Abstract
ObjectiveTo investigate asthma morbidity in Germany by calculating current prevalence, examining its temporal and spatial trends and estimating the total number of asthmatics in Germany and calculating age-, sex- and residence-specific risk.MethodsWe used claims data reported by physicians during 2009–2016, including outpatient diagnoses of all statutory health insured individuals, comprising 85.3% (70 416 019/82 521 653) of the total population in Germany in 2016. We performed a spatial analysis of asthma prevalence according to administrative district by calculating Global and Local Moran’s I. We assessed the risk of asthma by sex, age, type of residence (rural versus urban) and federal state (East versus West) using a multilevel parametric survival regression.FindingsWe estimated that 4.7 million individuals were affected by asthma in 2016, including 0.8 million children and 3.9 million adults. We observed a slightly higher prevalence (with an increasing trend) among adults (5.85%; 3 408 622/58 246 299) compared to children (5.13%; 624 899/12 169 720), and calculated an age-standardized prevalence of 5.76% (95% confidence interval, CI: 5.76–5.77). We found evidence of a strong spatial autocorrelation (Global Moran’s I: 0.50, P < 0.0001), and identified local spatial clusters with higher levels of prevalence. Living in the western (versus eastern) federal states and living in densely populated large urban municipalities (versus rural area) were independently associated with an increased risk of asthma, with hazard ratios of 1.33 (95% CI: 1.32–1.34) and 1.32 (95% CI: 1.31–1.32), respectively.ConclusionOur insights into the spatial distribution of asthma morbidity may inform public health interventions, including region-specific prevention programmes and control.
Highlights
Asthma is the most frequently diagnosed and chronic, noncommunicable, inflammatory disorder among children and adults
According to the latest Global Asthma Report, nearly 340 million individuals worldwide have been diagnosed with asthma;[1] it is estimated that an additional 100 million individuals will be affected by 2025.2 The prevalence of asthma varies substantially across the globe, and has been shown to vary between countries by up to a factor of 21.3 Prevalence tends to be higher in developed countries, with the highest reported prevalence of asthma in Australia (21%), Sweden (20%), the United Kingdom of Great Britain and Northern Ireland (18%), the Netherlands (15%) and Brazil (13%); the lowest prevalence of asthma has been observed for Viet Nam (0.8%) and China (0.2%).[3]
There were only minor differences across population distributions by age, type of residence and federal state; the proportion of females was higher in the study population than in the general population
Summary
Asthma is the most frequently diagnosed and chronic, noncommunicable, inflammatory disorder among children and adults. Prevalence estimates of 3–12% among children and 2–5% among adults have been reported in Germany;[12] current estimates of asthma incidence are lacking. Regional variations in Germany have only been examined for rough geographical units and for specific age groups (e.g. children or adults). One study demonstrated differences in asthma prevalence among children between East and West Germany.[13] Another study involving only adult participants investigated variations in asthma prevalence across the German federal states.[14]
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