Johannes Pollmanns1, Maria Weyermann2, Max Geraedts3, Saskia E Drösler2. 1. Fachbereich Gesundheitswesen, Hochschule Niederrhein, Reinarzstraße 49, 47805, Krefeld, Deutschland. johannes.pollmanns@hs-niederrhein.de. 2. Fachbereich Gesundheitswesen, Hochschule Niederrhein, Reinarzstraße 49, 47805, Krefeld, Deutschland. 3. Institut für Versorgungsforschung und Klinische Epidemiologie, Philipps-Universität Marburg, Marburg, Deutschland.
Abstract
BACKGROUND: Hospitalizations and lower limb amputations related to diabetes mellitus (DM) are considered to be potentially avoidable. Appropriate outpatient care of diabetes prevents complications. Rates on potentially avoidable hospitalizations for diabetes are core indicators of the German diabetes surveillance program. International comparisons showed high hospitalization rates in Germany for both indicators. OBJECTIVES: The objective of this analysis is to describe time trends on hospitalizations and inpatient lower limb amputations (major amputations) for DM. Furthermore, we analyze small area variations. MATERIALS AND METHODS: Based on the German diagnosis related groups (DRGs) dataset we calculated age-standardized rates covering 2005-2015. Calculations rely on the Organisation for Economic Co-operation and Development (OECD) indicator definitions. Time trends are obtained by linear regression modelling. We also stratified into age groups and analyzed 2015 small-area variations using age-adjusted rates. RESULTS: Crude hospitalization rates were 310 admissions per 100,000 inhabitants in men (amputation rate: 15.6) and 216 admissions per 100,000 inhabitants in women (amputation rate: 7.1) in 2015. Age-adjusted hospitalizations and amputations rates in women decreased over time (10.3 and 1.2 cases per 100,000 inhabitants and year, respectively). In men, the amputation rate decreased significantly (1.5 cases per 100,000 inhabitants and year). We found higher rates for men than for women in almost all age categories. In eastern Germany and parts of Bavaria and North Rhine-Westphalia rates are particularly high. CONCLUSIONS: A decrease in hospitalization rates may indicate improvements in ambulatory diabetes care over time. Future studies should consider age-specific differences and small-area variations.
BACKGROUND: Hospitalizations and lower limb amputations related to diabetes mellitus (DM) are considered to be potentially avoidable. Appropriate outpatient care of diabetes prevents complications. Rates on potentially avoidable hospitalizations for diabetes are core indicators of the German diabetes surveillance program. International comparisons showed high hospitalization rates in Germany for both indicators. OBJECTIVES: The objective of this analysis is to describe time trends on hospitalizations and inpatient lower limb amputations (major amputations) for DM. Furthermore, we analyze small area variations. MATERIALS AND METHODS: Based on the German diagnosis related groups (DRGs) dataset we calculated age-standardized rates covering 2005-2015. Calculations rely on the Organisation for Economic Co-operation and Development (OECD) indicator definitions. Time trends are obtained by linear regression modelling. We also stratified into age groups and analyzed 2015 small-area variations using age-adjusted rates. RESULTS: Crude hospitalization rates were 310 admissions per 100,000 inhabitants in men (amputation rate: 15.6) and 216 admissions per 100,000 inhabitants in women (amputation rate: 7.1) in 2015. Age-adjusted hospitalizations and amputations rates in women decreased over time (10.3 and 1.2 cases per 100,000 inhabitants and year, respectively). In men, the amputation rate decreased significantly (1.5 cases per 100,000 inhabitants and year). We found higher rates for men than for women in almost all age categories. In eastern Germany and parts of Bavaria and North Rhine-Westphalia rates are particularly high. CONCLUSIONS: A decrease in hospitalization rates may indicate improvements in ambulatory diabetes care over time. Future studies should consider age-specific differences and small-area variations.
Authors: Christian Schmidt; Christin Heidemann; Alexander Rommel; Ralph Brinks; Heiner Claessen; Jochen Dreß; Bernd Hagen; Annika Hoyer; Gunter Laux; Johannes Pollmanns; Maximilian Präger; Julian Böhm; Saskia Drösler; Andrea Icks; Stephanie Kümmel; Christoph Kurz; Tatjana Kvitkina; Michael Laxy; Werner Maier; Maria Narres; Joachim Szecsenyi; Thaddäus Tönnies; Maria Weyermann; Rebecca Paprott; Lukas Reitzle; Jens Baumert; Eleni Patelakis; Thomas Ziese Journal: J Health Monit Date: 2019-06-27