Zusammenfassung Hintergrund und Ziele Die Prävalenzraten atopischer Erkrankungen (atopische Dermatitis [AD], allergisches Asthma [AA], allergische Rhinokonjunktivitis [ARC]) sind in Deutschland gestiegen. Es fehlt jedoch an einer gleichzeitigen Betrachtung und an genauen Daten über die raumzeitliche Variation dieser Erkrankungen. Methodik Die Analysen basieren auf ambulanten Abrechnungsdaten (2011–2020) aller gesetzlich krankenversicherten Personen in Deutschland. Es wurden raumzeitliche Analysen der Prävalenzraten auf Kreisebene durchgeführt und die Werte statistisch geglättet. Ergebnisse Die Prävalenzraten stiegen für alle drei Erkrankungen an. Moderate, aber signifikante (p < 0,05) Korrelationen wurden unter anderem zwischen ARC und AA beobachtet (r = 0,47). Die Korrelationen mit dem Ost‐West‐Gradienten waren für alle Krankheiten signifikant, genauer gab es höhere Prävalenzraten von AD im Osten und höhere Prävalenzraten von AA und ARC im Westen. Die Korrelationskoeffizienten zeigten signifikante Werte zwischen dem Nord‐Süd‐Gradienten und AD sowie zwischen dem Nord‐Süd‐Gradienten und AA, was höhere Prävalenzen in Norddeutschland bedeutet. Schlussfolgerungen Die Prävalenzraten für atopische Erkrankungen sind im letzten Jahrzehnt gestiegen. Die räumlichen Muster unterscheiden sich zwischen AD und den anderen atopischen Erkrankungen. Die Gründe für den Anstieg und die räumliche Variation sollten im Hinblick auf eine verbesserte Prävention und Gesundheitsvorsorge eingehend analysiert werden.

BACKGROUND AND OBJECTIVES:Prevalence rates of atopic diseases (atopic dermatitis [AD], allergic asthma [AA], and allergic rhinoconjunctivitis [ARC]) have increased in Germany. However, there is a lack of simultaneous consideration and of precise data on the spatiotemporal variation of these diseases. This study investigates the spatiotemporal variation of atopic diseases in Germany. METHODS:Analyses based on outpatient care data (2011-2020) of all statutory health insured persons in Germany. Spatiotemporal analyses of prevalence rates were performed on county levels and statistical smoothing were applied. RESULTS:Prevalence rates increased for all three diseases. Moderate but significant (p < 0.05) correlations were among others observed between ARC and AA (r = 0.47). Correlations with the east-west gradient were significant for all diseases, meaning higher prevalence rates of AD in the east and higher prevalence rates of AA and ARC in the west. The correlation coefficients showed significant values between the north-south gradient and AD, as well as between the north-south gradient and AA, implying higher prevalences in northern Germany. CONCLUSIONS:Prevalence rates for atopic diseases have increased over the past decade. Regional patterns are different for AD and the other atopic diseases. The reasons for the increase and the variations need to be analysed in detail with a view to improving prevention and health care.

Background and Objectives: Epidemiological studies on the health care of patients with atopic dermatitis (AD) in dermatological treatment in Germany indicate no improvements within 10 years. In addition to dermatologists, general practitioners (GPs) are particularly involved in AD treatment. This study analyzed the health care situation of adult patients with AD by GPs. Patients and Methods: The cross-sectional questionnaire survey "PsoADA" was conducted from 2019 to 2021 in general practices throughout Germany and the results were compared with previous data from dermatology care (AtopicHealth2, 2017-19). Results: Among 150 patients (mean age: 40 years, 62.2% female), 39.2% received additional treatment by a dermatologist (GP+D). 20.7% of GP+D and 5.7% of patients in GP treatment only (GP only) had severe AD (p < 0.01, AtopicHealth2: 27.6%). Major limitations in quality of life were reported by 31.0% (GP+D) versus 3.4% (GP only) (p < 0.001, AtopicHealth2: 31.6%). Most patients received topicals, mainly glucocorticosteroids. Calcineurin inhibitors were currently administered by 2.7% (PsoADA total). Patient education was reported by 5.7% (PsoADA total). Conclusions: A considerable proportion of patients with AD in GP care shows poor outcomes, as has been observed in dermatological care - possibly due to the lack of use of modern systemic therapy.

ZusammenfassungHintergrund und ZieleAufgrund der steigenden Hautkrebsinzidenz wurde in Deutschland im Jahr 2008 ein bundesweites gesetzliches Hautkrebsscreening (gHKS) eingeführt. Die vorliegende Studie zielt darauf ab, (1) zu analysieren, welche patientenseitigen Faktoren mit der Teilnahme am gHKS in Deutschland assoziiert sind und (2) die Gründe für die Nichtteilnahme zu untersuchen.Patienten und MethodikTeilnehmer und Nichtteilnehmer von gHKS (≥ 35 Jahre) wurden im Rahmen der Routineversorgung in neun dermatologischen Ambulanzen rekrutiert. Es wurden Gründe für die (Nicht‐)Teilnahme, Wissen über Hautkrebs sowie klinische und sozioökonomische Daten erhoben. Nach Gruppen stratifiziert, wurden deskriptive Analysen und binäre logistische Regressionsanalysen für Zusammenhänge mit der Teilnahme durchgeführt.ErgebnisseVon den 294 gHKS‐Teilnehmern und 162 Nichtteilnehmern waren 46,5% männlich mit einem Durchschnittsalter von 54,5 ± 12,7 Jahren. Insgesamt hatten 87,1% der Teilnehmer in ihrer Kindheit einen Sonnenbrand und 47,1% hatten bereits Sonnenbanken benutzt. Höheres Alter, weibliches Geschlecht, frühere Nutzung von Sonnenbanken sowie die Sorge um und das Wissen über Hautkrebs standen in signifikantem Zusammenhang mit einer bisherigen Teilnahme an gHKS. Von den Nichtteilnehmern wussten 46% nichts von der Möglichkeit eines kostenlosen gHKS, und 40% begründeten ihre Nichtteilnahme mit dem Gefühl gesund zu sein.SchlussfolgerungenDie Gründe für die Nichtteilnahme an gHKS wie soziodemografische Merkmale und Risikoverhalten sollten bekannt sein, damit gHKS‐Programme optimiert werden können.

INTRODUCTION:According to the DLQI user manual, the patients' answers "not relevant" (NR) and "not at all" (affected in this aspect of life by the skin problem) are treated equally and interpreted as no impairment in health-related quality of life (HRQoL). The aim of this study was to gain more insights about "NR" responders with atopic dermatitis (AD). METHODS:A total of 3,353 patients with AD, recruited from dermatological offices and a patient organisation, were surveyed in three cross-sectional studies. Disease severity (SCORAD) and subjective health status (EQ VAS) were compared for each DLQI item between patients who answered "NR" and all others according to their response category. Different DLQI scoring versions were analysed. RESULTS:Those who stated "NR" in terms of HRQoL limitations in the DLQI domains sports, work/study, and sexual relationships were comparable in AD severity and health status to those who felt that their HRQoL was "a little affected." Some alternative DLQI scoring versions correlated slightly higher with the SCORAD and EQ VAS than the original DLQI. CONCLUSION:Patients with AD who rate certain life domains as "NR" in the DLQI are most similar in their disease burden to patients who feel a little affected in these areas of life. This suggests that some HRQoL limitations are underestimated by the traditional DLQI scoring. However, different scoring solutions did not lead to substantially higher correlations with other disease burden criteria compared to the original. Therefore, the gain in validity by alternative versions is small.

Zusammenfassung Hintergrund In den letzten Jahrzehnten traten in Deutschland Hochwasserereignisse auf, die eine Bedrohung für die Gesundheit der lokalen Bevölkerung darstellten. Es existieren allerdings kaum Studien, die die gesundheitlichen Folgen dieser Ereignisse untersuchen. Studienziel war daher die Untersuchung der Assoziationen des Ahrtal-Hochwassers im Jahr 2021 mit der Gesundheit der lokalen Bevölkerung. Methoden Datengrundlage dieser Studie sind bundesweite Abrechnungsdaten (stationär/ambulant) des BKK-Landesverbands Nordwest. Untersuchungsregion war die Region Ahrweiler, Untersuchungszeiträume jeweils das 3. Quartal der Jahre 2020 und 2021. Unter anderem mit Prevalence-Rate-Ratio-Tests wurde auf Grundlage von ICD-10-Kodierungen untersucht, welche Diagnosen (stationär/ambulant) räumlich und zeitlich in Assoziation mit dem Hochwasserereignis standen. Ergebnisse Die Ergebnisse zeigen im stationären Bereich eine deutliche Zunahme abgerechneter Leistungen in einigen Diagnosegruppen gegenüber dem Vorjahr. Verzeichnet wurden insbesondere Zunahmen bestimmter F‑Diagnosen ( psychische und Verhaltensstörungen ) und S‑Diagnosen ( Verletzungen ) sowie verschiedener Diagnoseschlüssel innerhalb der Z‑Kodierungen ( Faktoren, die den Gesundheitszustand beeinflussen und zur Inanspruchnahme des Gesundheitswesens führen ). Im ambulanten Sektor wurde in vielen Diagnosegruppen (F- und Z‑Diagnosen) eine Abnahme identifiziert. Diskussion Die Ergebnisse der Studie deuten darauf hin, dass vor allem die mentale Gesundheit der lokalen Bevölkerung und die Gesundheitsversorgung insgesamt (sektorspezifische Inanspruchnahme) vom Hochwasser beeinträchtigt wurden. Da Hochwasserereignisse zukünftig häufiger und stärker werden können, müssen die Maßnahmen zum Schutz der Bevölkerung und Gesundheitsinfrastruktur entsprechend angepasst werden.

Background Non-communicable diseases (NCDs) are responsible for many deaths. They are associated with several modifiable and metabolic risk factors and are therefore prone to significant regional variations on different scales. However, only few intra-urban studies examined spatial variation in NCDs and its association with social circumstances, especially in Germany. Thus, the present study aimed to identify associations of personal risk factors and local social conditions with NCDs in a large German city. Methods This study is based on a population-based cohort of the Hamburg City Health Study including 10,000 probands. Six NCDs were analyzed (chronic obstructive pulmonary disease [COPD], coronary heart disease [CHD], diabetes mellitus, heart failure, depression, and hypertension) in 68 city district clusters. As risk factors, we considered socio-demographic variables (age, sex, education) and risk behaviour variables (smoking, alcohol consumption). Logistic regression analyses identified associations between the district clusters and the prevalence rates for each NCD. Regional variation was detected by Gini coefficients and spatial cluster analyses. Local social condition indexes were correlated with prevalence rates of NCDs on city district level and hot-spot analyses were performed for significant high or low values. Results The analyses included 7,308 participants with a mean age of 63.1 years (51.5% female). The prevalence of hypertension (67.6%) was the highest. Risk factor associations were identified between smoking, alcohol consumption and education and the prevalence of NCDs (hypertension, diabetes, and COPD). Significant regional variations were detected and persisted after adjusting for personal risk factors. Correlations for prevalence rates with the local social conditions were significant for hypertension (r = 0.294, p < 0.02), diabetes (r = 0.259, p = 0.03), and COPD (r = 0.360, p < 0.01). Conclusions The study shows that regional differences in NCD prevalence persist even after adjusting for personal risk factors. This highlights the central role of both personal socio-economic status and behaviors such as alcohol and tobacco consumption. It also highlights the importance of other potential regional factors (e.g. the environment) in shaping NCD prevalence. This knowledge helps policy- and decision-makers to develop intervention strategies.

BACKGROUND:In recent decades, Germany has experienced flood events that posed a threat to the health of the local population. However, there is a paucity of studies on the health consequences of these events. Therefore, the aim of the study was to investigate the health consequences of the Ahr Valley flood in 2021. METHODS:The data basis of this longitudinal study are nationwide billing data (inpatient/outpatient) of the BKK-Landesverband Nordwest. The study region was Ahrweiler and the study periods were the third quarters of 2020 and 2021. Among other things, prevalence rate ratio tests were used to determine which diagnoses (inpatient/outpatient) were spatially and temporally associated with the flood event on the basis of ICD-10 coding. RESULTS:The results show a significant increase in billed services for some diagnosis groups in the inpatient sector. In particular, there was an increase in F diagnoses (mental and behavioural disorders), S diagnoses (injuries) and various diagnosis codes within Z codes (factors influencing health status and leading to healthcare utilisation). In the outpatient sector, a decrease was observed in many diagnosis groups (F and Z diagnoses). CONCLUSION:The results of the study showed that the mental health of the local population was particularly affected by the floods. Healthcare was also affected. As floods are expected to become more frequent and severe in the future, measures to protect the population and health infrastructure need to be adapted accordingly.

Summary Background and objectives Due to increasing skin cancer incidence, Germany implemented a statutory nationwide routine skin cancer screening (rSCS) in 2008. The present study aims (1) to analyze which patient factors are associated with the participation in rSCS in Germany and (2) to investigate reasons for nonparticipation. Patients and methods Participants and nonparticipants of rSCS (≥ 35 years) were recruited in routine care in nine dermatological outpatient clinics. Reasons for (non‐)participation, knowledge about skin cancer as well as clinical and socioeconomic data were obtained. Stratified by groups, descriptive analyses and binary logistic regression analyses for associations with participation were performed. Results Of the 294 rSCS participants and 162 non‐participants, 46.5% were male with a mean age of 54.5 ± 12.7 years. In total, 87.1% had sunburns in childhood and 47.1% used sunbeds before. Higher age, female gender, previous sunbed use, and concern for and knowledge of skin cancer were significantly associated with previous rSCS participation. Of the non‐participants, 46% were unaware of the option for free rSCS and 40% justified their nonparticipation on the basis of feeling healthy. Conclusions The reasons for nonparticipation in rSCS, such as sociodemographic characteristics and risk behavior, should be known in order to optimize rSCS programs.

Background:Limited data are available characterizing the impact of the SARS-CoV-2 pandemic on psoriasis care for patients in Germany.Objective:To analyze patient perception and impact of the pandemic on well-being and psoriasis management of German patients with moderate-to-severe psoriasis or psoriasis arthritis under systemic therapies.Methods:The CoronaBest registry captures events of SARS-CoV-2 infections and analyzes the impact of the pandemic on patients with psoriasis or psoriasis arthritis. In June 2020, and independently in February 2022, patients with psoriasis or psoriasis arthritis received a standardized questionnaire for current treatment, protective measures, well-being, and individual risks for COVID-19, among others.Results:Included were 4,194 patients in 2020 (mean age of 47.7 years and 41.8% women) and 4,818 patients in 2022 (mean age of 56.4 and 42.9% women). Treatment discontinuations were observed in 2.7% and 1.7% of patients in 2020 and 2022, respectively. In the vast majority of the cases (>92%), no additional measures were taken concerning the management of psoriasis treatments in either 2020 or 2022. Those patients with changes reported most frequently: telephone calls instead of face-to-face visits (80.2%, in 2020 vs 40.5% in 2022) or more frequent controls (27.1%, 2020 vs 22.0%, 2022). A majority (66.7%, 2020, and 70.6%, 2022) did not perceive the virus as a considerable threat. The proportion of patients feeling well informed about COVID-19 by physicians increased from 42.6% in 2020 to 51.8% in 2022. About 81.1% of patients in 2020 and 67.5% in 2022 stated that their overall personal condition was not affected due to the pandemic. Physicians attributed no special risk of contracting SARS-CoV-2 in most of the patients.Conclusion:A high rate of systemic treatment persistence and awareness of risks and protective measures indicate that health care for psoriasis largely followed current national and international recommendations during the COVID-19 pandemic.

Aim of the study was to characterise the association between screening, prevalence and mortality of skin cancer in Germany considering the spatial distribution. The study included the total set of outpatient data of all statutory health insured people and cause-of-death statistics in Germany between 2011-2015 on county level. To identify regions with high/low screening, prevalence and mortality rates, probability maps were calculated. Scenarios were developed based on the research questions. These were used to identify regions that share both high/low rates of screening, prevalence and mortality. Regression analyses were used to characterise these regions, taking into account sociodemographic characteristics. Significant regional variations in prevalence, screening and mortality in Germany were identified. Depending on the scenario, influences of sociodemographic conditions become apparent. For example, a lower income (p = 0.006) and poorer accessibility of the closest dermatologist (p = 0.03) predicted a lower prevalence of and fewer screenings for skin cancer. In regions with low screening and high mortality, significant (p = 0.03) associations with the educational status of the population were also found. The study identified the first spatial associations between screening, prevalence and mortality of skin cancer in Germany. The results indicate that regional population-related characteristics (e.g., sociodemographic characteristics) play an important role in explaining the associations and should be given more weight in further studies. However, further studies, particularly on the spatial variation of skin cancer mortality, are still necessary.

There are regional differences in the prevalence of psoriasis between countries, as well as within countries. However, regional determinants of differences in prevalence are not yet understood. The aim of this study was to identify sociodemographic and environmental determinants of regional prevalence rates for psoriasis. Analyses were based on German outpatient billing data from statutory health insurance, together with data from databases on sociodemographic and environment factors at the county level (N = 402) for 2015–2017. Descriptive statistics were calculated for all variables. To identify determinants for prevalence at the county level, spatiotemporal regression analysis was performed, with prevalence as the dependent variable, and the number of physicians, mean age, mean precipitation, sunshine hours, mean temperature, level of urbanity, and the German Index of Socioeconomic Deprivation (GISD) as independent variables. Mean prevalence of psoriasis increased from 168.63 per 10,000 in 2015 to 173.54 per 10,000 in 2017 for Germany as a whole, with high regional variation. Five determinants were detected (p < 0.05). The prevalence increased by 4.18 per 10,000 persons with SHI with each GISD unit, and by 3.76 per 10,000 with each year increase in age. Each additional hour of sunshine resulted in a decrease of 0.04 and each °C increase in mean temperature resulted in an increase of 4.22. Each additional dermatologist per 10,000 inhabitants resulted in a decrease of 0.07. In conclusion, sociodemographic and environmental factors result in significant differences in prevalence of psoriasis, even within-country.

ZusammenfassungHintergrund und ZielsetzungEpidemiologische Studien zur dermatologischen Versorgung von Patienten mit atopischer Dermatitis (AD) in Deutschland zeigen innerhalb von 10 Jahren keine Verbesserung. Neben Dermatologen sind vor allem auch Hausärzte (GP) an der Behandlung von Patienten mit AD beteiligt. In dieser Studie wurde die Versorgungssituation erwachsener Patienten, die wegen AD in hausärztlicher Behandlung sind, analysiert.Patienten und MethodikDie Querschnittserhebung „PsoADA‐AD“ wurde von 2019 bis 2021 bundesweit in hausärztlichen Praxen durchgeführt. Die Ergebnisse wurden mit Daten aus der dermatologischen Versorgung (AtopicHealth2, 2017–2019) verglichen.ErgebnisseVon den 150 Patienten (mittleres Alter: 40 Jahre, 62,2% weiblich) wurden 39,2% zusätzlich von Dermatologen (GP+D) behandelt. Unter diesen hatten 20,7% eine schwere AD, während dies unter den nur hausärztlich behandelten Patienten (GP only) auf 5,7% zutraf (p < 0,01, AtopicHealth2: 27,6%). Erhebliche Einschränkungen in ihrer Lebensqualität berichteten 31,0% (GP+D) vs. 3,4% (GP only) (p < 0,001, AtopicHealth2: 31,6%). Die meisten Patienten erhielten topische Medikamente, hauptsächlich Glukokortikosteroide. Calcineurininhibitoren wurden aktuell von 2,7% (PsoADA‐AD gesamt) verwendet. Bereits an einer Neurodermitisschulung teilgenommen zu haben, gaben 5,7% (PsoADA‐AD gesamt) an.SchlussfolgerungenEin erheblicher Teil der Patienten mit AD in der hausärztlichen Versorgung zeigt eine schlechte Erkrankungskontrolle, wie es auch in der dermatologischen Versorgung beobachtet wurde. Ein Grund könnte der fehlende Einsatz moderner Systemtherapeutika sein.

Enhanced treatment options for psoriasis and growing use of guidelines increased the potential to better quality of psoriasis care in Europe. The aim of the PsoBarrier EU study is to compare the quality and processes of psoriasis care in four European countries with different healthcare systems, based on validated quality indicators. This cross-sectional survey was conducted in dermatology centres in Denmark, Germany, Poland and Spain on 1,304 patients, using standardized patient and physician questionnaires. Measured by quality of psoriasis care indicators, patients in Poland had the most critical outcomes, such as the highest disease severity (Psoriasis Area and Severity Index; PASI) and lowest health-related quality of life (Dermatology Life Quality Index; DLQI). This indicates differences in psoriasis care, with Polish participants experiencing more severe psoriasis and its consequences. Differences in the healthcare systems, which create barriers to accessing treatments, could explain variations in quality of care.

Numerous studies and models address the determinants of health. However, in existing models, the spatial aspects of the determinants are not or only marginally taken into account and a theoretical discussion of the association between space and the determinants of health is missing. The aim of this paper is to generate a framework that can be used to place the determinants of health in a spatial context. A screening of the current first serves to identify the relevant determinants and describes the current state of knowledge. In addition, spatial scales that are important for the spatial consideration of health were developed and discussed. Based on these two steps, the conceptual framework on the spatial determinants of health was derived and subsequently discussed. The results show a variety of determinants that are associated with health from a spatial point of view. The overarching categories are global driving forces, policy and governance, living and physical environment, socio-demographic and economic conditions, healthcare services and cultural and working conditions. Three spatial scales (macro, meso and micro) are further subdivided into six levels, such as global (e.g., continents), regional (e.g., council areas) or neighbourhood (e.g., communities). The combination of the determinants and spatial scales are presented within a conceptual framework as a result of this work. Operating mechanisms and pathways between the spatial levels were added schematically. This is the first conceptual framework that links the determinants of health with the spatial perspective. It can form the working basis for future analyses in which spatial aspects of health are taken into account.