Diabetes Epidemic’ in Germany? A Critical Look at Health Insurance Data Sources

F. Hoffmann; A. Icks

doi:10.1055/s-0032-1306331

Experimental and Clinical Endocrinology & Diabetes, Table of Contents

Exp Clin Endocrinol Diabetes 2012; 120(07): 410-415
DOI: 10.1055/s-0032-1306331

Article

Diabetes ‘Epidemic’ in Germany? A Critical Look at Health Insurance Data Sources

F. Hoffmann

¹Centre for Social Policy Research, Division Health Economics, Health Policy and Outcomes Research, University of Bremen, Bremen, Germany

,

A. Icks

²Department of Public Health, Center of Health and Society, Faculty of Medicine, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany

³Institute of Biometrics and Epidemiology, German Diabetes Center at the Heinrich-Heine-University Düsseldorf, Leibniz-Center for Diabetes Research, Düsseldorf, Germany

› Author Affiliations

Abstract

Aims:

The German diabetes prevalence is considered to be one of the highest in Europe. It is often estimated based on claims data of a regional health insurance (Allgemeine Ortskrankenkasse; AOK). We studied the prevalence of diabetes within AOK members compared to other types of funds.

Methods:

We pooled data of the German National Telephone Health Interview Surveys 2003 and 2004 comprising a nationally representative sample of 15 354 adults aged 18 years and older. We first estimated the crude prevalence of diabetes stratified by funds. To analyze the association between diabetes prevalence and membership in different health insurance funds, we fitted logistic regression models and stepwise adjusted for age, sex, region, comorbidities, anthropometric measures, and lifestyle variables.

Results:

The overall prevalence of diabetes was 6.5%. Compared to all other statutory health insurance funds, the prevalence of diabetes was nearly twice as high within the AOK (10.1% vs. 5.4%; Odds Ratio [OR]: 1.96; 95% confidence interval [CI]: 1.67–2.31). Although continuously decreasing, significant differences remained after controlling for demographic variables (OR: 1.62; 95% CI: 1.38–1.90) and in the fully adjusted model (OR: 1.36; 95% CI: 1.14–1.62). Persons privately insured had a prevalence of 4.8%, which was not significantly different than for members of statutory health insurance funds other than the AOK.

Conclusions:

The prevalence of diabetes was roughly twice as high in the AOK compared to all other statutory health insurance funds. The estimated German prevalence of diabetes is likely to be too high when it is based on these data.

Key words

diabetes mellitus - prevalence - international comparison - health insurance claims data

Full Text

References

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