[Work Participation after Multimodal Rehabilitation due to Cancer: Representative Analyses using Routine Data of the German Pension Insurance]. / Berufliche Teilhabe nach einer medizinischen Rehabilitation aufgrund von onkologischen Erkrankungen: Repräsentative Analysen auf Basis der Routinedaten der Deutschen Rentenversicherung.

PURPOSE: Cancer diseases are associated with multiple physical, psychosocial, and occupational burdens that jeopardize work participation and must be specifically addressed with rehabilitative interventions. This study addressed the following questions regarding cancer patients whose rehabilitation was covered by German Pension Insurance (GPI): (a) What socio-medical risks existed prior to rehabilitation, (b) how well persons were able to return to work after rehabilitation, and (c) what conditions determined work participation? METHODS: We used the rehabilitation statistics database of the German Pension Insurance and included patients with completed medical rehabilitation due to cancer in 2017. Analyses were carried out for the entire group as well as for those differentiated according to their tumor sites (breast, prostate, colon and lung). Work participation was operationalized both via a monthly state up to 24 months after rehabilitation discharge and as a rate of all persons who were employed 12 or 24 months and the 3 preceding months (stable work participation). For the analysis of the influencing factors on stable work participation, multiple logistic regression models with stepwise inclusion were calculated separately for the rates after 12 and 24 months. RESULTS: A total of 63,587 data sets were included in the analysis (breast cancer: n=20,545, 32%; prostate: n=6,434, 10%; colon: n=4,727, 7%; lung: n=2,866, 5%). Of the rehabilitation participants 55% (lung), 49% (colon), 46% (breast), and 13% (prostate) had sickness absences of six or more months in the year before rehabilitation. Two years after rehabilitation, return-to-work rates were 66% (breast), 54% (prostate), 50% (colon), and 24% (lung). The strongest factors influencing stable work participation were time of sick leave, wage before rehabilitation and age. CONCLUSION: Two years after cancer rehabilitation, 5 to 6 out of 10 persons returned to stable work participation. Relevant influencing factors were the length of sick leave and wages prior to cancer rehabilitation. The results suggest inclusion of more work-related aspects in cancer rehabilitation and greater suppor, especially in the first year post-rehabilitation.

[Work Participation after Multimodal Rehabilitation due to Cardiovascular Diseases - Representative Analyses using Routine Data of the German Pension Insurance]. / Berufliche Teilhabe nach einer medizinischen Rehabilitation aufgrund von kardiovaskulären Erkrankungen ­ Repräsentative Analysen auf Basis der Routinedaten der Deutschen Rentenversicherung.

PURPOSE: Cardiovascular diseases represent a large proportion of the disease burden of the adult population in Germany. Their importance in rehabilitation has increased continuously in recent years. Several studies have investigated return to work of cardiac patients after rehabilitation, which is relevant from the perspective of pension insurance. However, there is a lack of representative findings for the German region on employment trajectories and their influencing factors. METHODS: The rehabilitation statistics database of the German Pension Insurance (GPI) was used for this study. Subjects were patients with cardiovascular diseases undergoing rehabilitation in 2017. Analyses were performed for the total group and differentiated by relevant diagnosis groups. Occupational participation was operationalized via a monthly state variable up to 24 months after rehabilitation and the rate of all persons who were employed at the 12- and 24- month follow-up and in the 3 months before, respectively. Multiple logistic regression models were calculated to analyze the influencing factors. RESULTS: The total sample comprised 59,667 patients. The average age in all groups was between 53 and 56 years. Men were disproportionately represented; 70% of the services were provided as follow-up rehabilitations and 88% in the inpatient setting. Stable employment rates were 66% after one year and 63% after two years in the overall group (disease groups: 49% to 71%). The strongest influencing factors were the amount of pay and the number of sickness absence days before rehabilitation, active employment before rehabilitation, and age. CONCLUSION: For the first time, representative data on occupational participation following rehabilitation on behalf of the GPI are available for the disease groups considered. The analyses underline the need to focus on occupational perspectives already in medical rehabilitation or directly thereafter.

Utilisation of rehabilitation due to mental disorders during the SARS-CoV-2 pandemic: a difference-in-differences analysis.

BACKGROUND: Our analyses examined the extent to which the use of rehabilitation for patients with mental disorders decreased due to the COVID-19 pandemic in Germany. METHODS: We used monthly cross-sectional administrative data on rehabilitation utilisation due to mental disorders in 2019 and 2020 and estimated a difference-in-differences model to determine the reduction in rehabilitation utilisation attributable to the pandemic. RESULTS: We included 151,775 rehabilitations in 2019 and 123,229 rehabilitations in 2020 in our analysis. The number of rehabilitations decreased from April to December by 14.2% due to the pandemic (March to December: 21.8%). The decline was more pronounced for women than for men and varied regionally. Temporal and regional differences in utilisation were moderately associated with the decrease in mobility in the pandemic year. In the first phase of the pandemic, i.e., March and April 2020, the decline was strongly associated with the regional incidence of SARS-CoV-2 infection. CONCLUSION: Due to the pandemic, significantly fewer rehabilitations due to mental disorders occurred in Germany in 2020 than in 2019. The likely increasing need for rehabilitation for people with mental disorders should be addressed by making rehabilitation access and delivery more flexible.

[Work Participation after Multimodal Rehabilitation due to Neurological Diseases - Representative Analyses Using Routine Data of the German Pension Insurance]. / Berufliche Teilhabe nach einer medizinischen Rehabilitation aufgrund neurologischer Erkrankungen.

PURPOSE: There is little representative evidence for the German rehabilitation system on occupational reintegration after medical rehabilitation. For persons who have undergone rehabilitation on behalf of the German Pension Insurance (GPI) due to a neurological disease, it is therefore important to determine (a) what socio-medical risks exist prior to rehabilitation, (b) how well persons were able to participate in working life after rehabilitation, and (c) what conditions determine the work participation. METHODS: The study is conducted on the basis of the GPI's database of rehabilitation statistics. Included were all persons, who completed medical rehabilitation in 2016 due to a neurological disease. The analyses were carried out for the entire group and also in a differentiated manner for the 2 main diseases, cerebrovascular diseases (CD) and multiple sclerosis (MS). Work participation was operationalized both via a monthly status variable until 24 months after rehabilitation and as a rate of all persons who were employed at the 12 and 24 months follow up and in the 3 months before, respectively. To analyse the factors influencing stable work participation, multiple logistic regression models with stepwise inclusion were calculated separately for the rates after 12 and 24 months. RESULTS: A total of 42,230 data sets were included in the analysis (CD: n=18,368, 44%; MS: n=6,343, 15%). Patients with neurological diseases were 50 years old on average, 43% were female. We found that approximately15% of patients reported no absenteeism, whereas 17% stated an absence leave of six months or more in the year prior to rehabilitation. Mental and cardiovascular comorbidity was documented in 31 and 44% of the cases respectively. Nearly 48% of patients with CD returned to work two years after rehabilitation. For MS patients, the percentage was slightly higher at 54%. The amount of sick leave of the rehabilitated individual, their gross/net income prior to rehabilitation as well their work capacity prior to admission were the three strongest influencing factors on their return to the labour market. CONCLUSION: About half of all persons with neurological diseases return to sustainable work after medical rehabilitation in Germany. The amount of sick leave and the income before rehabilitation are determining factors as to whether the person will return to work. The analysis provides representative data on occupational reintegration after medical rehabilitation due to a neurological disease for the first time.

[Work Participation after Multimodal Rehabilitation due to Diseases of the Digestive System. Representative Analyses using Routine Data of the German Pension Insurance]. / Berufliche Teilhabe nach einer medizinischen Rehabilitation aufgrund von Erkrankungen des Verdauungssystems. Repräsentative Analysen auf Basis der Routinedaten der Deutschen Rentenversicherung.

PURPOSE: Diseases of the digestive system such as Crohn's disease (CD) or ulcerative colitis (UC) are associated with problems in occupational participation, but they only make up a very small part of all rehabilitation services provided by the German Pension Insurance. Rehabilitation is a very good treatment option, but its effectiveness is largely unclear. So far, several studies exist on the return to work after medical rehabilitation. However, representative findings and the relevant influencing factors are still lacking. This is the aim of the present analysis. METHODS: We used the rehabilitation statistics database of the German Pension Insurance. Patients were included with completed medical rehabilitation due to a disease of the digestive system in 2017. The analyses were carried out for the entire group as well as differentiated according to the diagnosis groups CD, UC, diverticular diseases (DI) as well as pancreatic diseases (PA). Occupational participation was operationalised both via a monthly information up to 24 months after rehabilitation and as a rate of all persons who were employed after 12 or 24 months in the survey month and the 3 preceding months. For the analysis of the influencing factors on stable occupational participation, multiple logistic regression models with stepwise inclusion were calculated separately for the rates after 12 and 24 months. RESULTS: A total of 8,795 data sets were included in the analysis (CD: n=1,779, 20%; UC: n=1,438, 16%; DI: 1,282, 15%; PA: n=761, 9%). The average age in the groups ranged from 44 (CD) to 54 (DI) years; the proportion of women ranged from 28% (PA) to 57% (CD). Between 16% (DI) and 32% (PA) of the rehabilitation participants had sickness absences of 6 or more months in the year before rehabilitation. Two years after rehabilitation, the return-to-work rates were 69% (CD), 71% (UC), 68% (DI) and 58% (PA). The strongest influencing factors on stable occupational participation were time of sick leave and wage before rehabilitations well as work ability at admission. CONCLUSION: Two years after gastroenterological rehabilitation in Germany, 6 to 7 out of 10 affected persons return to stable work participation. Relevant influencing factors are the time of sick leave and the level of remuneration. The results support an expansion of rehabilitation concept to include work-related aspects.

[Impact of the SARS-CoV-2 Pandemic on the Utilization of Cancer Rehabilitation: a Difference-in-Differences Analysis]. / Auswirkungen der SARS-CoV-2-Pandemie auf die Inanspruchnahme der onkologischen Rehabilitation: eine Difference-in-Differences-Analyse.

PURPOSE: Restricted access to rehabilitative care due to the SARS-CoV-2 pandemic may affect the participation of cancer survivors and risks progression of the underlying disease. The aim of our analyses was to examined the extent to which cancer rehabilitations in Germany decreased due to the SARS-CoV-2 pandemic. METHODS: Data were retrieved from the German Pension Insurance which is the main provider for medical rehabilitation in Germany. We used monthly cross-sectional data on the utilization of cancer rehabilitation (Ca-rehab-services according to section 15 for working-aged people or section 31 social security code VI for pensioners) in 2019 and 2020. We used a difference-in-differences model to determine the reduction in rehabilitation utilization attributable to the pandemic and reported incidence rate ratios (IRR). RESULTS: We included 146,924 cancer rehabilitations in 2019 and 113,117 cancer rehabilitations in 2020. Compared to the previous year, the nationwide decline in cancer rehabilitations was greatest in April 2020 (63.2%). Utilization of cancer rehabilitation was reduced by 11.5% for benefits according to section 15 social security code VI (IRR=0.885; 95% CI: 0.864 to 0.906) and by 26.5% for benefits according to section 31 (IRR=0.735; 95% CI: 0.717 to 0.754) due to the pandemic. For pensioners the decline in utilization was more pronounced in Western Germany than in Eastern Germany and greater for non-post-acute rehabilitations than for post-acute rehabilitations. CONCLUSION: The analyses show a pandemic-related decline in cancer rehabilitations, especially in cancer rehabilitation services for pensioners. Failure to seek medical rehabilitation, through which physical and psychological recovery and relief from disease and treatment side effects can be achieved, will have a lasting impact on the participation for many cancer survivors. Repeated monitoring of work ability and health of chronically ill people could generate necessary data to clarify why people in need of rehabilitation have avoided seeking medical rehabilitation and how they can be supported.

Reduced Requests for Medical Rehabilitation Because of the SARS-CoV-2 Pandemic: A Difference-in-Differences Analysis.

OBJECTIVE: To examine the extent to which medical rehabilitation requests decreased because of the pandemic in Germany. DESIGN: Data were retrieved from the German Pension Insurance, which is the main provider for rehabilitation of working-age people in Germany. Our data represented all medical rehabilitation requests in 2019 and 2020. These requests have to be approved to use a rehabilitation program. We used a difference-in-differences model to determine the reduction in rehabilitation requests attributable to the pandemic. SETTING: General community. PARTICIPANTS: We included 1,621,840 rehabilitation requests from working-age people across Germany in 2019 and 1,391,642 rehabilitation requests in 2020 (N=3,013,482). INTERVENTION: Medical rehabilitation in inpatient or outpatient facilities. MAIN OUTCOME MEASURES: Number of medical rehabilitation requests. RESULTS: The number of medical rehabilitation requests decreased by 14.5% because of the pandemic (incidence rate ratio, 0.855; 95% confidence interval, 0.851-0.859). The decline in requests was more pronounced among women and in Western Germany than among men and in Eastern Germany. The reduction in requests affected non-postacute rehabilitations more clearly than postacute rehabilitation services. After the pandemic declaration by the German Bundestag in March 2020, the reduction in requests was initially strongly associated with the regional incidence of infection. This association weakened in the following months. CONCLUSIONS: The reduction in requests will have a significant effect on the number of completed rehabilitation services. For many people with chronic diseases, failure to provide medical rehabilitation increases the risk of disease progression.

[Work Participation after Multimodal Rehabilitation due to Respiratory Diseases - Representative Analyses using Routine Data of the German Pension Insurance]. / Berufliche Teilhabe nach einer medizinischen Rehabilitation aufgrund pneumologischer Erkrankungen.

PURPOSE: For the German rehabilitation system there are only few representative findings on occupational reintegration after medical rehabilitation. For persons who have undergone rehabilitation on behalf of the German Pension Insurance (GPI) due to a respiratory disease, it is therefore needed to determine (a) what socio-medical risks exist prior to rehabilitation, (b) how well persons were able to participate in working life after rehabilitation, and (c) what conditions determine the work participation. METHODS: The study is conducted on the basis of the GPI's database of rehabilitation statistics. Included were all persons, who completed medical rehabilitation in 2016 with a main discharged diagnosis from chapter J of the ICD-10. The analyses were carried out for the entire group and also in a differentiated manner for the the 2 main diseases bronchial asthma and COPD. Work participation was operationalized both via a monthly status variable until 24 months after rehabilitation and as a rate of all persons who were employed at the 12 and 24 months follow up and in the 3 months before, respectively. To analyze the factors influencing stable work participation, multiple logistic regression models with stepwise inclusion were calculated separately for the rates after 12 and 24 months. RESULTS: A total of 19,287 data sets were included in the analysis (bronchial asthma: n=9,108, 47%; COPD: n=6,215, 32%). Patients with respiratory diseases were 53 years old on average, both genders were equally distributed. 14% had no absenteeism, 11 % stated an absence leave 6 months or more in the year prior to rehabilitation. Mental and cardiovascular comorbidity was documented in 39 and 38% of the cases, respectively. Overall, patients with COPD had higher socio-medical risks before rehabilitation than asthma patients. Accordingly, only about half of the COPD patients remained in active employment, while about 80% of the asthma patients succeeded in this. The strongest influencing factors on stable work participation were the time of sick leave as well as income prior to rehabilitation. CONCLUSION: About two thirds of all persons with respiratory diseases are in stable employment after medical rehabilitation in Germany, with large differences between asthma bronchiale and COPD. In particular, the absenteeism as well as the wage before rehabilitation determine this. The analysis provides representative data on occupational reintegration after medical rehabilitation due to a respiratory disease for the first time.

[Vocational Rehabilitation - Comparing Clients of the Federal Employment Agency and the German Pension Insurance]. / Leistungen zur Teilhabe am Arbeitsleben ­ Rehabilitanden der Bundesagentur für Arbeit und der Deutschen Rentenversicherung im Vergleich.

OBJECTIVE: The Federal Employment Agency (Bundesagentur für Arbeit, BA) and the German Pension Insurance (Deutsche Rentenversicherung, DRV) are the major institutions responsible for vocational rehabilitation (VR) in Germany. The following paper compares the characteristics of persons in vocational rehabilitation and the utilization of rehabilitation services between those two institutions and presents short-term developments. METHODS: Administrative data of the BA and the DRV were made comparable. The study analyses persons who have completed VR between 2011 and 2015. RESULTS: We observe an increased use of VR services for both the BA and the DRV. Furthermore, the results show an absolute and proportional increase in persons being employed at the time of approval of VR and in persons receiving technical assistance. The clients of the BA are younger and better educated than the clients of the DRV. The clients of the DRV are more frequently employed at time of approval and receive mainly technical assistance. CONCLUSIONS: Though due to different regulatory responsibilities, BA and DRV clients in VR differ particularly in age, we observe comparable developments in the populations addressed and the interventions provided.