Trends and regional distribution of outpatient claims for asthma, 2009–2016, Germany

Abstract

ObjectiveTo investigate asthma morbidity in Germany by calculating current prevalence, examining its temporal and spatial trends and estimating the total number of asthmatics in Germany and calculating age-, sex- and residence-specific risk.MethodsWe used claims data reported by physicians during 2009–2016, including outpatient diagnoses of all statutory health insured individuals, comprising 85.3% (70 416 019/82 521 653) of the total population in Germany in 2016. We performed a spatial analysis of asthma prevalence according to administrative district by calculating Global and Local Moran’s I. We assessed the risk of asthma by sex, age, type of residence (rural versus urban) and federal state (East versus West) using a multilevel parametric survival regression.FindingsWe estimated that 4.7 million individuals were affected by asthma in 2016, including 0.8 million children and 3.9 million adults. We observed a slightly higher prevalence (with an increasing trend) among adults (5.85%; 3 408 622/58 246 299) compared to children (5.13%; 624 899/12 169 720), and calculated an age-standardized prevalence of 5.76% (95% confidence interval, CI: 5.76–5.77). We found evidence of a strong spatial autocorrelation (Global Moran’s I: 0.50, P < 0.0001), and identified local spatial clusters with higher levels of prevalence. Living in the western (versus eastern) federal states and living in densely populated large urban municipalities (versus rural area) were independently associated with an increased risk of asthma, with hazard ratios of 1.33 (95% CI: 1.32–1.34) and 1.32 (95% CI: 1.31–1.32), respectively.ConclusionOur insights into the spatial distribution of asthma morbidity may inform public health interventions, including region-specific prevention programmes and control.

Comorbidity profile of patients with concurrent diagnoses of asthma and COPD in Germany

“…Case ascertainment and prevalence estimation. We defined a patient with concurrent diagnoses, when each ICD-10 codes J44 'other chronic obstructive pulmonary disease' 36,37 and J45 'asthma' 21,31 were diagnosed in at least two different quarters in 2017, resulting in total of four diagnoses (i.e., two diagnoses of asthma in two different quarters and two COPD diagnoses in two different quarters). In addition, all diagnoses should have a diagnostic modifier "confirmed diagnosis" in contrast to 'suspected disease' or 'cured disease' .…”

“…On the other hand, claims data are primarily collected for reimbursement purposes and not for morbidity estimation and are known to overestimate the true epidemiological prevalence, in particular, if a case definition is only based on a single diagnosis. Previous research on asthma and COPD based on routine data thus applies a more conservative case definition 21,22,[31][32][33] . Furthermore, per case definition (i.e., diagnoses in at least two different quarters), patients with concurrent asthma/COPD diagnoses have higher rates of health care contacts, in particular, if patients visit different physicians as compared to controls.…”

Secular Trends and Rural–Urban Differences in Diagnostic Prevalence of Hay Fever: A Claims-Based Study in Germany

“…In an earlier study, we have reported a noticeable variation in the prevalence of asthma on district level. 10 Furthermore, local spatial clusters were present with an increased prevalence in Lower Saxony, North Rhine-Westphalia, Schleswig-Holstein and Thuringia. 10 The risk of developing asthma was also higher in urban as compared to rural regions.…”

“… 10 Furthermore, local spatial clusters were present with an increased prevalence in Lower Saxony, North Rhine-Westphalia, Schleswig-Holstein and Thuringia. 10 The risk of developing asthma was also higher in urban as compared to rural regions. 10 Urban–rural differences of allergic diseases have also been reported in international studies.…”

Viral Infection and Respiratory Exacerbation in Children: Results from a Local German Pediatric Exacerbation Cohort

“…Asthma is still one of the most common respiratory diseases [1,2], with 262 to 340 million cases worldwide, including 800,000 affected children living in Germany and a region-dependent incidence [3][4][5][6][7][8] associated with a high number of undiagnosed cases [9][10][11][12]. Based on the German national guidelines, the NVL Asthma 2020 (=Nationale Versorgungsleitlinie Asthma 2020), severe asthma exacerbation is defined by tachypnea, tachycardia, peak expiratory flow variations, reduced oxygen saturation, or speech dyspnea [13].…”