[Socioeconomic status and health insurance expenditures for children and adolescents with conduct disorder : An analysis of statutory health insurance data]. / Einfluss des sozioökonomischen Status auf Gesundheitskosten für Kinder und Jugendliche mit Störungen des Sozialverhaltens : Eine Analyse von Routinedaten einer gesetzlichen Krankenversicherung.

BACKGROUND: For various psychiatric and somatic disorders, there is evidence of an association between patients' socioeconomic status (SES), healthcare utilisation, and the resulting costs. In the field of child and adolescent psychiatric disorders, studies on this topic are lacking. OBJECTIVES: To exploratively analyse the association of healthcare expenditures for children and adolescents with conduct disorder (including oppositional-defiant disorder) - one of the most prevalent child and adolescent psychiatric disorders - and SES. MATERIALS AND METHODS: The analysis is based on routine data from the German statutory health insurance company AOK Nordost for the calendar year 2011, covering 6461 children and adolescents (age 5-18 years) with an ICD-10 diagnosis of conduct disorder. The insureds' SES was estimated indirectly, based on the social structure of the postcode area, using the German Index of Multiple Deprivation (Mecklenburg-Vorpommern, Brandenburg), and the Berliner Sozialindex I (Berlin), respectively. From the two indices, quintiles were derived. Based on these quintiles, average costs per case for the following cost types were analysed: inpatient healthcare, outpatient healthcare (general practitioners, paediatricians, child and adolescent psychiatrists, child and adolescent psychotherapists), and prescribed medication. RESULTS: There was no significant functional association between SES and healthcare costs for any of the analysed cost types. CONCLUSIONS: In contrast to findings in adults, this study on children and adolescents with conduct disorders did not reveal an association between SES and healthcare costs. Within this group of patients, social inequality does not seem to have a significant influence on healthcare utilisation in Germany.

[Cross-Sectional Analysis of the Health and Social Structure in Germany]. / Querschnittsanalyse der gesundheitlichen und sozialen Lage in Deutschland auf Bundeslandebene.

This research was conducted to find out if there are differences in health and social structure and, thus, living conditions within Germany on a federal state level. So far, research projects have mainly focused on either more aggregate or more small-scale, regional planning areas. However, due to the political, governmental, and institutional structures prevalent in Germany, it seems necessary to conduct health and social structure analyses not only on the macro and micro but also on the meso level. This would enable meeting the specific information requirements of all existing German political spheres and public health planning levels comprehensively. A set of 53 indicators taken from official German statistics was used to conduct a factor analysis. The latter revealed that the health and social structures could be thoroughly depicted by a total of 3 factors (indices) that, in total, explain roughly 80% of the total variance. In this case, the first index accounts for about 38%, the second for about 31%, and the third index explain roughly 11%. Testing the results through hierarchical as well k-Means cluster analyses provided additional confirmation. Overall, the results show great differences in health and social structures in Germany on a federal state level. In addition, a more in-depth look at the nature of the results shows that one needs to distinguish between 4, or rather even a total of 8 subregions. Most importantly, these findings reveal that the frequently and widely discussed East-West discrepancies do not enable an adequately differentiated approach to this issue. Rather, aside from aspects such as federal city state and state area differences, structures in Germany show several different and highly significant types of North-South divides.

Is early BCG vaccination associated with less atopic disease? An epidemiological study in German preschool children with different ethnic backgrounds.

We investigated the association of bacille Calmette-Guérin (BCG) vaccination and atopic manifestations among children. Because many children in the study area were from minority ethnic groups, the effect of ethnicity on disease prevalence was also analyzed. A mandatory health survey included all preschool children from Berlin in 1994. Trained medical personnel asked parents whether their child had ever had a diagnosis of atopic dermatitis (AD), bronchial asthma (BA), and hay fever (HF) or symptoms suggestive of these conditions. BCG-vaccination status was recorded from official vaccination documents. Ethnicity of the child was defined by maternal citizenship. We included 38 808 children in our study (20 813 children from former west Berlin), on average aged 6 years. The proportion of children with a foreign family background was 2.1% in East Berlin and 27.5% in West Berlin. BCG vaccination was more common in East Berlin than in West Berlin (94.2% vs. 16.5%) and in West Berlin more common among children with a foreign family background compared with Germans (25.3% vs. 13.2%). The adjusted odds ratio (95% CI) for BA was 0.85 (0.71-1.00) for BCG-vaccinated individuals. BCG vaccination was not significantly associated with AD or HF. Among non-German children, the odds ratios were 0.35 (0.30-0.42) for AD, 0.58 (0.48-0.70) for BA, and 0.72 (0.54-0.92) for HF. The OR for AD among children living in eastern Berlin was 1.19 (1.04-1.36), no significant regional differences were found for BA or HF. This study demonstrated a weak protective effect of BCG vaccination against asthma but a much stronger protective effect of non-German ethnicity against atopic manifestations among preschool children from Germany.