The usage of DiGA, stratified by sociodemographic/socioeconomic characteristics

Background

The German government undertakes efforts to implement DiGA into the statutory health insurance to improve its quality. DiGA are physician-prescribed applications for patients with certain diagnosed diseases, whose costs are covered by the statutory health insurers. DiGA have the potential to improve healthcare, but it is also possible, that the usage of these applications perpetuates existing health inequalities, summarized by the term Digital Divide; meaning that socially deprived populations are less able to benefit from digital technologies. The aim of this analysis is to determine whether differences exist in DiGA use by sociodemographic/socioeconomic characteristics.

Methods

The results based upon the analysis of an online survey involving 1,200 people (18-74 years) living in Germany between March 10 and March 18, 2022. The sample composition reflects the current distribution of age, gender, and place of residence in the federal states (uncrossed). The questionnaire focused, among other aspects, on the use of DiGA. A binary logistic regression was used for the analysis.

Results

Compared to the lowest subjective social status (SSS), probands with a medium (OR 2.865) or a high SSS (OR 4.085) are more likely to use DiGA. Compared to the reference group (60 years and older), the 18-29-year- (OR 2.044) and the 30-39-year-olds (OR 1.952) tend to have a higher likelihood of using DiGA. The likelihood of the use decreases among probands with medium (OR 0.632) and high educational degree (OR 0.580) compared to the reference group (low education).

Conclusions

In accordance with the results of existing studies, social differences could be identified regarding known determinants of health inequalities, like age and SSS. In this analysis, the highest degree of education does not appear as a predictor for an increased likelihood of use. Thus, further analyses are needed to address the influence of education, especially to develop a broader understanding of the DiGA use.

Key messages

• It appears that DiGA are not equally accessible or used across different population groups, and thus indicating an already existing or emerging Digital Divide regarding the use of DiGA.

• Contrary to the broad assumption that higher expressions of health determinants are related to a higher likelihood of using DiGA, a higher degree of education decreases the likelihood of using DiGA.

Subjectively perceived healthcare provision during the first wave of the COVID-19 pandemic

Background

An OECD benchmark (2020) shows that Germany has, in effect, an above-average healthcare infrastructure to face COVID-19. Nevertheless, at the beginning of the pandemic, there were restrictions and uncertainties in the use of health-related services. The following analysis examines the subjective perception of respondents with their healthcare provision whether there were sociodemographic differences.

Methods

Data from an online cross-sectional survey conducted between 29 April and 8 May 2020 were used (N = 1,570; 18-74 years). Bivariate test methods were used for analysis, stratified by age group, subjective social status (SSS) and chronic illness. The subjective perception was assessed via subjects' subjectively perceived worries, fears and difficulties of not receiving an adequate healthcare provision during the COVID-19 pandemic. Thus, an index was constructed with a range of values from 3 to 12 (Cronbach's α = 0.886). A higher index implies a poorer perception of the healthcare provision.

Results

Compared to the groups 50-59-year-olds and 60 years and older the 18-29-year-olds (MRank 431.1) had a significantly (p < 0.05) poorer perception of their healthcare provision during COVID-19. In addition, probands with low SSS were found to have a significantly (p < 0.05) worse perception (MRank 423.0) than subjects with medium SSS (MRank 374.1). Chronically ill subjects suffered significantly poorer perception (MRank 406.1; p < 0.05) compared to healthy subjects (MRank 366.0).

Conclusions

Vulnerable groups with poorer perceptions of their health care provision during COVID-19 can be identified. More investigation is needed to identify subjective or COVID-19 related predictors that cause this subjective perception.

Reference

OECD (2020). Beyond Containment: Health systems responses to COVID-19 in the OECD.

Available: https://read.oecd-ilibrary.org/view/?ref=119_119689-ud5comtf84&title=Beyond_Containment:Health_systems_responses_to_COVID-19_in_the_OECD (Accessed: 14.04.2021)

Key messages

It was found that respondents perceived their subjective healthcare provision during COVID-19 differently, according to sociodemographic stratification.

Especially younger, chronically ill, and socioeconomically deprived respondents experienced a poorer perception of their healthcare provision during the first wave of the COVID-19 pandemic.

DNA Methyltransferase 1 (DNMT1) Acts on Neurodegeneration by Modulating Proteostasis-Relevant Intracellular Processes

The limited regenerative capacity of neurons requires a tightly orchestrated cell death and survival regulation in the context of longevity, as well as age-associated and neurodegenerative diseases. Subordinate to genetic networks, epigenetic mechanisms, such as DNA methylation and histone modifications, are involved in the regulation of neuronal functionality and emerge as key contributors to the pathophysiology of neurodegenerative diseases. DNA methylation, a dynamic and reversible process, is executed by DNA methyltransferases (DNMTs). DNMT1 was previously shown to act on neuronal survival in the aged brain, whereby a DNMT1-dependent modulation of processes relevant for protein degradation was proposed as an underlying mechanism. Properly operating proteostasis networks are a mandatory prerequisite for the functionality and long-term survival of neurons. Malfunctioning proteostasis is found, inter alia, in neurodegenerative contexts. Here, we investigated whether DNMT1 affects critical aspects of the proteostasis network by a combination of expression studies, live cell imaging, and protein biochemical analyses. We found that DNMT1 negatively impacts retrograde trafficking and autophagy, with both being involved in the clearance of aggregation-prone proteins by the aggresome-autophagy pathway. In line with this, we found that the transport of GFP-labeled mutant huntingtin (HTT) to perinuclear regions, proposed to be cytoprotective, also depends on DNMT1. Depletion of Dnmt1 accelerated perinuclear HTT aggregation and improved the survival of cells transfected with mutant HTT. This suggests that mutant HTT-induced cytotoxicity is at least in part mediated by DNMT1-dependent modulation of degradative pathways.