Social Epidemiology after the German Reunification: East vs. West or Poor vs. Rich?

Abstract

Small-area analyses are required to disentangle the association between socio-economic inequalities and health in Germany. In such analyses, not only individual but also contextual (e.g. area level) characteristics need to be included. Contextual variables can be used to group smaller areas such as counties into clusters with similar properties. Thus, individual survey data can be linked with contextual characteristics while maintaining data protection and at the same time achieving sufficiently large case numbers. Concurrently, theoretical models explaining health inequalities need to be further developed so that they embrace contextual characteristics.

Zunehmende regionale Unterschiede bei den Lebensverhältnissen in Deutschland und ihre Bedeutung für die Erklärung gesundheitlicher Ungleichheit

“…Innerhalb der alten Bundesl ä nder l ä sst sich eine Zunahme regionaler Unterschiede bei der Arbeitslosenquote, Ä rztedichte und dem Frauenanteil feststellen. Dieser Befund spricht daf ü r, dass der sozialepidemiologische Erkenntnisgewinn eines Ost-WestVergleich dahingehend weiter abgenommen hat, dass es sich um einen Vergleich in sich sehr heterogener, zum Teil heterogener gewordener Entit ä ten handelt [8] . Die Entwicklung regionaler Unterschiede zwischen den Jahren 1995 und 2005 bzw.…”

“…Hinsichtlich der regionalen Erwerbsm ö glichkeiten z ä hlen dazu Expositionen wie Lohniveau, Qualit ä t der Arbeitsbedingungen, Sicherheit der berufl ichen Perspektive und die damit verbundene Neigung, Krankheiten zu verschleppen [13] . Die regionale Infrastrukturausstattung und damit auch die Erreichbarkeit der sozial und gesundheitlich bedeutsamen Versorgungseinrichtungen d ü rfte der zweite gro ß e Bereich sein, aus dem sich gesundheitsrelevante Expositionen ergeben [8] . Die angef ü hrten Untersuchungen belegen zwar ausgepr ä gte regionale Unterschiede in den Lebensverh ä ltnissen und damit assoziierte gesundheitliche Unterschiede.…”

Explaining health inequalities: the role of space and time

“…Individual risk factors such as smoking or a low socio-economic status and their effect on health have been examined in considerable detail, and explanatory models describing pathways and associations have been proposed. Our own previous work has shown that existing explanatory models often fail to acknowledge the role of ''space'', by which we mean contextual variables located at the level of regions, counties and neighbourhoods, as compared to factors at individual level (Razum et al 2008). In addition, they put very little emphasis on ''time'', i.e., the temporal dimension of the association of contextual factors and health (Voigtländer et al 2012(Voigtländer et al , 2014Richter and Blane 2013).…”

Colonoscopy and fecal occult blood test use in Germany: results from a large insurance-based cohort

“…Differences are likely to exist compared with privately insured persons (< 10 %), although offers of cancer screening tests would be similar [46,47]. General health disparities may exist on the city and county level rather than between federal states or east and west Germany [48]. In one recent survey, the estimate of lifetime colonoscopy use in the federal state of Hesse was very close to the average of the state-specific estimates [13].…”