Abstract
BackgroundHypertension is one of the most frequently diagnosed chronic conditions in Germany. Targeted prevention strategies and allocation of general practitioners where they are needed most are necessary to prevent severe complications arising from high blood pressure. However, data on chronic diseases in Germany are mostly available through survey data, which do not only underestimate the actual prevalence but are also only available on coarse spatial scales. The discussion of including area deprivation for planning of healthcare is still relatively young in Germany, although previous studies have shown that area deprivation is associated with adverse health outcomes, irrespective of individual characteristics. The aim of this study is therefore to analyze the spatial distribution of hypertension at very fine geographic scales and to assess location-specific associations between hypertension, socio-demographic population characteristics and area deprivation based on health insurance claims of the AOK Nordost.MethodsTo visualize the spatial distribution of hypertension prevalence at very fine geographic scales, we used the conditional autoregressive Besag–York–Mollié (BYM) model. Geographically weighted regression modelling (GWR) was applied to analyze the location-specific association of hypertension to area deprivation and further socio-demographic population characteristics.ResultsThe sex- and age-adjusted prevalence of hypertension was 33.1% in 2012 and varied widely across northeastern Germany. The main risk factors for hypertension were proportions of insurants aged 45–64, 65 and older, area deprivation and proportion of persons commuting to work outside their residential municipality. The GWR model revealed important regional variations in the strength of the examined associations.ConclusionArea deprivation has only a significant and therefore direct influence in large parts of Mecklenburg-West Pomerania. However, the spatially varying strength of the association between demographic variables and hypertension indicates that there also exists an indirect effect of area deprivation on the prevalence of hypertension. It can therefore be expected that persons ageing in deprived areas will be at greater risk of hypertension, irrespective of their individual characteristics. The future planning and allocation of primary healthcare in northeastern Germany would therefore greatly benefit from considering the effect of area deprivation.
Highlights
Hypertension is one of the most frequently diagnosed chronic conditions in Germany
Socio-demographic and –economic risk factors of hypertension We identified four variables as significant predictors of hypertension: (i) Area deprivation, (ii) proportions of insurants aged 45–64, (iii) proportion of insurants aged 65 and older and (iv), proportion of commuters
This study examined the spatial distribution of hypertension based on health insurance claims at the smallest administrative units available
Summary
Hypertension is one of the most frequently diagnosed chronic conditions in Germany. Targeted prevention strategies and allocation of general practitioners where they are needed most are necessary to prevent severe complications arising from high blood pressure. Lifestyle-related factors on an individual level play a substantial role for the development of chronic conditions, several studies point out that area deprivation is – independent of individual factors – an important determinant for chronic conditions [12,13,14,15]. These findings are important for planning of primary healthcare in Germany, which still relies mainly on the ratio of 1671 inhabitants per one general practitioner (GP) at the scale of aggregated municipalities – the socalled - central areas (Mittelbereiche), which was established in the 1990s [16, 17]. The discussion about the relevance of area deprivation indices for allocation of healthcare is still relatively young in Germany [18, 19] when compared to other countries such as the United Kingdom [20, 21], Canada [22], France [23] or Spain [24]
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