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.

Care for the chronically ill in Germany - The challenges during the COVID-19 pandemic.

The COVID-19 pandemic is posing major challenges to the health care sector. This scoping review compiles evidence concerning changes to health care service availability and utilisation as well as possible impacts on health for selected groups of chronically ill people in Germany. The focus is on cancer, cardiovascular diseases, diabetes mellitus and mental disorders. Most empirical data available concerned inpatient care and showed a clear decline in the utilisation of inpatient treatments in March and April 2020 in the areas of oncology and cardiology as well as in mental health. For cardiovascular emergencies such as heart attack and stroke, a decline was observed especially regarding less serious cases. Although there were indications of treatment delays, there was no evidence thus far that emergency care had been generally compromised due to adjustments to inpatient care capacities. In the outpatient setting, extensive adjustments to health care services availability were observed for all disease groups considered. Overall, very limited empirical data were available. In particular, hardly any data were available on how changes in care impacted population health. There is an urgent need for continuous surveillance and evaluation based on health care and epidemiological data.

Individual and area-level determinants associated with C-reactive protein as a marker of cardiometabolic risk among adults: Results from the German National Health Interview and Examination Survey 2008-2011.

BACKGROUND: High-sensitivity C-reactive protein (hsCRP) is a sensitive biomarker of systemic inflammation and is related to the development and progression of cardiometabolic diseases. Beyond individual-level determinants, characteristics of the residential physical and social environment are increasingly recognized as contextual determinants of systemic inflammation and cardiometabolic risks. Based on a large nationwide sample of adults in Germany, we analyzed the cross-sectional association of hsCRP with residential environment characteristics. We specifically asked whether these associations are observed independent of determinants at the individual level. METHODS: Data on serum hsCRP levels and individual sociodemographic, behavioral, and anthropometric characteristics were available from the German Health Interview and Examination Survey for Adults (2008-2011). Area-level variables included, firstly, the predefined German Index of Socioeconomic Deprivation (GISD) derived from the INKAR (indicators and maps on spatial and urban development in Germany and Europe) database and, secondly, population-weighted annual average concentration of particulate matter (PM10) in ambient air provided by the German Environment Agency. Associations with log-transformed hsCRP levels were analyzed using random-intercept multi-level linear regression models including 6,768 participants aged 18-79 years nested in 162 municipalities. RESULTS: No statistically significant association of PM10 exposure with hsCRP was observed. However, adults residing in municipalities with high compared to those with low social deprivation showed significantly elevated hsCRP levels (change in geometric mean 13.5%, 95%CI 3.2%-24.7%) after adjusting for age and sex. The observed relationship was independent of individual-level educational status. Further adjustment for smoking, sports activity, and abdominal obesity appeared to markedly reduce the association between area-level social deprivation and hsCRP, whereas all individual-level variables contributed significantly to the model. CONCLUSIONS: Area-level social deprivation is associated with higher systemic inflammation and the potentially mediating role of modifiable risk factors needs further elucidation. Identifying and assessing the source-specific harmful components of ambient air pollution in population-based studies remains challenging.

12-month prevalence of known chronic obstructive pulmonary disease (COPD) in Germany.

Chronic obstructive pulmonary disease (COPD) is associated with a high disease burden and is one of the leading causes of death worldwide. Smoking is the key modifiable risk factor for COPD in Germany. GEDA 2014/2015-EHIS surveyed the 12-month prevalence of known COPD using the European indicator on self-reported chronic bronchitis, chronic obstructive pulmonary disease, emphysema. Among adults aged 18 years or older with complete information on the indicator (n=22,702), the 12-month prevalence of known COPD is 5.8% (5.8% for women and 5.7% for men). In both genders, the prevalence increases strongly with age. Overall, the presence of COPD was more often reported by women and men with a low educational level than by those with a higher one. In a comparison of federal states, the 12-month prevalence of known COPD varies between 3.6% and 7.5% for women and 4.3% and 11.2% for men.

12-month prevalence of asthma among adults in Germany.

Asthma is a chronic inflammatory disease of the airways affecting people of all ages. The disease is characterised by a variable narrowing of the bronchia, which may be accompanied by symptoms such as wheezing or shortness of breath. In GEDA 2014/2015-EHIS, 6.2% of respondents aged 18 years or older with complete information on the respective indicator (n=22,671) reported having had asthma during the past 12 months. The 12-month prevalence among women (7.1%) is higher than among men (5.4%). Overall, women and men with a low level of education more often reported having had asthma than those with a higher level of education. In analyses stratified by age and gender, differences in asthma prevalence with regard to educational level are evident among women under 30 years of age. In a comparison of federal states, the prevalence of asthma ranges from 3.0% to 9.7% among women and from 2.9% to 7.0% among men.

Time trends in incidence and mortality of respiratory diseases of high public health relevance in Germany.

Respiratory diseases are major causes of disease burden and mortality throughout the world. In Germany, alongside acute respiratory infections (ARI), chronic lung diseases - including lung cancer, chronic obstructive pulmonary disease (COPD), and asthma - are of particular socioeconomic importance. ARI incidence rates differ significantly according to age, season and year. They are recorded as weekly consultation rates as reported by selected outpatient and inpatient care facilities. Between 2009 and 2016, the highest incidence rates of severe acute respiratory infection (SARI) were recorded among young children in outpatient (9.4%) and inpatient (0.2%) care. Mortality rates for ARI are also subject to seasonal and annual fluctuations. However, the official statistics on causes of death, which lead to estimates of more than 17,000 annual deaths, provide an inadequate measure of death rates because chronic underlying illnesses are often recorded as the cause of death rather than a more recently acquired acute infection. Therefore, the excess mortality caused by ARI needs to be assessed in the context of influenza outbreaks. Regarding lung cancer, COPD and asthma, the long-term time trends in disease incidence and mortality rates are of particular interest from a health policy perspective. Analyses of data from the official statistics on causes of death for the years 1998 through 2015 show that mortality rates for lung cancer and COPD decreased on average by 1.8% and 1.1% per year respectively, among men, whereas among women they increased by 2.5% (lung cancer) and 2.3% (COPD) annually. Nevertheless, more men than women died of lung cancer or COPD in 2015 in Germany: 29,378 men and 15,881 women died from lung cancer, and 17,300 men and 13,773 women died from COPD. During the same period, the asthma mortality rates decreased on average by 8.3% annually among women and by 11.2% annually among men, and the absolute number of deaths came down to 659 among women and 393 among men. Lung cancer incidence rates have been at similar levels as lung cancer death rates since 1998. No such data are available on time trends in COPD or asthma incidence rates. Coordinated surveillance of respiratory diseases needs to be expanded within the framework of international action plans for disease prevention.

Asthma management practices in adults--findings from the German Health Update (GEDA) 2010 and the German National Health Interview and Examination Survey (DEGS1) 2008-2011.

OBJECTIVES: In Germany, population-wide data on adherence to national asthma management guidelines are lacking, and performance measures (PM) for quality assurance in asthma care are systematically monitored for patients with German national asthma disease management program (DMP) enrollment only. We used national health survey data to assess variation in asthma care PM with respect to patient characteristics and care context, including DMP enrollment. METHODS: Among adults 18-79 years with self-reported physician-diagnosed asthma in the past 12 months identified from a recent German National Health Interview Survey (GEDA 2010: N = 1096) and the German National Health interview and Examination Survey 2008-2011 (DEGS1: N = 333), variation in asthma care PM was analyzed using logistic regression analysis. RESULTS: Overall, 38.4% (95% confidence interval: 32.5-44.6%) of adults with asthma were on current inhaled corticosteroid therapy. Regarding non-drug asthma management, low coverage was observed for inhaler technique monitoring (35.2%; 31.2-39.3%) and for provision of an asthma management plan (27.3%; 24.2-30.7%), particularly among those with low education. Specific PM were more complete among persons with than without asthma DMP enrollment (adjusted odds ratios ranging up to 10.19; 5.23-19.86), even if asthma patients were regularly followed in a different care context. CONCLUSIONS: Guideline adherence appears to be suboptimal, particularly with respect to PM related to patient counseling. Barriers to the translation of recommendations into practice need to be identified and continuous monitoring of asthma care PM at the population level needs to be established.

Chronic disease co-morbidity of asthma and unscheduled asthma care among adults: results of the national telephone health interview survey German Health Update (GEDA) 2009 and 2010.

BACKGROUND: Co-morbidities may complicate the clinical management of chronic conditions such as asthma. AIMS: To quantify the strength of the relationship between asthma and other chronic diseases and to analyse whether co-morbidities contribute to unscheduled asthma care. METHODS: Data from two consecutive national telephone health interview surveys (GEDA 2009 and 2010) including a total of 43,312 adults (>18 years of age) were analysed. Persons with and without a current diagnosis of asthma were compared with respect to concurrent diagnoses (diabetes mellitus, hypertension, chronic heart failure, depression, osteoarthritis, stroke, coronary heart disease, and cancer). Logistic regression models were applied to assess the strength of the association between asthma and co-morbidities in the total study population and, among persons with asthma, between the number of co-morbidities and unscheduled inpatient (hospital admissions and/or emergency department admissions) or outpatient asthma care in the past 12 months. RESULTS: Overall, 5.3% (95% CI 5.0% to 5.6%) of adults reported current physician-diagnosed asthma. Asthma was significantly associated with most of the conditions considered and 18% of persons with asthma had three or more co-morbidities. Adjusted odds ratios (AOR) of unscheduled asthma care increased with numbers of conditions, with AOR 3.40 (95% CI 1.39 to 8.31) for unscheduled inpatient care and AOR 2.32 (95% CI 1.30 to 4.14) for unscheduled outpatient care comparing those with three or more co-morbidities versus those with none. CONCLUSIONS: The magnitude of chronic disease co-morbidity is substantial in asthma, is related to unscheduled asthma care, and implies a significant number of adults with asthma facing complex healthcare needs.

Major comorbid conditions in asthma and association with asthma-related hospitalizations and emergency department admissions in adults: results from the German National Health Telephone Interview Survey (GEDA) 2010.

BACKGROUND: It remains unclear to what extent asthma in adults is linked to allergic rhinitis (AR), gastroesophageal reflux disease (GERD), and acetylsalicylic acid exacerbated respiratory disease (AERD), and how these comorbidities may affect asthma outcomes in the general population. We therefore aimed to assess the prevalence of these major comorbidities among adults with asthma and examine their impact on asthma exacerbations requiring hospital care. METHODS: A total of 22,050 adults 18 years and older were surveyed in the German National Health Telephone Interview Survey (GEDA) 2010 using a highly standardized computer-assisted interview technique. The study population comprised participants with self-reported physician-diagnosed asthma, among which the current (last 12 months) prevalence of AR and GERD-like symptoms (GERS), and life-time prevalence of AERD was estimated. Weighted bivariate analyses and logistic regression models were applied to assess the association of each comorbid condition with the asthma outcome (any self-reported asthma-related hospitalization and/or emergency department (ED) admission in the past year). RESULTS: Out of 1,136 adults with asthma, 49.6% had GERS and 42.3% had AR within the past 12 months; 14.0% met the criteria of AERD, and 75.7% had at least one out of the three conditions. Overall, the prevalence of at least one exacerbation requiring emergency room or hospital admission within the past year was 9.0%. Exacerbation prevalence was higher among participants with comorbidities than among those without (9.8% vs. 8.2% for GERS; 11.2% vs. 7.6% for AR, and 22.2% vs. 7.0% for AERD), but only differences in association with AERD were statistically significant. A strong association between asthma exacerbation and AERD persisted in multivariable logistic regression analyses adjusting for sex, age group, level of body mass index, smoking status, educational attainment, and duration of asthma: odds ratio (OR) = 4.5, 95% confidence interval (CI) = 2.5-8.2. CONCLUSIONS: Data from this large nation-wide study provide evidence that GERS, AR and AERD are all common comorbidities among adults with asthma. Our data underline the public health and clinical impact of asthma with complicating AERD, contributing considerably to disease-specific hospitalization and/or ED admission in a defined asthma population, and emphasize the importance of its recognition in asthma care.