Trends In Germany Research Articles

German centralization strategy during COVID-19: Continuing or interrupting a trend?

In response to the COVID-19 pandemic, many countries applied centralization strategies to the distribution of power between national government and regional/local governments over responsibility for regulatory tasks. As a result, health-policy decision-making competences were shifted from the regional level to the national level (vertical shift of decision-making competences). This centralization trend for the purpose of infection control is evident in Germany. We conducted a quantitative and qualitative analysis of health-policy regulatory measures (March 2018 to March 2020) in order to investigate whether the vertical shift in decision-making competences was already a trend in Germany before the COVID-19 pandemic and beyond infection control. Our results show that the centralization strategy observed during COVID-19 does not continue a trend. Before the COVID-19 pandemic, what was most important was the distribution of power at national level between government and non-government institutions (horizontal allocation of decision-making competences). This long-term trend strengthens the decision-making competences of government institutions and weakens non-government institutions.

Genital gender-affirming surgery trends in Germany: Total population data with 19,600 cases from 2006 to 2022.

To delineate the current trends regarding gender-affirming surgeries (GAS) in Germany. Analysis of German hospital quality reports from 2006 to 2022 was conducted using the reimbursement.info tool. The German procedure classification (OPS) codes 5-646.0 for masculinizing- and 5-646.1 for feminizing surgery were assessed to identify GAS. Linear regression models were utilized for the analysis and depiction of current trends. A total of 19,632 gender-affirming procedures were performed during the study period with an exponential increase over the years. Masculinizing surgeries increased from 246 in 2006 to 1291 cases in 2022 (increase by 424%; p<0.001). The highest annual increase of 37.2% in numbers was from 2018 to 2019 (from 1235 to 1694 cases). Feminizing surgeries increased from 180 cases in 2006 to 799 procedures in 2022 (increase by 343%; p<0.001). The cases increased most between 2015 and 2016 from 277 to 502 cases (81.2%). The number of hospitals offering these surgeries expanded from 24 in 2006 to 29 in 2022 (21% increase; p<0.001). This study demonstrates an exponential growth in numbers feminizing and masculinizing of GAS performed each year in Germany. Furthermore, a discernible trend emerges with a propensity for concentration of procedures within selected high-caseload centers across Germany.

An age-period-cohort analysis of hysterectomy incidence trends in Germany from 2005 to 2019

Recent studies show declining trends in hysterectomy rates in several countries. The objective of this study was to analyse hysterectomy time trends in Germany over a fifteen-year period using an age-period-cohort approach. Using an ecological study design, inpatient data from Diagnoses Related Group on hysterectomies by subtype performed in Germany from 2005 to 2019 were retrieved from the German Statistical Office. Descriptive time trends and age-period-cohort analyses were then performed. A total of 1,974,836 hysterectomies were performed over the study period. The absolute number of hysterectomies reduced progressively from 155,680 (365 procedures/100,000 women) in 2005 to 101,046 (257 procedures/100,000 women) in 2019. Total and radical hysterectomy decreased by 49.7% and 44.2%, respectively, whilst subtotal hysterectomy increased five-fold. The age-period-cohort analysis revealed highest hysterectomy rates in women aged 45–49 for total and subtotal hysterectomy with 608.63 procedures/100,000 women (95% CI 565.70, 654.82) and 151.30 procedures/100,000 women (95% CI 138.38, 165.44) respectively. Radical hysterectomy peaked later at 65–69 years with a rate of 40.63 procedures/100,000 women (95% CI 38.84, 42.52). The risk of undergoing total or radical hysterectomy decreased over the study period but increased for subtotal hysterectomy. Although, overall hysterectomy rates have declined, subtotal hysterectomy rates have increased; reflecting changes in clinical practice largely influenced by the availability of uterus-sparing options, evolving guidelines and introduction of newer surgical approaches.

Personalization of the Car-Sharing Fleet Selected for Commuting to Work or for Educational Purposes—An Opportunity to Increase the Attractiveness of Systems in Smart Cities

Car-sharing services, which provide short-term vehicle rentals in urban centers, are rapidly expanding globally but also face numerous challenges. A significant challenge is the effective management of fleet selection to meet user expectations. Addressing this challenge, as well as methodological and literature gaps, the objective of this article is to present an original methodology that supports the evaluation of the suitability of vehicle fleets used in car-sharing systems and to identify the vehicle features preferred by users necessary for specific types of travel. The proposed methodology, which incorporates elements of transportation system modeling and concurrent analysis, was tested using a real-world case study involving a car-sharing service operator. The research focused on the commuting needs of car-sharing users for work or educational purposes. The study was conducted for a German car-sharing operator in Berlin. The research was carried out from 1 January to 30 June 2022. The findings indicate that the best vehicles for the respondents are large cars representing classes D or E, equipped with a combustion engine with a power of 63 to 149 kW, at least parking sensors, navigation, hands-free, lane assistant, heated seats, and high safety standards as indicated by Euro NCAP ratings, offered at the lowest possible rental price. The results align with market trends in Germany, which focus on the sale of at least medium-sized vehicles. This suggests a limitation of small cars in car-sharing systems, which were ideologically supposed to be a key fleet in those kinds of services. The developed methodology supports both system operators in verifying whether their fleet meets user needs and urban policymakers in effectively managing policies towards car-sharing services, including fleet composition, pricing regulations, and vehicle equipment standards. This work represents a significant step towards enhancing the efficiency of car-sharing services in the context of smart cities, where personalization and optimizing transport are crucial for sustainable development.

Einkommens- und Vermögensverteilung in Deutschland

Abstract This article outlines income and wealth distribution trends in Germany since the 19th century, compared to other Western industrialised countries. We first discuss the evolution of aggregate wealth-to-income ratios. We then explore how the concentration of income and wealth among the top percentile evolved since the 19th century. For the period after 1990, we analyse the entire distributions from top to bottom, exploring why Germany differs from France and the U.S. Among European countries, Germany exhibits one of the highest concentrations of income and wealth.

Mortality trends in Germany in an international context

Due to its strong economy and awell-developed healthcare system, Germany is well positioned to achieve above-average reductions in mortality. Nevertheless, in terms of life expectancy, Germany is increasingly falling behind Western Europe. We compare mortality trends in Germany with other Western European countries, covering the period from 1960 to 2019. The focus is on long-term trends in Germany's ranking in international mortality trends. In addition, we conduct adetailed mortality analysis by age. Our analysis is mostly based on mortality data from the Human Mortality Database (HMD). Cause-specific mortality data originate from the database of the World Health Organization (WHO). For the international comparison of mortality trends, we use conventional mortality indicators (age-standardized mortality rate, period life expectancy). Compared to other Western European countries, Germany has higher mortality in the middle and older age groups. Germany's life expectancy gap compared to Western Europe has grown during the past 20years. In 2000, Germany was 0.73years behind for men and 0.74years behind for women. By 2019, these figures had risen to 1.43and 1.34years, respectively. This is mainly due to mortality from non-communicable diseases. For Germany to catch up with other Western European countries, astronger focus on further reducing mortality at ages 50+ is crucial. This also requires further research to understand the factors behind Germany's disadvantageous position.

Spatial patterns and temporal trends of trace elements in mosses from 1990 to 2020 in Germany

BackgroundThe accumulation of trace elements in mosses is used as an indirect measure of atmospheric deposition and an important complement to the techniques used to monitor the Geneva Air Pollution Convention. The aim of this paper is to quantify and map temporal and spatial trends of metal enrichment in mosses collected in Germany in 1990, 1995, 2000, 2005, 2015 and 2020. Collection and chemical analysis of the moss samples were carried out according to international guidelines.ResultsThe analysis shows that since 1990, the median concentrations of As, Cd, Cu, Ni, Pb and Sb in the mosses have been decreasing significantly, with the with the highest decline of Pb (− 86%). This trend reversed in 2000 and 2005 and between 2015 and 2020 by increases in the concentrations of some trace elements. In the 2000 Moss Survey, higher concentrations were measured for Cd, Cu, Ni and Sb than in 2015, ranging from + 26% (Cu) to + 165% (Ni). For As and Pb, no significant changes can be observed in 2020 compared to 2015. The increase in metal concentrations in the mosses over the last five years does not correspond to the corresponding trends in reported metal emissions in Germany (2015–2020). In contrast, the long-term trends of the As, Cd, Cu, Ni and Pb concentrations measured in the mosses showed good overall correspondence with the emission trends in Germany (1990–2020). The long-term trends of the moss data are mostly weaker than those of the emission data. The spatial patterns of the temporal trends were mapped and discussed for As, Cd, Cu, Ni, Pb and Sb.ConclusionsThe study shows that for valid monitoring of atmospheric deposition, it is not enough to consider only emission data or the modelled deposition derived from these data. In this respect, the study provides one of many necessary contributions to the discussion on the extent to which analytes of current monitoring programmes are still relevant and up-to-date and whether there are new substances that are also relevant or even more relevant than existing analytes and to what extent this should be taken into account in designing future environmental monitoring.

Surgical and per-oral endoscopic myotomy (POEM) for the treatment of primary esophageal motility disorders: A systematic analysis of current trends in Germany between 2011 and 2019.

While surgery remains a standard treatment for primary esophageal motility disorders (PEMDs), per-oral endoscopic myotomy (POEM) has recently evolved as an alternative. Systematic data on current trends of invasive procedures for PEMDs in Germany are missing. Hospital discharge data were used to evaluate trends and mortality of invasive treatment options for PEMDs in Germany between 2011 and 2019. 4543 cases of PEMDs (achalasia: n = 4349, dyskinesia of the esophagus: n = 194) receiving open surgery (n = 200), minimal invasive surgery (n = 2366), or POEM (n = 1977) were identified. The relative proportion of POEM significantly increased from 10.9% (2011) to 65.7% (2019). Hospital mortality was 0.2%. The median duration of mechanical ventilation was significantly lower in POEM patients (29.4 hours) compared to open (274.0 hours) or minimal invasive (91.9 hours) surgery. The duration of hospitalization was lowest among POEM patients (5.7 days) compared to surgical procedures (13.7 and 7.7 days). While the low in-hospital mortality of all procedures combined confirms the solid safety profile of invasive procedures in general, our findings show that POEM has the lowest duration of mechanical ventilation and hospitalization compared to invasive surgical options.

Real gains being made as a result of the transposition of the European Minimum Wage Directive

In most EU countries there were significant increases in minimum wages on 1 January 2024. Despite persistently high inflation rates in the majority of member states, these were sufficient to maintain or even expand the purchasing power of the minimum wage. The dynamics of minimum wages have also been advantaged by the European Minimum Wage Directive, passed in autumn 2022. In the course of transposing the Directive, many member states have been striving to achieve the reference values of 60% of the median wage or 50% of the average wage. However, the trend in Germany was different: the country’s Mindestlohnkommission (Minimum Wage Commission), against the votes of trade union members, only advocated a small increase in the minimum wage, and one which fell behind the rise in prices. In their approach and conclusions, the authors focus on the German aspect but this version of their original report slightly expands on that (see also the surrounding discussion) with the aim of widening the coverage and the consideration of its themes to the countries of south-east Europe.

Abstract 17828: Sex Differences in Mortality Trends of Rheumatic Heart Disease in High-Income Countries

Introduction: Rheumatic heart disease has traditionally been considered to be more prevalent among females; however, current trends in mortality in each sex are unclear in high-income countries. Hypothesis: We hypothesized that mortality from rheumatic heart disease is higher among females but has improved in both sexes in high-income countries. Methods: We analyzed the WHO mortality database to determine trends in mortality from rheumatic heart disease in the UK, Germany, France, Italy, Japan, Australia, the USA, and Canada from 2000 to 2020. Sex-specific age-standardized mortality rates per 100,000 persons were calculated and compared by using female-to-male ratio. Annual percentage change was analyzed using joinpoint regression. Results: In the most recent year, female sex-specific age-standardized mortality rates were significantly higher in the UK (0.60 vs 0.44), Italy (1.24 vs 0.98), the USA (0.63 vs 0.47) and Canada (0.79 vs 0.57). Over the observation period, there was a trend to deceasing sex-specific age-standardized mortality rates in both sexes in the UK, France, Japan, and USA (p&lt;0.01, respectively) and only in female sex in Italy and Australia (p&lt;0.01, respectively), while the mortality rates in both sexes were constant in Canada and demonstrated increasing trends in Germany. Average female-to-male mortality rates ranged from 1.07 (95% CI, 1.02, 1.11) in France to 1.59 (95% CI, 1.51, 1.67) in the UK and were decreasing toward 1 with statistical significance in all countries (average annual change ranged from -1.6% to -0.6%) except for France. Conclusions: Mortality from rheumatic heart disease in females exhibited a decreasing trend in the 6 studied high-income countries while increasing in Germany and constant in Canada. Female-dominated mortality was becoming less pronounced in the studied high-income countries, with the exception of France, which already had the lowest average female-dominant mortality rates.

Suicide trends in Germany during the COVID-19 pandemic and the war in Ukraine

AimsThe later phase of the COVID-19 pandemic overlaps with geopolitical and economic consequences from the Ukraine war. Financial hardship and concerns about gas supply may add to pandemic factors and lead to increased suicide rates in Germany. MethodsAge- and sex-stratified suicide data from police crime statistics covering 35 % of the German population were used for an interrupted time-series analysis and for a projection of total German suicides in 2022. ResultsFor both sexes, a trend reversal from constant or declining suicide rates to an increase was observed. This increase is particularly pronounced in 2022 and mainly relates to the 60+ age group that is highly vulnerable to suicide. The projection of the overall German suicide rate is at a level last observed in 2015. ConclusionsThe key challenge now is to combat potential causes of this rise in suicide rates to avert the emerging upward trend.

Observed temperature trends in Germany: Current status and communication tools

Observed temperature trends in Germany: Current status and communication tools

Nationwide trends of laparoscopic pyloromyotomy in patients with infantile hypertrophic pyloric stenosis in Germany: A slow path forward.

Since its introduction, laparoscopic pyloromyotomy (LP), has become increasingly popular in many countries. We have noticed an attenuated trend in Germany. The aim of this study was to analyse the distribution of open and LP in Germany. The national database of administrative claims data of the Institute for the Remuneration System in Hospitals (InEK) was analysed regarding numbers of patients with pyloromyotomy in the years 2019-2021. The German quality reports of the hospitals of 2019 and 2020 were analyzed regarding the number of procedures performed per hospital and pediatric surgical department. A total of 2050 patients underwent pyloromyotomy. The incidence of hypertrophic pylorus stenosis (HPS) was 699 and 657 patients in 2019 and 2021, respectively. Regarding age, 31.1% were admitted before 28 days of age. LP gradually increased from 216 patients (30.9%) in 2019 to 239 patients (36.4%) in 2021. Thirty-three laparoscopic operations (4.8%) were converted to an open approach. In 24 of all patients, there was an injury to the stomach, in 20 patients to the duodenum, needing repair with sutures. Analysis of the quality reports indicated that 44% of pediatric surgical departments performed LP. Although LP has became more prevalent in Germany recently, about two thirds of patients still undergo an open procedure.

War in European Museum Narratives and Cultural Memory

The article examines how the war narrative is displayed in modern European museum exhibitions, particularly in light of new museology and cultural memory trends in Germany and Poland. The study recognises that the contested nature of cultural and historical contexts influences the process of representing cultural memory in museum narratives. It combines the theoretical approach of museology with specific museum practices. Using case studies from the Bundeswehr Museum of Military History, Dresden, Germany; the Documentation Centre for Displacement, Expulsion, Reconciliation, Berlin, Germany; and the Museum of the Second World War, Gdansk, Poland, the author examines the impact of challenging issues centred on cultural memory of the war in museum exhibitions over recent decades. The study underlines the significance of innovative approaches to museum exhibitions that display the experience of war and contribute to social dialogue and sustainability.

Parsimonious stochastic forecasting of international and internal migration on the NUTS-3 level – an outlook of regional depopulation trends in Germany

Substantiated knowledge of future demographic changes that is derived from sound statistical and mathematical methods is a crucial determinant of regional planning. Of the components of demographic developments, migration shapes regional demographics the most over the short term. However, despite its importance, existing approaches model future regional migration based on deterministic assumptions that do not sufficiently account for its highly probabilistic nature. In response to this shortcoming in the literature, our paper uses age- and gender-specific migration data for German NUTS-3 regions over the 1995–2019 period and compares the performance of a variety of forecasting models in backtests. Using the bestperforming model specification and drawing on Monte Carlo simulations, we present a stochastic forecast of regional migration dynamics across German regions until 2040 and analyze their role in regional depopulation. The results provide evidence that well-known age-specific migration patterns across the urban-rural continuum of regions, such as the education-induced migration of young adults, are very likely to persist, and to continue to shape future regional (de)population dynamics.

Increased alcohol-specific mortality in Germany during COVID-19: State-level trends from 2010 to 2020.

The COVID-19 pandemic may have led to an increase in the alcohol-specific mortality. Against this backdrop, the aim of this report is to explore alcohol-specific mortality trends in Germany of the years 2010 to 2020. Alcohol-specific mortality data aggregated by sex, 5-year age groups and state were collected from the annual cause-of-death statistics and analysed descriptively by visual inspection. The overall alcohol-specific mortality rate (age-standardised) has mainly decreased between 2010 and 2020. However, increased alcohol-specific mortality rates for the year 2020 compared to 2019 were found for both, women (+4.8%) and men (+5.5%), particularly in age groups between 40 and 69 years. Changes in alcohol-specific mortality rates differed between federated states, with steeper increases in East Germany. Different mechanisms related to the increase in alcohol consumption, particularly among high-risk drinkers, and reduced resources in health care may have led to an increase in alcohol-specific mortality in Germany in 2020. Despite the recent decline in the alcohol-specific mortality in Germany, an increase in the death toll was observed in 2020.

Health literacy time trends in Germany

Abstract Background Health literacy (HL) is becoming increasingly important in the European public health sector. Since the Health information landscape is changing constantly there is a need for monitoring HL regularly in order to observe the influence of these changes, to enable trend statements and to obtain precise information on the societal and individual factors. For the first time, this has been done for the population in Germany. Methods Cross-sectional data collected in the adult population in Germany in 2014 (n = 1.940) and 2020 (n = 504) was used. The instrument HLS-EU-Q47 was used to measure HL in the domains of health care, disease prevention and health promotion. Changes between time points were analysed on the population level as well as in several population groups. Results The HL of the German population has become lower within the observed six years. This is evident in all three domains but is most pronounced in health promotion literacy. This trend is particularly visible among people with low social status and financial deprivation. Single health information tasks that are precepted as more difficult involve the evaluation of information and handling information from the media. Conclusions Over time, dealing with health and disease-related information has become more difficult. As this development is mainly driven by socioeconomically disadvantaged population groups, it has apparently increased social inequality in the health sector. Due to more complex and demanding health information, which lately result in an ‘infodemic’, it seems that these groups in particular are overburdened and cannot raise the resources and skills to adequately engage with health information. Key messages • HL interventions should focus on socioeconomically disadvantaged population groups to counteract the increasing health inequality. • Monitoring HL should be included in public health surveillance to determine needs and challenges for health policies as well as achievements of interventions.

Epidemiology of cardiac amyloidosis in Germany: a retrospective analysis from 2009 to 2018

BackgroundImproved imaging modalities contributed to increasing awareness of cardiac amyloidosis. Contemporary data on frequency trends in Germany are lacking.MethodsIn a retrospective study using health claims data of a German statutory health insurance, patients with diagnostic codes of amyloidosis and concomitant heart failure between 2009 and 2018 were identified.ResultsPrevalence increased from 15.5 to 47.6 per 100,000 person-years, and incidence increased from 4.8 to 11.6 per 100,000 person-years, with a continuous steepening in the slope of incidence trend. In patients with amyloidosis and heart failure age and proportion of men significantly increased, whereas the frequency of myeloma and nephrotic syndrome significantly decreased over time. Median (IQR) survival time after first diagnosis was 2.5 years (0.5–6 years), with a 9% (95% CI 2–15%, p = 0.008) reduced risk of death in the second compared to the first 5 years of observation. In the 2 years prior and 1 year after diagnosis, mean total health care costs were 6568 €, 11,872 € and 21,955 € per person and year.ConclusionThe rise in cardiac amyloidosis has continuously accelerated in the last decade. Considering the adverse outcome and high health care burden, further effort should be put on early detection of the disease to implement available treatment.

Toast Hawaii

Toast Hawaii

Eurodelta multi-model simulated and observed particulate matter trends in Europe in the period of 1990–2010

Abstract. The Eurodelta-Trends (EDT) multi-model experiment, aimed at assessing the efficiency of emission mitigation measures in improving air quality in Europe during 1990–2010, was designed to answer a series of questions regarding European pollution trends; i.e. were there significant trends detected by observations? Do the models manage to reproduce observed trends? How close is the agreement between the models and how large are the deviations from observations? In this paper, we address these issues with respect to particulate matter (PM) pollution. An in-depth trend analysis has been performed for PM10 and PM2.5 for the period of 2000–2010, based on results from six chemical transport models and observational data from the EMEP (Cooperative Programme for Monitoring and Evaluation of the Long-range Transmission of Air Pollutants in Europe) monitoring network. Given harmonization of set-up and main input data, the differences in model results should mainly result from differences in the process formulations within the models themselves, and the spread in the model-simulated trends could be regarded as an indicator for modelling uncertainty. The model ensemble simulations indicate overall decreasing trends in PM10 and PM2.5 from 2000 to 2010, with the total reductions of annual mean concentrations by between 2 and 5 (7 for PM10) µg m−3 (or between 10 % and 30 %) across most of Europe (by 0.5–2 µg m−3 in Fennoscandia, the north-west of Russia and eastern Europe) during the studied period. Compared to PM2.5, relative PM10 trends are weaker due to large inter-annual variability of natural coarse PM within the former. The changes in the concentrations of PM individual components are in general consistent with emission reductions. There is reasonable agreement in PM trends estimated by the individual models, with the inter-model variability below 30 %–40 % over most of Europe, increasing to 50 %–60 % in the northern and eastern parts of the EDT domain. Averaged over measurement sites (26 for PM10 and 13 for PM2.5), the mean ensemble-simulated trends are −0.24 and −0.22 µg m−3 yr−1 for PM10 and PM2.5, which are somewhat weaker than the observed trends of −0.35 and −0.40 µg m−3 yr−1 respectively, partly due to model underestimation of PM concentrations. The correspondence is better in relative PM10 and PM2.5 trends, which are −1.7 % yr−1 and −2.0 % yr−1 from the model ensemble and −2.1 % yr−1 and −2.9 % yr−1 from the observations respectively. The observations identify significant trends (at the 95 % confidence level) for PM10 at 56 % of the sites and for PM2.5 at 36 % of the sites, which is somewhat less that the fractions of significant modelled trends. Further, we find somewhat smaller spatial variability of modelled PM trends with respect to the observed ones across Europe and also within individual countries. The strongest decreasing PM trends and the largest number of sites with significant trends are found for the summer season, according to both the model ensemble and observations. The winter PM trends are very weak and mostly insignificant. Important reasons for that are the very modest reductions and even increases in the emissions of primary PM from residential heating in winter. It should be kept in mind that all findings regarding modelled versus observed PM trends are limited to the regions where the sites are located. The analysis reveals considerable variability of the role of the individual aerosols in PM10 trends across European countries. The multi-model simulations, supported by available observations, point to decreases in SO4-2 concentrations playing an overall dominant role. Also, we see relatively large contributions of the trends of NH4+ and NO3- to PM10 decreasing trends in Germany, Denmark, Poland and the Po Valley, while the reductions of primary PM emissions appear to be a dominant factor in bringing down PM10 in France, Norway, Portugal, Greece and parts of the UK and Russia. Further discussions are given with respect to emission uncertainties (including the implications of not accounting for forest fires and natural mineral dust by some of the models) and the effect of inter-annual meteorological variability on the trend analysis.