Trends and regional distribution of outpatient claims for asthma, 2009-2016, Germany.

Akmatov, Manas K.; Holstiege, Jakob; Steffen, Annika; Bätzing, Jörg

Objective To investigate asthma morbidity in Germany by calculating current prevalence, examining its temporal and spatial trends and estimating the total number of asthmatics in Germany and calculating age-, sex- and residence-specific risk. Methods We used claims data reported by physicians during 2009-2016, including outpatient diagnoses of all statutory health insured individuals, comprising 85.3% (70 416 019/82 521 653) of the total population in Germany in 2016. We performed a spatial analysis of asthma prevalence according to administrative district by calculating Global and Local Moran's I. We assessed the risk of asthma by sex, age, type of residence (rural versus urban) and federal state (East versus West) using a multilevel parametric survival regression. Findings We estimated that 4.7 million individuals were affected by asthma in 2016, including 0.8 million children and 3.9 million adults. We observed a slightly higher prevalence (with an increasing trend) among adults (5.85%; 3 408 622/58 246 299) compared to children (5.13%; 624 899/12 169 720), and calculated an age-standardized prevalence of 5.76% (95% confidence interval, CI: 5.76-5.77). We found evidence of a strong spatial autocorrelation (Global Moran's I: 0.50, P < 0.0001), and identified local spatial clusters with higher levels of prevalence. Living in the western (versus eastern) federal states and living in densely populated large urban municipalities (versus rural area) were independently associated with an increased risk of asthma, with hazard ratios of 1.33 (95% CI: 1.32-1.34) and 1.32 (95% CI: 1.31-1.32), respectively. Conclusion Our insights into the spatial distribution of asthma morbidity may inform public health interventions, including region-specific prevention programmes and control.

GERMANY; ASTHMA; CONFIDENCE intervals; HEALTH insurance; MATHEMATICAL statistics; METROPOLITAN areas; POPULATION geography; PUBLIC health; REGRESSION analysis; RURAL conditions; HEALTH insurance reimbursement; PARAMETERS (Statistics); DISEASE prevalence; PROPORTIONAL hazards models; DESCRIPTIVE statistics

Bulletin of the World Health Organization, 2020, Vol 98, Issue 1, p40

0042-9686

Academic Journal

10.2471/BLT.19.229773