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. 2018 Jan 10;18(1):121.
doi: 10.1186/s12889-017-5017-x.

Exploring the small-scale spatial distribution of hypertension and its association to area deprivation based on health insurance claims in Northeastern Germany

B Kauhl  1   2 , W Maier  3 , J Schweikart  4 , A Keste  5 , M Moskwyn  5
Affiliations

Exploring the small-scale spatial distribution of hypertension and its association to area deprivation based on health insurance claims in Northeastern Germany

B Kauhl et al. BMC Public Health. .

Abstract

Background: Hypertension is one of the most frequently diagnosed chronic conditions in Germany. Targeted prevention strategies and allocation of general practitioners where they are needed most are necessary to prevent severe complications arising from high blood pressure. However, data on chronic diseases in Germany are mostly available through survey data, which do not only underestimate the actual prevalence but are also only available on coarse spatial scales. The discussion of including area deprivation for planning of healthcare is still relatively young in Germany, although previous studies have shown that area deprivation is associated with adverse health outcomes, irrespective of individual characteristics. The aim of this study is therefore to analyze the spatial distribution of hypertension at very fine geographic scales and to assess location-specific associations between hypertension, socio-demographic population characteristics and area deprivation based on health insurance claims of the AOK Nordost.

Methods: To visualize the spatial distribution of hypertension prevalence at very fine geographic scales, we used the conditional autoregressive Besag-York-Mollié (BYM) model. Geographically weighted regression modelling (GWR) was applied to analyze the location-specific association of hypertension to area deprivation and further socio-demographic population characteristics.

Results: The sex- and age-adjusted prevalence of hypertension was 33.1% in 2012 and varied widely across northeastern Germany. The main risk factors for hypertension were proportions of insurants aged 45-64, 65 and older, area deprivation and proportion of persons commuting to work outside their residential municipality. The GWR model revealed important regional variations in the strength of the examined associations.

Conclusion: Area deprivation has only a significant and therefore direct influence in large parts of Mecklenburg-West Pomerania. However, the spatially varying strength of the association between demographic variables and hypertension indicates that there also exists an indirect effect of area deprivation on the prevalence of hypertension. It can therefore be expected that persons ageing in deprived areas will be at greater risk of hypertension, irrespective of their individual characteristics. The future planning and allocation of primary healthcare in northeastern Germany would therefore greatly benefit from considering the effect of area deprivation.

Keywords: AOK Nordost; Geographically weighted regression; German index of multiple deprivation; Germany; Health insurance claims; Healthcare; Hypertension; Spatial analysis.

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Conflict of interest statement

Ethics approval and consent to participate

The AOK Nordost - Die Gesundheitskasse (www.nordost.aok.de) permitted the use of aggregated and anonymized data for this study. The use of aggregated and anonymized data for research purposes does not require a vote by an ethics committee or an institutional research board.

Consent for publication

Not applicable

Competing interests

BK, WM, JS, AK and MM declare that they have no competing interests. The commercial affiliation of BK, AK and MM to the AOK Nordost – die Gesundheitskasse (www.nordost.aok.de), did not result in any competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Adaptation of the German Index of Multiple Deprivation at the level of a municipalities and b association of municipalities for the area covered by the AOK Nordost. Data source: Helmholtz Zentrum München, German Research Center for Environmental Health. Map source: Federal agency of cartography and geodesy
Fig. 2
Fig. 2
Sex- and age-adjusted prevalence of hypertension in northeastern Germany, 2012. Map source: Federal agency of cartography and geodesy
Fig. 3
Fig. 3
Geographically weighted regression coefficients of hypertension for a insurants aged 45–64 years, b insurants aged 65 years and older, c Area deprivation (GIMD) and d commuters. Map source: Federal agency of cartography and geodesy
See this image and copyright information in PMC

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