Diabetes ‘Epidemic’ in Germany? A Critical Look at Health Insurance Data Sources

 

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Abstract

Aims:

The German diabetes prevalence is considered to be one of the highest in Europe. It is often estimated based on claims data of a regional health insurance (Allgemeine Ortskrankenkasse; AOK). We studied the prevalence of diabetes within AOK members compared to other types of funds.

Methods:

We pooled data of the German National Telephone Health Interview Surveys 2003 and 2004 comprising a nationally representative sample of 15 354 adults aged 18 years and older. We first estimated the crude prevalence of diabetes stratified by funds. To analyze the association between diabetes prevalence and membership in different health insurance funds, we fitted logistic regression models and stepwise adjusted for age, sex, region, comorbidities, anthropometric measures, and lifestyle variables.

Results:

The overall prevalence of diabetes was 6.5%. Compared to all other statutory health insurance funds, the prevalence of diabetes was nearly twice as high within the AOK (10.1% vs. 5.4%; Odds Ratio [OR]: 1.96; 95% confidence interval [CI]: 1.67–2.31). Although continuously decreasing, significant differences remained after controlling for demographic variables (OR: 1.62; 95% CI: 1.38–1.90) and in the fully adjusted model (OR: 1.36; 95% CI: 1.14–1.62). Persons privately insured had a prevalence of 4.8%, which was not significantly different than for members of statutory health insurance funds other than the AOK.

Conclusions:

The prevalence of diabetes was roughly twice as high in the AOK compared to all other statutory health insurance funds. The estimated German prevalence of diabetes is likely to be too high when it is based on these data.

• References

• 1 Bundesärztekammer (BÄK), Kassenärztliche Bundesvereinigung (KBV), Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF). Nationale VersorgungsLeitlinie Typ-2-Diabetes Präventions- und Behandlungsstrategien für Fußkomplikationen. Langfassung Version 2.8, 2010 http://www.versorgungsleitlinien.de/themen/diabetes2/dm2_fuss/pdf/nvl_t2dfuss_lang.pdf (Accessed: 18 June, 2011)
  PubMedGoogle Scholar
• 2 Ellert U, Wirz J, Ziese T. Telefonischer Gesundheitssurvey des Robert Koch- Instituts (2. Welle). Deskriptiver Ergebnisteil. Berlin: Robert Koch-Institut,; 2006
  PubMedGoogle Scholar
• 3 Federal Ministry of Health Gesetzliche Krankenversicherung: Mitglieder, mitversicherte Angehörige, Beitragssätze und Krankenstand. Monatswerte Januar bis Juni 2004 (Ergebnisse der GKV-Statistik KM1), 2004 http://www.bmg.bund.de/fileadmin/redaktion/pdf_statistiken/krankenversicherung/KM1Monat-pdf-4865.pdf Accessed: 18 June, 2011. (Archived by WebCite® at http://www.webcitation.org/5xfvwMPXE)
  PubMed
• 4 Federal Ministry of Health Gesetzliche Krankenversicherung: Mitglieder, mitversicherte Angehörige und Krankenstand. Monatswerte Januar 2011 (Ergebnisse der GKV-Statistik KM1), 2011. http://www.bmg.bund.de/fileadmin/redaktion/pdf_statistiken/krankenversicherung/Mitglieder_Versicherte_GKV_Januar_2011.pdf Accessed: 18 June, 20101 (Archived by WebCite® at http://www.webcitation.org/5xfw4s90q)
  PubMed
• 5 Geyer S, Peter R, Nielsen I. Health inequalities in different age groups: the case of type 2-diabetes: a study with health insurance and medication data. Soz Praventivmed 2004; 49: 328-335
  PubMedGoogle Scholar
• 6 Hauner H, Köster I, Schubert I. Trends in der Prävalenz und ambulanten Versorgung von Menschen mit Diabetes mellitus. Eine Analyse der Versichertenstichprobe AOK Hessen/KV Hessen im Zeitraum von 1998 bis 2004. Dtsch Ärztebl 2007; 104: A2799-A2805
  PubMedGoogle Scholar
• 7 Hauner H. Diabetesepidemie und Dunkelziffer. In diabetes ed. Deutscher Gesundheitsbericht Diabetes 2011. Mainz: Kirchheim Verlag; 2011: 8-13
  Google Scholar
• 8 Heidemann C, Kroll L, Icks A et al. Prevalence of known diabetes in German adults aged 25–69 years: results from national health surveys over 15 years. Diabet Med 2009; 26: 655-658
  CrossrefPubMedGoogle Scholar
• 9 Hoffmann F, Haastert B, Koch M et al. The effect of diabetes on incidence and mortality in end-stage renal disease in Germany. Nephrol Dial Transplant 2011; 26: 1634-1640
  CrossrefPubMedGoogle Scholar
• 10 Hoffmann F, Icks A. Diabetes prevalence based on health insurance claims: large differences between companies. Diabet Med 2011; a 28: 919-923
  CrossrefPubMedGoogle Scholar
• 11 Hoffmann F, Icks A. Unterschiede in der Versichertenstruktur von Krankenkassen und deren Auswirkungen für die Versorgungsforschung: Ergebnisse des Bertelsmann-Gesundheitsmonitors. Gesundheitswesen 2011; b 2011 Jul 13 [Epub ahead of print]
  PubMedGoogle Scholar
• 12 Icks A, Haastert B, Trautner C et al. Incidence of lower-limb amputations in the diabetic compared to the non-diabetic population. findings from nationwide insurance data, Germany, 2005-2007. Exp Clin Endocrinol Diabetes 2009; 117: 500-504
  Article in Thieme ConnectPubMedGoogle Scholar
• 13 Icks A, Scheer M, Morbach S et al. Time-Dependent Impact of Diabetes on Mortality in Patients After Major Lower Extremity Amputation: Survival in a population-based 5-year cohort in Germany. Diabetes Care 2011; 34: 1350-1354
  CrossrefPubMedGoogle Scholar
• 14 International Diabetes Federation (IDF) . Diabetes Atlas. 4th Edition Brussels: International Diabetes Federation; 2009
  Google Scholar
• 15 Kohler M, Rieck A, Borch S et al. Erster telefonischer Gesundheitssurvey des Robert Koch-Instituts–Methodische Beiträge. Berlin: Robert Koch-Institut; 2005
  Google Scholar
• 16 Köster I, Huppertz E, Hauner H et al. Direct Costs of Diabetes Mellitus in Germany – CoDiM 2000–2007. Exp Clin Endocrinol Diabetes 2011; 119: 377-385
  Article in Thieme ConnectPubMedGoogle Scholar
• 17 Köster I, von Ferber L, Ihle P et al. The cost burden of diabetes mellitus: the evidence from Germany – the CoDiM study. Diabetologia 2006; 49: 1498-1504
  CrossrefPubMedGoogle Scholar
• 18 Linder R, Ahrens S, Köppel D et al. The benefit and efficiency of the disease management program for type 2 diabetes. Dtsch Arztebl Int 2011; 108: 155-162
  PubMedGoogle Scholar
• 19 Lisac M, Reimers L, Henke KD et al. Access and choice – competition under the roof of solidarity in German health care: an analysis of health policy reforms since 2004. Health Econ Policy Law 2010; 5: 31-52
  CrossrefPubMedGoogle Scholar
• 20 Meisinger C, Heier M, Doering A et al. KORA Group. Prevalence of known diabetes and antidiabetic therapy between 1984/1985 and 1999/2001 in southern Germany. Diabetes Care 2004; 27: 2985-2987
  CrossrefPubMedGoogle Scholar
• 21 Miksch A, Laux G, Ose D et al. Is there a survival benefit within a German primary care-based disease management program?. Am J Manag Care 2010; 16: 49-54
  PubMedGoogle Scholar
• 22 OECD , Diabetes Prevalence and Incidence. In: OECD. Health at a Glance: Europe 2010. 2010: 52-53 DOI: 10.1787/9789264090316-19-en
  Google Scholar
• 23 Robert Koch Institut . Daten und Fakten: Ergebnisse der Studie „Gesundheit in Deutschland aktuell 2009“. Berlin: Robert Koch Institut; 2011
  Google Scholar
• 24 Schipf S, Werner A, Tamayo T et al. Regional differences in the prevalence of known type 2 diabetes mellitus in 45–74 years old individuals: Results from six population-based studies in Germany (DIAB-CORE Consortium). Diabet Med 2012; DOI: 10.1111/j.1464-5491.2012.03578.x.. [Epub ahead of print]
  PubMedGoogle Scholar
• 25 Schulze MB, Rathmann W, Giani G et al. Diabetesprävalenz. Verlässliche Schätzungen stehen noch aus. Die von der International Diabetes Federation vorgelegten Daten sind nicht belastbar. Ein Plädoyer für bessere epidemiologische Daten. Dtsch Arztebl 2010; 10: A1694-A1696
  PubMedGoogle Scholar
• 26 Stock S, Drabik A, Büscher G et al. German diabetes management programs improve quality of care and curb costs. Health Aff (Millwood) 2010; 29: 2197-2205
  CrossrefPubMedGoogle Scholar
• 27 Stock SA, Redaelli M, Wendland G et al. Diabetes – prevalence and cost of illness in Germany: a study evaluating data from the statutory health insurance in Germany. Diabet Med 2006; 23: 299-305
  CrossrefPubMedGoogle Scholar
• 28 von Elm E, Altman DG, Egger M et al. STROBE initiative. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. PLoS Med 2007; 4 (10) e296
  CrossrefPubMedGoogle Scholar
• 29 von Ferber L, Köster I, Hauner H. Medical costs of diabetic complications total costs and excess costs by age and type of treatment results of the German CoDiM Study. Exp Clin Endocrinol Diabetes 2007; 115: 97-104
  Article in Thieme ConnectPubMedGoogle Scholar