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ABSTRACT: Dementia patients suffering from behavioral and psychological symptoms (BPSD) are often treated with antipsychotics. Trial results document an increased risk for serious adverse events and mortality in dementia patients taking these agents. Furthermore, the efficacy of treating BPSD with antipsychotics seems to be only modest. Using data of a German statutory health insurance company, we examined prescription trends of antipsychotics in prevalent dementia patients in the context of official warnings. The study period is 2004-2009. We studied trends in demographics, age and sex, as well as need of care and the intake of typical and atypical antipsychotics. Seeking for linear trends adjusted for age, sex and level of care between 2004 and 2009, we obtained p-values from a multivariate logistic regression. Prescription volumes were calculated by number of packages as well as defined daily doses (DDDs) using multiple linear regressions for trends in prescriptions amount. We included 3460-8042 patients per year (mean age 80 years). The prescription prevalence of antipsychotics decreased from 35.5% in 2004 to 32.5% in 2009 (multivariate analysis for linear trend: p=0.1645). Overall prescriptions for typical antipsychotics decreased (from 27.2% in 2004 to 23.0% in 2009, p<0.0001) and prescriptions for atypical antipsychotics increased from 17.1% to 18.9% (p<0.0001). The mean DDD per treated patient increased from 80.5 to 91.2 (2004-2009; p=0.0047). Our findings imply that warnings of international drug authorities and manufacturers against adverse drug events in dementia patients receiving antipsychotics did not impact overall prescription behavior.
European neuropsychopharmacology: the journal of the European College of Neuropsychopharmacology 03/2013; · 3.68 Impact Factor
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ABSTRACT: Objective: Data on the prevalence of depressive disorders in adolescents are scarce. We aimed to examine the administrative prevalence of depressive disorders and related comorbidities in German adolescents. A second objective of was to assess potential regional (East vs. West Germany) differences in depression prevalence. Method: Data of a statutory health insurance company were analysed and outpatients from 12 to 18 years of age with diagnosed depression during a one-year-period (2009) were identified. Results: The population at risk consisted of 140,563 adolescents. Of these, 4,295 (41.2% male; mean age: 15.5 years) had a diagnosis of depression. This equates to a prevalence of 3.1% (females: 3.7%, males: 2.5%). There were no significant differences between East and West Germany. Of all adolescents with depression, 62.5% had at least one comorbid psychiatric diagnosis, with anxiety and emotional disorders (23.7%), somatoform disorders (16.8%), hyperkinetic disorders (16.2%) and posttraumatic stress disorder (10.0%) being most frequently diagnosed. Conclusions: The depression prevalence in this sample was lower than that in studies of clinical samples. There was a marked prevalence of psychiatric comorbidities, especially of internalizing disorders. In adolescents, the risk of depression seems to be comparable in both East and West Germany.
Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie 11/2012; 40(6):399-404. · 0.99 Impact Factor
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ABSTRACT: To provide information about occurrence and patterns of geriatric morbidity and need for long-term care in patients newly diagnosed with dementia compared to controls without dementia.
An analysis of administrative data was conducted to compare the geriatric outpatient diagnoses and the patterns of care dependency of 1,848 incident dementia patients and 7,385 matched non-dementia controls older than 65 years in the incidence year.
In most cases the geriatric characteristics show an increased (partly statistically significant) prevalence in the group with dementia as compared to controls. Moreover, dementia patients show a higher number of geriatric comorbidities in contrast to non-dementia controls. Furthermore, the percentage of persons with need for long-term care in the dementia-group is significantly higher than for controls (44.4 vs. 12.9 %).
Prevention, early recognition or treatment of attendant symptoms are very important in daily clinical and nursing care in patients with dementia to ameliorate the progression of the disease and to improve the patients' quality of life.
Psychiatrische Praxis 07/2012; 39(5):222-7. · 1.64 Impact Factor
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ABSTRACT: Several studies evaluated hip fracture incidences and its predictors and trends using hospital discharge registries. However, this source does not provide patient-related data, therefore the hospital changes or re-hospitalisations cannot be identified as "double counting". If double counting differs with age, sex, region, and time, the estimates may be biased. Aim of our study was to evaluate the magnitude of multiple counting and, in particular, its variation with age, sex, region, and calendar year. We used data of a German-wide health insurance (1.6 million members). Between 1998 and 2009, we assessed all hip fractures (ICD 9: 820, ICD 10: S.72.0-2) in individuals aged 50 years or older and calculated the probability to be a patient's "first" fracture in each calendar year. Using multiple logistic regressions, we estimated the influence of age, sex, region, and calendar year. The probabilities of a "first fracture" per patient and year varied between 86.7 % (95 % confidence interval 83.9-89.2 %, year 2003) and 93.9 % (90.9-96.2 %, year 1998). Age (odds ratio per 5 years 0.89; 95 % CI 0.86-0.92), region (East vs. West Germany: 0.65; 0.52-0.81), and calendar year (per year 0.97; 0.95-0.99) were significantly associated in the multiple regression. The probability to have multiple counting of hip fracture events varied significantly with age, region, and calendar year. It should be discussed that analyses which do not account for this may provide invalid estimates and conclusions when differences between age groups and regions or trends are analyzed.
Wiener klinische Wochenschrift 06/2012; 124(11-12):391-4. · 0.81 Impact Factor
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ABSTRACT: To estimate the impact of diabetes on mortality in patients after first stroke event.
Using claims data from a nationwide statutory health insurance fund (Gmünder ErsatzKasse), we assessed all deaths in a cohort of 5,757 patients with a first stroke between 2005 and 2007 (69.3% male, mean age 68.1 years, 32.2% with diabetes) up to 2009. By use of Cox regression, we estimated time-dependent hazard ratios (HRs) to compare patients with and without diabetes stratified by sex.
The cumulative 5-year mortality was 40.0 and 54.2% in diabetic men and women, and 32.3 and 38.1% in their nondiabetic counterparts, respectively. In males, mortality was significantly lower in diabetic compared with nondiabetic patients in the first 30 days (multiple-adjusted HR 0.67 [95% CI 0.53-0.84]). After approximately a quarter of a year, the diabetes risk increased, yielding crossed survival curves. Later on, mortality risk tended to be similar in diabetic and nondiabetic men (1-2 years: 1.42 [1.09-1.85]; 3-5 years: 1.00 [0.67-1.41]; time dependency of diabetes, P = 0.008). In women, the pattern was similar; however, time dependency was not statistically significant (P = 0.89). Increasing age, hemorrhagic stroke, renal failure (only in men), levels of care dependency, and number of prescribed medications were significantly associated with mortality.
We found a time-dependent mortality risk of diabetes after first stroke in men. Possible explanations may be type of stroke or earlier and more intensive treatment of risk factors in diabetic patients.
Diabetes care 06/2012; 35(9):1868-75. · 8.09 Impact Factor
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ABSTRACT: Data on medical treatment of adolescents with depression are scarce. This study aimed to examine outpatient health services utilisation of depressive disorders in adolescents.
Data of a statutory health insurance company were analysed and outpatients from 12 to 18 years old with diagnosed depression during a 1-year period (2009) were identified. For this cohort, the prescription of antidepressants and psychotherapy was evaluated with respect to age and sex.
A total of 4295 patients (41.2% males; mean age, 15.5 years) matched the inclusion criteria. Of the patients, 29.7% consulted a child and adolescent psychiatrist. A total of 59.6% were treated with psychotherapy only, 9.6% were treated with a combination of psychotherapy and antidepressants, and 1.9% received only antidepressants. For 28.8% of patients, no specific depression-related treatment was prescribed. A total of 1357 packages of antidepressants were analysed, of which fluoxetine (24.4% of prescriptions), citalopram (14.0%), and mirtazapine (9.7%) were the most frequently prescribed substances. Regarding substance classes, selective serotonin reuptake inhibitors (SSRIs; 55.6%), tricyclic antidepressants (TCAs; 17.9%), and hypericum (St. John's wort; 8.5%) were most common.
Although the underlying data were coded for insurance purposes, which might result in some data impreciseness, this naturalistic study furnishes evidence that outpatient treatment of adolescents with depressive disorders in Germany only partly complies with guideline recommendations for first-line treatment: Although the prescriptions of SSRI for adolescent depression have risen over recent years, still, a quarter of antidepressant prescriptions for adolescents with depression were TCA or hypericum. Therefore, dissemination of knowledge on state-of-the-art treatment for adolescent depression remains a major educational goal.
Pharmacoepidemiology and Drug Safety 05/2012; 21(9):972-9. · 2.53 Impact Factor
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ABSTRACT: Hintergrund:
Krebserkrankungen rücken als häufige Todesursache, aufgrund des demographischen Wandels und der hohen Kosten in die öffentliche
und fachliche Diskussion. Über die Versorgung onkologischer Patienten ist vergleichsweise wenig bekannt.
Methodik:
In diesem Artikel wird zunächst ein Überblick über Versorgungsforschung und den Nutzen von Routinedaten der Gesetzlichen Krankenversicherung
(GKV) gegeben. Anschließend werden exemplarisch Arzneimittelverordnungen niedergelassener Onkologen mit Routinedaten der Gmünder
ErsatzKasse (GEK) im Zeitraum 10–12/2008 analysiert.
Ergebnisse:
Insgesamt wurden 1,98 Mio. Rezepte in die Auswertung eingeschlossen. Der Anteil der Rezepturen an den Gesamtverordnungen ist
bei Onkologen im Vergleich zu sonstigen Vertragsärzten mehr als 17-mal höher (34,4% vs. 2,0%). Onkologen verordnen zudem vergleichsweise
hochpreisige Rezepturen (Median: 397,68 Euro vs. 15,45 Euro).
Schlussfolgerung:
Mehr Versorgungsforschung in der Onkologie ist dringend erforderlich. Routinedaten der Kassen bieten hier eine breite Ausgangsbasis
für Forschungszwecke, insbesondere wenn diese mit anderen Daten verknüpft werden. Bei Rezepturen fehlen in Routinedaten allerdings
jegliche Informationen zum verordneten Arzneimittel.
Background:
Cancer is in the focus of public and scientific interest as one of the leading causes of death, with an increasing case load
due to demographic changes and rising treatment costs. Comparatively, little is known about health care utilization of cancer
patients.
Methods:
This article first gives an overview of health services research and claims data of German statutory health insurance funds.
Second, claims data of the Gmünder ErsatzKasse (GEK) for a period of 3 months (10–12/2008) are used to analyze patterns of
drug prescriptions by oncologists.
Results:
A total of 1.98 million prescriptions were included. Based on all prescriptions, the proportion of compounded prescriptions
is about 17 times higher for oncologists compared to other physicians (34.4% vs. 2.0%). Fur- thermore, the costs of these
solutions prescribed by oncologists are higher (median: 397.68 Euros vs. 15.45 Euros).
Conclusion:
Health services research in oncology is urgently needed. Claims data of German health insurance funds offer a broad range
of opportunities, especially when linked with other data. However, in the case of individually prepared solutions, claims
data provide no further information on the drug.
Schlüsselwörter:
Onkologie-Versorgungsforschung-Gesetzliche Krankenversicherung-Routinedaten-Arzneimittel
Key Words:
Oncology-Health services research-Statutory health insurance-Claims data-Drugs
04/2012; 105(6):409-415.
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ABSTRACT: Dementia is an important disease in older age. Existing studies on dementia mortality face limitations. For instance, they are based on prevalent, small, or geographically limited samples or do not include controls. We aimed to study survival after the first diagnosis of dementia compared with a control group.
We analyzed claims data of a German health insurance company, including 1,818 incident dementia cases and 7,235 age- and sex-matched non-dementia controls (53% male; mean age 78.8 years). The follow-up was five years. We assessed survival with the Kaplan-Meier curves and performed Cox proportional hazard regression, also including nursing care dependency and comorbidities.
The cumulative five-year mortality was 53.5% in the dementia cases and 31.1% in the control group (hazard ratio: 2.1). Even after adjusting for comorbidities and nursing care, the mortality risk was 1.5 times higher for patients with incident dementia than for controls. Nursing care dependency showed high influence on mortality, likewise in dementia patients and controls.
Although some factors, such as education or the type and severity of dementia, could not be included in the analyses, our study shows a clear influence of dementia on mortality irrespective of age, sex, care dependency, and comorbidities. The strongest influence on mortality was found for dementia patients with nursing care dependency. Taking into account their mortality of around 70% in care level 1 and up to 80% in care levels 2 and 3, healthcare delivery to these patient groups should strongly consider elements of palliative care focusing on the quality of life.
International Psychogeriatrics 03/2012; 24(9):1522-30. · 2.24 Impact Factor
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ABSTRACT: Although most guidelines recommend the use of cholinesterase inhibitors (ChEIs) for mild to moderate Alzheimer's Disease, only a small proportion of affected patients receive these drugs. We aimed to study if geriatric comorbidity and polypharmacy influence the prescription of ChEIs in patients with dementia in Germany.
We used claims data of 1,848 incident patients with dementia aged 65 years and older. Inclusion criteria were first outpatient diagnoses for dementia in at least three of four consecutive quarters (incidence year). Our dependent variable was the prescription of at least one ChEI in the incidence year. Main independent variables were polypharmacy (defined as the number of prescribed medications categorized into quartiles) and measures of geriatric comorbidity (levels of care dependency and 14 symptom complexes characterizing geriatric patients). Data were analyzed by multivariate logistic regression.
On average, patients were 78.7 years old (47.6% female) and received 9.7 different medications (interquartile range: 6-13). 44.4% were assigned to one of three care levels and virtually all patients (92.0%) had at least one symptom complex characterizing geriatric patients. 13.0% received at least one ChEI within the incidence year. Patients not assigned to the highest care level were more likely to receive a prescription (e.g., no level of care dependency vs. level 3: adjusted Odds Ratio [OR]: 5.35; 95% CI: 1.61-17.81). The chance decreased with increasing numbers of symptoms characterizing geriatric patients (e.g., 0 vs. 5+ geriatric complexes: OR: 4.23; 95% CI: 2.06-8.69). The overall number of prescribed medications had no influence on ChEI prescription and a significant effect of age could only be found in the univariate analysis. Living in a rural compared to an urban environment and contacts to neurologists or psychiatrists were associated with a significant increase in the likelihood of receiving ChEIs in the multivariate analysis.
It seems that not age as such but the overall clinical condition of a patient including care dependency and geriatric comorbidities influences the process of decision making on prescription of ChEIs.
BMC Psychiatry 12/2011; 11:190. · 2.55 Impact Factor
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Europace 07/2011; 13(12):1801; author reply 1801. · 1.98 Impact Factor
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ABSTRACT: Objectives of this study were to examine the administrative incidence of urinary incontinence in children and to assess related outpatient health services utilization in this cohort.
Data of a statutory health insurance company were analyzed and outpatients from 1 to 18 years of age with a first recorded ICD-10 code for non-organic urinary incontinence during a 1-year-period (2007) were identified. For this cohort, the prescription of desmopressin, antispasmodics, non-selective monoamine reuptake inhibitors, alarm devices, and incontinence pads in the quarter of the first diagnosis and in the following one (i.e., 6 months) was evaluated with respect to age and gender.
3,188 patients (59.4% male; mean age 6.8 years) matched the inclusion criteria, of whom 25.4% were under 5 years old. 7.9% were prescribed desmopressin, 7.4% received urinary antispasmodics, and 7.0% were treated with alarm devices. For 77.9% of patients, no specific incontinence-related treatments were prescribed. We found considerable differences in treatment patterns between age groups, with patients ≥ 7 years receiving desmopressin more frequently than alarm devices. Regarding gender differences, the proportion of males treated with alarm devices (prevalence ratio [PR] 1.46; 95% confidence interval [95%CI] 1.11-1.92) and at least one specific treatment (PR 1.19; 95%CI 1.04-1.35) remained statistically significantly higher, even after adjusting for age.
In our study, we found evidence that treatment modalities only partly comply with the current guidelines for treatment of children and adolescents with non-organic urinary incontinence. Therefore, the dissemination of current guidelines remains a major educational goal.
Neurourology and Urodynamics 07/2011; 31(1):93-8. · 2.96 Impact Factor
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ABSTRACT: To estimate the impact of diabetes on mortality in patients after first major lower extremity amputation (LEA).
Using claims data of a nationwide statutory health insurance, we assessed all deaths in a cohort of all 444 patients with a first major LEA since 2005 (71.8% male; mean age 69.1 years; 58.3% diabetic; 43% with amputation above the knee) up to 2009. Using Cox regression, we estimated the time-dependent hazard ratios to compare patients with and without diabetes.
The cumulative 5-year mortality was 68% in diabetic and 59% in nondiabetic individuals. In the first course, mortality was lower in diabetic compared with nondiabetic patients. Later, the diabetes risk increased yielding crossed survival curves after 2 to 3 years (time dependency of diabetes; P = 0.003). Age- and sex-adjusted hazard ratios for diabetes were as follows: 0-30 days: 0.50 [95% CI 0.31-0.84]; 31-60 days: 0.60 [0.25-1.41]; 61 days to 6 months: 0.75 [0.38-1.48]; >6-12 months: 1.27 [0.63-2.53]; >12-24 months: 1.65 [0.88-3.08]; >24-36 months: 2.02 [0.80-5.09]; and >36-60 months: 1.91 [0.70-5.21]. The pattern was similar in both sexes. In the full model, significant risk factors for mortality were age (1.05; 1.03-1.06), amputation above the knee (1.50; 1.16-1.94), and quartile category 3 or 4 of the number of prescribed medications (1.64; 1.12-2.40 and 1.76; 1.20-2.59). Further adjustment for comorbidity did not alter the results.
In this population-based study, we found a time-dependent mortality risk of diabetes following first major LEA, which may be in part a result of a healthier lifestyle in diabetic patients or the access to specific treatment structures in diabetic individuals.
Diabetes care 06/2011; 34(6):1350-4. · 8.09 Impact Factor
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ABSTRACT: Recently, Varga et al. reported in an observational study that guideline adherence could prevent 56.3-78.9% of all deaths in patients with early onset breast cancer [Oncology 2010;78:189-195]. This would mean that nearly all deaths due to breast cancer can be avoided by guideline-adherent treatment. We argue that some methodological issues like immortal time bias or healthy adherer bias may have contributed to these implausible findings. However, the non-transparent reporting of the methods, especially regarding the operationalization of guideline adherence, hampers critical assessment of this study.
Oncology 03/2011; 79(3-4):301-2; author reply 303-5. · 2.27 Impact Factor
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ABSTRACT: To estimate the impact of diabetes on the mortality of patients with incident renal replacement therapy (RRT).
We assessed the mortality of 544 incident RRT patients aged ≥ 30 years between 2002 and 2009 (57.9% men, mean age 70.3 years, 49.6% patients with diabetes) by analyzing the data of all dialysis centers covering a German region. We compared the estimated time-dependent hazard ratios of patients with and without diabetes by using the Cox proportional-hazards regression model.
Overall, 319 patients had died (158 diabetic), approximately 50% after 3 years. Up to about 3 years, the mortality rate was lower in diabetic than in nondiabetic patients. Thereafter, the survival curves crossed (interaction diabetes × time, p = 0.002; adjusted hazard ratios for diabetes: baseline, 0.66; year 1, 0.84; year 2, 1.05; year 3, 1.33; year 4, 1.68). The results were similar in men and women; however, the interaction of diabetes and time was significant only in men (p = 0.004). Further significant risk factors of mortality were age, sex, initial central venous catheter, cardiovascular disease, and malignancy.
In this population-based study, the influence of diabetes was time-dependent, with a lower mortality in diabetic versus non-diabetic patients in the first three years but a higher mortality in these patients after 3 years. Results were similar in men and women.
Diabetes research and clinical practice 03/2011; 92(3):380-5. · 2.16 Impact Factor
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ABSTRACT: The indication for the treatment of primary nocturnal enuresis was removed from all intranasal preparations of desmopressin in May 2007. Objective of this study was to examine whether and how fast this regulatory decision changed prescribing in affected children.
We analyzed claims data of the Gmünder ErsatzKasse (GEK) over the years 2004-2008. All children and adolescents aged 0-18 years who received at least one out-patient diagnosis of urinary incontinence in the corresponding years were included. Our outcome of interest was the proportion of oral desmopressin and its change over time.
A total of 6308 to 7207 children with a mean age of about 8 years were included annually (62-63% were male) and 14 746 packages of desmopressin were analysed (49.9% intranasal; 50.1% oral; 0.01% parenteral preparations). The proportion of patients using desmopressin decreased slightly from 13.9% in 2004 to 12.6% in 2008 ( p for trend = 0.0131). Between January 2004 (39.1%) and December 2006 (41.3%), the proportion of oral forms was nearly constant and doubled after that within a few months to about 80%.
Immediately after the removal of the indication for intranasal desmopressin, an increased prescribing of tablet forms in affected children was found in Germany.
Pharmacoepidemiology and Drug Safety 01/2011; 20(1):105-9. · 2.53 Impact Factor
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ABSTRACT: This study was conducted to estimate incidences of renal replacement therapy (RRT) in the diabetic and non-diabetic populations in Germany, as well as relative and attributable risks of RRT due to diabetes.
Using the data of a regional dialysis centre (region population of 310 000), we assessed all incident RRT patients aged 30 years or older in 2002-08. We estimated sex- and age-specific and -standardized incidences of RRT in the diabetic and non-diabetic populations, which were estimated by applying diabetes prevalences from a population-based study, and relative and attributable risks due to diabetes.
Of all subjects with incident RRT (n = 544), 49.6% had diabetes. Fifty-eight percent were male, mean age (SD) was 70.3 years (11.4 years). Incidences per 100 000 person-years (standardized to the 2004 German population) in the diabetic and the non-diabetic populations were 213.7 [95% confidence interval (95% CI), 159.5-267.8] and 26.9 (95% CI, 22.5-31.3) in men and 130.2 (95% CI, 65.6-194.9) and 16.4 (95% CI, 13.5-19.3) in women, respectively. Standardized relative risks were 7.9 (5.9-10.8) in men and 8.0 (4.7-13.5) in women. There was a significant interaction between age and diabetes, with lower relative risks in higher ages. Attributable risks among diabetic individuals were 0.87 in men and women, and population-attributable risks were 0.41 and 0.35 in men and women, respectively.
In this population-based study in a German region, we found the relative risk of RRT in the estimated adult diabetic population to be 8-fold increased compared with the non-diabetic population. A high proportion of the RRT risk can be attributed to diabetes in the diabetic as well as in the whole population.
Nephrology Dialysis Transplantation 01/2011; 26(1):264-9. · 3.40 Impact Factor
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ABSTRACT: Although evidence is lacking, there is general perception that zolpidem and zopiclone ('Z-drugs') are more effective and safer than benzodiazepines leading to an increased prescribing of Z-drugs. In Germany, 85% of the inhabitants are covered by statutory health insurance (SHI), the rest is privately insured. Z-drugs are covered by SHIs but physicians can also provide private prescriptions for SHI insured persons, who then have to pay for these out of pocket. Since private prescriptions are not documented in SHI claims data, physicians might prescribe drugs associated with abuse as private prescriptions. We aim to quantify SHI versus private prescriptions of Z-drugs and analyze regional variations.
We studied a sample of 2500 community pharmacies located across Germany from 2006 to 2008. We analyzed the amount of private prescriptions in numbers of packages. Drug utilization was expressed in defined daily doses (DDDs) per 1000 inhabitants per day (DID).
The proportions of private prescriptions ranged between 36.7% and 36.9% per annum for zopiclone, this was significantly higher for zolpidem (49.4-49.6% per annum). There are substantial regional variations for zolpidem (28.8-82.6%) and zopiclone (22.5-68.6%). In all federal states the proportion of zolpidem not reimbursed by SHIs is higher than that of zopiclone (6.3-15.4%). The nation-wide outpatient consumption was 2.5 DID for zolpidem and 2.7 DID for zopiclone with large regional variations.
In addition to large regional variations, zolpidem is more often prescribed as a private prescription than zopiclone. This might be a signal for a higher abuse potential of zolpidem.
Pharmacoepidemiology and Drug Safety 10/2010; 19(10):1071-7. · 2.53 Impact Factor
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ABSTRACT: We aimed to examine the epidemiology and mortality risk of patients with incident end-stage renal disease (ESRD) in diabetic and non-diabetic individuals and to determine differences between sexes.
We used the claims data of a statutory health insurance company. Patients aged 30 years and older who started dialysis or had pre-emptive kidney transplantation between 1 April 2006 and 7 October 2008 were included. We estimated incidence rates of ESRD according to diabetes status, sex and age as well as relative and attributable risks due to diabetes. Using Cox regression, we studied survival and estimated time-dependent hazard ratios (HR).
We included 623 patients with incident ESRD (n = 254 had diabetes); 477 (76.6%) were male, and the mean age was 66.5 years. Standardized to the German population, incidences of ESRD in patients with and without diabetes were 157.9 and 25.6 per 100,000 person-years respectively (6.2-fold increased risk). The impact of diabetes on mortality was time-dependent. Diabetics had an increased mortality risk after the first year. An interaction of diabetes with time (per additional year of follow-up) was found in the whole population (HR 2.01, 95% CI 1.21-3.33) and in females (HR 3.27, 95% CI 1.03-10.39); however, males did not reach statistical significance (HR 1.78, 95% CI 0.99-3.18). The fixed baseline effect of diabetes in these models was non-significant (HR ~ 0.7-0.8).
Diabetes is an important risk factor for ESRD. We provide further evidence that the impact of diabetes on survival after ESRD is time-dependent and that differences between sexes might exist.
Nephrology Dialysis Transplantation 10/2010; 26(5):1634-40. · 3.40 Impact Factor
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ABSTRACT: Cancer is in the focus of public and scientific interest as one of the leading causes of death, with an increasing case load due to demographic changes and rising treatment costs. Comparatively, little is known about health care utilization of cancer patients.
This article first gives an overview of health services research and claims data of German statutory health insurance funds. Second, claims data of the Gmünder ErsatzKasse (GEK) for a period of 3 months (10-12/2008) are used to analyze patterns of drug prescriptions by oncologists.
A total of 1.98 million prescriptions were included. Based on all prescriptions, the proportion of compounded prescriptions is about 17 times higher for oncologists compared to other physicians (34.4% vs. 2.0%). Fur- thermore, the costs of these solutions prescribed by oncologists are higher (median: 397.68 Euros vs. 15.45 Euros).
Health services research in oncology is urgently needed. Claims data of German health insurance funds offer a broad range of opportunities, especially when linked with other data. However, in the case of individually prepared solutions, claims data provide no further information on the drug.
Medizinische Klinik 06/2010; 105(6):409-15. · 0.34 Impact Factor
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ABSTRACT: Stock et al. (Eur Respir J 25:47-53, 2005) recently estimated asthma prevalence in Germany using claims data on prescriptions and hospital diagnoses and found high prevalence peaks in infants. Our objective was to critically assess and discuss various aspects of identifying children with asthma using prescription data.
We replicated the selection procedure of Stock et al. using data on 290,919 children aged 0-17 years insured in the Gmünder ErsatzKasse (GEK) in 2005. Asthma prevalence was also estimated in a sample of 17,641 children aged 0-17 years participating in the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) from 2003 to 2006.
In children aged 0-4 years insured in the GEK, prevalences were found to range from 11.7 to 17.7% for boys and from 7.2 to 11.1% for girls when the criteria of Stock et al. were applied. A steady decline in prevalences was observed in older age groups. Asthma prevalence estimated in the KiGGS data showed a quite different distribution. In the age group 0-4 years, prevalences were found to range from 0 to 2.6% in boys and from 0 to 1.0% in girls; in children >4 years, prevalences were found to increase with increasing age.
When additional validation studies were taken into account, asthma medications were found to be prescribed not only for asthma but also for other respiratory diseases. In addition, not all children with current asthma had prescriptions. We therefore conclude that asthma medications are therefore not a good proxy for the disease.
European Journal of Clinical Pharmacology 03/2010; 66(3):307-13. · 2.85 Impact Factor
