Spatial characteristics of non-communicable diseases and their associations to social conditions in a large urban cohort in Germany-Results from the Hamburg City Health Study.

BACKGROUND: Non-communicable diseases (NCDs) are responsible for many deaths. They are associated with several modifiable and metabolic risk factors and are therefore prone to significant regional variations on different scales. However, only few intra-urban studies examined spatial variation in NCDs and its association with social circumstances, especially in Germany. Thus, the present study aimed to identify associations of personal risk factors and local social conditions with NCDs in a large German city. METHODS: This study is based on a population-based cohort of the Hamburg City Health Study including 10,000 probands. Six NCDs were analyzed (chronic obstructive pulmonary disease [COPD], coronary heart disease [CHD], diabetes mellitus, heart failure, depression, and hypertension) in 68 city district clusters. As risk factors, we considered socio-demographic variables (age, sex, education) and risk behaviour variables (smoking, alcohol consumption). Logistic regression analyses identified associations between the district clusters and the prevalence rates for each NCD. Regional variation was detected by Gini coefficients and spatial cluster analyses. Local social condition indexes were correlated with prevalence rates of NCDs on city district level and hot-spot analyses were performed for significant high or low values. RESULTS: The analyses included 7,308 participants with a mean age of 63.1 years (51.5% female). The prevalence of hypertension (67.6%) was the highest. Risk factor associations were identified between smoking, alcohol consumption and education and the prevalence of NCDs (hypertension, diabetes, and COPD). Significant regional variations were detected and persisted after adjusting for personal risk factors. Correlations for prevalence rates with the local social conditions were significant for hypertension (r = 0.294, p < 0.02), diabetes (r = 0.259, p = 0.03), and COPD (r = 0.360, p < 0.01). CONCLUSIONS: The study shows that regional differences in NCD prevalence persist even after adjusting for personal risk factors. This highlights the central role of both personal socio-economic status and behaviors such as alcohol and tobacco consumption. It also highlights the importance of other potential regional factors (e.g. the environment) in shaping NCD prevalence. This knowledge helps policy- and decision-makers to develop intervention strategies.

PsoBarrier EU study: a Multicentre, Cross-sectional Survey Investigating the Quality of Psoriasis Care in Four European Countries.

Enhanced treatment options for psoriasis and growing use of guidelines increased the potential to better quality of psoriasis care in Europe. The aim of the PsoBarrier EU study is to compare the quality and processes of psoriasis care in four European countries with different healthcare systems, based on validated quality indicators. This cross-sectional survey was conducted in dermatology centres in Denmark, Germany, Poland and Spain on 1,304 patients, using standardized patient and physician questionnaires. Measured by quality of psoriasis care indicators, patients in Poland had the most critical outcomes, such as the highest disease severity (Psoriasis Area and Severity Index; PASI) and lowest health-related quality of life (Dermatology Life Quality Index; DLQI). This indicates differences in psoriasis care, with Polish participants experiencing more severe psoriasis and its consequences. Differences in the healthcare systems, which create barriers to accessing treatments, could explain variations in quality of care.

Development and validation of a disease-specific quality of life questionnaire for patients with peripheral artery disease (QOLPAD).

BACKGROUND: The aim of this study was to develop and validate a short and feasible questionnaire to measure health-related quality of life (HRQoL) in patients with peripheral artery disease (PAD). The content of the new instrument is intended to correspond with the simultaneously developed instrument Patient Benefit Index for PAD (PBI-PAD), which evaluates treatment goals and benefits in this patient group. METHODS: Fifty patients stated their disease burden on free-text questionnaires, which was used by an interdisciplinary expert panel to develop 12 items for the new instrument, named Quality of Life questionnaire for patients with peripheral artery disease (QOLPAD). The validity of the instrument was tested in patients from Germany with PAD stages I to IV who completed the QOLPAD, EuroQol questionnaire (EQ-5D-3L; EuroQol visual analogue scale (EQ VAS)), and Vascular Quality of Life questionnaire (VascuQoL) before (baseline) and three months after (follow-up) treatment. RESULTS: One hundred and three patients were included at baseline (mean age: 68.6 years; 68% male), among whom, 57 provided data at follow-up. Most patients (86.4%) rated the completion of QOLPAD as being easy. Internal consistency was satisfactory, with a Cronbach's alpha of 0.74 (baseline) and 0.84 (follow-up). Convergent validity was indicated by significant correlations with the EQ-5D-3L (baseline: - 0.62; follow-up: - 0.81), EQ VAS (baseline: - 0.44, follow-up: - 0.79), VascuQoL global score (baseline: - 0.77; follow-up: - 0.87), global rating of impairment (baseline: 0.64; follow-up: 0.71), and PAD stage (baseline: 0.40; follow-up: 0.67). Sensitivity to change was confirmed by significant correlations of change in the QOLPAD with changes in convergent criteria; however, the high number of dropouts limits the generalizability of this finding. CONCLUSION: This study provided evidence that the QOLPAD is internally consistent and valid in patients receiving treatment for PAD in Germany.

Epidemiology of skin diseases in Germany: systematic review of the current state of research - part 2: non-infectious skin diseases.

The aim of this work was to systematically collect all previously published population-based epidemiological data on skin diseases in Germany. The present part 2 of the publication series deals with non-infectious skin diseases. The results on cutaneous tumor diseases (part 1) and infectious skin diseases (part 3) form the other parts of this publication series. A systematic literature search was performed using PubMed/MEDLINE for the period of the last 15 years. With the aim of including all dermatologic diseases, a diagnostic list was developed based on the ICD-11 catalogue. This list included 1,347 skin diseases and formed the basis for the search. The literature search yielded 4,650 hits, of which 72 were included in the synthesis. Among them were 37 publications on non-infectious skin diseases. Among these, psoriasis and atopic eczema were the most common. The highest lifetime prevalence was found for acne. This work is the first systematic literature review that aimed to report all available epidemiological data on skin diseases in Germany. It was found that representative data on many non-infectious diseases are not yet available. Among the included studies, there was a high heterogeneity regarding the methodology. Nevertheless, the utility of these epidemiological data is wide-ranging and can serve as a reference of various epidemiological questions.

Epidemiology of skin diseases in Germany: systematic review of the current state of research - part 3: infectious skin diseases.

The aim of this work was to systematically collect all previously published population-based epidemiological data on skin diseases in Germany. A systematic literature search was performed using PubMed/MEDLINE for the period of the last 15 years. With the aim to include all dermatological diseases, a diagnostic list based on the ICD-11 catalogue was compiled. This list included 1,347 skin diseases and formed the basis for the search. The present part 3 of the publication series deals with infectious skin diseases. The results on cutaneous tumor diseases (part 1) and non-infectious skin diseases (part 2) form the other parts of this publication series. The literature search yielded 4,605 hits, of which 72 papers on 43 different skin diseases were included in the synthesis. Among them were twelve hits on infectious dermatoses, of which six papers were related to measles. The highest lifetime prevalence rates were found for varicella and verrucae vulgaris. This work is the first systematic literature review that aimed to report all available epidemiological data on skin diseases in Germany. It was found that representative data on many infectious diseases are not yet available. Among the included studies, a high heterogeneity was found with regard to the methodology. Nevertheless, these epidemiological data have a wide range of uses and can serve as a reference for various epidemiological questions.

Epidemiology of skin diseases in Germany: systematic review of the current state of research - part 1: cutaneous tumor diseases.

Epidemiological data are of great importance for the identification of health care needs, the detection of gaps in care, the development of targeted prevention measures, and for the optimization of resource allocation. The aim of this work was to systematically collect all previously published population-based epidemiological data on skin diseases in Germany. The present part 1 of the publication series deals with tumor diseases of the skin. The results on non-infectious (part 2) and infectious skin diseases (part 3) form the other parts of this publication series. A systematic search of the literature spanning the last 15 years was conducted using the PubMed/MEDLINE database. With the aim of including all dermatologic diseases, a diagnostic list was developed based on the ICD-11 catalogue. This list included 1,347 skin diseases and formed the basis for the search. The literature search yielded 4,650 publications. After two-stage screening, 72 studies on 43 different skin diseases were included in the synthesis. Among them were 30 publications on cutaneous tumor diseases, the majority was related to malignant melanoma. This work is the first systematic literature review that aimed to report all available epidemiological data on skin diseases in Germany. In terms of study characteristics, a high heterogeneity was found for the different skin diseases. Even though the methodology of the included epidemiological studies varied considerably, the usefulness of these epidemiological data is extremely wide-ranging. Thus, this work can serve as a reference for various epidemiological questions.

Epidemiology of rosacea in a population-based study of 161,269 German employees.

BACKGROUND: Rosacea is a common chronic skin condition, but data on its epidemiology and related comorbidities are scarce. OBJECTIVES: To analyze the prevalence and associated cutaneous comorbidities of rosacea in Germany. METHODS: Voluntary dermatological full-body examinations were conducted between 2001 and 2016 in more than 500 German companies by experienced dermatologists and documented electronically. Point-prevalence rates were calculated, and associations were tested with chi-squared tests and logistic regression analysis. RESULTS: A total of 161,269 participants (mean age was 43.2 ± 10.9 years; 55.5% male) were included; 2.1% had rosacea (men: 2.1%, women 2.1%, mean age 50.7 ± 9.3 years). The prevalence of rosacea increased significantly with age (16-29 years: 0.3%; 30-39 years: 0.9%; 40-49 years: 2.0%; 50-59 years: 3.5%; 60-70 years: 5.7%). Furthermore, there was a significant decreasing prevalence from skin type I toward type IV (skin type I: 3.2%; II: 2.2%; III: 1.5%; IV: 0.4%). The most frequent dermatological comorbidities were: telangiectasia (OR = 2.5), folliculitis (OR = 1.8), seborrheic dermatitis (OR = 1.6), acne (OR = 1.6), tinea pedis (OR = 1.4), psoriasis (OR = 1.4), spider veins (OR = 1.1), and hemangioma (OR = 1.1). CONCLUSIONS: Rosacea is a common skin condition that is most prevalent above the age of 65 years. Rosacea patients have an increased risk for associated comorbidities. Therefore, the diagnostic and therapeutic process for rosacea patients must ensure an integrated, complete dermatological approach in terms of medical care.

Adherence to Guideline-Oriented Preventive Measures in Patients with Atopic Dermatitis in Germany.

BACKGROUND: Atopic dermatitis (AD) is a chronic inflammatory skin disease that is often associated with comorbidities and quality of life losses. The implementation of evidence-based preventive measures strengthens patient participation and offers the potential to improve quality of care for AD. OBJECTIVES: To assess adherence to guideline-oriented preventive measures in adult patients with AD in dermatological routine care in Germany. METHODS: The self-responsible application of preventive measures, clinical features, pruritus, disease severity, and duration of disease as well as skin disease-related quality of life were assessed in two independent cross-sectional studies in 2010 and 2017-2019. RESULTS: Between 2017 and 2019, 706 patients (55.8% female, mean age 41 years) were recruited in a comparable way to the survey in 2010 with 1,678 patients (60.5% female, mean age 38 years). Regular skin care was applied by 99.5% (2010: 94.9%), 90.9% avoided skin irritants (2010: 84.6%), and 80.2% (2010: 61.6%) did not smoke at home. Relaxation techniques were applied by 44.4% (2010: 29.9%). Advice on self-help measures was taken by 36.4% (2010: 27.1%) and 29.2% (2010: 15.4%) attended AD patient education courses. All six preventive measures categorized as obligatory were performed by 13.9% of the patients (2010: 6.7%). Predictors for the number of obligatory preventive measures applied were a high level of education, a longer disease duration, and a lower quality of life. CONCLUSIONS: Although the self-reported use of evidence-based preventive measures in the 2017-2019 study appears to be more frequent than in 2010, important measures are still insufficiently established. Hence, more implementation, including education, is needed to increase the use of guideline-oriented preventive measures.

Population-Based Epidemiologic Study in Venous Diseases in Germany - Prevalence, Comorbidity, and Medical Needs in a Cohort of 19,104 Workers.

INTRODUCTION: Data on the prevalence of chronic venous disorders (CVD) at the national level in Germany are scarce. METHODS: We performed a population-based observational study based on clinical examinations, personal history, and technical examinations. Data were collected from 2006 to 2015. Descriptive data analysis was done to determine CVD and chronic venous insufficiency (CVI) prevalence and occurrence of potential risk factors. Chi-squared tests were performed to estimate the influence of risk factors on the prevalence of CVD. RESULTS: In total, 19,104 employees from different branches were included. The majority of the examined people were doing office work (n = 8157; 80.2%). A total of 4038 persons (21.1%) show at least one sign of CVD. At least one sign of CVI could be found in 679 persons (3.6%). Being female was found to be protective with an odds ratio of 0.66 (95% CI 0.59-0.73). CONCLUSION: There is clear indication for active venous treatment in 22.3% of the adult working population in Germany.

Regional variations and prevalence of psoriasis in Germany from 2010 to 2017: a cross-sectional, spatio-epidemiological study on ambulatory claims data.

OBJECTIVES: Global prevalence rates of psoriasis differ significantly, with lowest rates in the equator region and increasing tendencies towards the north but also differences within-country. Information on regional variations in Germany is missing. This study aims to analyse the change of psoriasis prevalence in Germany over time and to detect regional variations. DESIGN: Cross sectional, spatio-epidemiological study on regional psoriasis prevalence in Germany. SETTING: Claims data study based on nationwide outpatient billing data on county level. METHODS: Analyses based on outpatient billing data for 2010-2017 derived from all people insured in statutory health insurances (about 72.8 million). We performed descriptive spatio-temporal analyses of prevalence rates using probability mapping and statistical smoothing methods, identified spatial clusters and examined a north-south gradient using spatial statistics. RESULTS: The prevalence increased from 147.4 per 10 000 in 2010 to 173.5 in 2017. In 2017, counties' prevalence rates ranged between 93.8 and 340.9. Decreased rates occurred mainly in southern counties, increased rates in northern and eastern counties. Clusters of low rates occur in southern and south-western Germany, clusters of high rates in the north and north-east. The correlation between counties' latitudes and their prevalence rates was high with Pearson's r=0.65 (p<0.05). CONCLUSION: Increased prevalence of psoriasis over time and marked regional variations in Germany were observed which need further investigation.

Prevalence and Cutaneous Comorbidity of Acne Vulgaris in the Working Population.

PURPOSE: Although acne vulgaris (AV) is a common disease and can persist into adulthood, there are few large-scale epidemiological studies on the prevalence of acne vulgaris in adults. The aim of our study was to characterise the epidemiology and comorbidity of acne vulgaris in working adults in Germany. PATIENTS AND METHODS: Within the framework of a cross-sectional study, a total of 161,269 employees underwent dermatological whole-body examinations in more than 500 German companies between 2001 and 2016. Point prevalence rates for acne vulgaris and further skin diseases and their 95% confidence intervals were calculated and differences between participants with and without acne vulgaris were tested with chi-squared tests. RESULTS: Mean age was 43.2 years ± 10.9, 55.5% were male. In total, n = 5311 people (3.3%) with acne vulgaris were identified. Prevalence decreased by age. Controlling for age and gender, acne was significantly associated with folliculitis (OR = 1.91; CI: 1.76-2.07), contact dermatitis (OR = 1.74; CI: 1.08-2.81), rosacea (OR = 1.74; CI: 1.40-2.15), pyoderma (OR = 1.58; 1.22-2.06), seborrheic dermatitis (OR = 1.47; CI: 1.27-1.71), hand eczema (OR = 1.34; CI: 1.00-1.76), verruca vulgaris plantaris (OR = 1.29; CI: 1.09-1.51), tinea pedis (OR = 1.27; CI: 1.10-1.47), spider veins (OR = 1.26; CI: 1.16-1.38) and telangiectasia (OR = 1.15; CI: 1.02-1.30). CONCLUSION: These data underline the importance of acne vulgaris in the adult population. Further studies to better understand the pathophysiology of AV and its comorbidity in different phases of adulthood would be desirable to develop appropriate guidelines and therapy concepts.

Prevalence and Associated Diseases of Seborrheic Skin in Adults.

BACKGROUND: Seborrhea is a skin condition characterized by abundant production of sebum associated with typical dermatological conditions such as rosacea and acne. Little is known about the prevalence of seborrhea and the frequency of concurrent skin diseases in the general population. OBJECTIVE: To investigate the epidemiology and comorbidity of seborrhea in the adolescent and adult working population. METHODS: In large-scale examinations by dermatologists in 343 German companies, the seborrheic skin type and the occurrence of skin findings were documented electronically. Odds ratios (OR) and their 95% confidence intervals (95% CI) of further skin diseases were computed. Logistic regression analyses were conducted for each disease using seborrhea as dependent variable. RESULTS: A total of 48,630 employees were examined. About 6.0% showed seborrhea (6.6% in men, 5.4% in women). Seborrhea strongly predicted acne (OR 3.59; CI 3.18-4.05), trichilemmal cysts (OR 1.99; CI 1.25-3.18) and rosacea (OR 1.45; CI 1.17-1.81). Regression analyses controlling for age, gender and phototype confirmed significant associations of seborrhea with acne and rosacea. CONCLUSION: Only a minor proportion of the working population shows meaningful seborrheic skin. However, this condition predicts distinct skin diseases and thus needs attention, in particular, with respect to consulting and secondary prevention.

Prevalence and Medications of Atopic Dermatitis in Germany: Claims Data Analysis.

BACKGROUND: Information on the prevalence of atopic dermatitis (AD) varies greatly, and so far, only a few studies describe the healthcare of patients with AD in Germany. OBJECTIVE: The aim of the study is to describe the prevalence and medications of people with AD in Germany. METHODS: Health insurance data for the year 2019 were examined. Prevalence rates, the severity of disease, comorbidities and pharmaceutical supply were analyzed. Insured persons with AD were identified with at least one outpatient or inpatient International Classification Code of Diseases (L20). RESULTS: In 2019, 4.21% [95% CI 4.21-4.22%] of insured persons had AD (3.6 million). Women were affected slightly more frequently than men (4.74% [95% CI 4.73-4.74%] and 3.64% [95% CI 3.64-3.65%]). Adolescents and children under the age of 15 had the highest prevalence of AD compared to other age groups (9.44% [95% CI 9.42-9.46%]). Majority of the insured persons with AD were affected by a mild to moderate form of the disease. The most common co-morbidity was infections of the skin (RR 5.00 [95% CI 4.97-5.02%]). Some patients were treated by a dermatologist, while others by a general practitioner, 39.10% and 36.74%, respectively. Of the anti-inflammatory drugs, systemic glucocorticosteroids preparations were used most frequently and were most frequently prescribed by the general practitioner. With a total of 42,841 prescriptions (1.53%), methotrexate (third-line treatment option) was prescribed more frequently than ciclosporin with 19,628 prescriptions (0.70%) or azathioprine with 25,696 prescriptions (0.92%). Ciclosporin (first-line treatment option) was prescribed much more frequently by a dermatologist (44.00% versus 14.32% by general practitioner). The biological dupilumab was prescribed 30,801 times (1,10%) and was also primarily prescribed by a dermatologist (66.67%). CONCLUSION: The present results reveal that a specialist treats approximately one-third of the patients with AD and that there is still a drug undersupply in some cases, especially concerning innovative drugs.

Determining the Minimal Important Difference for the Wound-QoL Questionnaire.

BACKGROUND: The questionnaire for the quality of life with chronic wounds (Wound-QoL) is a valid and reliable instrument to determine the disease-specific health-related QoL of patients with chronic wounds. For the interpretation of HRQoL scores, it is additionally important to know which differences in scores are considered meaningful. The minimal important difference (MID) is defined as a change in HRQoL that a patient would consider meaningful, such that the patient would judge a treatment to be beneficial and worthy of repeating. OBJECTIVE: To interpret changes in the Wound-QoL scores and draw conclusions regarding the relevance of detected changes; the purpose of this study was to estimate the MID of the Wound-QoL global score and its subscales for patients with chronic wounds. PATIENTS AND METHODS: Patients completed the Wound-QoL before and four to six weeks after treatment and additionally gave a global rating of wound status change after treatment. The global rating of change served as an anchor question. MIDs were calculated based on an anchor-based and a distribution-based method. RESULTS: In total, 227 patients participated in the study. The mean age of the study population was 66.9 (± 12.7) median was 69.5, and 51.5% of the patients were female. MIDs for the Wound-QoL global score ranged from 0.47 to 0.52, proposing an overall estimation of 0.50. CONCLUSION: The results can be used to measure and interpret changes in wound-specific QoL over time.

Epidemiology of Vitiligo - A Dual Population-Based Approach.

BACKGROUND: Most epidemiological data on vitiligo refer to selected environments or focus on the prevalence of comorbidity unrelated to the population. OBJECTIVE: Aim of the study was to gain robust representative prevalence data on vitiligo and on associated dermatologic comorbidity in the German adult population. METHODS: A dual population-based approach was applied with 1) primary data obtained between 2004 and 2014 from dermatological exams in the general working population; 2) claims data from a large German statutory health insurance, reference year 2010. RESULTS: In the working cohort (N = 121,783; 57% male; mean age 43 years), the prevalence of vitiligo was 0.77% (0.84% in men; 0.67% in women). In the claims data (N = 1,619,678; 38% male; mean age 46 years), prevalence was 0.17% (0.14% in men; 0.18% in women). In the working cohort, vitiligo was significantly more common in people with fair skin type, ephelides and port-wine stains and less common in people with acne and solar lentigines. In the claims data, vitiligo was associated with a variety of skin conditions, eg, atopic dermatitis, psoriasis and alopecia areata. CONCLUSION: The resulting discrepancy of claims vs primary data between 0.17% and 0.77% indicates the most probable spectrum of vitiligo prevalence in Germany. It is more frequently observed in clinical exams than recorded in claims data, indicating a marked proportion of people seeking no medical help. Such nonattendance may result from the fact that many treatment options do not provide satisfying benefits to the patients.

Three-dimensional in vivo analysis of water uptake and translocation in maize roots by fast neutron tomography.

Root water uptake is an essential process for terrestrial plants that strongly affects the spatiotemporal distribution of water in vegetated soil. Fast neutron tomography is a recently established non-invasive imaging technique capable to capture the 3D architecture of root systems in situ and even allows for tracking of three-dimensional water flow in soil and roots. We present an in vivo analysis of local water uptake and transport by roots of soil-grown maize plants-for the first time measured in a three-dimensional time-resolved manner. Using deuterated water as tracer in infiltration experiments, we visualized soil imbibition, local root uptake, and tracked the transport of deuterated water throughout the fibrous root system for a day and night situation. This revealed significant differences in water transport between different root types. The primary root was the preferred water transport path in the 13-days-old plants while seminal roots of comparable size and length contributed little to plant water supply. The results underline the unique potential of fast neutron tomography to provide time-resolved 3D in vivo information on the water uptake and transport dynamics of plant root systems, thus contributing to a better understanding of the complex interactions of plant, soil and water.

Incidence of atopic conditions in people with psoriasis: a population-based analysis.

BACKGROUND: Large-scale data on the association between psoriasis and atopic diseases are scarce. OBJECTIVES: To evaluate the concomitant prevalence of atopic conditions and psoriasis. MATERIALS & METHODS: In this cross-sectional study, employees between 16 and 70 years of age were examined in more than 400 German companies by dermatologists, between 2006 and 2014. Two different definitions of atopic conditions were applied: "current atopic condition" (point prevalence) and "current or previous atopic condition" (lifetime prevalence). Bivariate comparisons as well as logistic regression analyses controlling for age and sex were performed. RESULTS: In total, 90,265 persons were included in the study; 58.5% male; mean age: 43.2 ± 10.7 years. Point prevalence for psoriasis was 2.0% (n = 1,788), and lifetime prevalence of atopic conditions was 32.7% (n = 29,501). Atopic conditions were significantly less frequent (29.6%, n = 530) in persons with psoriasis compared to those without psoriasis (32.7 %, n = 28,917; OR = 0.865; CI: 0.781 - 0.959). Concurrent and prior atopic conditions were observed in 13.7% (n = 245) of persons with psoriasis versus 15.6% without psoriasis (n = 13,835; OR = 0.857; CI: 0.748-0.981). Controlling for age and sex, significant differences were found between persons with and without psoriasis for symptomatic atopic conditions such as hypersensitivity to pollen (OR = 0.864; CI: 0.748-0.997) and animal epithelia (OR = 0.764; CI: 0.609-0.958). CONCLUSION: Even though the prevalence of atopic diseases is less frequent in individuals with psoriasis than in those without psoriasis, this study suggests that atopic conditions such as atopic dermatitis may also play a relevant role in psoriasis.