Variation in antibiotic prescriptions: is area deprivation an explanation? Analysis of 1.2 million children in Germany

Koller, Daniela; Hoffmann, Falk; Maier, Werner; Tholen, Kathrin; Windt, Roland; Glaeske, Gerd

doi:10.1007/s15010-012-0302-1

Cited by 64 publications

(59 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…income, employment, education, municipal or district revenue, social capital, environment, security). The GIMD already showed significant associations with T2DM, reported in a previous study confined to five regional surveys [6], and with other health-related outcomes [33], [34]. For the present study, we calculated the GIMD scores for all urban and rural districts covering the whole of Germany.…”

Section: Methodsmentioning

confidence: 95%

Area Level Deprivation Is an Independent Determinant of Prevalent Type 2 Diabetes and Obesity at the National Level in Germany. Results from the National Telephone Health Interview Surveys ‘German Health Update’ GEDA 2009 and 2010

et al. 2014

View full text Add to dashboard Cite

ObjectiveThere is increasing evidence that prevention programmes for type 2 diabetes mellitus (T2DM) and obesity need to consider individual and regional risk factors. Our objective is to assess the independent association of area level deprivation with T2DM and obesity controlling for individual risk factors in a large study covering the whole of Germany.MethodsWe combined data from two consecutive waves of the national health interview survey ‘GEDA’ conducted by the Robert Koch Institute in 2009 and 2010. Data collection was based on computer-assisted telephone interviews. After exclusion of participants <30 years of age and those with missing responses, we included n = 33,690 participants in our analyses. The outcome variables were the 12-month prevalence of known T2DM and the prevalence of obesity (BMI ≥30 kg/m2). We also controlled for age, sex, BMI, smoking, sport, living with a partner and education. Area level deprivation of the districts was defined by the German Index of Multiple Deprivation. Logistic multilevel regression models were performed using the software SAS 9.2.ResultsOf all men and women living in the most deprived areas, 8.6% had T2DM and 16.9% were obese (least deprived areas: 5.8% for T2DM and 13.7% for obesity). For women, higher area level deprivation and lower educational level were both independently associated with higher T2DM and obesity prevalence [highest area level deprivation: OR 1.28 (95% CI: 1.05–1.55) for T2DM and OR 1.28 (95% CI: 1.10–1.49) for obesity]. For men, a similar association was only found for obesity [OR 1.20 (95% CI: 1.02–1.41)], but not for T2DM.ConclusionArea level deprivation is an independent, important determinant of T2DM and obesity prevalence in Germany. Identifying and targeting specific area-based risk factors should be considered an essential public health issue relevant to increasing the effectiveness of diabetes and obesity prevention.

show abstract

Section: Methodsmentioning

confidence: 95%

Area Level Deprivation Is an Independent Determinant of Prevalent Type 2 Diabetes and Obesity at the National Level in Germany. Results from the National Telephone Health Interview Surveys ‘German Health Update’ GEDA 2009 and 2010

et al. 2014

View full text Add to dashboard Cite

show abstract

“…Regional disparities in prescription patterns based on insurance data have been described earlier for the prescription prevalence of antibiotic use. A recent German study showed a regional variation of 19–53% of antibiotic use in children which was partly explained by regional deprivation (especially by regional income and occupational deprivation) [34].…”

Section: Discussionmentioning

confidence: 99%

Treatment Pattern of Type 2 Diabetes Differs in Two German Regions and with Patients' Socioeconomic Position

et al. 2014

View full text Add to dashboard Cite

BackgroundDiabetes treatment may differ by region and patients' socioeconomic position. This may be particularly true for newer drugs. However, data are highly limited.MethodsWe examined pooled individual data of two population-based German studies, KORA F4 (Cooperative Health Research in the Region of Augsburg, south), and the HNR (Heinz Nixdorf Recall study, west) both carried out 2006 to 2008. To ascertain the association between region and educational level with anti-hyperglycemic medication we fitted poisson regression models with robust error variance for any and newer anti-hyperglycemic medication, adjusting for age, sex, diabetes duration, BMI, cardiovascular disease, lifestyle, and insurance status.ResultsThe examined sample comprised 662 participants with self-reported type 2 diabetes (KORA F4: 83 women, 111 men; HNR: 183 women, 285 men). The probability to receive any anti-hyperglycemic drug as well as to be treated with newer anti-hyperglycemic drugs such as insulin analogues, thiazolidinediones, or glinides was significantly increased in southern compared to western Germany (prevalence ratio (PR); 95% CI: 1.12; 1.02–1.22, 1.52;1.10–2.11 respectively). Individuals with lower educational level tended to receive anti-hyperglycemic drugs more likely than their better educated counterparts (PR; 95% CI univariable: 1.10; 0.99–1.22; fully adjusted: 1.10; 0.98–1.23). In contrast, lower education was associated with a lower estimated probability to receive newer drugs among those with any anti-hyperglycemic drugs (PR low vs. high education: 0.66; 0.48–0.91; fully adjusted: 0.68; 0.47–0.996).ConclusionsWe found regional and individual social disparities in overall and newer anti-hyperglycemic medication which were not explained by other confounders. Further research is needed.

show abstract

“…Volumes vary more than threefold across countries, with Chile, Estonia and the Netherlands reporting the lowest volumes and Greece, Luxembourg and Belgium reporting volumes around 1.5 times the OECD average. Variation is likely to be explained, on the supply side, by differences in the regulation, guidelines and incentives that govern primary care prescribers and, on the demand side, by cultural differences in attitudes and expectations regarding the natural history and optimal treatment of infective illness (Akkerman et al, 2005;Koller et al, 2013). 2 shows the volume of quinolones and cephalosporins as a proportion of all antibiotics prescribed in primary care.…”

Section: Prescribing In Primary Carementioning

confidence: 99%

Health at a Glance 2013

2013

Health at a Glance

424

128

View full text Add to dashboard Cite

Variation in antibiotic prescriptions: is area deprivation an explanation? Analysis of 1.2 million children in Germany

Cited by 64 publications

References 31 publications

Area Level Deprivation Is an Independent Determinant of Prevalent Type 2 Diabetes and Obesity at the National Level in Germany. Results from the National Telephone Health Interview Surveys ‘German Health Update’ GEDA 2009 and 2010

Area Level Deprivation Is an Independent Determinant of Prevalent Type 2 Diabetes and Obesity at the National Level in Germany. Results from the National Telephone Health Interview Surveys ‘German Health Update’ GEDA 2009 and 2010

Treatment Pattern of Type 2 Diabetes Differs in Two German Regions and with Patients' Socioeconomic Position

Health at a Glance 2013

Contact Info

Product

Resources

About