Enno Nowossadeck

Inanspruchnahme der ambulanten und stationären medizinischen Versorgung in Deutschland

The article provides representative benchmarks and trends for the use of medical and therapeutic services in Germany on the basis of the German Health Interview and Examination Survey for Adults (DEGS1) and the German National Health Interview and Examination Survey 1998 (GNHIES98) from the years 2008-2011 and 1997/98, respectively. DEGS1 shows that women seek most medical services more often than men. Differences by gender decreased with age. In almost all services, an increase in utilisation is recorded with age. There are large differences in utilisation depending on self-rated health, as opposed to fewer differences by social status, health insurance and region. At both time points, the proportion of the population that utilised outpatient or inpatient medical assistance at least once a year, is almost unchanged high. At the same time, a significant reduction in the annual number of contacts with medical practices and the length of hospital stay was recorded as well as an increase of the consulted specialist groups. This may be explained due to regulation effects of earlier reforms. An English full-text version of this article is available at SpringerLink as supplemental.ZusammenfassungDer vorliegende Beitrag liefert auf Basis der Studie zur Gesundheit Erwachsener in Deutschland (DEGS1) und des Bundes-Gesundheitssurveys (BGS98) aus den Jahren 2008–2011 und 1997/98 repräsentative Eckdaten und Trends zur Inanspruchnahme ärztlicher und therapeutischer Leistungen der 18- bis 79-jährigen Wohnbevölkerung in Deutschland. Die DEGS1-Daten zeigen, dass Frauen viele der einbezogenen medizinischen Leistungen häufiger in Anspruch nahmen als Männer. Mit dem Alter werden die Unterschiede nach Geschlecht geringer. Bei fast allen Leistungen ist mit zunehmendem Alter ein Anstieg der Inanspruchnahme zu verzeichnen. Große Unterschiede in der Inanspruchnahme bestehen in Abhängigkeit von der selbst eingeschätzten Gesundheit, geringere Unterschiede nach Sozialstatus, Krankenversicherung und Region. Zu beiden Erhebungszeitpunkten ist der Anteil der Bevölkerung, der mindestens 1-mal im Jahr ärztliche Hilfe (ambulant oder stationär) in Anspruch nahm, nahezu unverändert hoch. Gleichzeitig sind in diesem Zeitraum ein signifikanter Rückgang der Kontakte zu Arztpraxen pro Jahr und der Krankenhausverweildauer sowie eine Zunahme der konsultierten Facharztgruppen zu verzeichnen. Dies verweist auf Steuerungswirkungen früherer Reformen.AbstractThe article provides representative benchmarks and trends for the use of medical and therapeutic services in Germany on the basis of the German Health Interview and Examination Survey for Adults (DEGS1) and the German National Health Interview and Examination Survey 1998 (GNHIES98) from the years 2008–2011 and 1997/98, respectively. DEGS1 shows that women seek most medical services more often than men. Differences by gender decreased with age. In almost all services, an increase in utilisation is recorded with age. There are large differences in utilisation depending on self-rated health, as opposed to fewer differences by social status, health insurance and region. At both time points, the proportion of the population that utilised outpatient or inpatient medical assistance at least once a year, is almost unchanged high. At the same time, a significant reduction in the annual number of contacts with medical practices and the length of hospital stay was recorded as well as an increase of the consulted specialist groups. This may be explained due to regulation effects of earlier reforms. An English full-text version of this article is available at SpringerLink as supplemental.

Prävalenz von Herzinfarkt und koronarer Herzkrankheit bei Erwachsenen im Alter von 40 bis 79 Jahren in Deutschland

In the German Health Interview and Examination Survey for Adults (DEGS1), data on the prevalence of myocardial infarction and coronary heart disease were collected from 2008-2011 in a representative population-based sample of 5,901 adults aged 40-79 years. The results of DEGS1 were compared with the prevalence estimates from the German National Health Interview and Examination Survey 1998 (GNHIES98). The lifetime prevalence of myocardial infarction amongst 40-79 year olds in DEGS1 is 4.7 % (women 2.5 %; men 7 %). In comparison with GNHIES98 a small increase was observed in men, but not in women. The lifetime prevalence of coronary heart disease in adults aged 40-79 years in DEGS1 is 9.3 % (women 6.4 %; men 12.3 %). In comparison to GNHIES98 there is a slight reduction only in women. There is a significant inverse relationship between disease prevalence and socioeconomic status. The trend in prevalence of coronary heart disease is comparable with that in other high-income countries. Given a falling incidence of myocardial infarction and a decrease in the mortality rates due to coronary heart disease, the basically stable prevalence rates indicate a positive development in the field of cardiovascular prevention and therapy. An English full-text version of this article is available at SpringerLink as supplemental.

Population Aging and Hospitalization for Chronic Disease in Germany

BACKGROUND The population of Germany is aging, i.e., the elderly currently make up an increasing percentage of the population from year to year. Furthermore, many common chronic diseases mainly affect the elderly. For these two reasons, the overall cost of health care in Germany is expected to increase. We studied the effect that population aging has had on the number of hospitalizations for major types of chronic disease in Germany since the year 2000. METHODS This study is based on nationwide hospitalization statistics, classified by diagnosis, that were published by the German Federal Statistical Office. We analyzed data for three classes of diagnoses--malignant neoplasia, cardiovascular diseases, and diseases of the musculoskeletal system and connective tissue--which were further broken down into nine diagnostic subgroups. Changes in inpatient case numbers might be due either to population aging or to changing rates of hospitalization for individual diagnoses. We used index decomposition analysis to determine the relative influence of these two factors on changing case numbers. RESULTS The author found that the aging of the population increased the number of hospitalizations for all of the diagnoses studied. This was particularly evident with respect to the large birth cohorts born in the 1920s (with the diagnosis of congestive heart failure) and in the period 1934-1944 (with the diagnoses ischemic heart disease, lung cancer, colorectal cancer, and osteoarthritis). On the other hand, changing rates of hospitalization for individual diagnoses increased the number of hospitalizations for some diagnoses (congestive heart failure, diseases of the spine and back) and decreased it for others (ischemic heart disease, cerebrovascular diseases, colorectal cancer, breast cancer). CONCLUSION The aging of the population and the changing rates of hospitalization for various diagnoses are exerting separate effects on the number of hospitalizations for chronic diseases in Germany. Predictions of hospital case numbers in the future must take both factors into account.

Verbreitung von Fettstoffwechselstörungen bei Erwachsenen in Deutschland

Interview and laboratory data from the first wave of the German health interview and examination survey for adults (DEGS1) from 2008 to 2011 were used to provide current estimates of the prevalence of dyslipidemia which are representative of the population in Germany 18 to 79 years of age. A total of 56.6 % of men and 60.5 % of women 18 to 79 years have elevated serum total cholesterol concentrations in excess of the currently recommended threshold of 190 mg/dL; 17.9 % of men and 20.3 % of women have highly elevated total cholesterol concentrations ≥ 240 mg/dL. A total of 19.3 % of men and 3.6 % of women have high density lipoprotein cholesterol concentrations below 40 mg/dL. The overall prevalence of dyslipidemia (total cholesterol ≥ 190 mg/dL or medical diagnosis of dyslipidemia) is 64.5 % for men and 65.7 % for women. Of these, more than half of both men and women have previously undiagnosed dyslipidemia. Among persons with known dyslipidemia, 30.8% take lipid-lowering medication. Dyslipidemia is widely prevalent among adults in Germany. More in-depth analyses will examine time trends in the prevalence of dyslipidemia in Germany and in an international comparison. An English full-text version of this article is available at SpringerLink as supplemental.

Prävalenz des Schlaganfalls bei Erwachsenen im Alter von 40 bis 79 Jahren in Deutschland

In the German Health Interview and Examination Survey (DEGS1), data on the prevalence of physician-diagnosed stroke were collected from 2008 to 2011 in a representative population-based sample of 5,901 adults aged 40-79 years. The stroke prevalence in DEGS1 was compared with prevalence estimates from the German National Health Interview and Examination Survey 1998 (GNHIES98). The lifetime prevalence of stroke in adults aged 40-79 years is 2.9 % (women: 2.5 %; men: 3.3 %). In both sexes, the prevalence increases continuously with age, up to 6.3 % in women and 8.1 % in men 70-79 years old. More pronounced in women than in men, the prevalence of stroke decreases with increasing socioeconomic status. Compared to GNHIES98, there is no evidence for a change in stroke prevalence over time. The prevalence of stroke in adults aged 40-79 years in Germany is comparable to prevalence estimates from other national and international studies. Further studies should examine the reasons behind stable prevalence rates, accounting for population ageing and changes in incidence, mortality and case fatality rates. An English full-text version of this article is available at SpringerLink as supplemental.

[Prevalence of dyslipidemia among adults in Germany: results of the German Health Interview and Examination Survey for Adults (DEGS 1)].

Interview and laboratory data from the first wave of the German health interview and examination survey for adults (DEGS1) from 2008 to 2011 were used to provide current estimates of the prevalence of dyslipidemia which are representative of the population in Germany 18 to 79 years of age. A total of 56.6 % of men and 60.5 % of women 18 to 79 years have elevated serum total cholesterol concentrations in excess of the currently recommended threshold of 190 mg/dL; 17.9 % of men and 20.3 % of women have highly elevated total cholesterol concentrations ≥ 240 mg/dL. A total of 19.3 % of men and 3.6 % of women have high density lipoprotein cholesterol concentrations below 40 mg/dL. The overall prevalence of dyslipidemia (total cholesterol ≥ 190 mg/dL or medical diagnosis of dyslipidemia) is 64.5 % for men and 65.7 % for women. Of these, more than half of both men and women have previously undiagnosed dyslipidemia. Among persons with known dyslipidemia, 30.8% take lipid-lowering medication. Dyslipidemia is widely prevalent among adults in Germany. More in-depth analyses will examine time trends in the prevalence of dyslipidemia in Germany and in an international comparison. An English full-text version of this article is available at SpringerLink as supplemental.

[Prevalence of myocardial infarction and coronary heart disease in adults aged 40-79 years in Germany: results of the German Health Interview and Examination Survey for Adults (DEGS1)].

In the German Health Interview and Examination Survey for Adults (DEGS1), data on the prevalence of myocardial infarction and coronary heart disease were collected from 2008-2011 in a representative population-based sample of 5,901 adults aged 40-79 years. The results of DEGS1 were compared with the prevalence estimates from the German National Health Interview and Examination Survey 1998 (GNHIES98). The lifetime prevalence of myocardial infarction amongst 40-79 year olds in DEGS1 is 4.7 % (women 2.5 %; men 7 %). In comparison with GNHIES98 a small increase was observed in men, but not in women. The lifetime prevalence of coronary heart disease in adults aged 40-79 years in DEGS1 is 9.3 % (women 6.4 %; men 12.3 %). In comparison to GNHIES98 there is a slight reduction only in women. There is a significant inverse relationship between disease prevalence and socioeconomic status. The trend in prevalence of coronary heart disease is comparable with that in other high-income countries. Given a falling incidence of myocardial infarction and a decrease in the mortality rates due to coronary heart disease, the basically stable prevalence rates indicate a positive development in the field of cardiovascular prevention and therapy. An English full-text version of this article is available at SpringerLink as supplemental.

[Utilization of outpatient and inpatient health services in Germany: results of the German Health Interview and Examination Survey for Adults (DEGS1)].

The article provides representative benchmarks and trends for the use of medical and therapeutic services in Germany on the basis of the German Health Interview and Examination Survey for Adults (DEGS1) and the German National Health Interview and Examination Survey 1998 (GNHIES98) from the years 2008-2011 and 1997/98, respectively. DEGS1 shows that women seek most medical services more often than men. Differences by gender decreased with age. In almost all services, an increase in utilisation is recorded with age. There are large differences in utilisation depending on self-rated health, as opposed to fewer differences by social status, health insurance and region. At both time points, the proportion of the population that utilised outpatient or inpatient medical assistance at least once a year, is almost unchanged high. At the same time, a significant reduction in the annual number of contacts with medical practices and the length of hospital stay was recorded as well as an increase of the consulted specialist groups. This may be explained due to regulation effects of earlier reforms. An English full-text version of this article is available at SpringerLink as supplemental.ZusammenfassungDer vorliegende Beitrag liefert auf Basis der Studie zur Gesundheit Erwachsener in Deutschland (DEGS1) und des Bundes-Gesundheitssurveys (BGS98) aus den Jahren 2008–2011 und 1997/98 repräsentative Eckdaten und Trends zur Inanspruchnahme ärztlicher und therapeutischer Leistungen der 18- bis 79-jährigen Wohnbevölkerung in Deutschland. Die DEGS1-Daten zeigen, dass Frauen viele der einbezogenen medizinischen Leistungen häufiger in Anspruch nahmen als Männer. Mit dem Alter werden die Unterschiede nach Geschlecht geringer. Bei fast allen Leistungen ist mit zunehmendem Alter ein Anstieg der Inanspruchnahme zu verzeichnen. Große Unterschiede in der Inanspruchnahme bestehen in Abhängigkeit von der selbst eingeschätzten Gesundheit, geringere Unterschiede nach Sozialstatus, Krankenversicherung und Region. Zu beiden Erhebungszeitpunkten ist der Anteil der Bevölkerung, der mindestens 1-mal im Jahr ärztliche Hilfe (ambulant oder stationär) in Anspruch nahm, nahezu unverändert hoch. Gleichzeitig sind in diesem Zeitraum ein signifikanter Rückgang der Kontakte zu Arztpraxen pro Jahr und der Krankenhausverweildauer sowie eine Zunahme der konsultierten Facharztgruppen zu verzeichnen. Dies verweist auf Steuerungswirkungen früherer Reformen.AbstractThe article provides representative benchmarks and trends for the use of medical and therapeutic services in Germany on the basis of the German Health Interview and Examination Survey for Adults (DEGS1) and the German National Health Interview and Examination Survey 1998 (GNHIES98) from the years 2008–2011 and 1997/98, respectively. DEGS1 shows that women seek most medical services more often than men. Differences by gender decreased with age. In almost all services, an increase in utilisation is recorded with age. There are large differences in utilisation depending on self-rated health, as opposed to fewer differences by social status, health insurance and region. At both time points, the proportion of the population that utilised outpatient or inpatient medical assistance at least once a year, is almost unchanged high. At the same time, a significant reduction in the annual number of contacts with medical practices and the length of hospital stay was recorded as well as an increase of the consulted specialist groups. This may be explained due to regulation effects of earlier reforms. An English full-text version of this article is available at SpringerLink as supplemental.

Morbiditätsprognosen auf Basis von Bevölkerungsprognosen

ZusammenfassungDie Alterung der Gesellschaft, so wird angenommen, wird zu einem Anstieg der Zahl an erkrankten Menschen beziehungsweise der Neuerkrankungen und zu steigenden Belastungen des Gesundheitssystems führen. Morbiditätsprognosen fällt in diesem Zusammenhang die Aufgabe zu, plausible Informationen über den wahrscheinlichen Verlauf künftiger indikationsspezifischer Inzidenz- und Prävalenzzahlen bereitzustellen, um Hinweise auf notwendige Handlungsbedarfe des Gesundheitssystems ableiten zu können. Zur Berücksichtigung des demografischen Wandels knüpfen sie an Bevölkerungsprognosen an. Häufig wird ein einfacher methodischer Ansatz genutzt, bei dem empirisch gefundene Morbiditätsraten konstant in die Zukunft fortgeschrieben werden. Dieser ignoriert jedoch zu erwartende Veränderungen infolge des medizinischen Fortschritts, einer zunehmenden Prävention, einer sich verändernden Gesundheitsversorgung oder auch eines veränderten Gesundheitsverhaltens. Das Ausmaß dieser Veränderungen ist unbekannt. Dennoch lassen sich gegenwärtige Trends identifizieren, die zur Erarbeitung dynamisierter Szenarien der künftigen Entwicklung genutzt werden können. Das Gesundheitsmonitoring des Robert Koch-Instituts ist hierfür eine wertvolle Datenquelle. Auf seiner Grundlage können Morbiditätsraten und aktuelle Trends für wichtige Krankheitsentitäten ermittelt werden, die aus anderen Datenquellen nicht zur Verfügung stehen.AbstractIt is assumed that an aging population will lead to an increase of incidence and prevalence rates of many diseases, thus, resulting in rising health care costs in Germany. Forecasts of morbidity will have to provide plausible information on probable trends of incidence and prevalence rates in order to derive measures to be taken within the health care system. These forecasts are based on population projections considering demographic change. Often, a simple methodical approach is applied by constantly extrapolating empirical morbidity rates into the future. This approach not only takes into account changes resulting from advanced medical care and prevention measures, but also improved health behavior among the population. The dimensions of these changes are still not known. Nevertheless, present trends, which could be utilized for developing dynamic scenarios of future processes, can be identified. For this, the health monitoring administrated by the Robert Koch Institute is a valuable data source. Using these data, morbidity rates and present trends regarding important diseases, which are not available from other data sources, can be determined.It is assumed that an aging population will lead to an increase of incidence and prevalence rates of many diseases, thus, resulting in rising health care costs in Germany. Forecasts of morbidity will have to provide plausible information on probable trends of incidence and prevalence rates in order to derive measures to be taken within the health care system. These forecasts are based on population projections considering demographic change. Often, a simple methodical approach is applied by constantly extrapolating empirical morbidity rates into the future. This approach not only takes into account changes resulting from advanced medical care and prevention measures, but also improved health behavior among the population. The dimensions of these changes are still not known. Nevertheless, present trends, which could be utilized for developing dynamic scenarios of future processes, can be identified. For this, the health monitoring administrated by the Robert Koch Institute is a valuable data source. Using these data, morbidity rates and present trends regarding important diseases, which are not available from other data sources, can be determined.

[Prevalence of stroke in adults aged 40 to 79 years in Germany: results of the German Health Interview and Examination Survey for Adults (DEGS1)].

In the German Health Interview and Examination Survey (DEGS1), data on the prevalence of physician-diagnosed stroke were collected from 2008 to 2011 in a representative population-based sample of 5,901 adults aged 40-79 years. The stroke prevalence in DEGS1 was compared with prevalence estimates from the German National Health Interview and Examination Survey 1998 (GNHIES98). The lifetime prevalence of stroke in adults aged 40-79 years is 2.9 % (women: 2.5 %; men: 3.3 %). In both sexes, the prevalence increases continuously with age, up to 6.3 % in women and 8.1 % in men 70-79 years old. More pronounced in women than in men, the prevalence of stroke decreases with increasing socioeconomic status. Compared to GNHIES98, there is no evidence for a change in stroke prevalence over time. The prevalence of stroke in adults aged 40-79 years in Germany is comparable to prevalence estimates from other national and international studies. Further studies should examine the reasons behind stable prevalence rates, accounting for population ageing and changes in incidence, mortality and case fatality rates. An English full-text version of this article is available at SpringerLink as supplemental.