BARMER GEK

BackgroundThe demographic change in Germany leads to an increased number of centenarians. Within this population fragility fractures, such as the proximal humeral fracture (PHF), are not well investigated. This study aims to evaluate the epidemiology, treatment and outcome after a PHF in patients ≥ 100 years of age in Germany.MethodsRetrospective claims data of the BARMER health insurance were analyzed. All in- and outpatient cases of insurance holders ≥ 65 years from 01/2011 to 09/2022, with coded diagnosis of PHF were analyzed. The patients aged 65–99 years were used as a comparison group for the centenarians. Primary endpoints were overall survival, major adverse events (MAEs) and thrombo-embolic events.ResultsIn total, 100,482 patients with PHF were included in the study, with 230 aged 100 years and older. Centenarians with a PHF were more often female with several age-associated comorbidities, but less life-style associated risk factors. Centenarians were less often treated surgically. The outcome after PHF was worse with increasing age, 59.2% of the centenarians died one year after the PHF.ConclusionThe majority of centenarians sustaining a proximal humeral fracture was female. The most common treatment was the non-operative therapy. Nevertheless, also the operative therapy is associated with a low complication rate. As expected, the mortality rate is high, with almost 60% of deceased patients after one year. It remains unclear, if the mortality was related to proximal humeral fractures.Level of evidenceLevel III, retrospective comparative study.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12877-025-06820-w.

Background: Heart failure is the leading cause of death in patients with congenital heart disease (CHD). We used longitudinal health insurance data and robust statistical methods to emulate randomized trials and examine the prognostic impact of Sodium-glucose cotransporter 2 inhibitors (SGLT-2I) and Angiotensin Receptor-Neprilysin Inhibitors (ARNI) in CHD patients. Methods: All CHD patients treated with SGLT-2/ARNIs in a nationwide health insurance dataset were included. The prognostic impact of SGLT-2/ARNIs was assessed using propensity score matching and multivariable time-dependent Cox analysis in comparison to an untreated control group and a cohort of patients commenced on mineralocorticoid antagonists (MRAs). Multivariable adjusting was performed for underlying disease complexity, co-morbidities, diabetes and heart failure medication. The primary outcome was all-cause mortality, the secondary outcome emergency hospital admission free survival. Results: In total 1,049 CHD patients were treated with SGLT-2I and/or ARNIs (59.2% male, CHD complexity: 71 % mild, 20% moderate, and 9% complex CHD). Of these, 838 patients received ARNIs and 639 SGLT-2 inhibitors (57% empagliflozin, 39% dapagliflozin). In comparison with a propensity score matched untreated control group (n=333), patients with SGLT-2 therapy had a significantly lower all-cause mortality (Hazard-ratio [HR] 0.5; 95% CI 0.28-0.91; p=0.02). Compared to patients commenced on MRAs, patients treated with SGLT-2I or ARNIs had a significantly lower mortality rate (HR 0.73; 95% CI 0.59-0.91; p=0.005) and a superior emergency admission free survival rate (HR 0.69; 95% CI 0.60-0.80; p<0.001) after multivariable adjustment for demographics, pre-existing conditions, CHD complexity, diabetes and concomitant medication. This effect was most pronounced for SGLT-2 inhibitors (HR for mortality 0.47, p<0.001; emergency admission free survival 0.63, p<0.001 vs. MRA) and consistent across complexity groups, being most evident in CHD patients of moderate complexity: HR for mortality 0.5, p=0.015; emergency admission free survival 0. 47, p<0.001 vs. MRA) Conclusion: SGLT-2 inhibitors/ARNIs are associated with significantly reduced all-cause mortality and risk of death or emergency admission in CHD regardless of disease complexity, co-morbidities, diabetes, and co-existing heart failure medication and should be considered for routine treatment of CHD heart failure patients.

The number of people in Germany over the age of 70 will increase significantly over the next 10years. This will be accompanied by an increase in geriatric diseases and disabilities. An important goal for many geriatric patients is to remain in their own homes for as long as possible, while making use of support services. To achieve this, patients with limitations in their daily activities and in need of geriatric care should be identified as early as possible. The RubiN project implemented assessment-based care and case management for geriatric patients in physician networks in Germany. To support future planning, the present analysis investigated whether the intensity of case management increases with increasing limitations in patients' activities of daily living. Using the Barthel Index, an assessment tool to record patients' ability to perform activities of daily living, patients' current limitations were assessed for ten activities (eating; sitting up and moving; washing; toileting; bathing/showering; getting up and walking; climbing stairs; dressing/undressing; bowel incontinence; urinary incontinence). For each item, the score (0 to max. 15 points) is determined and added to the Barthel Index score (max. 100 points). Counselling and coordination services provided by case managers were documented according to medical, nursing, therapeutic and social counselling content. Linear multivariate analysis was performed to determine whether the Barthel Index score was a determinant of the intensity of care and case management. Two thousand three hundred six patients in the RubiN intervention group (65% female; mean age 81.5years (SD 5.6)) were included in the analysis. 74% of these patients achieved a Barthel Index score between 100 and 85 points at baseline, and correspondingly, 26% of the patients had a Barthel Index score of 80 points or less. Problems with 'bathing/showering', 'getting up and walking', 'climbing stairs', 'dressing/undressing' and 'controlling urination' were the most common reasons for not achieving the maximum Barthel Index score of 100 points. A total of 26,833 patient contacts were documented by the care and case manager. On average, patients received 11.6 contacts (SD = 9.1). Social (31.8%) and medical (26.3%) counselling and coordination services were provided in the majority of contacts. "Therapeutic counselling content" and "nursing counselling content" were provided in 21.7% and 20.1% of contacts, respectively. Multivariate analysis showed a significant correlation between an decreasing Barthel Index and a higher number of contacts with the care and case manager. The Barthel Index score can be used to predict the intensity of care and assistance needed by geriatric patients. The scores provide a good basis for planning and implementing care and case management. German Clinical Trials Register, ID: DRKS00016642. Registered on 29.10.2019-retrospectively registered.

BackgroundTo date, data on the prevalence and age at first management of permanent childhood hearing loss in Germany are lacking.ObjectiveThis study aims to depict how often and at what age children and adolescents receive their (first) hearing technology.Materials and methodsIn this study, we analyzed claims data from a large German statutory health insurance company (BARMER). A cross-sectional study determined the provision of hearing devices and cochlear implants for children and adolescents aged under 18 years with permanent hearing loss from 2010 to 2020. A longitudinal analysis of a cohort of children born in 2010 was performed to gain insights about age at first management with hearing technology during the first 10 years of life.ResultsBetween 2010 and 2020, approximately 2800 to 3600 children and adolescents per year were provided with hearing devices and 10 to 30 with cochlear implants. In the 2010 birth cohort, 1.22% of children received their first prescription for hearing devices before the age of 10. The proportionately highest number of first prescriptions was found between 3 and 6 years. In 2020, particularly few children gained access to hearing technology.ConclusionThe analysis of the prescribed hearing systems reveals inaccuracies in documentation but also a possible care gap in hearing loss management. For a large percentage of children and adolescents, management of hearing loss took place after the age of 1. The frequent initial provision of hearing technology at preschool age indicates that the proportion of hearing loss that is acquired, detected late, or treated late remained quite high even after the introduction of newborn hearing screening. There is an obvious need for comprehensive tracking of children who fail newborn hearing screening and for other screening and hearing tests. The data for 2020 suggest that hearing loss was diagnosed and treated later due to the COVID-19 pandemic.

The COVID-19 pandemic had a severe influence on the entire health sector. Until today, the effect of a SARS-CoV-2 infection on older patients with a proximal humeral fracture (PHF) is unknown. This study examined the following questions: Did the incidence of PHF of older people in Germany vary during the pandemic? Did the treatment change between the lockdown and non-lockdown periods? Was a SARS-CoV-2 infection associated with a worse outcome? Retrospective claims data of the BARMER health insurance were analysed. All in- and outpatient cases of insurance holders ≥65 years from 01/2010 to 09/2022, with coded diagnosis of PHF were analysed. Primary endpoints were the 1-month incidence of PHF per 100,000 insurance holders, number of operative therapies, in-hospital death and in-hospital major adverse events (MAEs). 174,898 inpatient PHF cases were included. During the lockdown periods, the total incidence fell, while the outpatient incidence partially increased during the pandemic-period. Regarding the therapy allocation, there were no relevant persisting changes. In a detailed analysis of 23,979 PHF cases from 01/2020 to 09/2022, 4.1% patients suffered from a SARS-CoV-2 infection and showed a notably higher in-hospital mortality (8.1% vs 2.5%; risk adjusted OR 2.79, 95% CI 2.11-3.70, p < 0.001) and more MAEs (17.0% vs 7.8%; risk adjusted OR 1.43, 95% CI 1.15-1.77, p < 0.001). During the COVID-19 pandemic, the overall incidence of PHF in older patients was reduced. The treatment allocation did not change between the pre- and intra-pandemic period. An infection with SARS-CoV-2 was associated with higher mortality and more MAEs.

Background and aimsThe impact of mitral regurgitation (MR) in asymptomatic patients is not well defined. We aimed to determine the prevalence of MR-related complications and their association with 10-year survival in a large unselected asymptomatic MR cohort.MethodsHealth insurance claims data from Germany’s second largest health insurance fund, BARMER, which maintains longitudinal data on 8.7 million German residents, were retrospectively analyzed. All patients with an outpatient diagnosis of MR in a minimum of two quarters during a calendar year and first recorded diagnosis between 2008 and 2011 were included. Patients with any complication attributable to MR or mitral valve intervention at index were excluded. Outcomes were compared between study group and age- and sex-matched controls (i.e., without known cardiac disease). MR-related complications of interest were new congestive heart failure, new-onset atrial fibrillation, pulmonary hypertension, or cardiac decompensation.ResultsA total of 56,577 individuals (median age 68 years, 67% female) with asymptomatic MR were identified. At 10 years, MR-related complications were more frequent in the study group vs. control group (46.5% vs. 20.8%, OR 3.31, P < 0.0001). Furthermore, MR-related complications were more common in male vs. female patients with an asymptomatic MR (OR 2.65, P < 0.0001). The occurrence of at least one MR-related complication was associated with a reduced 10-year survival (OR 1.80, P < 0.0001).ConclusionsAlmost half of patients with asymptomatic MR experience complications during a 10 year follow-up which result in impaired survival. These results imply the necessity of long-term disease management program. Furthermore, decision-making process and timing for mitral valve intervention in asymptomatic patients should be reevaluated.Graphical

Opioids are highly effective drugs but need close monitoring to avoid harm to patients. The aim of this study was to analyze how guideline recommendations are met for (i) the avoidance of the concomitant use of anxiolytics, hypnotics, or sedatives; (ii) the prescribing of laxatives in long-term opioid treatment; (iii) the co-prescribing of drugs to control the emetic effect of opioids; (iv) pretreatment with non-opioids; and (v) screening for depression when initiating opioids. The results are based on a routine data analysis of a large German health insurance fund. Different study populations of noncancer patients (18+ years old) treated with opioids were analyzed: 10.4% of the opioid recipients in 2021 received at least one concomitant prescription with anxiolytics, hypnotics, or sedatives; 69.3% of those with long-term opioid treatment received at least one laxative prescription. Of those with first-time opioid prescriptions, 4.8% received an antiemetic drug; 47.3% of those with a newly initiated opioid therapy received a non-opioid prescription within three months before the start of the opioid therapy; and 22.0% of patients with incident opioid prescription had at least one documentation of a depression diagnosis within three months of the first prescription. There is an urgent need to improve opioid prescribing to avoid risky combinations and adverse effects.