Psoriasis is a chronic disease with high impact on patients' health and their quality of life. Psoriasis often occurs along with other comorbidities, but it is not yet clear what role the ...comorbidities play in regional psoriasis prevalence. This study investigates the temporal and regional variation of the psoriasis comorbidities diabetes mellitus type II, obesity, hypertension, affective disorders in Germany and their association with psoriasis prevalence. This analysis based on the population set of ambulatory claims data (2010-2017) of the statutory health insurance (SHI) in Germany (approx. 70.3 million people in 2017). Psoriasis comorbidities rates were determined on county level. We performed descriptive spatiotemporal analyses of psoriasis comorbidity prevalence rates. In addition, we identified and compared spatial clusters and examined regional variations using spatial statistical methods. The results show strong regional variations (northeast to south gradient) and an increasing psoriasis prevalence (max. 28.8%) within the observation period. Considering the comorbidities, results indicate comparable spatial prevalence patterns for diabetes mellitus type II, obesity and hypertension. This means that the highest prevalence of comorbidities tends to be found where the psoriasis prevalence is highest. The spatiotemporal cluster analyses could once again confirm the results. An exception to this is to be found in the case of affective disorders with different spatial patterns. The results of the studies show the first spatiotemporal association between psoriasis prevalence and comorbidities in Germany. The causalities must be investigated in more detail in order to be able to derive measures for improved care.
Aim of the study was to characterise the association between screening, prevalence and mortality of skin cancer in Germany considering the spatial distribution. The study included the total set of ...outpatient data of all statutory health insured people and cause-of-death statistics in Germany between 2011–2015 on county level. To identify regions with high/low screening, prevalence and mortality rates, probability maps were calculated. Scenarios were developed based on the research questions. These were used to identify regions that share both high/low rates of screening, prevalence and mortality. Regression analyses were used to characterise these regions, taking into account sociodemographic characteristics. Significant regional variations in prevalence, screening and mortality in Germany were identified. Depending on the scenario, influences of sociodemographic conditions become apparent. For example, a lower income (p = 0.006) and poorer accessibility of the closest dermatologist (p = 0.03) predicted a lower prevalence of and fewer screenings for skin cancer. In regions with low screening and high mortality, significant (p = 0.03) associations with the educational status of the population were also found. The study identified the first spatial associations between screening, prevalence and mortality of skin cancer in Germany. The results indicate that regional population-related characteristics (e.g., sociodemographic characteristics) play an important role in explaining the associations and should be given more weight in further studies. However, further studies, particularly on the spatial variation of skin cancer mortality, are still necessary.
There are regional differences in the prevalence of psoriasis between countries, as well as within countries. However, regional determinants of differences in prevalence are not yet understood. The ...aim of this study was to identify sociodemographic and environmental determinants of regional prevalence rates for psoriasis. Analyses were based on German outpatient billing data from statutory health insurance, together with data from databases on sociodemographic and environment factors at the county level (N = 402) for 2015-2017. Descriptive statistics were calculated for all variables. To identify determinants for prevalence at the county level, spatiotemporal regression analysis was performed, with prevalence as the dependent variable, and the number of physicians, mean age, mean precipitation, sunshine hours, mean temperature, level of urbanity, and the German Index of Socioeconomic Deprivation (GISD) as independent variables. Mean prevalence of psoriasis increased from 168.63 per 10,000 in 2015 to 173.54 per 10,000 in 2017 for Germany as a whole, with high regional variation. Five determinants were detected (p < 0.05). The prevalence increased by 4.18 per 10,000 persons with SHI with each GISD unit, and by 3.76 per 10,000 with each year increase in age. Each additional hour of sunshine resulted in a decrease of 0.04 and each °C increase in mean temperature resulted in an increase of 4.22. Each additional dermatologist per 10,000 inhabitants resulted in a decrease of 0.07. In conclusion, sociodemographic and environmental factors result in significant differences in prevalence of psoriasis, even within-country.
Numerous studies and models address the determinants of health. However, in existing models, the spatial aspects of the determinants are not or only marginally taken into account and a theoretical ...discussion of the association between space and the determinants of health is missing. The aim of this paper is to generate a framework that can be used to place the determinants of health in a spatial context. A screening of the current first serves to identify the relevant determinants and describes the current state of knowledge. In addition, spatial scales that are important for the spatial consideration of health were developed and discussed. Based on these two steps, the conceptual framework on the spatial determinants of health was derived and subsequently discussed. The results show a variety of determinants that are associated with health from a spatial point of view. The overarching categories are global driving forces, policy and governance, living and physical environment, socio-demographic and economic conditions, healthcare services and cultural and working conditions. Three spatial scales (macro, meso and micro) are further subdivided into six levels, such as global (e.g., continents), regional (e.g., council areas) or neighbourhood (e.g., communities). The combination of the determinants and spatial scales are presented within a conceptual framework as a result of this work. Operating mechanisms and pathways between the spatial levels were added schematically. This is the first conceptual framework that links the determinants of health with the spatial perspective. It can form the working basis for future analyses in which spatial aspects of health are taken into account.
Zusammenfassung
Hintergrund
In Deutschland wurde 2008 ein flächendeckendes Hautkrebsscreening eingeführt, um die Hautkrebsmortalität und ‐morbidität zu senken. Noch unklar ist jedoch die Wirksamkeit ...des Programms. Wir untersuchen den Zusammenhang zwischen der Inzidenz von Melanom‐Frühstadien und Melanom‐Mortalität in den Folgejahren, wobei die Inzidenz von Melanom‐Frühstadien als Surrogatparameter für Screening‐Teilnahme und Früherkennung verwendet wird.
Methodik
Für 244 deutsche Landkreise wurden Daten zur Melanom‐Inzidenz von 2005–2016 und zur Melanom‐Mortalität von 2005–2018 erhoben. Die Zusammenhänge zwischen verschiedenen Maßen der Inzidenz und Mortalität wurden mit Korrelationsanalysen und linearen Regressionen untersucht.
Ergebnisse
Die Melanom‐Inzidenz früher Stadien (in situ und T1) stieg nach Einführung des Screenings (2005–2007 vs. 2008–2010) um 69%. Im Gegensatz dazu gab es bei der Mortalität keinen zeitlichen Trend. Die Korrelationen zwischen Inzidenz‐ und Mortalitätsvariablen lagen zwischen –0,14 und 0,10 (nicht signifikant). Die linearen Regressionsanalysen ergaben, dass die Mortalität sechs Jahre nach Einführung des Screenings mit zunehmendem Anstieg der Inzidenz früher Stadien abnimmt (b = –0,0029, 95%‐Konfidenzintervall –0,0066; 0,0007).
Schlussfolgerungen
Die geschätzten bevölkerungsbezogenen Auswirkungen des Hautkrebsscreenings auf die Melanom‐Mortalität waren minimal und nicht signifikant. Eine mögliche Wirksamkeit kann daher nicht nachgewiesen werden.
Summary
Background
Germany‐wide skin cancer screening was introduced in 2008 to reduce skin cancer mortality and morbidity. However, the effectiveness of the program is still unclear. We explore the ...relationship between early‐stage melanoma incidence and melanoma mortality in subsequent years, using early‐stage melanoma incidence as surrogate for screening participation and early detection.
Patients and Methods
Data on melanoma incidence for 2005–2016 and melanoma mortality for 2005–2018 were obtained for 244 German counties. We investigated the correlation between several measures of incidence and mortality with correlation analyses and linear regressions.
Results
Melanoma incidence of early stages (in situ and T1) rose by 69% between pre‐screening (2005–2007) and screening period (2008–2010). In contrast, there was no temporal trend in mortality over time. Correlation coefficients between incidence and mortality variables ranged between –0.14 and 0.10 (not significant). Linear regression indicated that mortality 6 years after screening introduction decreases with increasing change in early‐stage incidence (b = –0.0029, 95% confidence interval –0.0066, 0.0007).
Conclusions
The estimated population‐based effects of skin cancer screening on melanoma mortality were minimal and not significant. A potential effectiveness cannot be demonstrated.
ObjectivesGlobal 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.DesignCross sectional, spatio-epidemiological study on regional psoriasis prevalence in Germany.SettingClaims data study based on nationwide outpatient billing data on county level.MethodsAnalyses 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.ResultsThe 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).ConclusionIncreased prevalence of psoriasis over time and marked regional variations in Germany were observed which need further investigation.
Summary
Background
There are regional differences in skin cancer screening uptake in Germany. So far, it is unclear whether a high uptake of screening services leads to a reduction in mortality. This ...article presents study results on the investigation of spatiotemporal associations between skin cancer screening and mortality. The methods used are discussed regarding their suitability.
Material and methods
The basis is ambulatory claims data on the utilization of early skin cancer detection as well as data on skin cancer mortality from the cause‐of‐death statistics of the years 2011–2015 at county level in Germany. In addition to a descriptive evaluation, spatiotemporal cluster analyses and regression models were used to investigate the relationship between the uptake of early detection and mortality. In addition to age, adjustments were also made for other selected socio‐economic and socio‐graphical variables.
Results
The descriptive results show striking spatial patterns of skin cancer screening and mortality. Cluster analyses identified regions with significantly higher and lower cases of early detection and skin cancer mortality. The spatiotemporal regression analyses show no clear association. Only early detection by a dermatologist, adjusted for age, shows an association with mortality.
Conclusions
No clear association between early skin cancer detection and mortality can be derived from the results. However, the study design used with a spatiotemporal cluster and regression analysis has shown that these methods allow in‐depth statements about the relationship between early skin cancer detection and mortality.
Summary
Background and goals
The rising incidence of skin cancer in Germany has increased the need for secondary prevention measures. For this purpose, a statutory skin cancer screening for insured ...persons aged 35 and older was introduced on 1 June 2008. The aim of this work package in the Innovation Fund project “Perspectives of a multimodal evaluation of early skin cancer detection” (Pertimo) was to test an evaluation of skin cancer screening using secondary data.
Patients and methods
The data basis was statutory insured persons of the DAK Health from the age of 35 who were insured as of 31 December 2010 and were followed up until the end of 2015. The rates of participation, skin tumors detected in skin cancer screening (tumor detections), and interval tumors that occurred within two years after a finding‐free skin cancer screening were calculated.
Results
The biennial skin cancer screening take‐up rate in 2014 and 2015 was 33.6% for women and 32.6% for men. Of those screened, 4.2% had a skin cancer finding (tumor detection) in the course of skin cancer screening. Of all incident skin cancer diagnoses (2012–2015), 50.1% were detected in skin cancer screening. In 1.5% of the insured persons with skin cancer screening without findings, an incidental skin tumor was diagnosed in the following two years (interval tumor).
Conclusions
The data from the statutory health insurance mapped the skin cancer screening occurrence in Germany and highlighted the importance of dermatologists in the screening process. The analysis provided important new insights.
Zusammenfassung
Hintergrund
Es bestehen regionale Unterschiede in der Hautkrebsfrüherkennungsinanspruchnahme in Deutschland. Bislang ist ungeklärt, ob eine hohe Inanspruchnahme von ...Früherkennungsleistungen zu einer Senkung der Mortalität führt. Dieser Beitrag präsentiert Studienergebnisse zur Untersuchung raumzeitlicher Assoziationen von Hautkrebsfrüherkennung und Mortalität. Die angewendeten Methoden werden hinsichtlich ihrer Eignung diskutiert.
Material und Methodik
Grundlage sind ambulante Abrechnungsdaten zur Inanspruchnahme von Hautkrebsfrüherkennung sowie Daten zur Hautkrebsmortalität aus der Todesursachenstatistik der Jahre 2011–2015 auf Ebene der Kreise und kreisfreien Städte in Deutschland. Neben einer deskriptiven Auswertung wurden raumzeitliche Clusteranalysen und Regressionsmodelle angewendet, um den Zusammenhang zwischen der Inanspruchnahme von Früherkennung und Mortalität zu untersuchen. Dabei wurde neben Alter auch nach weiteren ausgewählten sozioökonomischen und ‐grafischen Variablen adjustiert.
Ergebnisse
Die deskriptiven Ergebnisse zeigen markante räumliche Muster der Hautkrebsfrüherkennung und Mortalität. Mittels Clusteranalysen konnten Regionen mit signifikant höheren und niedrigeren Fällen an Früherkennung und Hautkrebsmortalität identifiziert werden. Die raumzeitlichen Regressionsanalysen zeigen keine eindeutige Assoziation. Lediglich die Früherkennung beim Dermatologen, adjustiert nach Alter, zeigt eine Assoziation mit Mortalität.
Diskussion
Aus den Ergebnissen lässt sich kein eindeutiger Zusammenhang zwischen Hautkrebsfrüherkennung und ‐mortalität ableiten. Das verwendete Studiendesign mit einer raumzeitlichen Cluster‐ und Regressionsanalyse hat jedoch gezeigt, dass diese Methoden vertiefte Aussagen über den Zusammenhang von Hautkrebsfrüherkennung und ‐mortalität ermöglichen.
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