[In Process Citation]

Population change and the burden of hospitalization in Germany 2000-2040: Decomposition analysis and projection

Demographic factors, such as population aging and shrinkage, and non-demographic factors, such as hospitalization rate and length of hospital stay, generate challenges for inpatient care. This paper used decomposition analysis to assess how changes in these factors affected the number of hospital treatment days from 2000 to 2015 in Germany. Demographic aging was linked to increases in the number of treatment days for women (+10.0%) and men (+19.2%) and in hospitalization rates for women +6.0% and men +5.4%. However, these increases were offset by decreases in the number of hospital days (women: 16.5%; men: 7.3%) and length of stay (women: -27.4%; men -26.3%). For the projection up to 2040, 12 scenarios were developed (six for women and six for men) using three variants for future population demographics and two variants for future length of stay and hospitalization rates. One of the two variants for future length of stay and hospitalization rates provides for a constant value for the year 2015. For the second of these two variants variant, a logarithmic model was estimated on the basis of values from 2000 to 2015. and the trends were extrapolated using this model until 2040. The strongest overall predicted increase was 18.4% between 2015 and 2040, including a 22.4% increase for men. In two scenarios for women, only slight declines were predicted. All results, both for the decomposition analysis and projection, indicated a moderate but sustained effect of demographic aging on the number of hospital treatment days, leading to a significant increase in hospital treatment days over the study period. Non-demographic factors also had strong influences, especially in shorter time periods, but these effects offset each other over time. The change in the population size in the period under study had very little effect on the number of hospital treatment days.

Gender medicine: Lessons from COVID-19 and other medical conditions for designing health policy

Gender-specific differences in the prevalence, incidence, comorbidities, prognosis, severity, risk factors, drug-related aspects and outcomes of various medical conditions are well documented. We present a literature review on the extent to which research in this field has developed over the years, and reveal gaps in gender-sensitive awareness between the clinical portrayal and the translation into gender-specific treatment regimens, guidelines and into gender-oriented preventive strategies and health policies. Subsequently, through the lens of gender, we describe these domains in detail for four selected medical conditions: Asthma, obesity and overweight, chronic kidney disease and coronavirus disease 2019. As some of the key gender differences become more apparent during adolescence, we focus on this developmental stage. Finally, we propose a model which is based on three influential issues: (1) Investigating gender-specific medical profiles of related health conditions, rather than a single disease; (2) The dynamics of gender disparities across developmental stages; and (3) An integrative approach which takes into account additional risk factors (ethnicity, socio-demographic variables, minorities, lifestyle habits etc.). Increasing the awareness of gender-specific medicine in daily practice and in tailored guidelines, already among adolescents, may reduce inequities, facilitate the prediction of future trends and properly address the characteristics and needs of certain subpopulations within each gender.