DOI: 10.1002/ijc.33553] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 12/27/2020] [Accepted: 01/28/2021] [Indexed: 11/12/2022]
Abstract
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.
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Affiliation(s)
- Isabelle Finke
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Medical Faculty Heidelberg, University of Heidelberg, Heidelberg, Germany
| | - Gundula Behrens
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Werner Maier
- Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Neuherberg, Germany
| | - Lars Schwettmann
- Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Neuherberg, Germany.,Department of Economics, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Ron Pritzkuleit
- Institute for Cancer Epidemiology at the University of Lübeck, Cancer Registry Schleswig-Holstein, Lübeck, Germany
| | | | | | - Michael Gerken
- Tumor Center - Institute for Quality Management and Health Services Research, University of Regensburg, Regensburg, Germany
| | - Johann Mattutat
- Institute for Cancer Epidemiology at the University of Lübeck, Cancer Registry Schleswig-Holstein, Lübeck, Germany
| | | | - Lina Jansen
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany.,German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
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15
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Abstract
Zusammenfassung
Hintergrund
Ein Erklärungsmodell gesundheitlicher Ungleichheiten zwischen Stadt und Land fehlt bis dato.
Fragestellung
In dem vorliegenden Beitrag werden gesundheitsrelevante Unterschiede zwischen städtischen und ländlichen Umwelten identifiziert und erstmals in einem interdisziplinären Modell systematisiert.
Methodik
Es werden gesundheitsrelevante Determinanten auf Mikro‑, Meso- und Makroebene aus der bundesdeutschen Literatur gesichtet und vorgestellt. Dabei werden städtische und ländliche Umwelten auf der Mesoebene verortet und diese weiter in natürliche, physisch gebaute sowie psychosoziale und ökonomische Umwelteinflüsse differenziert.
Ergebnisse
Bezüglich Mikroklima, Lärmexposition und Luftschadstoffbelastung finden sich auf dem Land günstigere Lebensbedingungen. Dagegen ist dort die Pollen- und Ozonbelastung im Vergleich zur Stadt höher. Hinsichtlich der natürlichen Umwelteinflüsse sind außerdem im innerstädtischen Vergleich zentrale Wohnlagen am stärksten belastet. Die physisch gebaute Umwelt zeichnet sich auf dem Land einerseits durch geringere Verkehrsunfallrisiken und andererseits durch Defizite bei gesundheitsrelevanten Infrastrukturen aus. Bezüglich der psychosozialen Umwelt finden sich auf dem Land zum einen dichtere soziale Netzwerke und zum anderen geringere Kriminalitätsrisiken. Dagegen stehen ländlichen Regionen geringere ökonomische Ressourcen zur Verfügung.
Schlussfolgerung
Innerhalb aller berücksichtigten Dimensionen, der natürlichen Umwelt, der physisch gebauten sowie der psychosozialen und ökonomischen Umwelt, finden sich einige auf dem Land und einige in der Stadt tendenziell günstigere Verhältnisse. Darüber hinaus unterscheiden sich die innerstädtischen Rand- und Zentrumslagen in Bezug auf gesundheitsrelevante Belastungen und Ressourcen.
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16
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Estimation of the Potentially Avoidable Excess Deaths Associated with Socioeconomic Inequalities in Cancer Survival in Germany. Cancers (Basel) 2021; 13:cancers13020357. [PMID: 33478065 PMCID: PMC7835812 DOI: 10.3390/cancers13020357] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 01/14/2021] [Accepted: 01/14/2021] [Indexed: 12/15/2022] Open
Abstract
Many countries have reported survival inequalities due to regional socioeconomic deprivation. To quantify the potential gain from eliminating cancer survival disadvantages associated with area-based deprivation in Germany, we calculated the number of avoidable excess deaths. We used population-based cancer registry data from 11 of 16 German federal states. Patients aged ≥15 years diagnosed with an invasive malignant tumor between 2008 and 2017 were included. Area-based socioeconomic deprivation was assessed using the quintiles of the German Index of Multiple Deprivation (GIMD) 2010 on a municipality level nationwide. Five-year age-standardized relative survival for 25 most common cancer sites and for total cancer were calculated using period analysis. Incidence and number of avoidable excess deaths in Germany in 2013-2016 were estimated. Summed over the 25 cancer sites, 4100 annual excess deaths (3.0% of all excess deaths) could have been avoided each year in Germany during the period 2013-2016 if relative survival were in all regions comparable with the least deprived regions. Colorectal, oral and pharynx, prostate, and bladder cancer contributed the largest numbers of avoidable excess deaths. Our results provide a good basis to estimate the potential of intervention programs for reducing socioeconomic inequalities in cancer burden in Germany.
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17
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Addala A, Auzanneau M, Miller K, Maier W, Foster N, Kapellen T, Walker A, Rosenbauer J, Maahs DM, Holl RW. A Decade of Disparities in Diabetes Technology Use and HbA 1c in Pediatric Type 1 Diabetes: A Transatlantic Comparison. Diabetes Care 2021; 44:133-140. [PMID: 32938745 PMCID: PMC8162452 DOI: 10.2337/dc20-0257] [Citation(s) in RCA: 158] [Impact Index Per Article: 52.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 08/07/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE As diabetes technology use in youth increases worldwide, inequalities in access may exacerbate disparities in hemoglobin A1c (HbA1c). We hypothesized that an increasing gap in diabetes technology use by socioeconomic status (SES) would be associated with increased HbA1c disparities. RESEARCH DESIGN AND METHODS Participants aged <18 years with diabetes duration ≥1 year in the Type 1 Diabetes Exchange (T1DX, U.S., n = 16,457) and Diabetes Prospective Follow-up (DPV, Germany, n = 39,836) registries were categorized into lowest (Q1) to highest (Q5) SES quintiles. Multiple regression analyses compared the relationship of SES quintiles with diabetes technology use and HbA1c from 2010-2012 to 2016-2018. RESULTS HbA1c was higher in participants with lower SES (in 2010-2012 and 2016-2018, respectively: 8.0% and 7.8% in Q1 and 7.6% and 7.5% in Q5 for DPV; 9.0% and 9.3% in Q1 and 7.8% and 8.0% in Q5 for T1DX). For DPV, the association between SES and HbA1c did not change between the two time periods, whereas for T1DX, disparities in HbA1c by SES increased significantly (P < 0.001). After adjusting for technology use, results for DPV did not change, whereas the increase in T1DX was no longer significant. CONCLUSIONS Although causal conclusions cannot be drawn, diabetes technology use is lowest and HbA1c is highest in those of the lowest SES quintile in the T1DX, and this difference for HbA1c broadened in the past decade. Associations of SES with technology use and HbA1c were weaker in the DPV registry.
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Affiliation(s)
- Ananta Addala
- Division of Pediatric Endocrinology, Stanford University, Stanford, CA
| | - Marie Auzanneau
- University of Ulm, Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
| | | | - Werner Maier
- German Center for Diabetes Research (DZD), Neuherberg, Germany
- Helmholtz Zentrum München - German Research Center for Environmental Health, Institute of Health Economics and Health Care Management, Neuherberg, Germany
| | | | - Thomas Kapellen
- University of Leipzig, Department of Women and Child Health, Hospital for Children and Adolescents, Leipzig, Germany
| | - Ashby Walker
- Health Equity Initiatives, UF Diabetes Institute, University of Florida, Gainesville, FL
| | - Joachim Rosenbauer
- German Center for Diabetes Research (DZD), Neuherberg, Germany
- Leibniz Center for Diabetes Research at Heinrich Heine University, Institute for Biometrics and Epidemiology, German Diabetes Center, Düsseldorf, Germany
| | - David M Maahs
- Division of Pediatric Endocrinology, Stanford University, Stanford, CA
- Stanford Diabetes Research Center, Stanford, CA
| | - Reinhard W Holl
- University of Ulm, Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
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18
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Castillo-Reinado K, Maier W, Holle R, Stahl-Pehe A, Baechle C, Kuss O, Hermann J, Holl RW, Rosenbauer J. Associations of area deprivation and urban/rural traits with the incidence of type 1 diabetes: analysis at the municipality level in North Rhine-Westphalia, Germany. Diabet Med 2020; 37:2089-2097. [PMID: 31999840 DOI: 10.1111/dme.14258] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/28/2020] [Indexed: 12/25/2022]
Abstract
AIM To analyse the associations of area deprivation and urban/rural traits with the incidence of type 1 diabetes in the German federal state of North Rhine-Westphalia. METHODS Data of incident type 1 diabetes cases in children and adolescents aged <20 years between 2007 and 2014 were extracted from a population-based diabetes register. Population data, indicators of area deprivation and urban/rural traits at the municipality level (396 entities) were obtained from official statistics. Area deprivation was assessed in five groups based on quintiles of an index of multiple deprivation and its seven deprivation domains. Poisson regression accounting for spatial dependence was applied to investigate associations of area deprivation and urban/rural traits with type 1 diabetes incidence. RESULTS Between 2007 and 2014, 6143 incident cases were reported (99% completeness); the crude incidence was 22.3 cases per 100 000 person-years. The incidence decreased with increasing employment and environmental deprivation (relative risk of the most vs. the least deprived municipalities: 0.905 [95% CI: 0.813, 1.007] and 0.839 [0.752, 0.937], respectively) but was not associated with the composite deprivation index. The incidence was higher in more peripheral, rural, smaller and less densely populated municipalities, and the strongest association was estimated for the location trait (relative risk of peripheral/very peripheral compared with very central location: 1.231 [1.044, 1.452]). CONCLUSIONS The results suggest that the type 1 diabetes risk is higher in more remote, more rural, less densely populated and less deprived areas. Urban/rural traits were stronger predictors of type 1 diabetes risk than area deprivation indicators.
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Affiliation(s)
- K Castillo-Reinado
- German Diabetes Centre, Leibniz Institute for Diabetes Research at Heinrich Heine University Düsseldorf, Institute for Biometrics and Epidemiology, Düsseldorf, Germany
- German Centre for Diabetes Research (DZD), Neuherberg, Germany
| | - W Maier
- German Centre for Diabetes Research (DZD), Neuherberg, Germany
- Helmholtz Zentrum München, Institute of Health Economics and Health Care Management, German Research Centre for Environmental Health, Neuherberg, Germany
| | - R Holle
- German Centre for Diabetes Research (DZD), Neuherberg, Germany
- Helmholtz Zentrum München, Institute of Health Economics and Health Care Management, German Research Centre for Environmental Health, Neuherberg, Germany
| | - A Stahl-Pehe
- German Diabetes Centre, Leibniz Institute for Diabetes Research at Heinrich Heine University Düsseldorf, Institute for Biometrics and Epidemiology, Düsseldorf, Germany
- German Centre for Diabetes Research (DZD), Neuherberg, Germany
| | - C Baechle
- German Diabetes Centre, Leibniz Institute for Diabetes Research at Heinrich Heine University Düsseldorf, Institute for Biometrics and Epidemiology, Düsseldorf, Germany
- German Centre for Diabetes Research (DZD), Neuherberg, Germany
| | - O Kuss
- German Diabetes Centre, Leibniz Institute for Diabetes Research at Heinrich Heine University Düsseldorf, Institute for Biometrics and Epidemiology, Düsseldorf, Germany
- German Centre for Diabetes Research (DZD), Neuherberg, Germany
- Institute of Medical Statistics, Düsseldorf University Hospital and Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - J Hermann
- German Centre for Diabetes Research (DZD), Neuherberg, Germany
- University of Ulm, Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm, Germany
| | - R W Holl
- German Centre for Diabetes Research (DZD), Neuherberg, Germany
- University of Ulm, Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm, Germany
| | - J Rosenbauer
- German Diabetes Centre, Leibniz Institute for Diabetes Research at Heinrich Heine University Düsseldorf, Institute for Biometrics and Epidemiology, Düsseldorf, Germany
- German Centre for Diabetes Research (DZD), Neuherberg, Germany
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19
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Razum O, Sauzet O. Equality in Living Conditions as a Prerequisite for Health Equity. DEUTSCHES ARZTEBLATT INTERNATIONAL 2020; 117:491-492. [PMID: 33087227 PMCID: PMC7588611 DOI: 10.3238/arztebl.2020.0491] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Oliver Razum
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Odile Sauzet
- Center for Statistics, Bielefeld University, Bielefeld, Germany
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20
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Beyerlein A, Lack N, Maier W. Associations of area-level deprivation with adverse obstetric and perinatal outcomes in Bavaria, Germany: Results from a cross-sectional study. PLoS One 2020; 15:e0236020. [PMID: 32687491 PMCID: PMC7371156 DOI: 10.1371/journal.pone.0236020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 06/26/2020] [Indexed: 01/06/2023] Open
Abstract
Background We investigated associations of area-level deprivation with obstetric and perinatal outcomes in a large population-based routine dataset. Methods We used the data of n = 827,105 deliveries who were born in hospitals between 2009 to 2016 in Bavaria, Germany. The Bavarian Index of Multiple Deprivation (BIMD) on district level was assigned to each mother by the zip code of her residential address. We calculated odds ratios (ORs) with 95% confidence intervals (CIs) for preterm deliveries, Caesarian sections (CS), stillbirths, small for gestational age (SGA) births and low 5-minute Apgar scores by BIMD quintiles with and without adjustment for potential confounders. Results We observed a significantly increased risk for preterm deliveries in mothers from the most deprived compared to the least deprived districts (e.g. OR [95% CI] for highest compared to lowest deprivation quintile: 1.06 [1.03, 1.09]) in adjusted analyses. Increased deprivation was also associated with higher SGA and secondary CS rates, but with lower proportions of stillbirths, primary CS and low Apgar scores. When one large clinic with an unusually high stillbirth rate was excluded, the association of BIMD with stillbirths was attenuated and almost disappeared. Conclusions We found that area-level deprivation in Bavaria was positively associated with preterm and SGA births, confirming previous studies. In contrast, the finding of an inverse association between deprivation and both stillbirth rates and low Apgar score came somewhat surprising. However, we conclude that the stillbirths finding is spurious and reflects regional bias due to a clinic which seems to specialize in termination of pregnancies.
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Affiliation(s)
- Andreas Beyerlein
- Institute of Computational Biology, Helmholtz Zentrum München, Neuherberg, Germany
- * E-mail:
| | - Nicholas Lack
- German Bavarian Quality Assurance Institute for Medical Care, Munich, Germany
| | - Werner Maier
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Neuherberg, Germany
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Jansen L, Behrens G, Finke I, Maier W, Gerken M, Pritzkuleit R, Holleczek B, Brenner H. Area-Based Socioeconomic Inequalities in Colorectal Cancer Survival in Germany: Investigation Based on Population-Based Clinical Cancer Registration. Front Oncol 2020; 10:857. [PMID: 32670870 PMCID: PMC7326086 DOI: 10.3389/fonc.2020.00857] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 04/30/2020] [Indexed: 12/24/2022] Open
Abstract
Background: Socioeconomic inequalities in colorectal cancer survival have been observed in many countries. To overcome these inequalities, the underlying reasons must be disclosed. Methods: Using data from three population-based clinical cancer registries in Germany, we investigated whether associations between area-based socioeconomic deprivation and survival after colorectal cancer depended on patient-, tumor- or treatment-related factors. Patients with a diagnosis of colorectal cancer in 2000–2015 were assigned to one of five deprivation groups according to the municipality of the place of residence using the German Index of Multiple Deprivation. Cox proportional hazards regression models with various levels of adjustment and stratifications were applied. Results: Among 38,130 patients, overall 5-year survival was 4.8% units lower in the most compared to the least deprived areas. Survival disparities were strongest in younger patients, in rectal cancer patients, in stage I cancer, in the latest period, and with longer follow-up. Disparities persisted after adjustment for stage, utilization of surgery and screening colonoscopy uptake rates. They were mostly still present when restricting to patients receiving treatment according to guidelines. Conclusion: We observed socioeconomic inequalities in colorectal cancer survival in Germany. Further studies accounting for potential differences in non-cancer mortality and exploring treatment patterns in detail are needed.
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Affiliation(s)
- Lina Jansen
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Gundula Behrens
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Isabelle Finke
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Medical Faculty Heidelberg, University of Heidelberg, Heidelberg, Germany
| | - Werner Maier
- Helmholtz Zentrum München-German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Neuherberg, Germany
| | - Michael Gerken
- Tumor Center-Institute for Quality Management and Health Services Research, University of Regensburg, Regensburg, Germany
| | | | | | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Division of Preventive Oncology, German Cancer Research Center (DKFZ), National Center for Tumor Diseases (NCT), Heidelberg, Germany.,German Cancer Consortium (DKTK), German Cancer Research Center, Heidelberg, Germany
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Wandschneider L, Sauzet O, Breckenkamp J, Spallek J, Razum O. Small-Area Factors and Their Impact on Low Birth Weight-Results of a Birth Cohort Study in Bielefeld, Germany. Front Public Health 2020; 8:136. [PMID: 32411644 PMCID: PMC7199350 DOI: 10.3389/fpubh.2020.00136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 04/03/2020] [Indexed: 12/16/2022] Open
Abstract
Introduction: The location of residence is a factor possibly contributing to social inequalities and emerging evidence indicates that it already affects perinatal development. The underlying pathways remain unknown; theory-based and hypothesis-driven analyses are lacking. To address these challenges, we aim to establish to what extent small-area characteristics contribute to low birth weight (LBW), independently of individual characteristics. First, we select small-area characteristics based on a conceptual model and measure them. Then, we empirically analyse the impact of these characteristics on LBW. Material and methods: Individual data were provided by the birth cohort study "Health of infants and children in Bielefeld/Germany." The sample consists of 892 eligible women and their infants distributed over 80 statistical districts in Bielefeld. Small-area data were obtained from local noise maps, emission inventory, Google Street View and civil registries. A linear multilevel analysis with a two-level structure (individuals nested within statistical districts) was conducted. Results: The effects of the selected small-area characteristics on LBW are small to non-existent, no significant effects are detected. The differences in proportion of LBW based on marginal effects are small, ranging from zero to 1.1%. Newborns from less aesthetic and subjectively perceived unsafe neighbourhoods tend to have higher proportions of LBW. Discussion: We could not find evidence for negative effects of small-area factors on LBW, but our study confirms that obtaining adequate sample size, reliable measure of exposure and using available data for operationalisation of the small-area context represent the core challenges in this field of research.
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Affiliation(s)
- Lisa Wandschneider
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Odile Sauzet
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
- Center for Statistics, Bielefeld University, Bielefeld, Germany
| | - Jürgen Breckenkamp
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Jacob Spallek
- Department of Public Health, Faculty of Social Work, Health, and Music, Brandenburg University of Technology Cottbus–Senftenberg, Senftenberg, Germany
| | - Oliver Razum
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
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Finke I, Behrens G, Schwettmann L, Gerken M, Pritzkuleit R, Holleczek B, Brenner H, Jansen L. Socioeconomic differences and lung cancer survival in Germany: Investigation based on population-based clinical cancer registration. Lung Cancer 2020; 142:1-8. [PMID: 32044589 DOI: 10.1016/j.lungcan.2020.01.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 01/27/2020] [Accepted: 01/30/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Studies from several countries reported socioeconomic inequalities in lung cancer survival. Hypothesized reasons are differences in cancer care or tumor characteristics. We investigated associations of small-area deprivation and lung cancer survival in Germany and the possible impact of differences in patient, tumor or treatment factors. MATERIALS AND METHODS Patients registered with a primary tumor of the lung between 2000-2015 in three German population-based clinical cancer registries were included. Area-based socioeconomic deprivation on municipality level was measured with the categorized German Index of Multiple Deprivation. Association of deprivation with overall survival was investigated with Cox regression models. RESULTS Overall, 22,905 patients were included. Five-year overall survival from the least to the most deprived quintile were 17.2%, 15.9%, 16.7%, 15.7%, and 14.4%. After adjustment for patient and tumor factors, the most deprived group had a lower survival compared to the least deprived group (Hazard Ratio (HR) 1.06, 95% confidence interval (CI) 1.01-1.11). Subgroup analyses revealed lower survival in the most deprived compared to the least deprived quintile in patients with stage I-III [HR: 1.14, 95% CI: 1.06-1.22]. The association persisted when restricting to patients receiving surgery but was attenuated for subgroups receiving either chemotherapy or radiotherapy. CONCLUSION Our results indicate differences in lung cancer survival according to area deprivation in Germany, which were more pronounced in patients with I-III stage cancer. Future research should address in more detail the underlying reasons for the observed inequalities and possible approaches to overcome them.
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Affiliation(s)
- Isabelle Finke
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69120 Heidelberg, Germany; Medical Faculty Heidelberg, University of Heidelberg, Im Neuenheimer Feld 672, 69120 Heidelberg, Germany
| | - Gundula Behrens
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69120 Heidelberg, Germany
| | - Lars Schwettmann
- Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Ingolstädter Landstraße 1, 85764 Neuherberg, Germany; Department of Economics, Martin Luther University Halle-Wittenberg, 06099 Halle (Saale), Germany
| | - Michael Gerken
- Tumor Center ‑ Institute for Quality Management and Health Services Research, University of Regensburg, Am BioPark 9, 93053 Regensburg, Germany
| | - Ron Pritzkuleit
- Institute for Cancer Epidemiology at the University of Lübeck, Cancer Registry Schleswig-Holstein, Ratzeburger Allee 160, Haus 50, 23538 Lübeck, Germany
| | - Bernd Holleczek
- Saarland Cancer Registry, Präsident-Baltz-Straße 5, 66119 Saarbrücken, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69120 Heidelberg, Germany; Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Im Neuenheimer Feld 460, 69120 Heidelberg, Germany; German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
| | - Lina Jansen
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69120 Heidelberg, Germany.
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Mönkemöller K, Müller-Godeffroy E, Lilienthal E, Heidtmann B, Becker M, Feldhahn L, Freff M, Hilgard D, Krone B, Papsch M, Schumacher A, Schwab KO, Schweiger H, Wolf J, Bollow E, Holl RW. The association between socio-economic status and diabetes care and outcome in children with diabetes type 1 in Germany: The DIAS study (diabetes and social disparities). Pediatr Diabetes 2019; 20:637-644. [PMID: 30912245 DOI: 10.1111/pedi.12847] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 01/31/2019] [Accepted: 03/11/2019] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To evaluate the association between socioeconomic status (SES) and diabetes outcomes in German children and adolescents. METHODS A total of 1829 subjects <18 years old with type 1 diabetes mellitus from 13 German diabetes centers were included from June 2013 until June 2014. Data were collected within the multicenter DPV (Diabetes Prospective Follow-up) registry. SES was measured with a composite index. Multivariable regression models were applied to analyze the association of SES and outcomes adjusted for age, sex, diabetes duration, and migration status. RESULTS Low SES was significantly associated with worse diabetes outcomes: higher hemoglobin A1C (HbA1c) (64.3 mmol/mol), lower proportion of insulin pump therapy (43.6%), fewer daily self-monitored blood glucose (SMBG) measurements (5.7), more inpatient days per patient-year (5.8) compared to patients with medium/high SES (HbA1c: 61.3 mmol/mol, P < 0.001/59.8 mmol/mol, P < 0.0001; proportion of pump therapy: 54.5%, P < 0.01/ 54.9%, P < 0.01; SMBG: 6.0, P < 0.01/ 6.1, P < 0.01; inpatient days: 4.5, P < 0.0001/3.4, P < 0.0001). The inclusion of migration status in the models resulted in only minor changes in the outcomes. CONCLUSION Despite free health care, low SES is associated with unfavorable diabetes outcomes in Germany. The poorer diabetes outcomes of children with diabetes have been attributed to their migration status and may be partly explained by low SES. Both factors must become part of targeted diabetes care in children and adolescents with type 1 diabetes.
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Affiliation(s)
- Kirsten Mönkemöller
- Department of Pediatrics, Kinderkrankenhaus Amsterdamer Straße, Cologne, Germany
| | | | - Eggert Lilienthal
- Department of Pediatrics, University Hospital St. Josef Bochum, Bochum, Germany
| | - Bettina Heidtmann
- Department of Pediatrics, Katholisches Kinderkrankenhaus Wilhelmstift, Hamburg, Germany
| | - Marianne Becker
- Department of Pediatrics, HELIOS Dr. Horst Schmidt Kliniken Wiesbaden, Wiesbaden, Germany
| | - Lutz Feldhahn
- Department of Pediatrics, Klinik für Kinder- und Jugendmedizin Böblingen, Böblingen, Germany
| | - Markus Freff
- Department of Pediatrics, Kinderkliniken Prinzessin Margaret, Darmstadt, Germany
| | - Dörte Hilgard
- Department of Pediatrics, Pediatric Practice, Witten, Germany
| | - Beate Krone
- Department of Pediatrics, Klinikum Bremen-Nord, Bremen, Germany
| | - Matthias Papsch
- Department of Pediatrics, Marienhospital, Gelsenkirchen, Germany
| | - Andrea Schumacher
- Department of Pediatric Endocrinology, Medical Center, Endokrinologikum, Ulm, Germany
| | - Karl O Schwab
- Department of Pediatrics and Adolescent Medicine, University Medical Center, Freiburg, Germany
| | | | - Johannes Wolf
- Department of Pediatrics, St. Vincenz-Krankenhaus, Paderborn, Germany
| | - Esther Bollow
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany.,German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Reinhard W Holl
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany.,German Center for Diabetes Research (DZD), Neuherberg, Germany
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Schätzung kleinräumiger Krankheitshäufigkeiten für die deutsche Bevölkerung anhand von Routinedaten am Beispiel von Typ-2-Diabetes. ACTA ACUST UNITED AC 2019. [DOI: 10.1007/s11943-019-00241-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Hübner J, Lewin P, Pritzkuleit R, Eisemann N, Maier W, Katalinic A. Colorectal cancer screening by colonoscopy and trends in disease-specific mortality: a population-based ecological study of 358 German districts. Int J Colorectal Dis 2019; 34:599-605. [PMID: 30627848 DOI: 10.1007/s00384-018-03226-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/21/2018] [Indexed: 02/04/2023]
Abstract
PURPOSE Screening for colorectal cancer (CRC) by colonoscopy was implemented in Germany in 2002. Although the procedure has proven to be effective in reducing disease-specific mortality in numerous clinical studies, its effect at the population level is unclear. We performed an ecological study at the level of 358 German districts, testing the hypothesis that a higher participation rate in screening colonoscopy is associated with a stronger decline in CRC mortality from 2001 to 2012. METHODS Information on the use of colonoscopy in each district was extracted from settlement data, used for the remuneration of physicians of the ambulant sector from 2008 to 2011. Yearly mortality rates for each district from 2001 to 2012 were derived from the official mortality statistics. A spatial model was fitted, considering other factors which might influence early detection of CRC (fecal occult blood test (FOBT), diagnostic colonoscopy, material and social area deprivation, and rural-urban disparities). RESULTS The population-weighted mean annual participation rate during 2008-2011 in screening colonoscopy was 2.0% (range 0.6 to 3.9%). The weighted mean annual percentage change (APC) of CRC mortality was - 2.9% (range - 7.8 to 1.2%). According to the fully adjusted model, a 1% higher annual participation rate in colonoscopy screening was associated with an additional annual change in CRC mortality rate of - 0.34% (p = 0.015). Given an annual 2.0% participation rate, colonoscopy screening attributed 23% to the observed decline. CONCLUSIONS Our real-world data from Germany provide first evidence that colonoscopy screening for CRC is effective in reducing disease-specific mortality at the population level.
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Affiliation(s)
- Joachim Hübner
- Institute of Social Medicine and Epidemiology, University of Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany.
| | - Philip Lewin
- Institute of Social Medicine and Epidemiology, University of Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany
| | - Ron Pritzkuleit
- Institute of Cancer Epidemiology, University of Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany
| | - Nora Eisemann
- Institute of Social Medicine and Epidemiology, University of Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany
| | - Werner Maier
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München - German Research Center for Environmental Health, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany
| | - Alexander Katalinic
- Institute of Social Medicine and Epidemiology, University of Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany.,Institute of Cancer Epidemiology, University of Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany
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Schneider S, Bolbos A, Fessler J, Buck C. Deprivation amplification due to structural disadvantage? Playgrounds as important physical activity resources for children and adolescents. Public Health 2019; 168:117-127. [PMID: 30743013 DOI: 10.1016/j.puhe.2018.11.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 11/14/2018] [Accepted: 11/30/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The deprivation amplification hypothesis postulates that the socially disadvantaged are exposed to further structural deprivation by their residential environment such that social inequalities are therefore amplified. To date, no publication has investigated deprivation amplification solely using playgrounds; the present health geography study investigates this hypothesis with regard to the availability of playgrounds in a typical large German city. STUDY DESIGN Between July 2016 and January 2017, all playgrounds in the city of Mannheim, Germany, were identified and evaluated by systematic audits. The playground attributes such as availability, accessibility, surface area, and provided amenities were operationalized using well-established, validated instruments. METHODS Geo-information about playgrounds was digitalized in ArcGIS 10.2-10.4 and linked to socioeconomic indicators on the meso-level, that is, on the level of 44 social areas. Availability and accessibility of playgrounds were quantified by calculating kernel density and Euclidean distance, respectively. Playground surface area and equipment provided were linked to the number of children and adolescents in the particular social area. The association between availability and accessibility of playgrounds and area-level indicators were assessed using bivariate and multiple Poisson regressions on the meso-level. RESULTS In the city of Mannheim, which covers 145 km2 and is home to 311,000 inhabitants, 271 playgrounds were identified. Bivariate and multiple analyses showed no association between availability and accessibility of playgrounds and area-level indicators. However, significant negative associations were found in the bivariate analyses between playground area and amenities provided per child and various area-level indicators, but not in multiple models. CONCLUSIONS Children are provided with different opportunities to play and to be physically active, depending upon the population density of their social neighborhood. At least in our study area, many socially disadvantaged families are forced to move to densely populated areas for economic reasons. Against that background, the phenomenon of 'deprivation amplification' was not confirmed for availability and accessibility of playgrounds but for playground area and number of amenities provided.
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Affiliation(s)
- S Schneider
- Heidelberg University, Mannheim Institute of Public Health, Social and Preventive Medicine, Ludolf-Krehl-Str. 7-11, D-68167 Mannheim, Germany.
| | - A Bolbos
- Heidelberg University, Mannheim Institute of Public Health, Social and Preventive Medicine, Ludolf-Krehl-Str. 7-11, D-68167 Mannheim, Germany
| | - J Fessler
- Heidelberg University, Faculty of Chemistry and Earth Sciences, Institute of Geography, Im Neuenheimer Feld 348, D-69120 Heidelberg, Germany
| | - C Buck
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstraße 30, D-28359 Bremen, Germany
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Association of individual and area-level socioeconomic conditions with quality of life and glycaemic control in 11- to 21-year-old adolescents with early-onset type 1 diabetes: a cross-sectional study. Qual Life Res 2018; 27:3131-3136. [DOI: 10.1007/s11136-018-1949-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2018] [Indexed: 11/30/2022]
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