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Tetzlaff F, Sauerberg M, Grigoriev P, Tetzlaff J, Mühlichen M, Baumert J, Michalski N, Wengler A, Nowossadeck E, Hoebel J. Age-specific and cause-specific mortality contributions to the socioeconomic gap in life expectancy in Germany, 2003-21: an ecological study. Lancet Public Health 2024; 9:e295-e305. [PMID: 38702094 DOI: 10.1016/s2468-2667(24)00049-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 03/01/2024] [Accepted: 03/05/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND Earlier death among people in socioeconomically deprived circumstances has been found internationally and for various causes of death, resulting in a considerable life-expectancy gap between socioeconomic groups. We examined how age-specific and cause-specific mortality contributions to the socioeconomic gap in life expectancy have changed at the area level in Germany over time. METHODS In this ecological study, official German population and cause-of-death statistics provided by the Federal Statistical Office of Germany for the period Jan 1, 2003, to Dec 31, 2021, were linked to district-level data of the German Index of Socioeconomic Deprivation. Life-table and decomposition methods were applied to calculate life expectancy by area-level deprivation quintile and decompose the life-expectancy gap between the most and least deprived quintiles into age-specific and cause-specific mortality contributions. FINDINGS Over the study period, population numbers varied between 80 million and 83 million people per year, with the number of deaths ranging from 818 000 to 1 024 000, covering the entire German population. Between Jan 1, 2003, and Dec 31, 2019, the gap in life expectancy between the most and least deprived quintiles of districts increased by 0·7 years among females (from 1·1 to 1·8 years) and by 0·1 years among males (from 3·0 to 3·1 years). Thereafter, during the COVID-19 pandemic, the gap increased more rapidly to 2·2 years in females and 3·5 years in males in 2021. Between 2003 and 2021, the causes of death that contributed the most to the life-expectancy gap were cardiovascular diseases and cancer, with declining contributions of cardiovascular disease deaths among those aged 70 years and older and increasing contributions of cancer deaths among those aged 40-74 years over this period. COVID-19 mortality among individuals aged 45 years and older was the strongest contributor to the increase in life-expectancy gap after 2019. INTERPRETATION To reduce the socioeconomic gap in life expectancy, effective efforts are needed to prevent early deaths from cardiovascular disease and cancer in socioeconomically deprived populations, with cancer prevention and control becoming an increasingly important field of action in this respect. FUNDING German Cancer Aid and European Research Council.
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Affiliation(s)
- Fabian Tetzlaff
- Division of Social Determinants of Health, Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany.
| | - Markus Sauerberg
- Research Area of Ageing, Mortality and Population Dynamics, Federal Institute for Population Research (BiB), Wiesbaden, Germany
| | - Pavel Grigoriev
- Research Area of Ageing, Mortality and Population Dynamics, Federal Institute for Population Research (BiB), Wiesbaden, Germany
| | - Juliane Tetzlaff
- Medical Sociology Unit, Hannover Medical School, Hannover, Germany
| | | | - Jens Baumert
- Division of Physical Health, Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Niels Michalski
- Division of Social Determinants of Health, Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Annelene Wengler
- Division of Health Reporting, Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Enno Nowossadeck
- Division of Social Determinants of Health, Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Jens Hoebel
- Division of Social Determinants of Health, Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
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Beller J, Sperlich S, Epping J, Tetzlaff J. Trends in severe functional limitations among working and non-working adults in Germany: Towards an (un)-healthy working life? Eur J Ageing 2024; 21:13. [PMID: 38652375 DOI: 10.1007/s10433-024-00809-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2024] [Indexed: 04/25/2024] Open
Abstract
We examined trends in severe functional limitations among working and non-working adults in Germany (ages 40-65). Four population-based samples of 11,615 participants were used, spanning the time periods 2002-2021. The overall prevalence of severe limitations was found to be 12.8% in the sample, but also varied from 10 to 20% according to occupational group. Over time, severe limitations were found to have increased, from 10.6% in 2002 to 13.2% in 2021. Logistic regression analysis showed that severe limitations increased significantly in certain subgroups, including working women with a low skilled white collar occupational group, working men with a low skilled blue collar occupational group and, particularly, among the whole non-working population, whereas limitations remained largely the same in the other groups, including most of the working population. In terms of expectancies, overall working life expectancy increased. Along with this increase, healthy (non-severely limited) working life expectancy increased, but this trend was accompanied by a clear increase in unhealthy working life expectancy (severely limited). Thus, although severe limitations have increased in some groups in the working-age adults, people today can expect to work more years free from severe limitations than before. In the future, potentials to increase working life expectancy may come to an end, as severe limitations increased strongly in the non-working population, which could limit the prospects for a further increase in the proportion of the population in employment. Further studies are needed to investigate the potential impact of the increasing prevalence of severe limitations on the population's ability to work.
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Affiliation(s)
- Johannes Beller
- Medical Sociology Unit, Center for Public Health and Health Care, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - Stefanie Sperlich
- Medical Sociology Unit, Center for Public Health and Health Care, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Jelena Epping
- Medical Sociology Unit, Center for Public Health and Health Care, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Juliane Tetzlaff
- Medical Sociology Unit, Center for Public Health and Health Care, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
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Nowossadeck S, Nowossadeck E, Tetzlaff F, Tetzlaff J. [How has life expectancy without functional limitations developed in Germany? An analysis with data from the German Ageing Survey (DEAS)]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2024:10.1007/s00103-024-03875-9. [PMID: 38649507 DOI: 10.1007/s00103-024-03875-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 03/26/2024] [Indexed: 04/25/2024]
Abstract
INTRODUCTION The long-term increase in life expectancy raises the question of whether the increased life expectancy is accompanied by an extension of years without health limitations. The study analyzes how life expectancy without functional and mobility limitations from the ages of 46 and 65 and their proportions of remaining life expectancy have changed since 2008. METHODS We analyze data from the German Ageing Survey of the 2008, 2014, and 2020/21 waves. Life expectancy without functional limitations (disability-free life expectancy-DFLE) was calculated using the Sullivan method. Severe functional limitations (using the Global Activity Limitation Indicator-GALI) and mobility limitations (climbing stairs, walking more than 1 km) were examined. RESULTS Compression of morbidity in the GALI has been observed in 46- and 65-year-old men since 2014, but not in women of the same age. In terms of mobility, 46- and 65-year-old men show trends towards compression when climbing stairs and 46-year-old men when walking more than 1 km since 2014. The values for women have stagnated for the first two indicators mentioned, but not for 46-year-old women since 2014 when walking more than 1 km. DISCUSSION Our analyses show different trends in DFLE depending on the indicator, age, and gender and do not allow a clear answer to the question of morbidity compression or expansion. We tend to see morbidity compression in men, whereas trends of stagnation or expansion tend to be seen in women. These results signal challenges in maintaining functional health, especially in women, and point to the need for targeted interventions to improve quality of life and healthy life expectancy.
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Affiliation(s)
- Sonja Nowossadeck
- Deutsches Zentrum für Altersfragen, Manfred-von Richthofen-Str. 2, 12101, Berlin, Deutschland.
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Tetzlaff J, Epping J. [Healthier at work for longer? Trends in life years free of cardiovascular and musculoskeletal diseases in the employed and general population based on health insurance claims data]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2024:10.1007/s00103-024-03868-8. [PMID: 38607434 DOI: 10.1007/s00103-024-03868-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 03/13/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND Our study focuses on the development of disease-free life years of two disease groups with high public health relevance: musculoskeletal diseases (MSD) and cardiovascular diseases (CVD). Against the backdrop of prolonged working lives, the development of disease-free life years in the working-age population is compared with the trend in the employed population. Differences between occupational groups are also examined. METHODS The study is based on data from the statutory health insurance provider AOK Lower Saxony (N = 2,001,225). Incident cases were identified based on the diagnosis data. The expected years free of MSD and CVD were calculated using multistate life table analysis for three periods between 2006 and 2018. The occupational group is identified via the occupational key. Three groups are distinguished: unskilled and semi-skilled workers, skilled workers and specialists, and highly skilled workers. RESULTS Life years free of MSD clearly decreased in the general population and among the employed population. The decrease was strongest in the higher-skilled occupational groups. Life years free of CVD increased in the general population. The increase was weaker among the employed population. The only occupational group showing increases were men in unskilled and semi-skilled occupations. DISCUSSION The study shows that disease-free life years among employed persons developed in some cases worse than in the general population. For the analysed disease groups MSD and CVD, there are clear inequalities between occupational groups, which decreased somewhat over time. The inequalities and the decrease in years free of MSD highlight the high public health relevance and the need for effective prevention strategies to prevent CVD and MSD in working age.
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Affiliation(s)
- Juliane Tetzlaff
- Medizinische Soziologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Niedersachsen, Deutschland.
| | - Jelena Epping
- Medizinische Soziologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Niedersachsen, Deutschland
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Tetzlaff J, Epping J, Stahmeyer JT, Liebers F, Hegewald J, Sperlich S, Beller J, Tetzlaff F. The development of working life expectancy without musculoskeletal diseases against the backdrop of extended working lives. Sci Rep 2024; 14:7930. [PMID: 38575680 PMCID: PMC10994922 DOI: 10.1038/s41598-024-58650-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 04/02/2024] [Indexed: 04/06/2024] Open
Abstract
Musculoskeletal diseases (MSDs) are a major predictor of early retirement. Against the backdrop of the extension of working life, we investigated time trends and educational inequalities in years spent in the labour market free of MSD. Based on German statutory health insurance data (N = 3,405,673), total life years free of MSD (Healthy Life Expectancy, HLE) and years spent in the labour force free of MSD (Healthy Working Life Expectancy, HWLE) were estimated for three periods (2006-2008, 2011-2013, 2016-2018) using multistate analyses. Educational inequalities (8 to 11 vs. 12 or more years of schooling) are reported for 2011-2013. HLE decreased slightly over time in all genders. HWLE in women increased, while it remained rather constant in men. Over time, the share of years in the labour force spent free of MSD declined continuously. People with lower education had lower HLE and HWLE than individuals with higher education. With respect to musculoskeletal diseases, the increase in disease-free working life years cannot keep pace with the extension of working life, resulting in an increasing proportion of years spent in impaired musculoskeletal health in the labour market. Effective prevention strategies are needed, focusing especially on individuals with lower educational attainment.
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Affiliation(s)
- Juliane Tetzlaff
- Medical Sociology Unit, Hannover Medical School, Carl-Neuberg Str. 1, 30625, Hanover, Germany.
| | - Jelena Epping
- Medical Sociology Unit, Hannover Medical School, Carl-Neuberg Str. 1, 30625, Hanover, Germany
| | | | - Falk Liebers
- Federal Institute for Occupational Safety and Health (BAuA), Berlin, Germany
| | - Janice Hegewald
- Federal Institute for Occupational Safety and Health (BAuA), Berlin, Germany
| | - Stefanie Sperlich
- Medical Sociology Unit, Hannover Medical School, Carl-Neuberg Str. 1, 30625, Hanover, Germany
| | - Johannes Beller
- Medical Sociology Unit, Hannover Medical School, Carl-Neuberg Str. 1, 30625, Hanover, Germany
| | - Fabian Tetzlaff
- Division of Social Determinants of Health, Department of Epidemiology and Health Monitoring, Robert Koch-Institute, Berlin, Germany
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Beller J, Safieddine B, Sperlich S, Tetzlaff J, Geyer S. Time trends in limited lung function among German middle-aged and older adults. Sci Rep 2024; 14:5036. [PMID: 38424128 PMCID: PMC10904379 DOI: 10.1038/s41598-024-55624-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 02/26/2024] [Indexed: 03/02/2024] Open
Abstract
Limited lung function represents a serious health impairment. However, studies investigating changes in limited lung function over time are rare. Thus, the current study investigates time-related changes in limited lung function and potential social inequalities. Data from the 2008 and 2017 waves of the population-based German Aging Survey were used in a repeated cross-sectional study design (N = 8778), including participants aged 40 years and older. Lung function was assessed by the peak flow test. Socio-economic indicators included educational attainment, income and occupational group. Additionally, smoking history, occupational exposure to fumes and gases, and physical exercise were used as potentially explanatory variables for the observed changes. We found that the prevalence of limited lung function decreased strongly over time on a descriptive level from 9.0 to 5.4%. In line with these results, a decreasing trend emerged (OR = 0.48) when controlling for age and gender differences. When additionally controlling for changes in socio-economic indicators and explanatory variables there were still significant decreases over time, but the decline was slightly reduced (OR = 0.57). Moreover, similar significant relative decreases over time occurred for middle-aged and older participants, female and male participants, and those belonging to the different socio-economic groups. Thus, limited lung function generally decreased over time. This decrease could partially be explained by beneficial developments in socio-economic indicators, smoking, occupational exposures, and physical exercise. Future studies might investigate how changes in medicinal treatment and prevention efforts have contributed to the observed beneficial trends in lung health.
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Affiliation(s)
- Johannes Beller
- Hannover Medical School, Center for Public Health and Health Care, Medical Sociology Unit, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - Batoul Safieddine
- Hannover Medical School, Center for Public Health and Health Care, Medical Sociology Unit, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Stefanie Sperlich
- Hannover Medical School, Center for Public Health and Health Care, Medical Sociology Unit, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Juliane Tetzlaff
- Hannover Medical School, Center for Public Health and Health Care, Medical Sociology Unit, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Siegfried Geyer
- Hannover Medical School, Center for Public Health and Health Care, Medical Sociology Unit, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
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Geyer S, Tetzlaff J, Sperlich S, Safieddine B, Epping J, Eberhard S, Stahmeyer J, Beller J. Decreasing COPD-related incidences and hospital admissions in a German health insurance population. Sci Rep 2023; 13:21293. [PMID: 38042961 PMCID: PMC10693544 DOI: 10.1038/s41598-023-48554-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 11/28/2023] [Indexed: 12/04/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is associated with smoking and work-related health hazards. Most studies have reported prevalences, and the number of studies examining incidences and social inequalities is small. We analyzed the development of social inequalities of COPD-incidences in terms of income and exacerbations in terms of hospital admissions. Findings were based on claims data from a German statutory health insurance covering 2008 to 2019. Outpatient diagnoses were used for defining COPD-cases, hospital admissions were used for detecting exacerbations. Analyses were performed using Cox-regression. Individual incomes were depicted at three levels defined according to national averages for each year. Data of 3,040,137 insured men and women were available. From 2008 to 2019 COPD-incidences in men decreased by 42% and 47% in women. After stratification by income the reduction at the lowest income level was 41% and 50% in women. Respectively, at the highest income level reductions were 28% and 41%. Disease exacerbations decreased over time, and also social inequalities between income groups emerged. COPD-rates decreased over time at all income levels, but at a faster pace in the lowest income group, thus leading to a positive development of diminishing social gradients in men as well as in women.
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Affiliation(s)
- Siegfried Geyer
- Medical Sociology Unit, Medizinische Hochschule Hannover, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany.
| | - Juliane Tetzlaff
- Medical Sociology Unit, Medizinische Hochschule Hannover, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany
| | - Stefanie Sperlich
- Medical Sociology Unit, Medizinische Hochschule Hannover, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany
| | - Batoul Safieddine
- Medical Sociology Unit, Medizinische Hochschule Hannover, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany
| | - Jelena Epping
- Medical Sociology Unit, Medizinische Hochschule Hannover, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany
| | - Sveja Eberhard
- General Local Statutory Health Insurance of Lower Saxony, Hannover, Germany
| | - Jona Stahmeyer
- General Local Statutory Health Insurance of Lower Saxony, Hannover, Germany
| | - Johannes Beller
- Medical Sociology Unit, Medizinische Hochschule Hannover, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany
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Tetzlaff F, Nowossadeck E, Epping J, di Lego V, Muszynska-Spielauer M, Beller J, Sperlich S, Tetzlaff J. Trends in cancer-free working life expectancy based on health insurance data from Germany-Is the increase as strong as in working life expectancy? PLoS One 2023; 18:e0288210. [PMID: 37494349 PMCID: PMC10370751 DOI: 10.1371/journal.pone.0288210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 06/21/2023] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND Against the backdrop of population ageing, governments are facing the need to raise the statutory retirement age. In this context, the question arises whether these extra years added to working life would be spent in good health. As cancer represents a main contributor to premature retirement this study focuses on time trends and educational inequalities in cancer-free working life expectancy (WLE). METHODS The analyses are based on the data of a large German health insurer covering annually about 2 million individuals. Cancer-free WLE is calculated based on multistate life tables and reported for three periods: 2006-2008, 2011-2013, and 2016-2018. Educational inequalities in 2011-2013 were assessed by two educational levels (8 to 11 years and 12 to 13 years of schooling). RESULTS While labour force participation increased, cancer incidence rates decreased over time. Cancer-free WLE at age 18 increased by 2.5 years in men and 6.3 years in women (age 50: 1.3 years in men, 2.4 years in women) between the first and third period while increases in WLE after a cancer diagnosis remained limited. Furthermore, educational inequalities are substantial, with lower groups having lower cancer-free WLE. The proportion of cancer-free WLE in total WLE remained constant in women and younger men, while it decreased in men at higher working age. CONCLUSION The increase in WLE is accompanied by an increase in cancer-free WLE. However, the subgroups considered have not benefitted equally from this positive development. Among men at higher working age, WLE increased at a faster pace than cancer-free WLE. Particular attention should be paid to individuals with lower education and older men, as the general level and time trends in cancer-free WLE are less favourable.
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Affiliation(s)
- Fabian Tetzlaff
- Medical Sociology Unit, Hannover Medical School, Hanover, Germany
- Division of Social Determinants of Health, Robert Koch-Institute, Berlin, Germany
| | - Enno Nowossadeck
- Division of Social Determinants of Health, Robert Koch-Institute, Berlin, Germany
| | - Jelena Epping
- Medical Sociology Unit, Hannover Medical School, Hanover, Germany
- Comprehensive Cancer Center Hannover, Hannover Medical School, Hanover, Germany
| | - Vanessa di Lego
- Wittgenstein Centre for Demography and Global Human Capital (IIASA, OeAW, Univ. Vienna), Vienna, Austria
- Vienna Institute of Demography, Austrian Academy of Sciences, Vienna, Austria
| | - Magdalena Muszynska-Spielauer
- Wittgenstein Centre for Demography and Global Human Capital (IIASA, OeAW, Univ. Vienna), Vienna, Austria
- Vienna Institute of Demography, Austrian Academy of Sciences, Vienna, Austria
| | - Johannes Beller
- Medical Sociology Unit, Hannover Medical School, Hanover, Germany
- Comprehensive Cancer Center Hannover, Hannover Medical School, Hanover, Germany
| | | | - Juliane Tetzlaff
- Medical Sociology Unit, Hannover Medical School, Hanover, Germany
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Beller J, Epping J, Sperlich S, Tetzlaff J. Changes in disability over time among older working-age adults: Which global and specific limitations are increasing in Germany using the SHARE-data from 2004 to 2015? SAGE Open Med 2023; 11:20503121231184012. [PMID: 37435099 PMCID: PMC10331346 DOI: 10.1177/20503121231184012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 06/07/2023] [Indexed: 07/13/2023] Open
Abstract
Objectives Previous studies have observed increasing limitations among the middle-aged, including those aged 40-64, raising the question how healthy work participation has changed. Helping answer this question, we ask: How have general and specific limitations changed in working and non-working adults in Germany? Methods We used population-based data of older working-age adults, aged 50-64 years old, from Germany provided by the Survey of Health Aging and Retirement (SHARE) study from 2004 to 2014 (N = 3522). Multiple logistic regression analyses were used to study changes in limitations over time. Results We found that employment rates generally increased over time, whereas limitation rates mostly increased among participants aged 50-54 and mostly decreased among participants aged 60-64 in both the working and non-working population. Regarding type of disability, increases were more pronounced with movement-related and general activity-related limitations. Conclusion Therefore, if the comparatively younger more-limited cohorts age and replace the older less-limited cohorts, a larger part of the working and non-working life might be expected to be spent with limitations in the future, and it seems questionable whether further substantial increases in healthy work participation can be achieved. Further prevention efforts and assistance should be directed at current middle-aged cohorts to improve and maintain their health, including adapting current working conditions to a work force with more limitations.
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Sperlich S, Beller J, Epping J, Geyer S, Tetzlaff J. Trends of healthy and unhealthy working life expectancy in Germany between 2001 and 2020 at ages 50 and 60: a question of educational level? J Epidemiol Community Health 2023; 77:430-439. [PMID: 37193584 PMCID: PMC10314014 DOI: 10.1136/jech-2023-220345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 04/29/2023] [Indexed: 05/18/2023]
Abstract
BACKGROUND Extending the number of active working years is an important goal both for maintaining individual quality of life and safeguarding social security systems. Against this background, we examined the development of healthy and unhealthy working life expectancy (HWLE/UHWLE) in the general population and for different educational groups. METHODS The study is based on data from the German Socio-Economic Panel study, including 88 966 women and 85 585 men aged 50-64 years and covering four time periods (2001-05, 2006-2010, 2011-2015 and 2016-2020). Estimates of HWLE and UHWLE in terms of self-rated health (SRH) were calculated using the Sullivan's method. We adjusted for hours worked and stratified by gender and educational level. RESULTS Working-hours adjusted HWLE at age 50 increased in women and men from 4.52 years (95% CI 4.42 to 4.62) in 2001-2005 to 6.88 years (95% CI 6.78 to 6.98) in 2016-2020 and from 7.54 years (95% CI 7.43 to 7.65) to 9.36 years (95% CI 9.25 to 9.46), respectively. Moreover, UHWLE also rose with the proportion of working life spent in good SRH (health ratio) remaining largely stable. At age 50, educational differences in HWLE between the lowest and highest educational groups increased over time in women and in men from 3.72 to 4.99 years and from 4.06 to 4.40 years, respectively. CONCLUSIONS We found evidence for an overall increase but also for substantial educational differences in working-hours adjusted HWLE, which widened between the lowest and highest educational group over time. Our findings suggest that policies and health prevention measures at workplace should be more focused on workers with low levels of education in order to extend their HWLE.
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Affiliation(s)
| | - Johannes Beller
- Medical Sociology, Hannover Medical School, Hannover, Germany
| | - Jelena Epping
- Medical Sociology, Hannover Medical School, Hannover, Germany
| | - Siegfried Geyer
- Medical Sociology, Hannover Medical School, Hannover, Germany
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Epping J, Stahmeyer JT, Tetzlaff F, Tetzlaff J. [M2Q or Something else? The Impact of Varying Case Selection Criteria on the Prevalence Estimation of Chronic Diseases Based on Outpatient Diagnoses in German Claims Data]. Gesundheitswesen 2023. [PMID: 37236225 DOI: 10.1055/a-2052-6477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND To determine the prevalence of chronic disease conditions based on outpatient health insurance data, we often rely on repeated occurrence of a diagnosis over the course of a year, usually in two or more quarters (M2Q). It remains unclear whether prevalence estimates change after adapting repeated occurrence of a diagnosis in different quarters of a year compared to a single occurrence or to some other case selection criteria. This study applies different case selection criteria and analyses their impact on the prevalence estimation based on outpatient diagnoses. METHODS Administrative prevalence for 2019 was estimated for eight chronic conditions based on outpatient physician diagnoses. We applied five case selection criteria: (1) single occurrence, (2) repeated occurrence (including in the same quarter or treatment case), (3) repeated occurrence in at least two different treatment cases (including in the same quarter), (4) occurrence in two quarters and (5) occurrence in two consecutive quarters. Only information on persons with continuous insurance history within the statutory health insurance provider AOK Niedersachsen in 2019 was used (n=2,168,173). RESULTS Prevalence estimates differed quite strongly depending on the diagnosis and on age group if a criterion with repeated occurrence of a diagnosis was applied compared to a single occurrence. These differences turned out to be higher among men and younger patients. The application of a repeated occurrence (criterion 2) did not show different results compared to the repeated occurrence in at least two treatment cases (criterion 3) or in two quarters (criterion 4). The application of the strict criterion of two consecutive quarters (criterion 5) resulted in further reduction of the prevalence estimates. CONCLUSIONS Repeated occurrence is increasingly becoming the standard for diagnosis validation in health insurance claims data. Applying such criteria results partly in a distinct reduction of prevalence estimates. The definition of the study population (e. g., repeated visits to a physician in two consecutive quarters as a mandatory condition) can also strongly influence the prevalence estimates.
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Affiliation(s)
- Jelena Epping
- Medizinische Soziologie , Medizinische Hochschule Hannover, Hannover, Germany
| | - Jona T Stahmeyer
- Stabsbereich Versorgungsforschung, AOK - Die Gesundheitskasse für Niedersachsen, Hannover, Germany
| | - Fabian Tetzlaff
- FG28 Soziale Determinanten der Gesundheit, Robert Koch Institut, Berlin, Germany
| | - Juliane Tetzlaff
- Medizinische Soziologie , Medizinische Hochschule Hannover, Hannover, Germany
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12
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Epping J, Safieddine B, Geyer S, Tetzlaff J. [Are Prevalence Rates Comparable in Survey and Routine Data? Prevalence of Myocardial Infarction in Claims Data of the AOK Lower Saxony and in Data of German Health Interview and Examination (DEGS1)]. Gesundheitswesen 2023; 85:S111-S118. [PMID: 34798662 DOI: 10.1055/a-1649-7575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
AIMS OF THE STUDY This study compared prevalences of myocardial infarction between data drawn from health interviews and claims data from statutory health insurance. Previous comparative studies have drawn comparisons without having considered possible differences in the sociodemographic structure of the underlying study populations. The approach applied here aimed to match the sociodemographic structure via available information in both datasets and to compare prevalences in parallelized samples. METHODOLOGY Data from the German Health Interview and Examination Study for Adults (DEGS1) and claims data from the AOK Lower Saxony (AOKN) were used. To match the sociodemographic structure of the two data sets, a parallelized sample was drawn from the AOKN data according to sex, age, and vocational training qualification. As part of a sensitivity analysis, additional samples were drawn and a mean overall prevalence was calculated from them. RESULTS Data from 5779 DEGS1 respondents and 22 534 AOKN insured persons were used for the analysis. After parallelization of the AOKN-sample by sex, age, and vocational training qualification, no significant differences in prevalence of myocardial infarction could be found between claims data from the AOKN and data from the DEGS1 Health Survey. In men, there were tendencies toward lower prevalence of myocardial infarction in the AOKN data. Possible explanations include the selection of less morbid insured persons by using the vocational education degree for parallelization or memory discrepancies in survey data. CONCLUSION Differences in sociodemographic structure may play a role the interpretation of disease prevalence from difference data sources. This can be compensated for by parallelizing the samples. Future comparative analyses should take into account characteristics of the socioeconomic status. Similar analyses of other diseases such as stroke, diabetes, and metabolic disorders would be desirable.
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Affiliation(s)
- Jelena Epping
- Medizinische Soziologie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Batoul Safieddine
- Medizinische Soziologie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Siegfried Geyer
- Medizinische Soziologie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Juliane Tetzlaff
- Medizinische Soziologie, Medizinische Hochschule Hannover, Hannover, Deutschland
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Beller J, Luy M, Giarelli G, Regidor E, Lostao L, Tetzlaff J, Geyer S. Trends in Activity Limitations From an International Perspective: Differential Changes Between Age Groups Across 30 Countries. J Aging Health 2022:8982643221141123. [DOI: 10.1177/08982643221141123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Objectives: Examine trends in limitations among young (15–39), middle-aged (40–64) and older age-groups (>=65) and their socioeconomic differences. Methods: Population-based European Social Survey data ( N = 396,853) were used, covering 30 mostly European countries and spanning the time-period 2002–2018. Limitations were measured using a global activity limitations indicator. Results: Age-differential trends in limitations were found. Activity limitations generally decreased in older adults, whereas trends varied among younger and middle-aged participants, with decreasing limitations in some countries but increasing limitations in others. These age-differential trends were replicated across limitation severity and socioeconomic groups; however, stronger limitation increases occurred regarding less-severe limitations. Discussion: Functional health has improved in older adults. Contrarily, the increasing limitations in younger and middle-aged individuals seem concerning, which were mostly observed in Western and Northern European countries. Given its public health importance, future studies should investigate the reasons for this declining functional health in the young and middle-aged.
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Affiliation(s)
| | - Marc Luy
- Vienna Institute of Demography, Austrian Academy of Sciences, Austria
| | - Guido Giarelli
- Department of Health Sciences, University “MAGNA GRAECIA” Catanzaro, Italy
| | - Enrique Regidor
- Department of Public Health & Maternal and Child Health, Complutense University of Madrid, Spain
| | - Lourdes Lostao
- Department of Sociology, Public University of Navarre, Germany
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14
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Tetzlaff J, Luy M, Epping J, Geyer S, Beller J, Stahmeyer J, Sperlich S, Tetzlaff F. Estimating trends in working life expectancy based on health insurance data from Germany – Challenges and advantages. SSM Popul Health 2022; 19:101215. [PMID: 36091300 PMCID: PMC9450162 DOI: 10.1016/j.ssmph.2022.101215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 08/17/2022] [Accepted: 08/19/2022] [Indexed: 11/30/2022] Open
Abstract
Against the backdrop of population aging and growing strain on pension systems, monitoring the development of Working Life Expectancy (WLE) is vital to assess whether the policies taken are effective. This is the first study investigating time trends and educational inequalities in WLE based on German health insurance data. The analyses are based on the data of the AOK Lower Saxony (N = 3,347,912) covering three time periods (2006-08, 2011-13, and 2016-18). WLE is defined as years spent in the labor force (i.e. in employment and unemployment) and was calculated for each age between 18 and 69 years for the three periods to depict changes over time using multistate life table analysis. Educational inequalities in 2011-13 are reported for two educational levels (8–11 years and 12–13 years of schooling). WLE increased in both sexes with increases being stronger among women. This holds irrespective of whether WLE at age 18 (35.8–38.3 years in men, 27.5–34.0 years in women) or the older working-age (e.g. at age 50 10.2–11.7 years in men, 7.8–10.5 years in men) is considered. Among women at all ages and men from their mid-20s onwards, WLE was higher among higher-educated individuals. Inequalities were most pronounced among women (e.g. Δ3.1 years in women, Δ1.3 years in men at age 50). The study supports previous research indicating that measures to extend working life are effective, but that noticeable inequalities in WLE exist. Health insurance data represent a valuable source for such research that has so far remained untapped. The data provide a suitable basis to investigate trends and inequalities in WLE. Future research should build on the strengths of the data by broadening the research towards a more comprehensive analysis of the development of WLE from a health perspective. Working Life Expectancy has increased substantially since the mid-2000s. The gender gap narrowed over time, but men still spend considerably more years in the labor force than women. Educational inequalities in WLE exist in both sexes, but are larger in women. Measures to increase labor force participation should focus especially on lower-educated women, as WLE is low in this group. Prevention should be strengthened for vulnerable groups to reduce health inequalities and early labor market exits.
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Tetzlaff J, Epping J, Geyer S, Beller J, Sperlich S, Tetzlaff F. Länger leben, länger arbeiten? Zeittrends und
Bildungsungleichheiten in der Working Life Expectancy auf der Basis von
Krankenkassendaten. Das Gesundheitswesen 2022. [DOI: 10.1055/s-0042-1753711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- J Tetzlaff
- Medizinische Hochschule Hannover, Medizinische Soziologie, Hannover,
Deutschland
| | - J Epping
- Medizinische Hochschule Hannover, Medizinische Soziologie, Hannover,
Deutschland
| | - S Geyer
- Medizinische Hochschule Hannover, Medizinische Soziologie, Hannover,
Deutschland
| | - J Beller
- Medizinische Hochschule Hannover, Medizinische Soziologie, Hannover,
Deutschland
| | - S Sperlich
- Medizinische Hochschule Hannover, Medizinische Soziologie, Hannover,
Deutschland
| | - F Tetzlaff
- Medizinische Hochschule Hannover, Medizinische Soziologie, Hannover,
Deutschland
- Robert Koch-Institut, Fachgebiet Soziale Determinanten der Gesundheit,
Berlin, Deutschland
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16
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Sperlich S, Adler FM, Beller J, Safieddine B, Tetzlaff J, Geyer S. Zeitliche Entwicklung subjektiver Gesundheit von alleinerziehenden
Müttern in Deutschland – eine Dekompositionsanalyse des
Einflusses von Veränderungen der sozioökonomischen
Lebenssituation von 1994 bis 2018. Das Gesundheitswesen 2022. [DOI: 10.1055/s-0042-1753619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Heller C, Sperlich S, Tetzlaff F, Geyer S, Epping J, Beller J, Tetzlaff J. Living longer, working longer: analysing time trends in working life expectancy in Germany from a health perspective between 2002 and 2018. Eur J Ageing 2022; 19:1263-1276. [PMID: 36692756 PMCID: PMC9729498 DOI: 10.1007/s10433-022-00707-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2022] [Indexed: 01/26/2023] Open
Abstract
Population ageing poses growing challenges to social security systems, in particular to public pension funds. The study analyses how Working Life Expectancy (WLE) and Healthy Working Life Expectancy (HWLE) in terms of three health indicators developed in Germany. Based on the German Socio-Economic Panel (GSOEP) from 2002 to 2018 (n = 211,141), time trends in labour force rates, mental and physical Health-Related Quality of Life (HRQoL), self-rated health (SRH) and the respective combinations (health indicator*labour force) were analysed for all respondents aged 18-74. WLE and HWLE were calculated using the Sullivan method. WLE and HWLE in men and women at age 18 and 50 clearly increased over time. These increases in HWLE were found in terms of all three health indicators. This development was mainly driven by the clear increase of the labour force rates, since the shares of individuals with good and satisfactory SRH or average and good HRQoL remained largely stable over time. The results show that from a health perspective there have been potentials for increases in WLE during the past two decades and that increasingly more healthy life years are spent economically active. However, life years in the labour force but in poor health have increased, too. The absence of clear improvements in health emphasises the importance of current and future preventive measures to maintain health, especially among the middle-aged and older labour force.
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Affiliation(s)
- Chiara Heller
- Medical Sociology Unit, Hannover Medical School, Hanover, Germany
| | | | - Fabian Tetzlaff
- Medical Sociology Unit, Hannover Medical School, Hanover, Germany
| | - Siegfried Geyer
- Medical Sociology Unit, Hannover Medical School, Hanover, Germany
| | - Jelena Epping
- Medical Sociology Unit, Hannover Medical School, Hanover, Germany
| | - Johannes Beller
- Medical Sociology Unit, Hannover Medical School, Hanover, Germany
| | - Juliane Tetzlaff
- Medical Sociology Unit, Hannover Medical School, Hanover, Germany
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Tetzlaff F, Hoebel J, Epping J, Geyer S, Golpon H, Tetzlaff J. Time Trends and Income Inequalities in Cancer Incidence and Cancer-Free Life Expectancy - a Cancer Site-Specific Analysis of German Health Insurance Data. Front Oncol 2022; 12:827028. [PMID: 35494022 PMCID: PMC9046985 DOI: 10.3389/fonc.2022.827028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 03/22/2022] [Indexed: 11/13/2022] Open
Abstract
Cancer represents a major burden of morbidity and mortality globally. So far, however, little is known on time trends and inequalities in the lengths of life spent free of any cancer. This study steps into this gap by analyzing time trends and income inequalities in cancer-free life expectancy (CFLE). For this retrospective cohort study, data of a large German health insurer were used (N = 3,405,673individuals, 2006-2018). Income inequalities were assessed using individual income (<60% of German average income (GAI) and ≥60% of GAI). Trends in incidence risks were analysed employing proportional-hazard regression models by splitting the observation time into three periods of 52 months. Trends in CFLE in total and for the most common site-specific cancers were calculated based on multiple decrement life tables. Incidence rates declined in almost all cancers and CFLE increased substantially over time (49.1 (95% CI 48.8-49.4) to 51.9 (95% CI 51.6-52.2) years for men, 53.1 (95% CI 52.7-53.5) to 55.4 (95% CI 55.1-55.8) years for women at age 20 for total cancer) and income groups. Considerable income inequalities in cancer risks were evident in both sexes, but were more pronounced in men (total cancer HR 0.86 (95% CI 0.85-0.87)), with higher-income individuals having lower risks. The highest income inequalities were found in colon (HR 0.90 (95% CI 0.87-0.93)), stomach (HR 0.78 (95% CI 0.73-0.84)), and lung cancer (HR 0.58 (95% CI 0.56-0.60)) in men. A reverse gradient was found for skin (HR 1.39 (95% CI 1.30-1.47) men; HR 1.27 (95% CI 1.20-1.35) women) and prostate cancer (HR 1.13 (95% CI 1.11-1.15)). The proportion of CFLE in total life expectancy declined for lung, skin and cervical cancer in women, indicating a relative shortening of lifetime spent cancer-free. In contrast, increasing proportions were found in breast and prostate cancer. To our knowledge, this is the first study analysing trends and income inequalities in CFLE. The life span free of cancer increased clearly over time. However, not all cancer types contributed equally to this positive development. Income inequalities persisted or tended to widen, which underlines the need for increased public health efforts in socioeconomically vulnerable groups.
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Affiliation(s)
- Fabian Tetzlaff
- Medical Sociology Unit, Hannover Medical School, Hanover, Germany
| | - Jens Hoebel
- Division of Social Determinants of Health, Robert Koch Institute, Berlin, Germany
| | - Jelena Epping
- Medical Sociology Unit, Hannover Medical School, Hanover, Germany
- Comprehensive Cancer Center Hannover, Hannover Medical School, Hanover, Germany
| | - Siegfried Geyer
- Medical Sociology Unit, Hannover Medical School, Hanover, Germany
- Comprehensive Cancer Center Hannover, Hannover Medical School, Hanover, Germany
| | - Heiko Golpon
- Comprehensive Cancer Center Hannover, Hannover Medical School, Hanover, Germany
- Department of Pneumology, Hannover Medical School, Hanover, Germany
| | - Juliane Tetzlaff
- Medical Sociology Unit, Hannover Medical School, Hanover, Germany
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Sperlich S, Adler FM, Beller J, Safieddine B, Tetzlaff J, Tetzlaff F, Geyer S. Getting Better or Getting Worse? A Population-Based Study on Trends in Self-Rated Health among Single Mothers in Germany between 1994 and 2018. Int J Environ Res Public Health 2022; 19:ijerph19052727. [PMID: 35270418 PMCID: PMC8909933 DOI: 10.3390/ijerph19052727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 02/20/2022] [Accepted: 02/22/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND While numerous studies suggest that single motherhood is associated with socioeconomic disadvantages and poor health, few studies have analyzed how these conditions have evolved over time. Addressing this gap, we examined the temporal development of self-rated health (SRH) among single compared to partnered mothers, and the role of socioeconomic factors that may have influenced this trend. METHODS We used representative longitudinal data from the German Socioeconomic Panel Survey (G-SOEP) between 1994 and 2018, consisting of 83,843 women with children, aged 30-49 years (13,664 single and 70,179 partnered mothers). Time trends in SRH and socioeconomic factors were analyzed by means of logistic regression analyses. We applied the Karlson-Holm-Breen (KHB) method for decomposing the total time effect into direct and indirect parts via socioeconomic mediators. RESULTS The predicted probabilities of good SRH decreased in single mothers from 57.0% to 48.4%, while they increased in partnered mothers from 54.8% to 61.3%. Similarly, predicted probabilities of poor SRH rose from 15.0% to 22.7% in single mothers while decreasing slightly from 12.0% to 11.4% in partnered mothers. Moreover, socioeconomic factors worsened over time for single mothers, while they mostly improved for partnered mothers. Decomposing the time trend revealed that the deterioration of single mothers' health was partly explained by the worsening of socioeconomic disadvantages, of which the decline in full-time employment, the rise in low incomes, and in unemployment contributed most. CONCLUSIONS The alarming rise in socioeconomic and health disadvantages among single mothers in Germany shows that action is needed to counter this trend.
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Tetzlaff J, Tetzlaff F, Geyer S, Sperlich S, Epping J. Widening or narrowing income inequalities in myocardial infarction? Time trends in life years free of myocardial infarction and after incidence. Popul Health Metr 2021; 19:47. [PMID: 34952590 PMCID: PMC8709953 DOI: 10.1186/s12963-021-00280-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 10/10/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Despite substantial improvements in prevention and therapy, myocardial infarction (MI) remains a frequent health event, causing high mortality and serious health impairments. Previous research lacks evidence on how social inequalities in incidence and mortality risks developed over time, and on how these developments affect the lifespan free of MI and after MI in different social subgroups. This study investigates income inequalities in MI-free life years and life years after MI and whether these inequalities widened or narrowed over time. METHODS The analyses are based on claims data of a large German health insurance provider insuring approximately 2.8 million individuals in the federal state Lower Saxony. Trends in income inequalities in incidence and mortality were assessed for all subjects aged 60 years and older by comparing the time periods 2006-2008 and 2015-2017 using multistate survival models. Trends in the number of life years free of MI and after MI were calculated separately for income groups by applying multistate life table analyses. RESULTS MI incidence and mortality risks decreased over time, but declines were strongest among men and women in the higher-income group. While life years free of MI increased in men and women with higher incomes, no MI-free life years were gained in the low-income group. Among men, life years after MI increased irrespective of income group. CONCLUSIONS Income inequalities in the lifespan spent free of MI and after MI widened over time. In particular, men with low incomes are disadvantaged, as life years spent after MI increased, but no life years free of MI were gained.
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Affiliation(s)
- Juliane Tetzlaff
- Medical Sociology Unit, Hannover Medical School, Hanover, Germany.
| | - Fabian Tetzlaff
- Institute for General Practice, Hannover Medical School, Hanover, Germany
| | - Siegfried Geyer
- Medical Sociology Unit, Hannover Medical School, Hanover, Germany
| | | | - Jelena Epping
- Medical Sociology Unit, Hannover Medical School, Hanover, Germany
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21
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Epping J, Geyer S, Eberhard S, Tetzlaff J. [Completely Different or Quite Similar? The Sociodemographic Structure of the AOK Lower Saxony in Comparison to the General and Working Population in Lower Saxony and the Federal Republic of Germany]. Gesundheitswesen 2021; 83:S77-S86. [PMID: 34695865 DOI: 10.1055/a-1553-3565] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
ZIEL DER STUDIE Routinedaten von Krankenkassen sind als Datenquelle mittlerweile gut etabliert. Hinsichtlich der Verallgemeinerbarkeit der Ergebnisse bei Analysen mit Daten einer Krankenkasse treten Fragen der Repräsentativität der Versichertenpopulation auf, insbesondere da nicht alle Studien auf soziodemografische Merkmale adjustieren. Diese Arbeit untersucht mittels deskriptiver Analyse, ob und inwieweit sich die Sozialstruktur der Versichertenpopulation der AOK Niedersachsen von der Sozialstruktur der Allgemeinbevölkerung und der sozialversicherungspflichtig Beschäftigten in Niedersachsen (NDS) und in der Bundesrepublik (BRD) unterscheiden. METHODIK Die Datengrundlage bilden pseudonymisierte Daten der AOK NDS, die Beschäftigtenstatistik der Bundesagentur für Arbeit und der Bevölkerungsstand in NDS und der BRD. Die Versichertenpopulation wird an zwei Stichtagen 31.12.2012 und 31.12.2017 hinsichtlich der Geschlechter-und Altersstruktur mit der Bevölkerung in NDS und der BRD verglichen. Anschließend werden die Daten der sozialversicherungspflichtig Beschäftigten in der AOK NDS und aus der Beschäftigtenstatistik der Bundesagentur für Arbeit gegenübergestellt, um Ausbildungsabschlüsse, Komplexität der ausgeübten Tätigkeit und elf Berufsbereiche zu vergleichen. ERGEBNISSE Die Geschlechterstruktur unterscheidet sich nicht zwischen den drei Vergleichspopulationen. Verglichen mit der Bevölkerung in NDS und der BRD ist der Anteil der unter 30-Jährigen in der AOK NDS überdurchschnittlich, der Anteil der Personen zwischen 50 und 76 Jahren etwas unterdurchschnittlich. Sozialversicherungspflichtig Beschäftigte mit Hochschulabschluss und in Tätigkeiten mit höherer Komplexität sind in der AOK NDS unterrepräsentiert. Die Verteilung der sozialversicherungspflichtig Beschäftigten auf elf Berufsbereiche unterscheidet sich ebenfalls. SCHLUSSFOLGERUNG Die Studie zeigt, dass soziodemographische und sozio-ökonomische Merkmale in Studien mit Krankenkassendaten wann immer möglich berücksichtigt werden sollten. In Zukunft wird das Informationssystem Versorgungsdaten krankenkassenübergreifende Analysen mit Sekundärdaten ermöglichen. Fragestellungen der gesundheitlichen Ungleichheit können damit jedoch aufgrund des Fehlens von sozio-ökonomischen Merkmalen nicht beantwortet werden. Auch die Identifikation von vulnerablen Gruppen, die gezielt geeigneten Maßnahmen zugeführt werden könnten, ist ohne Berücksichtigung von sozio-ökonomischen Merkmalen erschwert. AIM OF THE WORK Routine data from statutory health insurance funds are now a well-established source of data for scientific research. With regard to the generalizability of findings based on data from one health insurance fund, questions arise regarding the representativeness of the insured population, especially since not all studies adjust for socio-demographic characteristics. Our study examines whether and to what extent socio-demographic and occupational characteristics of the population insured with the AOK Lower Saxony differ from the total and working population of Lower Saxony and the Federal Republic of Germany. METHODS The analyses are based on pseudonymised data from the AOK, the employment statistics of the Federal Employment Agency (FEA) and population statistics. The insured population was compared with the population of Lower Saxony and Germany at two cut-off dates (31.12.2012 and 31.12.2017) with respect to the distributions of age and gender. Subsequently, data of employed insured persons were compared with FEA-data in order to compare educational level, complexity of the work and occupational areas. RESULTS The gender structure did not differ between the three populations. The proportion of insured women and men below 30 years of age was above the corresponding figures of Lower Saxony and Germany. Employed individuals holding a university degree or jobs with higher complexity were under-represented in the AOK. The distribution across eleven occupational areas in the AOK also differed from the reference populations. CONCLUSIONS The study shows that socio-demographic and socio-economic characteristics should be considered whenever possible in studies using statutory health insurance data. In future, the new database "Information System Health Care Data" will enable analyses across all statutory health insurance providers. However, research questions of health inequalities cannot be answered with this approach due to the lack of socio-economic characteristics in these data. Identifying vulnerable groups that could be targeted for appropriate interventions is also difficult without taking socio-economic characteristics into account.
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Affiliation(s)
- Jelena Epping
- Medizinische Soziologie , Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Siegfried Geyer
- Medizinische Soziologie , Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Sveja Eberhard
- Stabsbereich Politik, Forschung & Presse, Allgemeine Ortskrankenkasse Niedersachsen, Hannover, Deutschland
| | - Juliane Tetzlaff
- Medizinische Soziologie , Medizinische Hochschule Hannover, Hannover, Deutschland
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Tetzlaff F, Epping J, Tetzlaff J, Golpon H, Geyer S. Socioeconomic inequalities in lung cancer - a time trend analysis with German health insurance data. BMC Public Health 2021; 21:538. [PMID: 33740928 PMCID: PMC7977592 DOI: 10.1186/s12889-021-10576-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 03/07/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Lung Cancer (LC) is one of the most prevalent cancer diseases. Due to the lack of databases which allow the combination of information on individual socioeconomic status (SES) and cancer incidence, research on social inequalities in LC among the German population is rare. The aim of the study is to analyse time trends in social inequalities in LC in Germany. METHODS The analyses are based on data of a large statutory health insurance provider. The data contain information on diagnoses, occupation and education (working age), and income (full age range) of the insurance population. Trends were analysed for two subpopulations (retirement age and working age) and stratified by sex. The analyses are based on incidence rates and proportional hazard models spanning the periods 2006-2009, 2010-2013 and 2014-2017. RESULTS Incidence rates declined in men but increased in women. For men, inequalities were strongest in terms of income and the decline in incidence was most pronounced in middle- and higher-income men. Among women at retirement age, a reversed income gradient was found which disappeared in the second period. The educational gradient among the working-age population decreased over time due to the trend towards increasing incidence among individuals with higher education. Declining gradients were also found for occupational position. CONCLUSION The findings reveal considerable inequalities in LC and that trends vary with respect to SES, sex and age. Widening income inequalities were found in the retired population, while educational and occupational inequalities tend to narrow among the working-age population.
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Affiliation(s)
- Fabian Tetzlaff
- Institute for General Practice, Hannover Medical School, Hanover, Germany.
| | - Jelena Epping
- Medical Sociology Unit, Hannover Medical School, Hanover, Germany
- Comprehensive Cancer Center Hannover, Hannover Medical School, Hanover, Germany
| | - Juliane Tetzlaff
- Medical Sociology Unit, Hannover Medical School, Hanover, Germany
| | - Heiko Golpon
- Department of Pneumology, Hannover Medical School, Hanover, Germany
| | - Siegfried Geyer
- Medical Sociology Unit, Hannover Medical School, Hanover, Germany
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Sperlich S, Klar MK, Safieddine B, Tetzlaff F, Tetzlaff J, Geyer S. Life stage-specific trends in educational inequalities in health-related quality of life and self-rated health between 2002 and 2016 in Germany: findings from the German Socio-Economic Panel Study (GSOEP). BMJ Open 2021; 11:e042017. [PMID: 33664070 PMCID: PMC7934728 DOI: 10.1136/bmjopen-2020-042017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 12/30/2020] [Accepted: 01/21/2021] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES While evidence suggests persisting health inequalities, research on whether these trends may vary according to different stages of life has rarely been considered. Against this backdrop, we analysed life stage-specific trends in educational inequalities in health-related quality of life (HRQOL) and poor self-rated health (SRH) for individuals in 'later working life' (50-64 years), 'young seniors' (65-79 years) and persons of 'old age' (80+ years). METHODS We used survey data from the German Socio-Economic Panel Study comprising the period from 2002 to 2016. The sample consists of 26 074 respondents (160 888 person-years) aged 50 years and older. Health was assessed using the mental and physical component summary scale (MCS/PCS) of the HRQOL questionnaire (12-Item Short Form Health Survey V.2) and the single item SRH. To estimate educational health inequalities, we calculated the regression-based Slope Index of Inequality (SII) and Relative Index of Inequality (RII). Time trends in inequalities were assessed by the inclusion of a two-way interaction term between school education and time. RESULTS With increasing age, educational inequalities in PCS and poor SRH decreased whereas they rose in MCS. Over time, health inequalities decreased in men aged 65-79 years (MCSSII=2.76, 95% CI 0.41 to 5.11; MCSRII=1.05, 95% CI 1.01 to 1.10; PCSSII=2.12, 95% CI -0.27to 4.51; PCSRII=1.05, 95% CI 1.00 to 1.11; poor SRHSII=-0.10, 95% CI -0.19 to 0.01; poor SRHRII=0.73, 95% CI 0.48 to 1.13) and among women of that age for MCS (MCSSII=2.82, 95% CI 0.16 to 5.50; MCSRII=1.06, 95% CI 1.01 to 1.12). In contrast, health inequalities widened in the 'later working life' among women (PCSSII=-2.98, 95% CI -4.86 to -1.11; PCSRII=0.94, 95% CI 0.90 to 0.98; poor SRHSII=0.07, 95% CI 0.00 to 0.14) while remained largely stable at old age for both genders. CONCLUSIONS We found distinctive patterns of health inequality trends depending on gender and life stage. Our findings suggest to adopt a differentiated view on health inequality trends and to pursue research that explores their underlying determinants.
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Affiliation(s)
| | | | | | - Fabian Tetzlaff
- Medical Sociology, Hannover Medical School, Hannover, Germany
| | | | - Siegfried Geyer
- Medical Sociology, Hannover Medical School, Hannover, Germany
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Klar MK, Geyer S, Safieddine B, Tetzlaff F, Tetzlaff J, Sperlich S. Trends in healthy life expectancy between 2002 and 2018 in Germany - Compression or expansion of health-related quality of life (HRQOL)? SSM Popul Health 2021; 13:100758. [PMID: 33732863 PMCID: PMC7937823 DOI: 10.1016/j.ssmph.2021.100758] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 01/29/2021] [Accepted: 02/13/2021] [Indexed: 12/29/2022] Open
Abstract
The question of whether rising life expectancy has led to additional life years spent in good health or poor health is of major public health relevance. We tested the theories of compression or expansion of morbidity for Germany with respect to the mental and physical component summary scales (MCS/PCS) of the health-related quality of life (HRQOL) questionnaire (SF-12). Data of 90,758 women and 81,400 men were obtained from the German Socio-Economic Panel between 2002 and 2018. Linear and logistic regression analyses were applied to estimate temporal changes in MCS and PCS in different life stages. The development of healthy life expectancy (H-LE) expressed by life years without severe functional limitations was calculated by applying the Sullivan method. Overall, a significant increase of MCS and PCS was found in both genders. The rise was mainly due to declining proportions of severe limitations (norm values < 40 points) while the proportions of norm values > 60 points did not change substantially. Improvements were most apparent for the 'young seniors' (65-79 years) and at 'old age' (80 years +). In contrast, no improvements in PCS were found for 'later working life' (50-64 years) and decreasing levels were observed for persons of 'middle working age' (30-49 years). During the study period, H-LE at age 50 increased in women/men by 2.93/2.90 years (MCS) and 1.92/2.53 years (PCS), respectively. Our results support the hypothesis of absolute compression of morbidity. However, since consistent improvements were not found for ages below 65 years, it remains open to debate whether the positive health trend will also persist in the future. Our findings suggest that health promotion efforts should be strengthened for people of middle and later working age to support healthy aging.
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Affiliation(s)
| | - Siegfried Geyer
- Hannover Medical School, Medical Sociology, Hannover, Germany
| | | | - Fabian Tetzlaff
- Hannover Medical School, Medical Sociology, Hannover, Germany
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Sperlich S, Beller J, Epping J, Safieddine B, Tetzlaff J, Geyer S. Are Disability Rates among People with Diabetes Increasing in Germany? A Decomposition Analysis of Temporal Change between 2004 and 2015. J Aging Health 2021; 33:205-216. [PMID: 33135530 PMCID: PMC7917560 DOI: 10.1177/0898264320970324] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Objectives: We investigated changes in the prevalence of disabilities among individuals with type 2 diabetes and analyzed the contribution of comorbidities on this change. Methods: Data were drawn from the Survey of Health, Ageing, and Retirement in Europe (SHARE). We estimated predicted probabilities of impaired (instrumental) activities of daily living (IADL and ADL) by means of logistic regression. Multivariate decomposition was employed for analyzing the impact of comorbidities on changes in disability rates. Results: Among people with diabetes, ADL difficulties rose significantly from 11.3% (2004) to 19.1% (2015), while IADL difficulties increased among younger diabetics from 11.5% to 18.3%. Decomposition analysis revealed that the parallel increase in comorbidities contributed to the rise in disabilities. Discussion: We found disability rates among people with diabetes in Germany to be increasing over time, pointing toward a growing demand of tertiary prevention for these individuals to maintain functional health and quality of life.
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Affiliation(s)
| | - Johannes Beller
- Medical Sociology, Hannover Medical School, Hannover, Germany
| | - Jelena Epping
- Medical Sociology, Hannover Medical School, Hannover, Germany
| | | | | | - Siegfried Geyer
- Medical Sociology, Hannover Medical School, Hannover, Germany
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Tetzlaff J, Geyer S, Westhoff-Bleck M, Sperlich S, Epping J, Tetzlaff F. Social inequalities in mild and severe myocardial infarction: how large is the gap in health expectancies? BMC Public Health 2021; 21:259. [PMID: 33526035 PMCID: PMC7852180 DOI: 10.1186/s12889-021-10236-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 01/13/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Acute myocardial infarction (MI) remains a frequent health event and a major contributor to long-term impairments globally. So far, research on social inequalities in MI incidence and mortality with respect to MI severity is limited. Furthermore, evidence is lacking on disparities in the length of life affected by MI. This study investigates social inequalities in MI incidence and mortality as well as in life years free of MI and affected by the consequences of mild or severe MI. METHODS The study is based on data of a large German statutory health insurance provider covering the years 2008 to 2017 (N = 1,253,083). Income inequalities in MI incidence and mortality risks and in life years with mild or severe MI and without MI were analysed using multistate analyses. The assessment of MI severity is based on diagnosed heart failure causing physical limitations. RESULTS During the study period a total of 39,832 mild MI, 22,844 severe MI, 276,582 deaths without MI, 15,120 deaths after mild MI and 16,495 deaths after severe MI occurred. Clear inequalities were found in MI incidence and mortality, which were strongest among men and in severe MI incidence. Moreover, substantial inequalities were found in life years free of MI in both genders to the disadvantage of those with low incomes and increased life years after mild MI in men with higher incomes. Life years after severe MI were similar across income groups. CONCLUSIONS Social inequalities in MI incidence and mortality risks led to clear disparities in the length of life free of MI with men with low incomes being most disadvantaged. Our findings stress the importance of primary and secondary prevention focusing especially on socially disadvantaged groups.
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Affiliation(s)
- Juliane Tetzlaff
- Medical Sociology Unit, Hannover Medical School, Hanover, Germany.
| | - Siegfried Geyer
- Medical Sociology Unit, Hannover Medical School, Hanover, Germany
| | | | | | - Jelena Epping
- Medical Sociology Unit, Hannover Medical School, Hanover, Germany
| | - Fabian Tetzlaff
- Institute for General Practice, Hannover Medical School, Hanover, Germany
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Tetzlaff F, Epping J, Golpon H, Tetzlaff J. Compression, expansion, or maybe both? Growing inequalities in lung cancer in Germany. PLoS One 2020; 15:e0242433. [PMID: 33216766 PMCID: PMC7679006 DOI: 10.1371/journal.pone.0242433] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 11/02/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Lung Cancer (LC) is one of the most common malign diseases worldwide. So far, it is unclear if the development of LC incidence and mortality leads to morbidity compression or expansion and whether these developments differ by socioeconomic characteristics. This study analyses time trends in social and gender inequalities in life years with and without LC in Germany. METHODS The study is based on data of a large German statutory health insurance provider (N = 2,511,790). Incidence and mortality risks were estimated from multistate survival models. Trends in life years with and without LC were analysed using multistate life table analyses. All analyses were performed separately for gender, time period (2006-2009 and 2014-2017), and income group (<60% and ≥60% of the German average income). RESULTS Among men, declining LC incidence rates resulted in gains of life years free of LC and declining LC- affected life years and led to a relative compression, which was strongest in men with higher incomes. Among women, a clear increase in life years with LC led to an expansion of the lifespan affected by LC. This expansion was mainly driven by increasing incidence rates in women with low incomes. Overall, income inequalities in LC increased in both genders. CONCLUSIONS Our analyses reveal that developments in the length of life affected by LC differed substantially by gender and income and led to widening health inequalities over time. Public health efforts should mainly focus on vulnerable groups to reduce the persisting social inequalities in LC.
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Affiliation(s)
- Fabian Tetzlaff
- Institute for General Practice, Hannover Medical School, Hanover, Germany
| | - Jelena Epping
- Medical Sociology Unit, Hannover Medical School, Hanover, Germany
- Comprehensive Cancer Center Hannover, Hannover Medical School, Hanover, Germany
| | - Heiko Golpon
- Department of Pneumology, Hannover Medical School, Hanover, Germany
| | - Juliane Tetzlaff
- Medical Sociology Unit, Hannover Medical School, Hanover, Germany
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Epping J, Geyer S, Tetzlaff J. The effects of different lookback periods on the sociodemographic structure of the study population and on the estimation of incidence rates: analyses with German claims data. BMC Med Res Methodol 2020; 20:229. [PMID: 32917135 PMCID: PMC7488660 DOI: 10.1186/s12874-020-01108-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 08/30/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Defining incident cases has always been a challenging issue for researchers working with routine data. Lookback periods should enable researchers to identify and exclude recurrent cases and increase the accuracy of the incidence estimation. There are different recommendations for lookback periods depending on a disease entity of up to 10 years. Well-known drawbacks of the application of lookback periods are shorter remaining observation period in the dataset or smaller number of cases. The problem of selectivity of the remaining population after introducing lookback periods has not been considered in the literature until now. METHODS The analyses were performed with pseudonymized claims data of a German statutory health insurance fund with annual case numbers of about 2,1 million insured persons. Proportions of study population excluded due to the application of lookback periods are shown according to age, occupational qualification and income. Myocardial infarction and stroke were used to demonstrate changes in incidence rates after applying lookback periods of up to 5 years. RESULTS Younger individuals show substantial dropouts after the application of lookback periods. Furthermore, there are selectivities regarding occupational qualification and income, which cannot be handled by age standardization. Due to selective dropouts of younger individuals, crude incidence rates of myocardial infarction and stroke increase after applying lookback periods. Depending on the income group, age-standardized incidence rates changed differentially, leading to a decrease and possible underestimation of the social gradient after applying lookback periods. CONCLUSIONS Selectivity analyses regarding age and sociodemographic structure should be performed for the study population after applying lookback periods since the selectivity can affect the outcome especially in health care research. The selectivity effects might occur not only in claims data of one health insurance fund, but also in other longitudinal data with left- or right-censoring not covering the whole population. The effects may also apply to health care systems with a mix of public and private health insurance. A trade-off has to be considered between selectivity effects and eliminating recurrent events for more accuracy in the definition of incidence.
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Affiliation(s)
- Jelena Epping
- Medical Sociology Unit, Hannover Medical School, Carl-Neuberg-Str 1, 30625, Hannover, Germany.
| | - Siegfried Geyer
- Medical Sociology Unit, Hannover Medical School, Carl-Neuberg-Str 1, 30625, Hannover, Germany
| | - Juliane Tetzlaff
- Medical Sociology Unit, Hannover Medical School, Carl-Neuberg-Str 1, 30625, Hannover, Germany
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Safieddine B, Sperlich S, Beller J, Lange K, Epping J, Tetzlaff J, Tetzlaff F, Geyer S. Socioeconomic inequalities in type 2 diabetes among different population subgroups. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.1044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Type 2 diabetes (T2D) is a rising global epidemic with lower socioeconomic status (SES) groups being more affected. Considering specific population subgroups to examine prevalence and SES inequalities in T2D is rare. In addition, using only one indicator to depict SES inequalities in health has been a common practice despite evidence on differences in what different indicators measure. This study examines the prevalence of and SES (school education, occupation and income) inequalities in T2D in the three population subgroups: employed individuals, nonworking spouses and pensioners. This study also determines the SES indictor with the highest explanatory power.
Methods
This study is based on claims data from a statutory health insurance provider in Lower Saxony, Germany. T2D prevalence in the period between 2013 and 2017 was examined in 1,345,841 employed individuals, 180,949 nonworking spouses and 773,427 pensioners. Multivariate logistic regression analysis was applied to examine SES inequalities in T2D in the three subgroups. Explanatory power of the three SES indicators was compared by deviance analysis.
Results
T2D prevalence was four times higher in male nonworking spouses (24.2%) and 2.6 times higher in female nonworking spouses (12.7%) compared to employed men (6.4%) and women (4.7%) respectively, while it accounted for 40% of men and 36% of women in pensioners. Clear gradients in T2D inequalities emerged for all three SES indicators and were observed in the three population subgroups. School education had the highest explanatory power in employed men and women and male nonworking spouses.
Conclusions
Nonworking spouses are an important target group in T2D prevention interventions. The three SES indicators differ in their explanatory power where low school education appears to be a major risk factor. It can be discussed that health literacy and the associated health behavior play a role in mediating the association between education and T2D.
Key messages
The population subgroup “nonworking spouses” is an important target group for type 2 diabetes prevention interventions. The level of school education is a substantial determinant of socioeconomic inequalities in type 2 diabetes.
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Affiliation(s)
- B Safieddine
- Medical Sociology Unit, Hannover Medical School, Hannover, Germany
| | - S Sperlich
- Medical Sociology Unit, Hannover Medical School, Hannover, Germany
| | - J Beller
- Medical Sociology Unit, Hannover Medical School, Hannover, Germany
| | - K Lange
- Medical Psychology Unit, Hannover Medical School, Hannover, Germany
| | - J Epping
- Medical Sociology Unit, Hannover Medical School, Hannover, Germany
| | - J Tetzlaff
- Medical Sociology Unit, Hannover Medical School, Hannover, Germany
| | - F Tetzlaff
- Institute for General Practice, Hannover Medical School, Hannover, Germany
| | - S Geyer
- Medical Sociology Unit, Hannover Medical School, Hannover, Germany
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Tetzlaff F, Epping J, Sperlich S, Tetzlaff J. Widening income inequalities in life expectancy? Analysing time trends based on German health insurance data. J Epidemiol Community Health 2020; 74:592-597. [PMID: 32277000 DOI: 10.1136/jech-2019-212966] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 02/17/2020] [Accepted: 03/21/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND While social disparities in mortality have been shown in the majority of high-income countries, research on inequalities in the German population is still limited. This applies especially to studies investigating time trends in social inequalities with respect to life expectancy. The aim of this study is to examine income inequalities in life expectancy and whether inequalities have narrowed or widened over time. METHODS The analyses are based on the claims data of a large German health insurance provider, which facilitates the combining of information on individual income and mortality. Life expectancy is calculated separately for three income groups (<60%, 60% to 80% and ≥80% of the average income in Germany) and for sex by applying period life table analyses. Trends are assessed by comparing the time periods 2005-2008 (N = 1 773 122), 2009-2012 (N=1 792 735) and 2013-2016 (N = 1 987 114). RESULTS Trends in life expectancy differed by sex, age and income group. Especially among elderly men, the gap between low- and high-income groups widened over time, disadvantaging men with low incomes. Among women, a slight reduction in inequalities was observed, which was driven by the increases in life expectancy in low-income groups. CONCLUSION Our study shows that not all population subgroups benefitted equally from the continuing rise in life expectancy. The persisting inequalities emphasise the importance of public health efforts concentrating on reducing mortality risks among individuals in lower socioeconomic positions. Special attention should be paid to elderly men with low incomes. Further research is needed on the mechanisms underlying increasing health inequalities over time.
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Affiliation(s)
- Fabian Tetzlaff
- Institute for General Practice, Hannover Medical School, Hanover, Germany
| | - Jelena Epping
- Medical Sociology Unit, Hannover Medical School, Hanover, Germany
| | | | - Juliane Tetzlaff
- Medical Sociology Unit, Hannover Medical School, Hanover, Germany
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Sperlich S, Beller J, Epping J, Tetzlaff J, Geyer S. Trends in self-rated health among the elderly population in Germany from 1995 to 2015 - the influence of temporal change in leisure time physical activity. BMC Public Health 2020; 20:113. [PMID: 31992257 PMCID: PMC6988275 DOI: 10.1186/s12889-020-8218-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 01/14/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Against the backdrop of rising statutory retirement age in Germany, we analyzed time trends in self-rated health (SRH) among the elderly population between 50 and 70 years of age and explored the mediating role of leisure time physical activity (LTPA) on the relationship between time period and self-rated health (SRH). METHODS We used longitudinal survey data (n = 23,161) from a national panel study (GSOEP) to analyze time trends in SRH and regular LTPA (at least once a week) by means of Generalized Estimation Equation (GEE) analysis for logistic regression. The Karlson-Holm-Breen (KHB) method was applied for decomposing trend effects into direct and indirect parts via LTPA. In addition to odds ratios (OR), we illustrated the results by means of predicted probabilities and average partial effects (APE). RESULTS Over time, the predicted probabilities of good SRH and regular LTPA increased while those of poor SRH decreased. After adjusting for socioeconomic status (SES) 53.4% of the trend in good SRH in women (OR = 1.34 / APE = 6.8%-points) could be attributed to the rise in regular LTPA. In men, the remaining smaller effect (OR = 1.13 / APE = 2.7%) could be fully assigned to temporal changes in regular LTPA. With respect to poor health we found a suppression effect of LTPA in the adjusted model, indicating that without improvements in regular LTPA over time an increase in poor SRH would have occurred. CONCLUSIONS The increase of regular LTPA accounted for improved SRH from 1995 to 2015 among the elderly, indicating that promoting LTPA might be a key factor to raise healthy working life expectancy.
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Affiliation(s)
- Stefanie Sperlich
- Hannover Medical School, Medical Sociology Unit, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Johannes Beller
- Hannover Medical School, Medical Sociology Unit, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Jelena Epping
- Hannover Medical School, Medical Sociology Unit, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Juliane Tetzlaff
- Hannover Medical School, Medical Sociology Unit, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Siegfried Geyer
- Hannover Medical School, Medical Sociology Unit, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
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Tetzlaff J, Geyer S, Tetzlaff F, Epping J. Income inequalities in stroke incidence and mortality: Trends in stroke-free and stroke-affected life years based on German health insurance data. PLoS One 2020; 15:e0227541. [PMID: 31945102 PMCID: PMC6964859 DOI: 10.1371/journal.pone.0227541] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 12/20/2019] [Indexed: 12/28/2022] Open
Abstract
Background Due to substantial improvements in prevention and therapy, stroke incidence and mortality rates have decreased during the last decades, but evidence is still lacking on whether all socioeconomic groups benefited equally and how the length of life affected by stroke developed over time. Our study investigates time trends in stroke-free life years and life years affected by stroke. Special emphasis is given to the question whether trends differ between income groups, leading to decreasing or increasing social inequalities. Methods The analyses are based on claims data of a German statutory health insurance company of the two time periods 2006–2008 and 2014–2016. Income inequalities and time trends in incidence and mortality risks were estimated using multistate survival models. Trends in stroke-free life years and life years affected by stroke are analysed separately for income groups by applying multistate life table analyses. Results Stroke incidence and mortality risks decreased in men and women in all income groups. While stroke-free lifetime could be gained in men having higher incomes, improvements in mortality counterbalanced decreasing incidences, leading to increases in life years affected by stroke among men of the lower and higher income group. Among women, no significant changes in life years could be observed. Conclusions Changes in stroke-affected life years occur among men in all income groups, but are more pronounced in the higher income group. However, irrespective of the income group the proportion of stroke-affected life years remains quite stable over time, pointing towards constant inequalities. Further research is needed on whether impairments due to stroke reduced over time and whether all socioeconomic groups are affected equally.
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Affiliation(s)
- Juliane Tetzlaff
- Medical Sociology Unit, Hannover Medical School, Hanover, Germany
- * E-mail:
| | - Siegfried Geyer
- Medical Sociology Unit, Hannover Medical School, Hanover, Germany
| | - Fabian Tetzlaff
- Institute for General Practice, Hannover Medical School, Hanover, Germany
| | - Jelena Epping
- Medical Sociology Unit, Hannover Medical School, Hanover, Germany
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Geyer S, Eberhard S, Schmidt BMW, Epping J, Tetzlaff J. Morbidity compression in myocardial infarction 2006 to 2015 in terms of changing rates and age at occurrence: A longitudinal study using claims data from Germany. PLoS One 2018; 13:e0202631. [PMID: 30138437 PMCID: PMC6107226 DOI: 10.1371/journal.pone.0202631] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 08/07/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND According to James Fries morbidity compression is present if morbidity rates are decreasing to a larger extent than mortality rates. Compression also occurs if age at onset is increasing at a faster pace than age at death. These two variants of the compression hypothesis were formulated as a population concept. Compression has seldom been studied with a specific disease as application. METHODS Morbidity compression was examined in terms of myocardial infarction (MI) by using German claims data covering the years 2006 to 2015. The findings are based on an annual case number of about 2 m women and men aged 18 years and older. Analyses were performed by means of proportional hazards regression and by using linear regression. RESULTS Decreases of morbidity rates were more pronounced than those of mortality. For men, the hazard ratio for contracting MI in 2015 as compared to 2006 was hr = 0.66 and hr = 0.71 for the female population. The respective results for mortality were hr = 0.75 in men and hr = 1.0 in women. They can be interpreted in favor of morbidity compression. For the subgroup of women and men with MI, changes of onset age revealed marked gender differences. For 2015 as compared with 2006, age at MI-occurrence in men increased by 10.5 months as compared to an increase of 10.4 months for age at death. In women changes were smaller and statistically not significant. The findings referring to women have to be interpreted against the backdrop of higher onset age and higher age at death than in men. CONCLUSIONS Taken together, morbidity compression has occurred in terms of decreasing MI-rates as well as in terms of increased onset age in men. It can be concluded that both processes have led to an improvement of healthy lifetime. Decreasing morbidity rates in women are also pointing towards morbidity compression, a finding that is not complemented by changes of onset age. Our data are demonstrating that morbidity rates and age at onset may vary independently. From this perspective morbidity compression is a multi-faceted phenomenon.
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Affiliation(s)
- Siegfried Geyer
- Medical Sociology Unit, Hannover Medical School, Hannover, Germany
- * E-mail:
| | - Sveja Eberhard
- Local Statutory Health Insurance of Lower Saxony (AOK Niedersachsen), Hannover, Germany
| | | | - Jelena Epping
- Medical Sociology Unit, Hannover Medical School, Hannover, Germany
| | - Juliane Tetzlaff
- Medical Sociology Unit, Hannover Medical School, Hannover, Germany
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Tetzlaff J, Epping J, Sperlich S, Geyer S. Wachsende gesundheitliche Ungleichheiten in der Multimorbidität? Eine Analyse der Zeittrends in der erwerbstätigen Bevölkerung auf der Basis von Krankenversicherungsdaten. Psychother Psychosom Med Psychol 2018. [DOI: 10.1055/s-0038-1667958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
| | | | - S Sperlich
- Medizinische Hochschule Hannover, Medizinische Soziologie, Hannover, Deutschland
| | - S Geyer
- Medizinische Hochschule Hannover, Medizinische Soziologie, Hannover, Deutschland
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Geyer S, Tetzlaff J, Sperlich S. Lässt sich der Gesundheitstrend in der älteren Bevölkerung von 1995 bis 2013 durch Veränderungen in der sportlichen Aktivität erklären? Psychother Psychosom Med Psychol 2018. [DOI: 10.1055/s-0038-1667943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- S Geyer
- Medizinische Hochschule Hannover, Medizinische Soziologie, Hannover, Deutschland
| | | | - S Sperlich
- Medizinische Hochschule Hannover, Medizinische Soziologie, Hannover, Deutschland
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Tetzlaff J, Epping J, Sperlich S, Eberhard S, Stahmeyer JT, Geyer S. Widening inequalities in multimorbidity? Time trends among the working population between 2005 and 2015 based on German health insurance data. Int J Equity Health 2018. [PMID: 30012163 DOI: 10.1186/s12939‐018‐0815‐z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Previous research has produced evidence for social inequalities in multimorbidity, but little is known on how these disparities change over time. Our study investigates the development of social inequalities in multimorbidity among the middle-aged and older working population. Special attention is paid to whether differing time trends between socio-economic status (SES) groups have taken place, increasing or decreasing inequalities in multimorbidity. METHODS The analyses are based on claims data of a German statutory health insurance company covering an observation period from 2005 to 2015. Multimorbidity prevalence risks are estimated using logistic generalized estimation equations (GEE) models. Predicted probabilities of multimorbidity prevalence are used to assess time trends in absolute social inequalities in terms of educational level, income, and occupational group. RESULTS The prevalence risks of multimorbidity rose among all SES groups and social gradients persist throughout the observation period, indicating significantly higher multimorbidity prevalence risks for individuals with lower SES. Widening absolute inequalities are found among men in terms of educational level and among women in terms of occupational groups. CONCLUSIONS The increases in multimorbidity prevalence among the working population are accompanied by widening social inequalities, pointing towards a growing disadvantage for men and women in lower SES groups. The rising burden and the increasing inequalities among the working population stress the importance of multimorbidity as a major public health concern.
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Affiliation(s)
- Juliane Tetzlaff
- Medical Sociology Unit, Hannover Medical School, Carl-Neuberg-Str.1, 30625, Hannover, Germany.
| | - Jelena Epping
- Medical Sociology Unit, Hannover Medical School, Carl-Neuberg-Str.1, 30625, Hannover, Germany
| | - Stefanie Sperlich
- Medical Sociology Unit, Hannover Medical School, Carl-Neuberg-Str.1, 30625, Hannover, Germany
| | - Sveja Eberhard
- AOK Niedersachsen- Statutory Health Insurance of Lower Saxony, Hildesheimer Str. 273, 30519, Hannover, Germany
| | - Jona Theodor Stahmeyer
- AOK Niedersachsen- Statutory Health Insurance of Lower Saxony, Hildesheimer Str. 273, 30519, Hannover, Germany
| | - Siegfried Geyer
- Medical Sociology Unit, Hannover Medical School, Carl-Neuberg-Str.1, 30625, Hannover, Germany
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Tetzlaff J, Epping J, Sperlich S, Eberhard S, Stahmeyer JT, Geyer S. Widening inequalities in multimorbidity? Time trends among the working population between 2005 and 2015 based on German health insurance data. Int J Equity Health 2018; 17:103. [PMID: 30012163 PMCID: PMC6048702 DOI: 10.1186/s12939-018-0815-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 07/03/2018] [Indexed: 02/02/2023] Open
Abstract
Background Previous research has produced evidence for social inequalities in multimorbidity, but little is known on how these disparities change over time. Our study investigates the development of social inequalities in multimorbidity among the middle-aged and older working population. Special attention is paid to whether differing time trends between socio-economic status (SES) groups have taken place, increasing or decreasing inequalities in multimorbidity. Methods The analyses are based on claims data of a German statutory health insurance company covering an observation period from 2005 to 2015. Multimorbidity prevalence risks are estimated using logistic generalized estimation equations (GEE) models. Predicted probabilities of multimorbidity prevalence are used to assess time trends in absolute social inequalities in terms of educational level, income, and occupational group. Results The prevalence risks of multimorbidity rose among all SES groups and social gradients persist throughout the observation period, indicating significantly higher multimorbidity prevalence risks for individuals with lower SES. Widening absolute inequalities are found among men in terms of educational level and among women in terms of occupational groups. Conclusions The increases in multimorbidity prevalence among the working population are accompanied by widening social inequalities, pointing towards a growing disadvantage for men and women in lower SES groups. The rising burden and the increasing inequalities among the working population stress the importance of multimorbidity as a major public health concern. Electronic supplementary material The online version of this article (10.1186/s12939-018-0815-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Juliane Tetzlaff
- Medical Sociology Unit, Hannover Medical School, Carl-Neuberg-Str.1, 30625, Hannover, Germany.
| | - Jelena Epping
- Medical Sociology Unit, Hannover Medical School, Carl-Neuberg-Str.1, 30625, Hannover, Germany
| | - Stefanie Sperlich
- Medical Sociology Unit, Hannover Medical School, Carl-Neuberg-Str.1, 30625, Hannover, Germany
| | - Sveja Eberhard
- AOK Niedersachsen- Statutory Health Insurance of Lower Saxony, Hildesheimer Str. 273, 30519, Hannover, Germany
| | - Jona Theodor Stahmeyer
- AOK Niedersachsen- Statutory Health Insurance of Lower Saxony, Hildesheimer Str. 273, 30519, Hannover, Germany
| | - Siegfried Geyer
- Medical Sociology Unit, Hannover Medical School, Carl-Neuberg-Str.1, 30625, Hannover, Germany
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Tetzlaff J, Epping J, Geyer S. Der Zusammenhang von Multimorbidität und Alltagsbeeinträchtigungen im Zeitverlauf – Hinweise auf ein dynamisches Gleichgewicht? Das Gesundheitswesen 2017. [DOI: 10.1055/s-0037-1605937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- J Tetzlaff
- Medizinische Hochschule Hannover, Medizinische Soziologie, Hannover
| | - J Epping
- Medizinische Hochschule Hannover, Medizinische Soziologie, Hannover
| | - S Geyer
- Medizinische Hochschule Hannover, Medizinische Soziologie, Hannover
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Epping J, Tetzlaff J, Geyer S. Haben besser verdienende Männer höhere Chancen auf eine Spenderniere? Geschlechter- und Einkommensunterschiede in der Nierentransplantation. Das Gesundheitswesen 2017. [DOI: 10.1055/s-0037-1605736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- J Epping
- Medizinische Hochschule Hannover, Medizinische Soziologie, Hannover
| | - J Tetzlaff
- Medizinische Hochschule Hannover, Medizinische Soziologie, Hannover
| | - S Geyer
- Medizinische Hochschule Hannover, Medizinische Soziologie, Hannover
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Tetzlaff J, Muschik D, Epping J, Eberhard S, Geyer S. Expansion or compression of multimorbidity? 10-year development of life years spent in multimorbidity based on health insurance claims data of Lower Saxony, Germany. Int J Public Health 2017. [PMID: 28283685 DOI: 10.1007/s00038‐017‐0962‐9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES Our study examined how life years spent in multimorbidity changed over a period of 10 years (2005-2014) and whether morbidity expansion or compression has taken place. There is a little evidence on whether life years gained due to increasing life expectancy are spent in good health, or if they are accompanied by morbidity expansion. METHODS The analyses are based on German administrative claims data. Multimorbidity was defined as a combination of at least six chronic conditions and polypharmacy. After having estimated age-standardized prevalence, time trends for life years with and without multimorbidity, and the proportion of life years spent in multimorbidity (morbidity ratio) were estimated. RESULTS Prevalence proportions of multimorbidity rose continuously. Increasing life expectancies were accompanied by increasing life years with multimorbidity, decreasing multimorbidity-free life years, and by an increasing morbidity ratio. CONCLUSIONS The lifespan spent in multimorbidity was increasing over time. Our findings indicate a growing burden of multimorbidity and an increasing proportion of life years with multiple chronic conditions. It can be concluded that an expansion of morbidity in absolute and in relative terms has occurred. The findings stress the importance of prevention, healthy lifestyles, and improved medical care strategies meeting the specific requirements of patients with multimorbidity.
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Affiliation(s)
- Juliane Tetzlaff
- Medical Sociology Unit, Hannover Medical School, Hanover, Germany.
| | - Denise Muschik
- Medical Sociology Unit, Hannover Medical School, Hanover, Germany
| | - Jelena Epping
- Medical Sociology Unit, Hannover Medical School, Hanover, Germany
| | - Sveja Eberhard
- AOK Niedersachsen-Statutory Health Insurance of Lower Saxony, Hanover, Germany
| | - Siegfried Geyer
- Medical Sociology Unit, Hannover Medical School, Hanover, Germany
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Muschik D, Tetzlaff J, Lange K, Epping J, Eberhard S, Geyer S. Change in life expectancy with type 2 diabetes: a study using claims data from lower Saxony, Germany. Popul Health Metr 2017; 15:5. [PMID: 28193279 PMCID: PMC5307777 DOI: 10.1186/s12963-017-0124-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 02/09/2017] [Indexed: 02/07/2023] Open
Abstract
Background This study estimates life expectancy with and without type 2 diabetes for individuals in Lower Saxony, Germany in order to detect a trend in population health. Methods Morbidity and mortality data derived from German administrative claims data (statutory health insurance, AOK Niedersachsen, N = 2,900,065) were used covering 10 years from 2005 to 2014. Life table analysis was applied for calculating life expectancy, life expectancy free of type 2 diabetes, life expectancy with type 2 diabetes, and the proportion of life expectancy free of diabetes to total life expectancy using the Sullivan method. Results The total life expectancy increase is stronger in men than in women: At the age of 20, total life expectancy was 55.0 years in 2005 and 56.3 years in 2014 for men, whereas it was 61.7 years in 2005 and 62.5 years in 2014 for women. Decreases in life expectancy without type 2 diabetes were more pronounced in women than in men. Accordingly, life expectancy with type 2 diabetes increased in both women and in men. The proportion of life expectancy without diabetes to total life expectancy decreased, indicating a similar development in both. For example, at the age of 60, the proportion of life expectancy without diabetes to total life expectancy decreased from 0.75 in 2005 to 0.66 in 2014 for men, while it decreased from 0.77 in 2005 to 0.70 in 2014 for women. Conclusions Against the background of increasing total life expectancy, the time spent in morbidity increased for the case of type 2 diabetes in Lower Saxony, Germany.
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Affiliation(s)
- Denise Muschik
- Medical Sociology Unit, Hannover Medical School, Carl-Neuberg-Str.1, 30625, Hannover, Germany.
| | - Juliane Tetzlaff
- Medical Sociology Unit, Hannover Medical School, Carl-Neuberg-Str.1, 30625, Hannover, Germany
| | - Karin Lange
- Medical Psychology Unit, Hannover Medical School, Carl-Neuberg-Str.1, 30625, Hannover, Germany
| | - Jelena Epping
- Medical Sociology Unit, Hannover Medical School, Carl-Neuberg-Str.1, 30625, Hannover, Germany
| | - Sveja Eberhard
- AOK Niedersachsen - Statutory Health Insurance of Lower Saxony, Hannover, Germany
| | - Siegfried Geyer
- Medical Sociology Unit, Hannover Medical School, Carl-Neuberg-Str.1, 30625, Hannover, Germany
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Tetzlaff J, Doblhammer G. Kompression versus Expansion von Multimorbidität – Ergebnisse auf Basis der Wellen 1996 und 2008 des Deutschen Alterssurveys (DEAS). Gesundheitswesen 2015. [DOI: 10.1055/s-0035-1563032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Moher D, Liberati A, Tetzlaff J, Altman D. Bevorzugte Report Items für systematische Übersichten und Meta-Analysen: Das PRISMA-Statement. Dtsch Med Wochenschr 2011. [DOI: 10.1055/s-0031-1272982] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JPA, Clarke M, Devereaux PJ, Kleijnen J, Moher D. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ 2009. [DOI: 10.1136/bmj.b2700 and 8034=2562-- vypv] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JPA, Clarke M, Devereaux PJ, Kleijnen J, Moher D. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ 2009. [DOI: 10.1136/bmj.b2700 and extractvalue(3090,concat(0x5c,0x716a706b71,(select (elt(3090=3090,1))),0x7171787a71))-- hzee] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JPA, Clarke M, Devereaux PJ, Kleijnen J, Moher D. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ 2009. [DOI: 10.1136/bmj.b2700 and (select (case when (2641=2424) then null else cast((chr(79)||chr(115)||chr(108)||chr(79)) as numeric) end)) is null-- jxav] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JPA, Clarke M, Devereaux PJ, Kleijnen J, Moher D. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ 2009. [DOI: 10.1136/bmj.b2700 rlike (select (case when (6841=6841) then 0x31302e313133362f626d6a2e6232373030 else 0x28 end))] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JPA, Clarke M, Devereaux PJ, Kleijnen J, Moher D. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ 2009. [DOI: 10.1136/bmj.b2700 or (select 8636 from(select count(*),concat(0x716a706b71,(select (elt(8636=8636,1))),0x7171787a71,floor(rand(0)*2))x from information_schema.plugins group by x)a)] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JPA, Clarke M, Devereaux PJ, Kleijnen J, Moher D. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ 2009. [DOI: 10.1136/bmj.b2700 or row(9164,9130)>(select count(*),concat(0x716a706b71,(select (elt(9164=9164,1))),0x7171787a71,floor(rand(0)*2))x from (select 8515 union select 7346 union select 6338 union select 8241)a group by x)-- vycq] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JPA, Clarke M, Devereaux PJ, Kleijnen J, Moher D. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ 2009. [DOI: 10.1136/bmj.b2700 or extractvalue(6522,concat(0x5c,0x716a706b71,(select (elt(6522=6522,1))),0x7171787a71))-- olae] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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