German Federal Statistical Office Research Articles

Editor's Choice – High Annual Hospital Volume is Associated with Decreased in Hospital Mortality and Complication Rates Following Treatment of Abdominal Aortic Aneurysms: Secondary Data Analysis of the Nationwide German DRG Statistics from 2005 to 2013

The aim of this study was to analyse the association between annual hospital procedural volume and post-operative outcomes following repair of abdominal aortic aneurysms (AAA) in Germany. Data were extracted from nationwide Diagnosis Related Group (DRG) statistics provided by the German Federal Statistical Office. Cases with a diagnosis of AAA (ICD-10GM I71.3, I71.4) and procedure codes for endovascular aortic repair (EVAR; OPS 5-38a.1*) or open aortic repair (OAR; OPS 5-38.45, 5-38.47) treated between 2005 and 2013 were included. Hospitals were empirically grouped to quartiles depending on the overall annual volume of AAA procedures. A multilevel multivariable regression model was applied to adjust for sex, medical risk, type of procedure, and type of admission. Primary outcome was in hospital mortality. Secondary outcomes were complications, use of blood products, and length of stay (LOS). The association between AAA volume and in hospital mortality was also estimated as a function of continuous volume. A total of 96,426 cases, of which 11,795 (12.6%) presented as ruptured (r)AAA, were treated in >700 hospitals (annual median: 501). The crude in hospital mortality was 3.3% after intact (i)AAA repair (OAR 5.3%; EVAR 1.7%). Volume was inversely associated with mortality after OAR and EVAR. Complication rates, LOS, and use of blood products were lower in high volume hospitals. After rAAA repair, crude mortality was 40.4% (OAR 43.2%; EVAR 27.4%). An inverse association between mortality and volume was shown for rAAA repair; the same accounts for the use of blood products. When considering volume as a continuous variate, an annual caseload of 75-100 elective cases was associated with the lowest mortality risk. In hospital mortality and complication rates following AAA repair are inversely associated with annual hospital volume. The use of blood products and the LOS are lower in high volume hospitals. A minimum annual case threshold for AAA procedures might improve post-operative results.

Armut und Schmerz

Poverty is an important problem in Germany. The health effects of poverty can lead to ahigher risk of disease and the arising of chronic affections. On the other hand chronic illness may support the development and continuance of poverty. The context of chronic pain and poverty has not been analyzed so far. We investigated the correlation between chronic pain and poverty. In aprospective manner we interviewed 20patients with pain syndromes during our consultation hour regarding their household income. Further, data from the German Federal Statistical Office were analyzed with respect to the correlation between the incidence of achronic pain diagnosis and household income. At 1546 €, the average household income of the patients studied was below the poverty level. The analyzed data showed that women suffered from chronic pain more often than men did and also had alower income. Another economic inequality was found between Eastern and Western Germany. There was astatistically significant correlation between income and the incidence of the diagnostic codes for chronic pain (R52.1, 2, 9) for men. Our investigation showed the correlation between chronic pain and poverty. Acommitment and cooperation of German medical associations and federal politics is necessary to overcome this sociopolitical issue.

Spontaneous Pneumothorax.

Few reliable data are available on the epidemiology and treatment of spontaneous pneumothorax. We studied the sex and age distribution, frequency of hospitalization, mortality, and conservative versus surgical care of this condition in Germany in order to draw well-founded conclusions about its in-hospital diagnosis and treatment. Data from all patients aged 10 or older who were hospitalized in the period 2011-2015 with a main discharge diagnosis of pneumothorax of neither traumatic nor iatrogenic origin were retrieved from the German Federal Statistical Office. Because of their source, all data were based on case numbers rather than patient numbers. During the period of the study, there were 52 738 admissions with the main diagnosis of spontaneous pneumothorax, corresponding to an annual frequency of hospitalization of 14.3 per 100 000 persons per year (95% confidence interval, 14.0 to 14.5). Men were more frequently affected than women. The lethality and in-hospital mortality of this condition (≤ 0.08% and ≤ 0.3%, respectively) were low among persons aged 15 to 45, but markedly higher in persons over age 90 (9.4% and 15.9%, respectively). The frequency of accompanying pulmonary diagnoses also rose with age. Computerized tomography (CT) was performed in 38.9-54.6% of hospitalizations, depending on age. Monitoring on an intensive care unit was carried out in 36% of cases. More than one-quarter of cases involved surgical treatment. The danger to life and the likelihood of an accompanying pulmonary diagnosis are both low up to age 45. Treatment on an intensive care unit and computerized tomography of the chest should be performed only for strict indications in patients under age 45. The pathophysiological basis of the differing patterns of illness depending on age and sex requires further investigation.

Assessment of the potential public health impact of Herpes Zoster vaccination in Germany

ABSTRACT The aim of this study was to compare the public health impact of introducing 2 Herpes Zoster (HZ) vaccines, Zoster Vaccine Live (ZVL) versus a non-live adjuvanted subunit candidate vaccine (HZ/su), in the German population aged 50+ years split into 3 age cohorts, i.e. 50–59, 60–69 and 70+ years, respectively. A multi-cohort static Markov model was developed following age cohorts over their lifetime. Demographic data were obtained from the German federal statistical office. HZ incidence and the proportion of HZ individuals developing post-herpetic neuralgia (PHN) were derived from German specific sources. Age-specific vaccine efficacy and waning rates were based on published clinical trial data. Vaccine coverage for both vaccines was assumed to be 40%, with compliance of the second dose of the HZ/su vaccine of 70%. Sensitivity analyses were performed to assess the robustness of the results. It was estimated that, over the remaining lifetime since vaccination, the HZ/su vaccine would reduce the number of HZ cases by 725,233, 533,162 and 486,794 in the 3 age cohorts, respectively, compared with 198,477, 196,000 and 104,640, using ZVL. The number needed to vaccinate (NNV) to prevent one HZ case ranged from 8 to 11 using the HZ/su vaccine compared with 20 to 50 using ZVL. Corresponding NNV to prevent one PHN case ranged from 39 to 53 using the HZ/su vaccine compared with 94 to 198 using ZVL. Due to the higher, sustained vaccine efficacy, the candidate HZ/su vaccine demonstrated superior public health impact compared with ZVL.

NOROVIRUS GASTROENTERITIS IS AN IMPORTANT CAUSE OF NOSOCOMIAL INFECTIONS IN GERMANY

Noroviruses are the most important global cause of acute gastroenteritis (AGE). Testing for norovirus in patients hospitalized with AGE is incentivized in Germany because a positive diagnosis impacts reimbursement. We estimated the number of nosocomial infections overall and by age-group for norovirus gastroenteritis (NGE) using federal German databases. All hospitalizations in Germany are registered with the German Federal Statistics Office (DESTATIS). We extracted aggregate data for patients hospitalized with NGE (ICD-10 codes A08.1) as primary or non-primary diagnosis for the period 2007–2012. Cases with a non-primary diagnoses were assumed to be due to nosocomial infection. During the six-year study period and based on our assumption, there were a total of 241,667 nosocomial NGE cases among hospitalized patients in Germany; an average of 40,278 cases per year studied (range 32,259–57,561). In any study year the number of nosocomial NGE cases was 1.3 to 1.7-fold higher than the number of community acquired NGE hospitalizations. The average duration of hospitalization was 3.4 to 4.5-fold longer (17–18 days versus 4–5 days) when NGE was nosocmial compared to community-acquired. Adults of 85 years of age and older suffered the highest rate of nosocomial NGE (range 33.6 to 59.1/10,000 population). We conclude that Noroviruses are an important cause of nosocomial infections among hospitalized patients in Germany. Assuming all non-primary coded NGE episodes to be nosocomial in nature may have lead to an overestimation.

Incidence, Treatment and Mortality in Patients with Abdominal Aortic Aneurysms.

Aim of this study was to analyze hospital incidence, type of treatment, and hospital mortality rates of patients with abdominal aortic aneurysm (AAA) in Germany from 2005 to 2014. Microdata of the diagnosis-related group (DRG) statistics compiled by the German Federal Statistical Office for the years 2005-2014 were analyzed. Patients who were hospitalized for a ruptured AAA (rAAA, ICD-10 code I71.3, treated either surgically or conservatively) or received surgical treatment for an unruptured AAA (nrAAA, ICD-10-Code I71.4, treated either with open surgery or an endovascular procedure) were included in the analysis. The "European Standard Population 2013" was used for direct standardization of the hospital incidences. In-hospital mortality was calculated with standardization for age and risk. The standardized overall hospital incidence of AAA was 27.9 and 3.3 cases per 100 000 people for men and women, respectively; over the period of the study, the incidence of rAAA fell by 30% in both sexes and that of nrAAA rose by 16% in men and 42% in women. The percentage of patients receiving endovascular treatment rose from 29% to 75% in patients with nrAAA and from 8% to 36% in patients with rAAA. The age- and risk-standardized in-hospital mortality of nrAAA was 3.3% in men and 5.3% in women. The in-hospital mortality of surgically treated rAAA was 39% in men and 48% in women. The hospital incidence of AAA rose from 2005 to 2014, while that of rAAA fell. Endovascular treatment became more common for nrAAA as well as rAAA, and in-hospital mortality fell for both.

Subarachnoid Hemorrhage in Germany Between 2010 and 2013: Estimated Incidence Rates Based on a Nationwide Hospital Discharge Registry.

Nordic countries are the primary source for nationwide data on the incidence of subarachnoid hemorrhage (SAH). Reliable estimates of national incidence rates of SAH in other countries are lacking, yet studies from Nordic countries with exceptional incidence rates are sometimes disregarded because of concerns regarding external validity. Autopsies are rarely performed for sudden deaths; therefore, estimates of the SAH incidence commonly reflect the hospital discharge rates. Our aim was to estimate the nationwide incidence of nontraumatic SAH in Germany using a national hospital discharge register. The German federal statistical office provided the number of patients discharged from all German hospitals between 2010 and 2013 with the primary diagnosis of nontraumatic SAH (ICD code I60.0-I60.9) and corresponding age distribution. Age-standardized attack rates of nontraumatic SAH were calculated using the 2011 German demographic distribution. Between 2010 and 2013, the overall age-standardized incidence rate of nontraumatic SAH was 11.3 per 100,000 person-years, and it reached a maximum of 22.1 per 100,000 person-years in the oldest age group. The absolute number of SAHs was highest in the 50-55-year age group. The distribution of intracranial aneurysms displayed a propensity toward the posterior circulation with advancing age (P < 0.001), although in absolute numbers SAH originated mostly from the anterior circulation. Our estimate of the German nationwide attack rate suggests that the incidence of nontraumatic SAH is more homogeneous than previously assumed. Rejecting the external validity of studies from countries believed to display an exceptional incidence rates may therefore not be justified.

Insight into the incidence of acute aortic dissection in the German region of Berlin and Brandenburg

BackgroundStanford acute type A aortic dissection (ATAAD) is a potentially lethal condition. Epidemiology studies show a statistical incidence in Europe of approximately 2–16 cases/100,000 inhabitants/year. In Germany, the estimated incidence (here subsumed under “thoracic aortic dissection” with 4.63 cases/100,000 inhabitants/year) is mainly extracted from medical death certificates by the German Federal Statistical Office. The prehospital incidence of ATAAD deaths is largely unknown. Since patients often die in the pre-hospital setting, the incidence of ATAAD is therefore likely to be higher than current estimates. Material and methodsFor the period from 2010 to 2014, we retrospectively analyzed all in-hospital ATAAD data from two of the largest cardiac surgical centers that treat ATAAD in the Berlin-Brandenburg region. In addition, autopsy reports of all forensic medicine institutes and of one large pathological provider in the region were analyzed to identify additional non-hospitalized ATAAD patients. Based on these findings, the regional incidence of ATAAD was calculated. ResultsIn addition to in-hospital ATAAD patients (n=405), we identified additional 145 lethal ATAAD cases among 14,201 autopsy reports. The total of 550 ATAAD cases led to an estimated incidence of 11.9 cases/100,000 inhabitants/year for the whole Berlin-Brandenburg region. Arterial hypertension, pre-existing aortic dilatation, and hereditary connective tissue disorder were found in, respectively, 62.7%, 10%, and 1.8% of patients. ConclusionATAAD is more frequent than previously reported. Our results show that when patients who die outside of cardiac surgery centers are included, the incidence of ATAAD significantly exceeds the rate reported by the Federal Statistical Office.

Trends and incidences of ligament-surgeries and osteotomies of the knee: an analysis of German inpatient records 2005-2013.

In Germany most surgical procedures of the ligaments of the knee and correcting osteotomies of the knees are performed within an inpatient setting. The purpose of this study was to analyze the available data to assess epidemiological trends and incidences in inpatient knee joint surgery. Approximately 154million anonymized DRG inpatient records were collected by the German Federal Statistical Office between 2005 and 2013. These data were screened and analyzed for knee joint surgical ligamental procedures and osteotomies. Anterior cruciate ligament reconstruction (ACLR) or repair had a high incidence (46 per 100,000persons/year). In addition, the most frequent grafts included hamstring tendon (90%) and the patellar tendon (6.3%) autografts (2013). Peak age group for ACLR was 15-20years (14.5%) for female and 20-25years (23.6%) for male patients, while there was a second peak in the age group 45-50years (13.8%) for female patients. Male patients had a higher risk for receiving ACLR (RR 1.96; 95% CI 1.92-2.00) and for receiving valgizing high tibial osteotomy (RR 2.43; 95% CI 2.27-2.61). Females had a higher risk for receiving varizing distal femur osteotomy (RR 1.89; 95% CI 1.58-2.26). There are growing trends for joint- and activity-preserving procedure in the middle-aged patients. The knowledge of the trends and incidences related to these procedures may help to validate and discuss the results of clinical and register studies.

Trends and incidence of cartilage, ligament- and arthroscopic surgery: Analysis of German in-patient records 2005-2013

Aims and Objectives:Apart from some international cruciate ligament and arthroplasty register data, little epidemiological baseline facts are known about many joint surgical procedures. The German Federal Statistical Office collects the encoded population-based data of all medical in-patient procedures performed in Germany. The purpose of this study was to analyze these data to assess epidemiological trends and incidences in joint surgery.Materials and Methods:The comprehensive database of medical procedures of the German DRG system between 2005 and 2013, including 154 million anonymized in-patient records, were screened and analyzed for joint surgical procedures.Results:Trends of incidence rates of many joint surgical procedures have been detected. There was an increasing incidence of arthroscopic procedures in relation to the open procedures. Anterior cruciate ligament reconstruction or repair has a high incidence of 46 per 100,000 person-years, most popular grafts were hamstring tendon (90%) and patellar tendon (6.3%) autografts (2013).Conclusion:This is the first baseline epidemiological data out of 154 million in-patient records in Germany including joint and ligament surgical procedures with a focus on knee and shoulder surgery. The knowledge of the trends and incidences of these procedures help to validate and discuss the results of clinical studies and registers.

Lower Limb Amputation in Germany.

Declining amputation rates have been reported in multiple countries in recent years. It is not yet known whether amputation rates have declined in Germany as well. On the basis of DRG (diagnosis-related group) data, we received a list from the German Federal Statistical Office of all major and minor amputations documented in German hospitals from 2005 to 2014. Changes over this period were studied with linear regression. The absolute number of amputations per year in Germany rose slightly from 55 689 in 2005 to 57 637 (+3.5%) in 2014. After the exclusion of cases in which the main diagnosis was trauma, intoxication, musculoskeletal disease, diseases of the skin and subcutaneous tissue, or neoplasia, the corresponding numbers were 48 043 in 2005 and 48 561 in 2014 (+1.1%). The age-adjusted rate of major amputations per 100 000 persons per year fell from 23.3 to 16.1 (-30.9%), while the rate of minor amputations rose from 35.0 to 43.9 (+25.4%). The percentage of major amputations that took place in patients with diabetes mellitus as the main diagnosis or a side diagnosis declined from 70.2% to 63.7%. For all of these changes, p <0.0001. From 2005 to 2014, the major amputation rate fell by 30.9% while the minor amputation rate rose by 25.4%. The goal of lowering amputation rates still further will be best served not only by applying the recognized preventive measures in patients with foot lesions, but also by further research into the causes of the recent changes in amputation numbers. Prospective registries will be needed.

Pregnant Women in Sport Climbing - Is there a Higher Risk for Preterm Birth?

Sport climbing is a popular recreational sport with an increasing proportion of female athletes. International recommendations emphasize the physical and mental benefits of regular sport activity during any uncomplicated pregnancy. In this context, sport climbing is associated with a high risk potential.The aim of this study was to examine if there is a higher risk for preterm birth in active climbing athletes.Original manuscript.A retrospective self-report online survey in the German language collected data between September 2012 and November 2013. In addition to anthropometric and demographic data, data on climbing experience, preferred climbing discipline, skill level and changes of climbing habits during pregnancy, known risk factors for preterm birth and information on delivery and the newborn were requested. The rate of preterm birth of the survey was tested with Fisher's exact test with information from the German Federal Statistical Office.Sample size was 32. 72% had a university degree, 81% were primiparous, all were singleton pregnancies. A 33rd questionnaire was excluded because of described preeclampsia. Age ranged between 21 and 39 years, climbing experience before pregnancy between 2 and 24 years, and skill level before pregnancy between 4 and 7 on the UIAA scale (International Climbing and Mountaineering Federation). Half of the women climbed until the 36th week and 90% adjusted their climbing habits mostly by reducing climbing difficulty and doing more top roping. 2 preterm births in the 36th week of gestation were found (2 from 15, p=0.36). According to the data from the German Federal Statistical Office, 8.9% births in the year 2013 in Germany were preterm.This is the first study investigating the risk of preterm birth in recreational sport climbing athletes. No significantly higher proportion of preterm birth could be found. Limitations are small sample size and high social status of participants. What is known about the subject: Sport climbing is not a high-risk sport, but it is regarded as a dynamic whole-body exercise and has been shown to be a valuable therapy for various physical and mental diseases. Higher performance levels are associated with overuse damage to the upper extremity, especially the fingers. What this study adds to existing knowledge: This is first study investigating climbing-related risk of preterm birth. When continuing sport climbing as a recreational activity during an uncomplicated pregnancy, experienced athletes do not have a higher risk of adverse events.

The Distribution of Economic Resources to Children in Germany

This paper investigates the redistributive impact of private and public childcare provision and education on children's resources in Germany between 2009 and 2013. It takes account of the multidimensionality of children's needs and access to economic resources by applying an extended income approach. Combining survey data from the Socio-Economic Panel (SOEP) with administrative data from the German Federal Statistical Office, extended disposable income inequality is found to be significantly lower than disposable cash income inequality at the five percent level across all years. However, the extension does not significantly change distributional trends. At the same time, publicly provided childcare and schooling notably decrease inequality among children such that it cushions cash income inequality. One major reason for this effect is that public in-kind benefits profit children living with single parents, which are deprived in terms of cash incomes, most. This gives additional evidence on the importance of publicly provided childcare and schooling as a policy instrument to equalize economic resources and opportunities in children's lives.

Modern Public Enterprises: Organisational Innovation and Productivity

In advanced economies, state-owned enterprises play an important role in sectors of general interest such as energy and water supply. The conditions under which they operate have changed fundamentally since 1998, with new strategies required for firms to preserve market shares in the face of liberalisation and technological innovation. This paper investigates the productivity effect of three strategies in new public management: corporatisation, outsourcing, and partial privatisation. Firm-level productivity is estimated from production data using a control function approach. As most of the firms are typically multiproduct firms, we suggest a method for modelling differences in the product mix and to account for heterogeneous production environments. Using a newly constructed and unique dataset from the German Federal Statistical Office, we find that outsourcing and corporatisation positively impact productivity, while partial privatisation does not increase productivity.

PMD128 - Adoption of Endoscopic Lung Volume Reduction for Emphysema in Germany: Utilization Patterns and Case Volumes in the Period 2010-2014

Endoscopic lung volume reduction (LVR) is a treatment approach that has been shown to improve functional outcomes and quality of life of selected patient groups suffering from severe emphysema. Current available endoscopic LVR treatments include endobronchial valve therapy, coil therapy, and thermoablation. Our objective was to estimate the adoption patterns of these approaches in the German healthcare system, which was among the first to adopt these technologies. Therapy- and age-specific procedure volumes were collected from German Federal Statistics Office databases for the period 2010-2014. We computed therapy-specific and total procedure volumes and growth stratified by age groups <65, and >65 years, and in total. In addition, for valve and coil therapy, we estimated the average number of devices used per procedure and approximated the number of patients treated in 2014. In the studied period overall endoscopic LVR procedure volumes grew from 466 to 2,629 (+464%). In 2014, valve therapy constituted 54.3%, coil therapy 41.1%, and thermoablation 4.6% of all procedures. Across therapies and studied years, approximately half of the patients were younger than 65 years of age (43.0-51.9%). The estimated average number of valves per procedure was 2.78; 2.89; 3.08; 3.35; and 3.13 in years 2010-2014, and the estimated number of coils in the three reported years 2012-2014 was 9.29; 9.15; and 9.70 coils per procedure. As a consequence almost 1,000 and 600 patients got access to valves and coils in 2014, respectively. Coil estimates do not consider any duplicate procedure codes, and hence might partially underestimate actual device use per procedure and number of patients treated. Endoscopic lung volume reduction treatment broadens the therapeutic options in selected patients with advanced emphysema. Our analysis shows continued uptake of endoscopic LVR in Germany, with consistent treatment patterns in each of the two procedures relying on multiple devices.

MD3 - Adoption of Transcatheter Mitral Valve Repair in Germany: Utilization Patterns and Case Volumes Compared to Mitral Valve Surgery in the Period 2010-2014

The German healthcare system was among the first markets to introduce transcatheter mitral valve repair (TMVR) in routine care for patients suffering from mitral valve insufficiency. Our objective was to estimate the impact of TMVR availability on overall mitral valve repair volumes and competing therapies in this real-world setting. Therapy- and age-specific procedure volumes were collected from German Federal Statistics Office databases for TMVR and mitral valve surgery for the period 2010 through 2014. We computed therapy-specific and total procedure volumes and growth stratified by age groups <65, 65-74, 75-84, and >85 years, and in total. In the time period 2010 to 2014 overall procedure volumes grew from 17,521 to 24,033 (+37%). This growth was driven by both TMVR (508 to 3,715; +631%) and surgical procedure growth (17,013 to 20,318; +19%). The share of TMVR as percent of total procedures grew from 2.9% to 15.5% over the 5-year period. In 2014, TMVR use reached 4%, 13%, 26%, and 68% in the studied age groups. Absolute TMVR procedure growth was highest in age group 75-84 years (+1,606). Concurrently, surgical volumes grew in all age groups, except for age >85 years, with the highest absolute growth in younger patients (+2,079 in age group <65 years). The availability of TMVR has contributed to pronounced growth in mitral valve repair in Germany, specifically in elderly populations previously left untreated. At the same time, surgical procedure volumes continued to grow substantially in the study period in all age segments, except for the group of very elderly patients.

Fertility in Germany before and after the 2011 Census: Still no Trend Reversal in Sight

The population projections by the German Federal Statistical Office show a likely decrease in the number of births in the 2020s. This development will be the result of a declining number of prospective mothers combined with an assumed continued low fertility rate. Given the available empirical findings prior to the 2011 census, there was no indication that a possible distinct rise in the fertility rate in the next decade would compensate for the declining number of potential mothers. However, the 2011 census led to revisions in the population size, age structure and consequently in relative fertility measures such as period and cohort fertility rates.The objective of this article is to quantify the effects of the 2011 census on these fertility statistics and to check the validity of previous findings for fertility trends on the census-adjusted data basis. A special focus is laid on analyses of the cohort fertility and the consequences of ever-later entry into motherhood on the completed fertility and on parity distribution. Using numerous findings, we will show that a continuous rise in the completed fertility in the coming two decades cannot be realised without a reversal of fertility behaviour. A greater increase in fertility from the age of 30 onwards would be necessary to offset the decrease in fertility for ages under 30 – a trend which intensified with cohort 1974 – and thereby stabilise the total cohort fertility rate at a relatively low level between 1.5 and 1.6 births per woman. A rise and subsequent stabilisation of the total cohort fertility rate at the level of at least 1.6 births per woman would, additionally, necessitate a trend reversal in the development of childlessness and distinct changes in birth timing.

Small Area Estimation in the German Census 2011

Abstract In 2011, Germany conducted the first census after the reunification. In contrast to a classical census, a register-assisted census was implemented using population register data and an additional sample. This paper provides an overview of how the sampling design recommendations were set up in order to fulfil legal requirements and to guarantee an optimal but still flexible source of information. The aim was to develop a design that fosters an accurate estimation of the main objective of the census, the total population counts. Further, the design should also adequately support the application of small area estimation methods. Some empirical results are given to provide an assessment of selected methods. The research was conducted within the German Census Sampling and Estimation research project, financially supported by the German Federal Statistical Office.

Small area estimation in the German Census 2011

In 2011, Germany conducted the first census after the reunification. In contrast to a classical census, a register-assisted census was implemented using population register data and an additional sample. This paper provides an overview of how the sampling design recommendations were set up in order to fulfil legal requirements and to guarantee an optimal but still flexible source of information. The aim was to develop a design that fosters an accurate estimation of the main objective of the census, the total population counts. Further, the design should also adequately support the application of small area estimation methods. Some empirical results are given to provide an assessment of selected methods. The research was conducted within the German Census Sampling and Estimation research project, financially supported by the German Federal Statistical Office.

Demographic distribution of hospital admissions for brain arteriovenous malformations in Germany--estimation of the natural course with the big-data approach.

Estimation of the natural history of arteriovenous malformations based on short-term observation is potentially biased by multiple factors. Retrieval of demographic information of all AVM patients of national data pools and comparison with the national demographic profile might be another way to approach the natural history. Upon request, the German Federal Statistical Office provided the numbers of patients admitted in Germany from 2009 through 2013 with ICD Q28.2 (brain AVM) as primary discharge diagnosis, and the corresponding age distribution. Age-related admission rates of AVM were calculated by comparison with the German demographic distribution. A total of 6527 patients were hospitalized from 2009-2013 with brain AVM (Q28.2) as the principal diagnosis. Age-specific admission rate during the first year of life was high with 19.0/100,000 during the 5-year study period, corresponding to a yearly admission rate of 3.8 per 100,000 babies. Apart from the high admission rate during the first year of life, the admission rate was low, but steadily increasing during first decades of life reaching a plateau with 11.1/100,000 in the age group 30-34 years, corresponding to an annual admission rate of 2.2/100,000. After the age of 30-34 years, admission rates decreased continuously, reaching 0 in the age group 90-95 years. The lifetime risk of admission in terms of admission per 100,000 age-matched people was calculated by retrograde integration of the admission rates. At the age of 1 year, the cumulative number offuture admissions for AVM during lifetime amounted to 131.3/100,000 children. For the older age groups, the chance of future admission for AVM decreased as expected, reaching 43.8/100,000 by the age of 50 and 0 by the age of 90. Despite some open issues, the current data suggests that achieving old age with an untreated brain AVM is unlikely. Furthermore, the data support the concept that most brain AVMs are not necessarily a congenital entity but develop during the first decades of life.