[Utilizing Routine Health Insurance Data for Calculation of Disease Frequencies in the Project BURDEN 2020]. / Nutzung von Krankenkassenroutinedaten zur Bestimmung von Krankheitshäufigkeiten im Projekt BURDEN 2020.

OBJECTIVE: The concept of disease burden enables a comprehensive analysis of the health status of a population. Key indicators are years of life lost due to mortality (YLL) and morbidity (years lived with disability, YLD), summarised in the DALY indicator (disability adjusted life years). These indicators are suitable for planning prevention, health care or provision of health services. With the project BURDEN 2020, funded by the German Federal Joint Committee's Innovation Fund, a national and regionalised calculation of burden of disease for Germany is being carried out for the first time, based on the methodology of the international "Global Burden of Disease" study. METHODS: Calculation of YLD requires data on the frequency and severity of diseases, with routine health insurance data constituting an important data source. Case definitions for 18 selected diseases and severity levels for 11 of these diseases were developed in expert meetings. Based on these case definitions, the AOK Research Institute (WIdO) calculated disease frequencies from health utilisation data of patients insured with the AOK. A specific concept for prevalence calculation takes into account the dynamics of an open cohort of insurees. For severity levels, the results of the AOK insurees were extrapolated to the total population in Germany according to age and gender groups. For disease frequencies, the results were additionally adjusted for morbidity and estimated on regional levels. RESULTS: Disease frequencies measured by prevalences or rates are available for 18 diseases from seven categories (cardiovascular diseases, diabetes, cancer, mental disorders, dementia, COPD and lower respiratory tract infections) at the regional levels of the 16 federal states and 96 regional planning areas. Severity distributions are provided on the national level stratified by age groups and gender. The results and documentation of methods are available at www.krankheitslage-deutschland.de (in German language). CONCLUSION: Routine health insurance data are an important data source in the BURDEN 2020 project because regional figures and, in some cases, severity levels can be determined on the basis of a large number of cases. A comprehensive publication of results creates transparency and allows reutilisation of methods in further projects. Future research should extend burden of disease calculations to other diseases. In addition, there is an increasing demand for health data linkage.

The Burden of Disease in Germany at the National and Regional Level.

BACKGROUND: .Summary measures such as disability-adjusted life years (DALY) are becoming increasingly important for the standardized assessment of the burden of disease due to death and disability. The BURDEN 2020 pilot project was designed as an independent burden-of-disease study for Germany, which was based on nationwide data, but which also yielded regional estimates. METHODS: DALY is defined as the sum of years of life lost due to death (YLL) and years lived with disability (YLD). YLL is the difference between the age at death due to disease and the remaining life expectancy at this age, while YLD quantifies the number of years individuals have spent with health impairments. Data are derived mainly from causes of death statistics, population health surveys, and claims data from health insurers. RESULTS: In 2017, there were approximately 12 million DALY in Germany, or 14 584 DALY per 100 000 inhabitants. Conditions which caused the greatest number of DALY were coronary heart disease (2321 DALY), low back pain (1735 DALY), and lung cancer (1197 DALY). Headache and dementia accounted for a greater disease burden in women than in men, while lung cancer and alcohol use disorders accounted for a greater disease burden in men than in women. Pain disorders and alcohol use disorders were the leading causes of DALY among young adults of both sexes. The disease burden rose with age for some diseases, including cardiovascular diseases, dementia, and diabetes mellitus. For some diseases and conditions, the disease burden varied by geographical region. CONCLUSION: The results indicate a need for age- and sex-specific prevention and for differing interventions according to geographic region. Burden of disease studies yield comprehensive population health surveillance data and are a useful aid to decision-making in health policy.

N-Nitrosodimethylamine-Contaminated Valsartan and the Risk of Cancer­A Longitudinal Cohort Study Based on German Health Insurance Data.

BACKGROUND: N-Nitrosodimethylamine (NDMA), classified as a probable human carcinogen, has been found as a contaminant in the antihypertensive drug valsartan. Potentially carcinogenic effects associated with the consumption of NDMAcontaminated valsartan have not yet been analyzed in large-scale cohort studies. We therefore carried out the study reported here to explore the association between NDMA-contaminated valsartan and the risk of cancer. METHODS: This cohort study was based on longitudinal routine data obtained from a large German statutory health insurance provider serving approximately 25 million insurees. The cohort comprised patients who had filled a prescription for valsartan in the period 2012-2017. The endpoint was an incident diagnosis of cancer. Hazard ratios (HR) for cancer in general and for certain specific types of cancer were calculated by means of Cox regression models with time-dependent variables and adjustment for potential confounders. RESULTS: A total of 780 871 persons who had filled a prescription for valsartan between 2012 and 2017 were included in the study. There was no association between exposure to NDMA-contaminated valsartan and the overall risk of cancer. A statistically significant association was found, however, between exposure to NDMA-contaminated valsartan and hepatic cancer (adjusted HR 1.16; 95% confidence interval [1.03; 1.31]). CONCLUSION: These findings suggest that the consumption of NDMA-contaminated valsartan is associated with a slightly increased risk of hepatic cancer; no association was found with the risk of cancer overall. Close observation of the potential long-term effects of NDMA-contaminated valsartan seems advisable.

Erratum to: BURDEN 2020-Burden of disease in Germany at the national and regional level.

Erratum to:Bundesgesundheitsbl (2018) https://doi.org/10.1007/s00103-018-2793-0 The original publication of this article contained an error in the list of the authors, in which the contributing author Christian Schmidt was missing. The full list of authors has now been updated. The original article ….

BURDEN 2020-Burden of disease in Germany at the national and regional level.

BACKGROUND: Evidence-based policy measures need non-interest-guided information about the health status of a population and the diseases that affect the population the most. In such cases, a national burden of disease study can provide reliable insights at the regional level. AIM: This article presents the potential of the BURDEN 2020 project and its expected outcome for Germany at the national and regional level. METHODS: The BURDEN 2020 project uses several indicators including years of life lost (YLL) to cover the impact of mortality and years lived with disability (YLD) to cover morbidity. The sum of both is the measure of population health called disability adjusted life years (DALY). RESULTS: The study ranks individual diseases and risk factors based on their impact on population health. The burden of disease approach is assumed to be sensitive to subnational differences and may generate immediate benefits for regional planning. The BURDEN 2020 study will pilot a national burden of disease study for Germany that will later be transformed into a continuous data processing and visualization tool. This is done by using, modifying and supplementing the methodology employed by the Global Burden of Disease (GBD) study to better fit the needs of health policy in Germany. This study is aimed at calculating the disease burden for up to 17 preselected diseases. Furthermore, the estimates of burden of disease are attributed to a selected set of risk factors. CONCLUSION: The Burden 2020 study will provide the results of a new, health-related data processing system to the public. This includes a noninterest-guided presentation of the burden of disease (DALY) in Germany at the national and regional level.