Health inequalities in terms of myocardial infarction and all-cause mortality: a study with German claims data covering 2006 to 2015

Geyer, Siegfried; Tetzlaff, Juliane; Eberhard, Sveja; Sperlich, Stefanie; Epping, Jelena

doi:10.1007/s00038-019-01224-1

Cited by 9 publications

(14 citation statements)

References 42 publications

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“…Studies aimed at analysing whether compression or expansion has occurred over time need therefore to focus on the interplay of trends in incidence and mortality without and after disease onset. With respect to income inequalities, our findings indicate that differences in MI incidence and mortality between income groups are substantial in men but less pronounced in women, which is in accordance with a recent study on inequalities among individuals aged 18 years and older of the same insurance population [ 34 ]. However, the analyses also show that time trends in MI incidence and mortality risks tend to differ by income group, leading to different trends in life years spent free of MI and after MI incidence between income groups.…”

Section: Discussionsupporting

confidence: 91%

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Widening or narrowing income inequalities in myocardial infarction? Time trends in life years free of myocardial infarction and after incidence

Tetzlaff

Geyer

et al. 2021

Popul Health Metrics

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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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Section: Discussionsupporting

confidence: 91%

“…The development of social inequalities in MI incidence over time in Germany has rarely been examined. One of the few existing studies found narrowing income inequalities in MI incidence risks in men aged 18 years and older, while no changes were reported in women [ 34 ].…”

Section: Introductionmentioning

confidence: 99%

Widening or narrowing income inequalities in myocardial infarction? Time trends in life years free of myocardial infarction and after incidence

Tetzlaff

Geyer

et al. 2021

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“…In addition, distortions of the results are possible because the AOKN morbidity level might have exceeded that of other statutory health insurance funds (Geyer et al 2019). The socioeconomic composition of the AOKN's insurance population included a higher proportion of persons with lower professional qualifications than in Germany as a whole (Geyer et al 2019). However, the age and sex distribution was consistent with that of Lower Saxony and Germany more broadly.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

“…patients' need for care, (lack of) access and quality of care, and possible under-, mis-or over-provision). In addition, distortions of the results are possible because the AOKN morbidity level might have exceeded that of other statutory health insurance funds (Geyer et al 2019). The socioeconomic composition of the AOKN's insurance population included a higher proportion of persons with lower professional qualifications than in Germany as a whole (Geyer et al 2019).…”

Section: Strengths and Limitationsmentioning

confidence: 99%

The frequency and time point of outpatient palliative care integration for people before death: an analysis of health insurance data in Lower Saxony, Germany

Willinger

Hemmerling

Stahmeyer

et al. 2021

J Public Health (Berl.)

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Aim This study aimed to analyse the number of deceased people who received different types of outpatient palliative care, the length of time prior to death that care was initiated, and their palliative care trajectory including the rate of hospital death. Subject and methods Data on 35,514 adults insured by the statutory health insurance who died in 2017 in Lower Saxony, Germany, were analysed. The study examined the provision of three different types of outpatient palliative care: general (GPC), intermediate (IPC) and specialised palliative care (SPC). In addition, oncological palliative care services (OS) were considered. Descriptive analyses include frequencies, timing and duration of these services, the number of inpatient hospital stays and hospital deaths. Results Prior to death, 31.4% of the deceased received outpatient palliative care: 21.3% GPC, 6.4% GPC with IPC and/or SPC and/or OS; and 3.7% IPC and/or SPC and/or OS, but no GPC. On average, GPC and OS were initiated 9 months and SPC 3 months prior to death. Six percent of the analytic sample received outpatient palliative care more than 2 years before death. Compared to those without outpatient palliative care, patients who received outpatient palliative care had more and longer inpatient hospital stays, but less frequently died in hospital. Conclusion Early outpatient palliative care took place in a minor percentage of deceased. Outpatient palliative care starts late before death for most patients, but enables more people not to die in hospital. However, significantly fewer people receive outpatient palliative care relative to current demand estimates. This is particularly true of general outpatient palliative care.

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“…At the second step of the analyses we quantify changes in incidence rates of myocardial infarction and stroke after applying lookback periods of up to 5 years. Due to the occurrence of both disease entities in older ages [ 14 , 15 ] and the presence of social gradient in both [ 16 , 17 ], we expect to observe changes in incidence rates.…”

Section: Introductionmentioning

confidence: 99%

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

Epping

Geyer

Tetzlaff

2020

BMC Med Res Methodol

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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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Health inequalities in terms of myocardial infarction and all-cause mortality: a study with German claims data covering 2006 to 2015

Cited by 9 publications

References 42 publications

Widening or narrowing income inequalities in myocardial infarction? Time trends in life years free of myocardial infarction and after incidence

Widening or narrowing income inequalities in myocardial infarction? Time trends in life years free of myocardial infarction and after incidence

The frequency and time point of outpatient palliative care integration for people before death: an analysis of health insurance data in Lower Saxony, Germany

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

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