Higher prevalence of heart failure in rural regions: a population-based study covering 87% of German inhabitants
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So far the extent of regional variation of heart failure (HF) prevalence in Germany is unknown.
Using a full sample of nationwide claims data covering ambulatory care of approximately 87% of the German population, this study aimed to (i) examine regional differences of HF prevalence on the level of 402 German administrative districts and (ii) investigate factors associated with HF prevalence. This study included all statutory health-insured patients aged ≥ 40 years in 2017, comprising about 40 million individuals. Age- and sex-standardized HF prevalence was estimated on the district level. Two-level logistic regression analysis was employed to study the influence of the district-related factors degree of urbanisation and regional socio-economic status on HF diagnosis, adjusted for the individual’s age and sex.
HF prevalence in 2017 was 6.0%. Standardized prevalence on the district level varied by a factor of 4.3 (range 2.8–11.9%). Regional socio-economic status and degree of urbanisation were independently associated with HF prevalence. The prevalence increased with decreasing degree of urbanisation. The adjusted risk of suffering from HF was 40% higher in ‘rural areas with a low population density’ as compared to ‘big urban municipalities’ (odds ratio 1.40, 99% CI 1.24–1.59).
Strong regional variations in HF prevalence may inform future public health policies regarding targeted resource planning and prevention strategies. High prevalence in areas with low population density adds to the challenge of ensuring universal access to health services in rural German regions.
KeywordsAdults Claims data Germany Heart failure Prevalence
The authors would like to thank the 17 regional Associations of Statutory Health Insurance Physicians in Germany for provision of data and their support in interpreting the results of our analyses.
Compliance with ethical standards
Conflict of interest
JH, MKA, AS and JB declare that they have no conflict of interest. SS receives funding from the German Federal Ministry of Education and Research (01EO1004 and 01EO1504).
In Germany the use of claims data for scientific research is regulated by the Code of Social Law (SGB X). An ethical approval and informed consent are not required as this study used routinely collected anonymized data.
Data sharing statement
The datasets analysed during the current study are not publicly available due to data protection regulations by the German Social Security Code (Sozialgesetzbuch (SGB) V).
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