Background: Coronary artery bypass grafting (CABG) and drug-eluting stent implantation (DES) are established as central methods of revascularization for patients with coronary artery disease. This study aims to analyse the health trajectories of patients after first CABG or first, second or third DES within the first three years, with a focus on follow-up interventions, severe care need, transition into a nursing home, and death. Methods: Based on health claims data (n=11,581), we estimated age-and sex standardized probabilities of reintervention, and of transition to severe care need, nursing home and death following initial CABG (n=2,008) or DES (n=9,573) for patients aged 50 years and older using logistic regression models and direct standardization. Up to three follow-up DES interventions and one follow-up CABG were considered. Results: There was a fairly high probability of reintervention, particularly after a DES and within the first year. Follow-up interventions were more likely to involve DES than CABG. The probability of death was notably higher for CABG patients. The probabilities of severe care need and moving to a nursing home were slightly lower and similar across the revascularization methods and over time. Conclusions: DES and CABG are often associated with a need for follow-up interventions. Depending on the procedure, however, the risk of repeat surgery or adverse health outcomes varies. DES is associated with a relatively high probability of follow-up revascularization and a nearly constant probability of negative health outcomes in the short and medium term. In contrast, within three years after a CABG, follow-up reinterventions are rather rare. However, this procedure is particularly associated with an increased risk of mortality and short-term transition into a nursing home.

Objective Glaucoma is a leading cause of severe visual impairment and blindness (SVI/B) worldwide. Hence, it is of utmost importance to explore relevant risk factors and study the pace of progression to SVI/B. Methods and analysis We used a random sample of 250 000 persons from administrative individual-level health records of the Allgemeine Ortskrankenkassen between 2004 and 2015. We identified 3535 primary open-angle glaucoma (POAG) patients aged 55 and older and followed them for up to 10 years. Monocular and binocular SVI/B were defined by the ICD-10 classifications H54.0 and H54.4. Ophthalmological and chronic disease risk factors were analysed by applying a multivariable Cox proportional hazard model. Results The risk of SVI/B in POAG patients was significantly increased by the presence of specific additional eye diseases such as secondary glaucoma (HR: 3.08, p<0.001), retinal vascular occlusion (HR: 3.00, p<0.001) or age-related macular degeneration (AMD) (HR: 2.26, p<0.001). The risk was highest in the first 2 years after the POAG diagnosis and significantly decreased after the fifth year (HR: 0.36, p=0.002). Ocular injuries, other ocular diseases, non-ophthalmological comorbidities, and age and sex had no significant influence (p>0.05). Conclusion Although progression to SVI/B is relatively rare in POAG patients in Germany, one must be aware of additional risk factors, such as secondary glaucoma, retinal vascular occlusion and AMD. Regular ophthalmological examinations help prevent the progression of SVI/B, especially in the first years after the POAG diagnosis. Specific, targeted, and timely treatments for the other eye diseases could help prevent or delay SVI/B.

Background: There is an ongoing debate about whether environmental characteristics influence dementia risk like individual traits do, and whether these differ by sex and gender. Objective: This study examines the influence of regional characteristics on the incidence of dementia and explores sex and gender differences using individual-level health information and regional characteristics. Methods: Using a random sample of 250,000 people aged 70 + insured through Germany's largest German public health agency, we analyzed quarterly data about diagnoses and place of residence from 2014 to 2019. Using five-digit postal codes, we added data on various dimensions of regional characteristics offered by the INKAR database and the 2011 Census database. We used multilevel survival regressions to tease out regional incidence differences while accounting for spatial clustering. Results: After adjusting for multi-morbidity and relocation-related selection bias, we saw that people living in regions with the highest tertile of income (HR = 0.87, p < 0.001), and who had the highest tertile of remaining life expectancy at age 60 (HR = 0.93, p = 0.012) had lower dementia risks. There was no gender difference in the regional income effect, but the effect of education (HR = 0.91, p = 0.015) was significant only for men and remaining life-expectancy was significant only for women (HR = 0.93, p = 0.026). Conclusion: Environmental characteristics related to wealth and health resources of a region influence the risk of dementia among the elderly in Germany. This effect is independent of the health profiles of the individuals and differs between the two genders. Health policies need to acknowledge these modifiable risk factors and consider how they affect men and women differently.

Objectives Due to demographic aging, the prevalence of coronary artery disease (CAD) is expected to increase in the future, resulting in a growing demand for stent and bypass interventions. This study aims to investigate the mortality risk of patients following conventional coronary artery bypass grafting (CABG) or endovascular procedure by the implantation of bare-metal stents (BMS) or drug-eluting stents (DES). Methods Based on a random sample of 250,000 members of Germany’s largest health insurance ‘Allgemeine Ortskrankenkassen’ (AOK) from 2004 to 2015, incident CAD patients were analyzed by Cox Proportional-Hazard models. Risk adjustment was made for sex, age, other cardiac diseases, non-cardiovascular comorbidities and years since intervention. Due to later admission of DES and thus a shorter observation time, mortality was examined for 3 years since the intervention. Results BMS represented the most frequent procedure (48%). We found similar proportions of CABG (19%) and DES interventions (23%). After risk adjustment, the models showed a 21% ( p = 0.004) lower mortality risk of patients with DES and also a 21% ( p = 0.002) lower mortality risk of CABG patients compared to persons with BMS. Conclusion Based on a large-scale dataset, our study demonstrated survival advantages of CABG and DES interventions over BMS, with no differences between the DES and CABG groups. The results help to assess the risks of coronary interventions. Aspects of quality of life, severity of postoperative physical limitations, duration of rehabilitation, patients’ preferences, and aspects of cost-effectiveness for hospitals and society should be further considered. Graphical abstract

ABSTRACTThere is a general consensus that SARS-CoV-2 infections and COVID-19 deaths have hit lower social groups the hardest, however, for Germany individual level information on socioeconomic characteristics of infections and deaths does not exist. The aim of this study was to identify the key features explaining SARS-CoV-2 infections and COVID-19 deaths during the upswing of the second wave in Germany.We considered information on COVID-19 diagnoses and deaths from 1. October to 15. December 2020 on the county-level, differentiating five two-week time periods. We used 155 indicators to characterize counties in nine geographic, social, demographic, and health domains. For each period, we calculated directly age-standardized COVID-19 incidence and death rates on the county level. We trained gradient boosting models to predict the incidence and death rates with the 155 characteristics of the counties for each period. To explore the importance and the direction of the correlation of the regional indicators we used the SHAP procedure. We categorized the top 20 associations identified by the Shapley values into twelve categories depicting the correlation between the feature and the outcome.We found that counties with low SES were important drivers in the second wave, as were those with high international migration and a high proportion of foreigners and a large nursing home population. During the period of intense exponential increase in infections, the proportion of the population that voted for the Alternative for Germany (AfD) party in the last federal election was among the top characteristics correlated with high incidence and death rates.We concluded that risky working conditions with reduced opportunities for social distancing and a high chronic disease burden put populations in low-SES counties at higher risk of SARS-CoV-2 infections and COVID-19 deaths. In addition, noncompliance with Corona measures and spill-over effects from neighbouring counties increased the spread of the virus. To further substantiate this finding, we urgently need more data at the individual level.

(1) Background: In the absence of individual level information, the aim of this study was to identify the regional key features explaining SARS-CoV-2 infections and COVID-19 deaths during the upswing of the second wave in Germany. (2) Methods: We used COVID-19 diagnoses and deaths from 1 October to 15 December 2020, on the county-level, differentiating five two-week time periods. For each period, we calculated the age-standardized COVID-19 incidence and death rates on the county level. We trained gradient boosting models to predict the incidence and death rates by 155 indicators and identified the top 20 associations using Shap values. (3) Results: Counties with low socioeconomic status (SES) had higher infection and death rates, as had those with high international migration, a high proportion of foreigners, and a large nursing home population. The importance of these characteristics changed over time. During the period of intense exponential increase in infections, the proportion of the population that voted for the Alternative for Germany (AfD) party in the last federal election was among the top characteristics correlated with high incidence and death rates. (4) Machine learning approaches can reveal regional characteristics that are associated with high rates of infection and mortality.

Objective This study aims to estimate the incidence of severe binocular vision impairment and blindness (SVI/B) and to identify eye diseases and regional risk factors of persons with SVI/B at ages 50 years and older. Methods We designed an observational cohort study based on longitudinal, multifactorial, and administrative information of a random sample of 250,000 persons at ages 50+. All individuals were included in the process-produced health claims register of the Allgemeine Ortskrankenkasse in 2004, and were followed until 2015. We analyzed ten selected eye diseases and regional characteristics as risk factors for SVI/B using Cox models, adjusting for demographic characteristics and multi-morbidity. Results The age-standardized incidence was 79 new diagnoses of SVI/B per 100,000 person-years (95%-CI: 76-82); 77 for males (72-82) and 81 for females (77-85). By adjusting for multiple factors, the model revealed and confirmed that individuals who were very old (Hazard ratio 90+: 6.67; 3.59-12.71), male (1.18; 1.01-1.38), had multi-morbidities (three+ diseases: 3.36; 2.51-4.49), or had diabetes (1.26; 1.07-1.49) had an increased risk of SVI/B. Compared to persons without the particular eye disease (all p<0.001), persons diagnosed with secondary glaucoma had a multiple-adjusted 4.66 times (3.17-6.85) higher risk, those with retinal vascular occlusion had a 4.51 times (3.27-6.23) higher risk, and those with angle-closure glaucoma had a 4.22 times (2.60-6.85) higher risk. Population density was not a risk factor, while persons living in wealthier regions had 0.75 times (p=0.003) to 0.70 times (p<0.001) the risk of SVI/B than persons in the least wealthy regions of Germany. Conclusion The study revealed and confirmed some profound risk factors of SVI/B at both the individual and the macro level. The sizes of the effects of the characteristics of the living context were smaller than those of the individual characteristics, especially for some severe eye diseases. While urbanity and access to health services had no effect, regional economic wealth was a risk factor for SVI/B. Future health care measures and advice by physicians should take these dimensions of inequalities in SVI/B into account.

This study estimates the prevalence and mortality of diseases of the deep veins of the legs such as deep vein thrombosis (DVT), postthrombotic syndrome (PTS), and venous leg ulceration (VLU). We used a random sample of 250 000 patients at age 50+ years of the register of the Allgemeine Ortskrankenkasse from 2004 to 2015. Selected manifestations of venous diseases assumed as risk factors for mortality were analyzed using Cox models while adjusting for various basic demographic and health characteristics. The prevalence in 2004 was 0.05% for DVT of the femoral veins, 0.50% for DVT of any deep veins, 0.86% for PTS, and 0.91% for VLU. The mortality rate in 2004 to 2015 was 20.40 deaths/100 person-years for DVT of the femoral veins, 10.69 for DVT of any deep veins, 4.34 for PTS, and 7.02 for VLU. The model revealed a 35% higher risk (p < .001) in patients with any DVT, an 88% higher mortality (p < .001) for femoral DVT, a 23% higher risk (p < .001) for VLU, and no health disadvantage in persons with PTS. Our study revealed an increased mortality for patients with VLU and DVT. Even after adjustment for embolic events and infections of the venous ulcers mortality remained significantly higher.

Objective To assess factors associated with diabetic retinopathy (DR) screening uptake following a diagnosis of type 2 diabetes mellitus (type 2 diabetes) in Germany. Materials and methods A nationally representative prospective sample of individual-level health claims data for 250,000 members from Germany's largest public insurance provider in 2004-2013 was assessed. In the sample, 26,560 persons with incident type 2 diabetes were identified. Factors associated with subsequent DR screening were assessed using descriptive statistics, Kaplan-Meier estimator, and Cox regression analysis. Results On average 27.6 visits to an ophthalmologist per 100 person-years in persons with incident type 2 diabetes occurred. Half of all incident cases (Kaplan-Meier estimator) had not seen an ophthalmologist after more than two years (2.25 years) following their diabetes diagnosis. In the multivariate analysis, an older age (from hazard ratio HR(70-74) = 0.93 [95%-CI: 0.89-0.97] to HR(90+) = 0.50 [95%-CI: 0.42-0.60] compared to persons aged 50-69 years) and a higher disability level (i.e. HR(disability level 3) = 0.30 [95%-CI: 0.25-0.36]) were associated with a lower likelihood, while female sex (HR =1.12 [95%-CI: 1.08-1.15]), six or more comorbidities (HR = 1.26 [95%-CI: 1.15-1.37]), moderate (HR = 1.51 [95%-CI: 1.461.56]) or severe type 2 diabetes (HR = 1.53 [95%-CI: 1.45-1.61]) as well as being enrolled in a type 2 diabetes disease management program (HR = 1.78 [95%-CI: 1.69-1.87]) were associated with a higher likelihood of DR screening. Conclusions A high proportion of newly diagnosed persons with type 2 diabetes did not follow current German recommendations for DR screening, impeding timely detection and management of potential complications. This was more apparent among persons who were men, older or had a disability. The uptake of screening was considerably greater among those enrolled in a diseases management program. These factors need to be considered when planning DR screening services and/or referrals.

Germany is characterized by the “natural experiment” of reunification in 1991 which can be used to explore long-term effects of differences in environment on the occurrence of dementia today. At the same time, in East German life expectancy has been increasing at an unprecedented pace with now similar life expectancy in both parts of the country. Nevertheless, prevalence of dementia is higher in Eastern than in Western Germany despite. We explored whether trends in dementia prevalence are similar in both parts of the country and did preliminary analyses on trends in incidence and mortality of the demented. We used claims data of Germany's largest public health insurer (AOK). Dementia is defined by the ICD-10 classification using the numbers G30, G31.0, G31.82, G23.1, F00, F01, F02, F03, und F05.1. We apply negative binomial regression to estimate time trends between the years 2007 to 2012 for the age groups 65–74, 75–84, and 85–100+. During this period we observed one million dementia cases with a risk population of more than 28 million individuals. Time trends differ for the two parts of the country but are similar for the two sexes (Table 1). Rate ratios at ages 75–84 (reference year=2007) show a significant continuous decrease among West Germans, which is stronger among women (RR 2012 =0.94, p-value=0.01) than men (RR 2012 =0.97, p-value=0.01). For East Germans of the same age we find an increase (women RR 2012=1.10, p-value<=0.001), men RR 2012=1.14, p-value<=0.001). A similar tendency exists at younger ages. At ages 85+ prevalence significantly declined in West Germany and remained stable in East Germany. Dementia prevalence only declined in West Germany and increased in East Germany. Using the same data source we performed preliminary analyses of trends in incidence and the mortality of the demented and found different trends for the two parts of the country. Differences in life-style during midlife and the general catch-up process of life expectancy since reunification may explain why East Germans fare worse in terms of trends in dementia prevalence.

With increasing age the prevalence of dementia doubles every five to six years and reaches a plateau between ages 95 and 100 (Figure 1). We explored whether the existence of the plateau supports the hypothesis that dementia is linked to a certain age rather than to ageing itself. In addition, we explored whether the occurrence of dementia influences survival to age 100 when controlled for comorbidity. We used claims data of the largest public health insurance company in Germany with complete inpatient and outpatient diagnoses according to ICD-10. Dementia is defined by the numbers G30, G31.0, G31.82, G23.1, F00, F01, F02, F03, und F05.1 and the prescription of anti-dementia drugs. We took three independent random samples of persons aged 97 in 2004, 2007 and 2010, and followed these 1,985 persons until they died or reached aged 100. We calculated the prevalence of dementia in the four groups that either died at age 97, 98, 99 or reached age 100. We estimated GEE logit models to explore the likelihood of reaching age 100 dependent on the presence of dementia and other major diseases. In each of the four groups dementia prevalence continued to increase with increasing age. In the groups who died earlier, dementia prevalence was higher at similar ages. For example, at age 97 it was 68% among the decedents aged 97, 64% among the decedents aged 98, and 44% among the survivors to age 100 (Figure 2). The presence of dementia reduced the likelihood to survive to age 100 (OR=0.85, p=0.00), which was also true for diabetes and lower extremity injuries. The dementia plateau observed between ages 95 and 100 is mainly due to mortality selection with only the fittest and healthiest surviving to the next age. This supports the view that dementia is an ageing-related disease. Dementia, diabetes and lower extremity injuries, which are highly interdependent, are decisive factors of surviving to 100, while hypertension, cardio- and cerebrovascular disease as well as cancer become less important. Future reduction in mortality among the oldest old may largely hinge on future trends in dementia. Dementia prevalence per 100 population, Germany, AOK claims data 2010. Prevalence rate of dementia by survival group (1=100%), AOK claims data.

BACKGROUND:Studies state profound cross-country differences in healthy life years and its time trends, suggesting either the health scenario of expansion or compression of morbidity. A much-discussed question in public health research is whether the health scenarios are heterogeneous or homogeneous on the subnational level as well. Furthermore, the question arises whether the morbidity trends or the mortality trends are the decisive drivers of the care need-free life years (CFLY), the life years with care need (CLY), and, ultimately, the health scenarios.METHODS:This study uses administrative census data of all beneficiaries in Germany from the Statutory Long-Term Care Insurance 2001-2009. We compute the CFLY and CLY at age 65+ for 412 counties. The CFLY and CLY gains are decomposed into the effects of survival and of the prevalence of care need, and we investigate their linkages with the health scenarios by applying multinomial regression models.RESULTS:We show an overall increase in CFLY, which is higher for men than for women and higher for severe than for any care need. However, spatial variation in CFLY and in CLY has increased. In terms of the health scenarios, a majority of counties show an expansion of any care need but a compression of severe care need. There is high spatial heterogeneity, with expansion-counties surrounding compression-counties and vice versa, which is mainly caused by divergent trends in the prevalence of care need. We show that mortality is responsible for the absolute changes in CFLY and CLY, while morbidity is the decisive driver that determines the health scenario of a county.CONCLUSION:Combining regionalized administrative data and advanced statistical methods permits a deeper insight into the complex relationship between health and mortality. Our findings demonstrate a compression of life years with severe care need, which however, depends on the region of residence. To attenuate regional inequalities, more efforts are needed that improve health by medical and infrastructural interventions and by the exchange of insights in the efficiency of small- and large-area policy measures between the vanguard and the rearguard counties. In future research, the underlying latent mechanisms should be investigated in more detail.

Aussiedler, also referred to as ethnic German immigrants from countries of the former Soviet Union and other parts of Eastern Europe, constitute one of the largest immigrant groups in Germany. Little is known about their health relative to the health of native Germans. Using the German Microcensus 2005, which includes information about the health of 10,022 Aussiedler and 322,813 native Germans aged 20+ we find that in both groups high regional centrality depresses health, as does living in a region with low GDP. The proportion of foreigners does not have any consistent effect. The two groups differ with respect to educational gradients in health: there is none for Aussiedler, while there is a steep gradient for native Germans. Aussiedler who have lived in Germany for less than 15 years are healthier than native Germans which supports the healthy migrant hypothesis. Their deteriorating health status by duration of stay suggests that migration, deprivation and discrimination may have negative effects on the health of Aussiedler.

In order to make precise and forward-looking decisions in nearly all social fields, detailed information on the size and structure of prospective populations in specific regional areas is needed. For that purpose, this article will show how current trends of demographic parameters affect the development of the population in administrative districts of the federal state of Mecklenburg-Western Pomerania until 2030. Based upon population data from 1982 until 2005, provided by the Federal State Agency of Statistics of Mecklenburg-Western Pomerania, this paper presents a projection of the population as well as the aging and the sex proportion of the federal state until 2030. The development of off-county cities, counties and the whole federal state were calculated by applying the cohort-survival-method and prediction module of the Federal State Agency of Statistics of Mecklenburg-Western Pomerania. The fertility and migration assumptions chosen, are following the assumptions of the last coordinated population projection of the Federal State Agency of Statistics of Mecklenburg-Western Pomerania (2007). The mortality assumptions enter the analysis analogously to the countyand sex-specific projections of life expectancy, as they are used within the Lee-Carter-method (1982 – 2005). 10 soFid Bevolkerungsforschung 2010/1 Bevolkerungsprognose fur Mecklenburg-Vorpommern auf Kreisebene bis zum Jahr 2030

Journal of Pediatric Gastroenterology and NutritionVolume 24, Issue 4 p. 452-452 Annual Meeting of the European Society of Pediatric Gastroenterology and Nutrition Thessaloniki, May 21–24, 1997 THE IN VITRO-INFLUENCE OF GLIADIN PEPTIDES ON THE HYDROLASES OF THE DUODENAL BRUSH BORDER MEMBRANE IN COELIAC DISEASE IN REMISSION D Kreft, D Kreft University Center of Paediatrics Bonn, GermanySearch for more papers by this authorH-P Hauri, H-P Hauri University Center of Paediatrics Bonn, GermanySearch for more papers by this authorD C Belli, D C Belli University Center of Paediatrics Bonn, GermanySearch for more papers by this authorP Bähler, P Bähler University Center of Paediatrics Bonn, GermanySearch for more papers by this authorH Y Naim, H Y Naim University Center of Paediatrics Bonn, GermanySearch for more papers by this authorK M Keller, K M Keller University Center of Paediatrics Bonn, GermanySearch for more papers by this authorM J Lentze, M J Lentze University Center of Paediatrics Bonn, GermanySearch for more papers by this author D Kreft, D Kreft University Center of Paediatrics Bonn, GermanySearch for more papers by this authorH-P Hauri, H-P Hauri University Center of Paediatrics Bonn, GermanySearch for more papers by this authorD C Belli, D C Belli University Center of Paediatrics Bonn, GermanySearch for more papers by this authorP Bähler, P Bähler University Center of Paediatrics Bonn, GermanySearch for more papers by this authorH Y Naim, H Y Naim University Center of Paediatrics Bonn, GermanySearch for more papers by this authorK M Keller, K M Keller University Center of Paediatrics Bonn, GermanySearch for more papers by this authorM J Lentze, M J Lentze University Center of Paediatrics Bonn, GermanySearch for more papers by this author First published: 01 April 1997 https://doi.org/10.1002/j.1536-4801.1997.tb00506.xRead the full textAbout ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume24, Issue4April 1997Pages 452-452 RelatedInformation

Phenylglyoxylic acid (1) in aqueous solution is recommended as a convenient chemical actinometer (φ ≈ 0.6 – 0.8) for the region 250 – 400 nm. UV spectroscopy, nuclear magnetic resonance spectroscopy, gas chromatography, high performance liquid chromatography and titrimetry are suitable analytical methods for monitoring the photodecarboxylation of 1 and the formation of benzaldehyde (2). Quantum yield φ determinations and 1H photochemically induced dynamic nuclear polarization (photo-CIDNP) experiments in different media reveal that the photochemistry of 1 is strongly dependent on the nature, water content and pH value of the solvent. Photodecarboxylation of 1 requires the presence of water, and φ is drastically enhanced by increasing the water concentration in acidic solution. On the basis of photo-CIDNP results it is suggested that the photoreduction of 1 in 2-propanol, yielding a 1:1 mixture of meso- and D, L-2,3-diphenyl-tartaric acid, proceeds via a radical-pair mechanism. Two pathways are discussed for the formation of 2 by photodecarboxylation of 1. The main reaction is proposed to occur without polarization under photo-CIDNP conditions while side reactions give rise to polarized benzoin and benzaldehyde proton nuclear magnetic resonance spectra.