Do Persons that Changed Health Insurance Differ From those Who did not? The Case of Diabetes

Hoffmann, Falk; Icks, Andrea

doi:10.1055/s-0031-1275277

Cited by 10 publications

(9 citation statements)

References 10 publications

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“…However, a very high proportion of cases and controls were continuously insured with the AOK NordWest. This finding is well in line with results of a study conducted by Hoffmann and Icks . Sixth, no adjustment for multiple testing was performed.…”

Section: Discussionsupporting

confidence: 89%

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Excess Mortality After Pelvic Fractures Among Older People

Andrich

Haastert

Neuhaus

et al. 2017

Journal of Bone and Mineral Research

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The study aimed to estimate excess mortality in patients aged 60 years or older up to 1 year after pelvic fracture compared with a population without pelvic fracture. In this retrospective population-based observational study, we use routine data from a large health insurance in Germany. For each patient with a first pelvic fracture between 2008 and 2010 (n ¼ 5685 cases, 82% female, mean age 80 AE 9 years), about 34 individuals without pelvic fracture (n ¼ 193,159 controls) were frequency matched by sex, age at index date, and index month. We estimated survival probabilities in the first year after the index date separated for cases (further stratified into inpatient/ outpatient treated or minor/major pelvic fractures) and controls using Kaplan-Meier curves. Additionally, time-dependent hazard ratios (HRs) measuring excess mortality in 4-week intervals up to 52 weeks were estimated by fitting Cox regression models including adjustment for relevant confounders. Twenty-one percent of cases and 11% of controls died within 1 year. HRs (95% confidence intervals) decreased from 3.9 (3.5-4.5) within the first 4 weeks to 1.4 (1.1-1.9) within weeks 49 to 52 after the index date. After full adjustment, HRs lowered substantially (3.0 [2.6-3.4] and 1.0 [0.8-1.4]) but were still significantly increased up to week 32. Adjusted HRs in women were lower than in men: 2.8 (2.4-3.2) and 1.0 (0.7-1.4) versus 3.8 (2.9-5.0) and 1.2 (0.6-2.3). We found a clear excess mortality among older people in the first 8 months after pelvic fracture even after full adjustment. Excess mortality was higher among men in the beginning as well as for inpatienttreated persons. Absence of excess mortality was noticed for outpatient-treated persons within the first 3 months. When broken down into site-specific data, excess mortality was no longer significant for most pelvic fractures classified as minor. The only exception was fracture of pubis within the first 4 weeks.

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Section: Discussionsupporting

confidence: 89%

“…This finding is well in line with results of a study conducted by Hoffmann and Icks. (34) Sixth, no adjustment for multiple testing was performed. Some significant tests might be inflated by chance.…”

Section: Limitations and Strengthsmentioning

confidence: 99%

Excess Mortality After Pelvic Fractures Among Older People

Andrich

Haastert

Neuhaus

et al. 2017

Journal of Bone and Mineral Research

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“…Person-years were aggregated for all insured persons aged 60 years or older and at risk of having a first pelvic fracture. Most persons were continuously insured with the AOK N ord W est, which is in line with results of a study conducted by Hoffmann and Icks [ 37 ]. Therefore, person-years per calendar year should resemble persons in a very adequate manner.…”

Section: Discussionsupporting

confidence: 87%

Epidemiology of Pelvic Fractures in Germany: Considerably High Incidence Rates among Older People

et al. 2015

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Epidemiological data about pelvic fractures are limited. Until today, most studies only analyzed inpatient data. The purpose of this study was to estimate incidence rates of pelvic fractures in the German population aged 60 years or older, based on outpatient and inpatient data. We conducted a retrospective population-based observational study based on routine data from a large health insurance company in Germany. Age and sex-specific incidence rates of first fractures between 2008 and 2011 were calculated. We also standardized incidence rates with respect to age and sex in the German population. Multiple Poisson regression models were used to evaluate the association between the risk of first pelvic fracture as outcome and sex, age, calendar year and region as independent variables. The total number of patients with a first pelvic fracture corresponded to 8,041 and during the study period 5,978 insured persons needed inpatient treatment. Overall, the standardized incidence rate of all first pelvic fractures was 22.4 [95% CI 22.0–22.9] per 10,000 person-years, and the standardized incidence rate of inpatient treated fractures 16.5 [16.1–16.9]. Our adjusted regression analysis confirmed a significant sex (RR 2.38 [2.23–2.55], p < 0.001, men as reference) and age effect (higher risk with increasing age, p < 0.001) on first fracture risk. We found a slight association between calendar year (higher risk in later years compared to 2008, p = 0.0162) and first fracture risk and a further significant association with region (RR 0.92 [0.87–0.98], p = 0.006, Westfalen-Lippe as reference). The observed incidences are considerably higher than incidences described in the international literature, even if only inpatient treated pelvic fractures are regarded. Besides which, non-inclusion of outpatient data means that a relevant proportion of pelvic fractures are not taken into account. Prevention of low energy trauma among older people remains an important issue.

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“…A previous study demonstrated that people who change their insurance company are younger, better educated, and have a lower prevalence of diabetes and cardiovascular disease. 42 As a consequence, our study population was somewhat older than the general German population, which was particularly true for women (proportion in 2010: 5.4% women over 80 years in our data set vs 3.5% women over 80 years in the whole of Germany; 2.1% men over 80 years in our data set vs 1.7% men over 80 years in the whole of Germany). However, the prevalence of diabetes in our study was well in line with recently published nationwide data.…”

Section: Discussionmentioning

confidence: 73%

Lower-extremity amputations in people with and without diabetes in Germany, 2008–2012 – an analysis of more than 30 million inhabitants

Claessen

Narres

Haastert³

et al. 2018

CLEP

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Background and purposeLower-extremity amputations (LEAs) in people with diabetes are associated with reduced quality of life and increased health care costs. Detailed knowledge on amputation rates (ARs) is of utmost importance for future health care and economics strategies. We conducted the present cohort study in order to estimate the incidences of LEA as well as relative and attributable risk due to diabetes and to investigate time trends for the period 2008–2012.MethodsOn the basis of the administrative data from three large branches of German statutory health insurers, covering ~34 million insured people nationwide (about 40% of the German population), we estimated age-sex-standardized AR (first amputation per year) in the populations with and without diabetes for any, major, and minor LEAs. Time trends were analyzed using Poisson regression.ResultsA total of 108,208 individuals (diabetes: 67.3%; mean age 72.6 years) had at least one amputation. Among people with diabetes, we observed a significant reduction in major and minor ARs during 2008–2012 from 81.2 (95% CI 77.5–84.9) to 58.4 (55.0–61.7), and from 206.1 (197.3–214.8) to 177.0 (169.7–184.4) per 100,000 person-years, respectively. Among people without diabetes, the major AR decreased significantly from 14.3 (13.9–14.8) to 11.6 ([11.2–12.0], 12.0), whereas the minor AR increased from 15.8 (15.3–16.3) to 17.0 (16.5–17.5) per 100,000 person-years. The relative risk (RR) comparing the diabetic with the nondiabetic populations decreased significantly for both major and minor LEAs (4% and 5% annual reduction, respectively).ConclusionIn this large nationwide population, we still found higher major and minor ARs among people with diabetes compared with those without diabetes. However, AR and RR of major and minor LEAs in the diabetic compared with the nondiabetic population decreased significantly during the study period, confirming a positive trend that has been observed in smaller and regional studies in recent years.

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Do Persons that Changed Health Insurance Differ From those Who did not? The Case of Diabetes

Cited by 10 publications

References 10 publications

Excess Mortality After Pelvic Fractures Among Older People

Excess Mortality After Pelvic Fractures Among Older People

Epidemiology of Pelvic Fractures in Germany: Considerably High Incidence Rates among Older People

Lower-extremity amputations in people with and without diabetes in Germany, 2008–2012 – an analysis of more than 30 million inhabitants

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Do Persons that Changed Health Insurance Differ From those Who did not? The Case of Diabetes

Cited by 10 publications

References 10 publications

Excess Mortality After Pelvic Fractures Among Older People

Excess Mortality After Pelvic Fractures Among Older People

Epidemiology of Pelvic Fractures in Germany: Considerably High Incidence Rates among Older People

Lower-extremity amputations in people with and without diabetes in Germany, 2008&ndash;2012 &ndash; an analysis of more than 30 million inhabitants

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Lower-extremity amputations in people with and without diabetes in Germany, 2008–2012 – an analysis of more than 30 million inhabitants