Mortality In Germany Research Articles

Recalculation of Tobacco-Attributable Mortality: National and Regional Data for Germany

Tobacco use accounts for about 5 million annual premature deaths worldwide. Tobacco thus is the single most important preventable health risk. In this paper we present a recalculation of tobacco-attributable mortality in Germany, and examine gender and regional differences. The calculation is based on the prevalence of current and former smokers, the relative mortality risks for diseases for which tobacco use is associated with an increased mortality risk, and the number of deaths by ICD-10 diagnoses. For the first time, colorectal and liver cancer as well as type 2 diabetes and tuberculosis were taken into consideration. In 2013, 121 087 deaths were attributable to smoking (i. e. 13.5% of all deaths), including 84 782 deaths in men and 36 305 deaths in women. The tobacco-attributable mortality rate was higher in men than in women, and in terms of regional discrepancies a north-south-gradient was observed. The number of tobacco-attributable deaths is substantial and higher than previously predicted. Compared to 2007, numbers have increased in absolute terms, whereas in relative terms the tobacco-attributable mortality rate declined. Given processes of demographic aging, a continued rise in absolute numbers of tobacco-attributable mortality is to be expected in the future.

Public health impact of colonoscopy use on colorectal cancer mortality in Germany and the United States

Colonoscopy has been demonstrated to be effective in reducing colorectal cancer (CRC) incidence and mortality and has been widely used for primary CRC screening in Germany and the United States. We performed a population-based analysis to evaluate and compare the public health impact of recent colonoscopy use on CRC deaths among adults aged 55 to 79 years in Germany and the United States from 2008 to2011. The epidemiologic metrics of attributable fraction and prevented fraction as well as the impact numbers were calculated using colonoscopy utilization data from nationally representative health surveys, relative risk estimates from medical literature, and CRC death registry data. Overall, 36.6% (95% credible interval [CrI], 27.3%-45.5%) of CRC deaths in Germany were estimated to be attributable to nonuse of colonoscopy, compared with the U.S. estimates of 38.2% (95% CrI, 28.6%-47.1%) and 33.6% (95% CrI, 24.8%-42.2%) for years 2008 to 2009 and 2010 to 2011, respectively. The proportion of CRC deaths theoretically prevented by colonoscopy use within 10 years was 30.7% (95% CrI, 24.8%-35.7%) in Germany, whereas in the United States this proportion ranged from 29.0% (95% CrI, 23.4%-33.6%) for 2008 to 2009 to 33.9% (95% CrI, 27.4%-39.2%) for 2010 to2011. Recent colonoscopy use is likely to have prevented a considerable fraction of CRC mortality in both countries, and more deaths could be avoided by increasing colonoscopy use in the target population. Attributable and prevented fraction can provide valuable information on the public health impact of colonoscopy use and guide policymaking.

Antidepressant sales and regional variations of suicide mortality in Germany

Suicides account for over one million deaths per year worldwide with depression among the most important risk factors. Epidemiological research into the relationship between antidepressant utilization and suicide mortality has shown heterogeneous and contradictory results. Different methodological approaches and limitations could at least partially explain varying results. This is the first study assessing the association of suicide mortality and antidepressant sales across Germany using complex statistical approaches in order to control for possible confounding factors including spatial dependency of data. German suicide counts were analyzed on a district level (n = 402) utilizing ecological Poisson regressions within a hierarchical Bayesian framework. Due to significant spatial effects between adjacent districts spatial models were calculated in addition to a baseline non-spatial model. Models were adjusted for several confounders including socioeconomic variables, quality of psychosocial care, and depression prevalence. Separate analyses were performed for Eastern and Western Germany and for different classes of antidepressants (SSRIs and TCAs). Overall antidepressant sales were significantly negatively associated with suicide mortality in the non-spatial baseline model, while after adjusting for spatially structured and unstructured effects the association turned out to be insignificant. In sub-analyses, analogue results were found for SSRIs and TCAs separately. Suicide risk shows a distinct heterogeneous pattern with a pronounced relative risk in Southeast Germany. In conclusion, the results reflect the heterogeneous findings of previous studies on the association between suicide mortality and antidepressant sales and point to the complexity of this hypothesized link. Furthermore, the findings support tailored suicide preventive efforts within high risk areas.

Management of anesthesia in endovascular interventions

Cardiovascular diseases are one of the leading causes of morbidity and mortality in Germany. In these patients, the high-risk profile necessitates an interdisciplinary and multimodal approach to treatment. Endovascular interventions and vascular surgery have become established as an important element of this strategy in the past; however, the different anatomical localizations of pathological vascular alterations make it necessary to use awide spectrum of procedural options and methods; therefore, the requirements for management of anesthesia are variable and necessitate adifferentiated approach. Endovascular procedures can be carried out with the patient under general or regional anesthesia (RA); however, in the currently available literature there is no evidence for an advantage of RA over general anesthesia regarding morbidity and mortality, although a reduction in pulmonary complications could be found for some endovascular interventions. Epidural and spinal RA procedures should be carefully considered with respect to the risk-benefit ratio and consideration of the recent guidelines on anesthesia against the background of the current study situation and the regular use of therapy with anticoagulants. The following article elucidates the specific characteristics of anesthesia management as exemplified by some selected endovascular interventions.

Regional variations in the prevalence of eight major cardiovascular risk factors between the 16 federal states in Germany

Objective: More than 60% of cardiovascular deaths are caused by eight major risk factors. We investigated whether there are differences in the prevalence of these risk factors in the 16 German federal states that could help explain the known regional variations in cardiovascular disease prevalence and mortality in Germany.

Influenza pandemic deaths in Germany from 1918 to 2009. Estimates based on literature and own calculations

Estimation of the number of deaths as a consequence of the influenza pandemics in the twentieth and twenty-first centuries (i.e. 1918-1919, 1957-1958, 1968-1970 and 2009) is a challenge worldwide and also in Germany. After conducting a systematic literature search complemented by our own calculations, values and estimates for all four pandemics were collated and evaluated. A systematic literature search including the terms death, mortality, pandemic, epidemic, Germany, 1918, 1957, 1968, 2009 was performed. Hits were reviewed by title and abstract and selected for possible relevance. We derived our own estimates using excess mortality calculations, which estimate the mortality exceeding that to be expected. All identified values were evaluated by methodology and quality of the database. Numbers of pandemic deaths were used to calculate case fatality rates and were compared with global values provided by the World Health Organization. For the pandemic 1918-1919 we identified 5 relevant publications, 3 for the pandemics 1957-1958 and 1968-1970 and 3 for 2009. For all four pandemics the most plausible estimations were based on time series analyses, taken either from the literature or from our own calculations based on monthly or weekly all cause death statistics. For the four pandemics these estimates were in chronological order 426,600 (1918-1919), 29,100 (1957-1958), 46,900 (1968-1970) and 350 (2009) excess pandemic-related deaths. This translates to an excess mortality ranging between 691 per 100,000 (0.69 % in 1918-1919) and 0.43 per 100,000 (0.00043 % in 2009). Case fatality rates showed good agreement with global estimates. We have proposed plausible estimates of pandemic-related excess number of deaths for the last four pandemics as well as excess mortality in Germany. The heterogeneity among pandemics is large with a variation factor of more than 1000. Possible explanations include characteristics of the virus or host (immunity), social conditions, status of the healthcare system and medical advances.

Incidence and Mortality Trends in German Women with Breast Cancer Using Age, Period and Cohort 1999 to 2008

Longitudinal analysis investigates period (P), often as years. Additional scales of time are age (A) and birth cohort (C) Aim of our study was to use ecological APC analysis for women breast cancer incidence and mortality in Germany. Nation-wide new cases and deaths were obtained from Robert Koch Institute and female population from federal statistics, 1999–2008. Data was stratified into ten 5-years age-groups starting 20–24 years, ten birth cohorts starting 1939–43, and two calendar periods 1999–2003 and 2004–2008. Annual incidence and mortality were calculated: cases to 100,000 women per year. Data was analyzed using glm and apc packages of R. Breast cancer incidence and mortality increased with age. Secular rise in breast cancer incidence and decline in mortality was observed for period1999-2008. Breast cancer incidence and mortality declined with cohorts; cohorts 1950s showed highest incidence and mortality. Age-cohort best explained incidence and mortality followed by age-period-cohort with overall declining trends. Declining age-cohort mortality could be probable. Declining age-cohort incidence would require future biological explanations or rendered statistical artefact. Cohorts 1949–1958 could be unique in having highest incidence and mortality in recent time or future period associations could emerge relatively stronger to cohort to provide additional explanation of temporal change over cohorts.

Declining Bowel Cancer Incidence and Mortality in Germany.

In October 2002, screening colonoscopy from age 55 onward was introduced as part of the German national statutory cancer screening program. Screening colonoscopy is intended to lower both the mortality and the incidence of bowel cancer by enabling the detection and removal of precursor lesions. The authors studied trends in bowel cancer incidence and mortality in Germany from 2003 to 2012 on the basis of data from the epidemiological cancer registries and from cause-of-death statistics. Over the period of investigation, the age-standardized incidence of bowel cancer (with the European population as a standard) fell from 66.1 to 57.0 cases per 100 000 persons per year (-13.8%) in men and from 42.6 to 36.5 per 100 000 persons per year (-14.3%) in women. In parallel with these changes, the age-standardized mortality from bowel cancer fell by 20.8% in men and by 26.5% in women. In the age groups 55-64, 65-74, and 75-84 years, the cumulative risk of receiving a diagnosis of bowel cancer fell by 17-26%; in persons under age 55, this risk fell by only 3% in men, but increased by 14% in women. Long-term data from the cancer registry in the German federal state of Saarland revealed that the incidence of bowel cancer, but not its mortality, had risen over the decades preceding the study; it was only during the period of investigation that the trend reversed itself. Within 10 years of the introduction of screening colonoscopy in Germany, the incidence of bowel cancer in persons over age 55 fell by 17-26%, after having risen steadily over the preceding decades.

Melanoma mortality following skin cancer screening in Germany

ObjectivesIn 2003, a skin cancer screening campaign based on total body skin examination was launched in the federal state of Schleswig-Holstein, Germany. 20% of adults aged 20 and over were...

Temporal Changes in Alcohol-Related Morbidity and Mortality in Germany

Aims: Trends in morbidity and mortality, fully or partially attributable to alcohol, for adults aged 18-64 were assessed for Germany. Methods: The underestimation of population exposure was corrected by triangulating survey data with per capita consumption. Alcohol-attributable fractions by sex and two age groups were estimated for major disease categories causally linked to alcohol. Absolute numbers, population rates and proportions relative to all hospitalizations and deaths were calculated. Results: Trends of 100% alcohol-attributable morbidity and mortality over thirteen and eighteen years, respectively, show an increase in rates of hospitalizations and a decrease in mortality rates. Comparisons of alcohol-attributable morbidity including diseases partially caused by alcohol revealed an increase in hospitalization rates between 2006 and 2012. The proportion of alcohol-attributable hospitalizations remained constant. Rates of alcohol-attributable mortality and the proportion among all deaths decreased. Conclusions: The increasing trend in mortality due to alcohol until the mid-1990s has reversed. The constant proportion of all hospitalizations that were attributable to alcohol indicates that factors such as improved treatment and easier health care access may have influenced the general increase in all-cause morbidity. To further reduce alcohol-related mortality, efforts in reducing consumption and increasing treatment utilization are needed.

Baseline data of oral and pharyngeal cancer before introducing an oral cancer prevention campaign in Germany

ObjectivesOral and pharyngeal cancer is still a serious health problem with an annual incidence of about 13,000 in Germany. This study aimed at describing trends of incidence and mortality in Germany by age, sex, and sub-site as a baseline for an oral cancer prevention campaign. MethodsUsing data from the National Association of Population-based Cancer Registries, incidence rates for oral and pharyngeal cancer (ICD-10, C00–C14) from 2003 to 2011 and mortality rates from 1990 to 2012 were analysed by age, sex, and sub-site (C00–C06, C07–C08, C09–C14). Trends were described by annual percentage changes. ResultsMen are 2.5-times more likely than women to be diagnosed and 3-times more likely to die from this tumour. Incidence and mortality in women increased slightly during the last decade, while incidence and mortality in men remained stable at a high level. While a decline was observed for younger age groups, an increase was seen in the elderly. For some sub-sites a deviation from this overall pattern was observed. ConclusionsThe decrease in this tumour in younger age groups is pleasing and may be attributed to public efforts in non-smoker protection in recent years. Further efforts are needed to counteract the increasing burden of disease in older age groups and in men.

Climate Change Effects on Heat Waves and Future Heat Wave-Associated IHD Mortality in Germany

The influence of future climate change on the occurrence of heat waves and its implications for heat wave-related mortality due to ischemic heart diseases (IHD) in Germany is studied. Simulations of 19 regional climate models with a spatial resolution of 0.25° × 0.25° forced by the moderate climate change scenario A1B are analyzed. Three model time periods of 30 years are evaluated, representing present climate (1971–2000), near future climate (2021–2050), and remote future climate (2069–2098). Heat waves are defined as periods of at least three consecutive days with daily mean air temperature above the 97.5th percentile of the all-season temperature distribution. Based on the model simulations, future heat waves in Germany will be significantly more frequent, longer lasting and more intense. By the end of the 21st century, the number of heat waves will be tripled compared to present climate. Additionally, the average duration of heat waves will increase by 25%, accompanied by an increase of the average temperature during heat waves by about 1 K. Regional analyses show that stronger than average climate change effects are observed particularly in the southern regions of Germany. Furthermore, we investigated climate change impacts on IHD mortality in Germany applying temperature projections from 19 regional climate models to heat wave mortality relationships identified in a previous study. Future IHD excess deaths were calculated both in the absence and presence of some acclimatization (i.e., that people are able to physiologically acclimatize to enhanced temperature levels in the future time periods by 0% and 50%, respectively). In addition to changes in heat wave frequency, we incorporated also changes in heat wave intensity and duration into the future mortality evaluations. The results indicate that by the end of the 21st century the annual number of IHD excess deaths in Germany attributable to heat waves is expected to rise by factor 2.4 and 5.1 in the acclimatization and non-acclimatization approach, respectively. Even though there is substantial variability across the individual model simulations, it is most likely that the future burden of heat will increase considerably. The obtained results point to public health interventions to reduce the vulnerability of the population to heat waves.

Vaccination of children with a live-attenuated, intranasal influenza vaccine - analysis and evaluation through a Health Technology Assessment.

The present HTA provides an extensive basis for further scientific approaches and pending decisions relating to health policy.

PIH30 - Cost-Effectiveness Analysis of Coffee Consumption for Prevention of All-Cause Mortality in Germany

Coffee contains over 1,000 distinct molecular compounds and is one of the most widely consumed beverages worldwide. Epidemiologic studies have shown an inverse relationship between coffee consumption and all-cause mortality. This analysis aims to assess the cost-effectiveness of coffee from a blended German consumer and payer perspective. An existing decision-analytic model was adapted with German data. A cohort life-table analysis was developed to model life-years (LYs) of German coffee consumers vs. non-consumers over a lifetime horizon. Age- and gender-specific mortality rates were used to model survival outcomes. Relative risks of death by average coffee intake (cups/day) were obtained from a recent large, prospective cohort study. Cost were considered for cost per cup (home prepared and from a national sample of low and high-cost vendors) and for health care. Incremental analyses were conducted by cost, sex, and level of daily coffee consumption. Deterministic and probabilistic sensitivity analysis was performed. Coffee increased undiscounted LYs in 1,2-3,4-5, and 6+ cup/day male (0.65,1. 10,1. 33 and 1.10) and female (0.45,1. 21,1. 51,1. 41) consumers, respectively, versus non-consumers. ICERs per undiscounted LY gained were € 3,938/ € 7,047/ € 16,271 for males and € 5,514/ € 5,066/ € 13,537 for females, respectively, for 1,2-3, and 4-5 cups/day consumption of home-prepared coffee; ≥6 cups/day was strictly dominated. Consumption of 4-5 cups per day purchased from high-cost vendors was not cost-effective (male: € 168,780/ female: € 135,636). Results were consistent throughout the sensitivity analyses, whereas coffee effectiveness in preventing death and coffee acquisition cost has the largest impact on ICERs. In this analysis, coffee consumption was associated with increased LYs and was shown to be potentially cost-effective, especially if home-prepared or purchased from low-cost vendors. Given the observational nature of the study data, further research is warranted to validate these findings.

Development of a microsimulation of melanoma mortality for evaluating the effectiveness of population-based skin cancer screening.

A nationwide skin cancer screening (SCS) was implemented in Germany in 2008. It aims at improving early detection of melanoma in order to reduce melanoma mortality. While the idea of early detection is compelling, demonstrating the effectiveness of melanoma screening is crucial. Since it is not feasible to conduct epidemiological studies to investigate the impact of factors such as screening interval or targeted age groups, we developed a microsimulation model that is able to predict melanoma mortality in Germany under several SCS conditions. Using German cancer registry data, population data, and other published data on melanoma progression and screening participation, we developed a stochastic microsimulation model. With this model, 10,000 populations of 100,000 persons and their melanoma-related life histories were simulated separately for women and for men and calibrated to observed melanoma incidence. In a second step, life histories of melanoma were changed by an SCS. Compared with a nonscreening scenario (age-standardized mortality rate: 1.6 and 2.9 per 100,000 for women and men), a biennial SCS of the 35- to 85-year-old population with a participation probability of 20% for each screening-eligible individual and a test sensitivity of 80% reduced mortality by up to 0.7 and 1.4 deaths per 100,000 person-years for women and men, respectively, corresponding to a relative reduction of melanoma mortality by 45% in women and men. We developed a microsimulation model of melanoma mortality that can be used to evaluate the effectiveness of population-based skin cancer screening. The simulation provided plausible melanoma mortality predictions and is a tool for comparing different SCS scenarios. However, it does not provide estimates on total costs of SCS.

Air pollution and infant mortality: A natural experiment from power plant desulfurization

The paper estimates the effect of SO2 pollution on infant mortality in Germany, 1985–2003. To avoid endogeneity problems, I exploit the natural experiment created by the mandated desulfurization at power plants and power plants’ location and prevailing wind directions, which together determine treatment intensity for counties. Estimates translate into an elasticity of 0.07–0.13 and the observed reduction in pollution implies an annual gain of 826–1460 infant lives. There is no evidence for disproportionate effects on neonatal mortality, but for an increase in the number of infants with comparatively low birth weight and length.

Stroke Unit Care and Trends of In-Hospital Mortality for Stroke in Germany 2005–2010

In Germany, the financing of stroke unit care was implemented into the hospital reimbursement system in 2006. Since then, many acute care hospitals newly implemented stroke units. Simultaneous, in-hospital mortality for stroke declined. The study aims to analyze the association of mortality trends for stroke with the increasing provision of stroke unit care in German hospitals. Hospitalizations for acute stroke from 2005 to 2010 are identified in the nationwide German Diagnosis Related Groups statistics. Trends of risk-adjusted in-hospital mortality are studied stratified by existence of a stroke unit in the admitting hospital, as well as stratified by cohorts of hospitals defined by the respective period of stroke unit implementation. Overall, mortality in patients admitted to stroke unit hospitals is lower (crude 9.2%; adjusted 9.8%) compared to patients admitted to nonstroke unit hospitals (12.7%; 11.6%). The longitudinal analysis revealed a general secular trend of declining mortality in all cohorts of hospitals. However, while all stroke unit-providing hospital cohorts converge to a quite similar level of mortality in 2010, mortality in hospitals without stroke unit remains significantly higher. Reduction of mortality in hospitals with early provision of stroke unit care seems to be attributable to the secular trend. A reduction of mortality exceeding the secular trend was observed in hospitals with late stroke unit implementation. The earlier stroke unit implementations might represent rather 'formal' inceptions in experienced hospitals with preexisting appropriate stroke care, whereas late implementations seem to have caused extra improvements. Overall, stroke patients are more likely to survive when admitted to an stroke unit-providing hospital. A more stringent assignment of acute stroke patients to stroke unit-providing hospitals could possibly further reduce stroke mortality in Germany.

Auswirkungen von Hitzewellen auf die Mortalität in Deutschland

Heat waves present an increasing threat to population's health; there is increased activity in terms of research and preventive measures since the heat waves in 2003. This is the first narrative review of studies on heat wave-associated mortality in Germany. The review and critical evaluation includes 12 studies. Notable differences in the research methodology were observed. Scientific knowledge on heat wave-associated mortality in Germany is insufficient. So far, most studies have focused on large cities or states/provinces. However, risk assessments play an important role in deciding upon and planning of preventive measures.

Ärztliche Behandlung von an Krebs Erkrankten – Alles ganz anders?

Cancer deaths contribute to more than 25% of the overall mortality in Germany, which is only superseded by death from cardiovascular diseases. Apart from improving cancer prevention, the development of effective therapies for advanced cancer is a key task in oncology. Here we compare the criteria of clinical effectiveness that are applied to medical cancer therapies with those that are applied to therapies for cardiovascular diseases. (As supplied by publisher).

Wissen Studierende im Praktischen Jahr genug über die Behandlung der Alkohol- und Tabak-Abhängigkeit?

Smoking and alcohol use disorders (AUD) are associated with significant morbidity and mortality in Germany. However, it has recently been shown that German medical students in years 1 to 5 do not feel competent to treat patients who are addicted to tobacco or alcohol. This study examined whether these deficits are also prevalent in students in the final (sixth) year of training. Students enrolled in the final year at University Medical Centre Hamburg-Eppendorf were invited to complete a questionnaire assessing smoking status and self-reported knowledge of health consequences of and treatment options for AUD and smoking as well as arterial hypertension and diabetes mellitus. Students were also asked to provide effectiveness estimates for different methods to treat AUD and smoking. A total of 228 out of 345 students participated in the survey (response rate 66 %). Smoking prevalence was 24 %. Approximately 90 % of students believed they knew how to treat arterial hypertension and diabetes mellitus, but less than a third thought they knew how to treat smokers and patients with AUD. Effectiveness ratings of treatments for the two addictive disorders revealed severe misconceptions. The deficits in undergraduate medical education regarding the treatment of addictive disorders reported for students from years 1 to 5 extend to students in the sixth year. Just before graduation, students still have severe knowledge gaps. In order to prevent tobacco- and alcohol-related deaths, medical school curricula need to be urgently improved.