Assoziation von Krankenversicherung und soziodemografischen Faktoren mit der Versorgung maligner Melanome

Abstract

To analyze the relationship between socio-demographic and regional factors, health insurance status and clinical features of malignant melanoma (MM). Primary data from a nationwide dermato-histopathologic laboratory on all consecutive excisions with proven diagnosis of MM over the 5-year period 2009-2013 were analyzed regarding tumor-specific and socioeconomic characteristics. The tumor depth (Breslow index) being a predictor of invasive MM progression and mortality was defined as a major indicator for early detection and intervention, thus reflecting quality of health care. N=4 840 histologically verified MM samples from 4 583 patients were analyzed; of these, 2 537 (52.4%) were invasive MM. The tumor depth, which was 1.09 mm on average, increased with age from 1.00 mm in the lowest to 1.56 mm in the highest age group, p<0.001). Controlled for age and sex, the members of agricultural health insurances (LKK) and of German local public health insurances (AOK) showed significantly increased tumor depths (1.67 resp. 1.20 mm). The lowest average levels were found in members of the substitute health funds (e. g. Barmer GEK 0.93 mm) and in privately insured persons (0.99 mm). Based on a regional 4-step classification, there was a gradient in MM depth from more populated to more rural areas, ranging from 1.05 mm in nucleated cities to 1.22 in small rural communities. Distribution of MM locations varied significantly by health insurance: The highest proportion of MM in the head/neck area was seen in members of the agricultural (52.3%) and of the local public health insurances (30.2%) vs. 18.5% in patients from the substitute health funds. In contrast, MM located on the trunk and lower extremities was more prevalent in private, substitute and company health insurance funds. Age, gender and health insurance status are relevant determinants of MM health care and progression risk in Germany. Prevention and early detection programs by health insurances should take this into account.

Melanom – Prävention und Versorgung

“…Beide Faktoren sind wesentlich durch den Zeitpunkt der Diagnosestellung bestimmt, der somit einen relevanten Qualitätsindikator der Melanomversorgung darstellt [13]. Eine 2017 veröffentlichte Arbeit untersuchte diesen Zusammenhang erstmals auch für Deutschland [14].…”

Forschung an der Versorgung – 10 Jahre Competenzzentrum Versorgungsforschung in der Dermatologie (CVderm)

“…Hier hat das CVderm eine breite Aufstellung entwickelt und seine methodische Sicherheit im Umgang mit Daten unterschiedlicher Quellen unter Beweis gestellt. So zählen zu den wichtigsten vielfach genutzten Datenquellen die direkten Erhebungen in der dermatologischen Versorgung [13,14], Erhebungen in der Allgemeinbevölkerung [15,16], Surveys in Kooperation mit Patientenorganisationen [17 -19], Erhebung in Apothekennetzwerken [20,21], betriebliche Screeninguntersuchungen [22 -24], Krankenkassendaten [25 -27], Daten aus Patientenregistern [28,29] und Daten aus der histopathologischen Versorgungsforschung [30,31]. Neben den häufigen dermatologischen Erkrankungen wie Psoriasis, Neurodermitis, Akne Vulgaris oder allergische Rhinitis wurden dabei auch seltene Erkrankungen wie die Neurofibromatose [32,33]…”