Bronchiectasis is a chronic airway disease with often disabling symptoms, which is associated with excess mortality and a substantial economic burden for healthcare systems [1]. Although considered to be one of the most neglected diseases in respiratory medicine [2], bronchiectasis is apparently more common than previously thought [3, 4]. While trends regarding its epidemiology have been published for the UK and the USA, with marked increases in prevalence rates reported [5][6][7], such studies are missing for most countries including Germany. However, these basic epidemiological data are needed in order to inform healthcare authorities and policy makers regarding resource allocation and requirements planning. Thus, the objective of the present study was to provide insights into the trends of bronchiectasis prevalence in Germany.Our study was based on the externally validated InGef research database [8], which contains anonymised patient-level claims data from approximately 7 million insured mandatory or voluntary members of the German public health scheme, including data from several German statutory health insurance (SHI) companies, regardless of their social security status (dependently employed, self-employed or unemployed subjects, dependently insured spouses and/or children, pensioners, subjects on disability or sick-leave, etc.). Briefly, between 2009 and 2017, approximately 70 of 81 million population (86%) were members of the public health scheme, while the rest had private health coverage [9]. Samples of approximately four million insured persons per year were randomly selected from the entire InGef database. These samples were representative of the German population regarding age and sex [9]. Finally, all patients with complete data and continuous SHI coverage in the respective periods served as the study population, including on average 96% (range 90-100%) of subjects from the initial random samples. This resulted in representative ∼5% samples of the German population covered by SHI for each year between 2009 and 2017. Data were extracted using the ICD-10 diagnosis code J47 (acquired bronchiectasis) as primary or secondary hospital discharge or verified outpatient diagnosis. Subsequently, data were analysed according to age, sex, the sector of healthcare provision (hospital or outpatient care), and chronic obstructive pulmonary disease (COPD)/emphysema and asthma as concomitant diagnoses (ICD-10 codes J43-44 and J45-46, respectively). Subjects with cystic fibrosis (ICD-10 code E84) were excluded from analysis. Official census data were obtained from the German Federal Statistical Office [9]. Poisson log-linear regression analysis was used to assess the significance of prevalence trend (IBM SPSS Statistics, version 25; IBM Corp., New York, NY, USA). Prevalence rates and 95% confidence intervals were calculated using OpenEpi version 3.03a [10]. In order to extrapolate the total number of subjects with bronchiectasis in the German population per year, the number of bronchiectasis case-patients was divide...

ObjectivesTo analyse the prevalence and incidence of pregabalin and gabapentin (P/G) prescriptions, typical therapeutic uses of P/G with special attention to pain-related diagnoses and discontinuation rates.DesignSecondary data analysis.SettingPrimary and secondary care in Germany.ParticipantsFour million patients in the years 2009–2015 (anonymous health insurance data).InterventionNone.Primary and secondary outcome measuresP/G prescribing rates, P/G prescribing rates associated with pain therapy, analysis of pain-related diagnoses leading to new P/G prescriptions and the discontinuation rate of P/G.ResultsIn 2015, 1.6% of insured persons received P/G prescriptions. Among the patients with pain first treated with P/G, as few as 25.7% were diagnosed with a typical neuropathic pain disorder. The remaining 74.3% had either not received a diagnosis of neuropathic pain or showed a neuropathic component that was pathophysiologically conceivable but did not support the prescription of P/G. High discontinuation rates were observed (85%). Among the patients who had discontinued the drug, 61.1% did not receive follow-up prescriptions within 2 years.ConclusionThe results show that P/G is widely prescribed in cases of chronic pain irrespective of neuropathic pain diagnoses. The high discontinuation rate indicates a lack of therapeutic benefits and/or the occurrence of adverse effects.

Objective We propose a data-driven method to detect temporal patterns of disease progression in high-dimensional claims data based on gradient boosting with stability selection. Materials and methods We identified patients with chronic obstructive pulmonary disease in a German health insurance claims database with 6.5 million individuals and divided them into a group of patients with the highest disease severity and a group of control patients with lower severity. We then used gradient boosting with stability selection to determine variables correlating with a chronic obstructive pulmonary disease diagnosis of highest severity and subsequently model the temporal progression of the disease using the selected variables. Results We identified a network of 20 diagnoses (e.g. respiratory failure), medications (e.g. anticholinergic drugs) and procedures associated with a subsequent chronic obstructive pulmonary disease diagnosis of highest severity. Furthermore, the network successfully captured temporal patterns, such as disease progressions from lower to higher severity grades. Discussion The temporal trajectories identified by our data-driven approach are compatible with existing knowledge about chronic obstructive pulmonary disease showing that the method can reliably select relevant variables in a high-dimensional context. Conclusion We provide a generalizable approach for the automatic detection of disease trajectories in claims data. This could help to diagnose diseases early, identify unknown risk factors and optimize treatment plans.

PurposeThis study aims to assess the implementation of published research, contraindications, and warnings on the prescription of dual renin‐angiotensin‐hormone system (RAS) blockade in ambulatory care in Germany.MethodsCohort study based on health claims data of 6.7 million subjects from 2008 to 2015. Yearly prevalence and incidence for dual RAS blockade with (a) angiotensin‐converting enzyme inhibitors and angiotensin‐receptor blockers (ACEI + ARB) and (b) aliskiren and ACEI or ARB (aliskiren + ACEI/ARB) were calculated. We assessed prescriber specialty and associations between discontinuing dual RAS blockade with specialist (internal medicine, cardiology, nephrology) visits and hospital discharge in the previous year.ResultsA total of 2 984 517 patients were included (age 51.4 ± SD 18.4 y, 48.5% male). Prescription rates for ACEI + ARB decreased from 0.6% (n = 17 907) to 0.4% (n = 12 237) and for aliskiren + ACEI/ARB from 0.23% (n = 6634) to 0.03% (n = 818). Incident prescriptions decreased from 0.23% (n = 6705) to 0.19% (n = 5055) (ACE + ARB) and from 0.1% (n = 2796) to 0.005% (n = 142) (aliskiren + ACE/ARB); 59% of ACEI + ARB and 48% of aliskiren + ACE/ARB combinations were prescribed only by one physician. Of those, 73% (ACEI + ARB) and 58% (aliskiren + ACE/ARB) were primary care providers (PCPs). Discontinuing dual RAS blockade was associated with specialist care and hospital discharge in the previous year (specialist care: RR 1.4, 95% CI, 1.3‐1.6; hospital visit: RR 1.5, 95% CI, 1.3‐1.6).ConclusionsOur results suggest a delayed uptake of treatment recommendation for ACEI + ARB and a higher impact of Dear Doctor letters addressing PCPs directly compared with published research, contraindications, and warnings. Targeted continuous medical education, practice software alerts, and stronger involvement of pharmacists might improve the implementation of medication safety recommendations in ambulatory care.

In March 2021 several cases of cerebral venous sinus thrombosis (CVST) accompanied by thrombocytopenia were reported that occurred within two weeks after immunization with a viral vector-based COVID-19 vaccine. This study aimed to assess the background incidence of CVST and CVST with concurrent thrombocytopenia in adults using anonymized claims data from 2015-2019 in Germany. The average annual CVST incidence was 1.9 per 100,000 individuals (95%-CI 1.4-2.3). It was higher in women aged 18 to 59 years as compared to same-aged men. In contrast to the currently reported immunization-related cases, CVST was rarely associated with concurrent thrombocytopenia or death.