Institute for Applied Economic Research

Iron deficiency (ID) and ID anemia (IDA), the most common deficiency diseases, may occur as isolated diseases or secondary to a causative disorder such as menorrhagia, inflammatory bowel disease (IBD), and heart disease (HD). As real-world data are limited, our objective was to assess the prevalence of ID/IDA, associated comorbidity, drug treatments focusing on trivalent ferric maltol, and healthcare resource utilization (HRU) with associated costs in Germany. This retrospective, non-interventional cohort study analyzed anonymized German health claims data covering 2016–2021. Data on patients with ID/IDA and matched control individuals, subgroups of patients with ID/IDA and concurrent disease (menorrhagia, IBD, HD), as well as patients with ID/IDA treated with ferric maltol were descriptively analyzed to evaluate prevalences, comorbidities (Elixhauser Comorbidity Index [ECI]), drug prescriptions, HRU, and HRU-associated costs. In 2021, 129,462 individuals were diagnosed with ID/IDA. Concurrent menorrhagia, IBD, and HD were observed in 34,421, 8,422, and 44,699 individuals, respectively. ID/IDA prevalences were stable throughout the study at approximately 3.3% but were higher in older individuals (up to 10.1%) and women of reproductive age (5.6–7.35%). Comorbidity burden (ECI) was two-fold higher in patients with ID/IDA than in control individuals (4.5 ± 3.6 vs. 2.3 ± 2.5, 2021 [mean ± SD]) and increased with concurrent diseases (menorrhagia [3.4 ± 2.8], IBD [5.0 ± 3.9], HD [7.9 ± 3.5]). The most frequently prescribed medication was oral bivalent iron preparation (25.0–27.5%; parenteral iron: 5.8–6.5%; oral trivalent iron: 0.2–0.7%). Ferric maltol dispensations increased slightly from 2018 to 2021 compared to other trivalent iron preparations. In patients with ID/IDA, the percentages of hospitalizations and sick leaves were higher than in control individuals (41.2% vs. 22.0%; 21.4% vs. 3.1%), corresponding to higher total costs that further increased with concurrent disease. In the subgroup of patients treated with ferric maltol (n = 686), HRU was lower in some parameters, with slightly higher ID/IDA-related total costs. Within 180 days after treatment initiation, most patients continued ferric maltol and did not switch to another iron preparation. Despite the heterogeneity of the disease, monitoring prevalence of ID/IDA, comorbidities, drug treatments, and HRU may help identify populations at increased health risk to optimize treatment strategies.

ABSTRACT Background: COVID-19-exposure and related restrictions may have contributed to the development or exacerbation of post-traumatic stress disorders (PTSD), especially in youth. However, data in this population is lacking. Objective: This study aimed to provide a thorough insight into the epidemiology and psychiatric comorbidities of PTSD as well as in- and outpatient treatment utilisation by those affected during vs. before COVID-19 in a representative sample of children and adolescents statutorily insured in Germany. Methods: The study is based on anonymized claims data of statutory insured youth aged 0.0–17.9 years from the InGef research database, which is representative of the German population. Prevalence, incidence, comorbidities of PTSD (ICD-10: F43.1, F43.8, F43.9) and in- and outpatient treatment for those affected were compared pre-COVID (01/2018–03/2020; N = 710.629) vs. intra-COVID (04/2020–12/2021; N = 698.108) using descriptive statistics, χ 2 tests, Welch-tests and interrupted time series analyses stratified by sex, age (children: 0–13 years; adolescents: 14–17 years), and socio-economic status (SES). Results: PTSD prevalence decreased intra-COVID (girls: 0.8%, n = 2.595 vs. 0.6%, n = 1.965; OR = 0.77 [0.73, 0.82]; boys: 0.6%, n = 2.066 vs. 0.4%, n = 1.547; OR = 0.76 [0.71, 0.81]). Quarterly incidence in female children with high SES showed a significant increase in slope pre-COVID to intra-COVID (p = .018). Externalising comorbidities increased especially in female adolescents (OR = 1.34 [1.05, 1.72]). Psychotherapy utilisation decreased in male children with low SES (OR = 0.63 [0.41, 0.98]) and increased in adolescent girls with low SES (OR = 1.73 [1.09, 2.74]). Hospitalisations among female adolescents only decreased for those with low SES (OR = 0.67 [0.38, 1.19]). Conclusions: We observed similar decreases in clinical PTSD-diagnoses for girls and boys, possibly reflecting overstretched health services, particularly at an early stage of COVID-19. However, treatment utilisation shows sex and SES differences that cannot be fully explained by our data.

ABSTRACTWe analyse the policy feedback on the minimum wage introduction in Germany, which was the core promise of the Social Democrats in the 2013 elections. Overall, there is no positive policy effect on the electorate's preference for the Social Democrats. We find even the contrary: workers earning below the minimum wage tend to give a negative policy feedback in Eastern Germany. Our main estimation strategy exploits the variation of median wages across regions using the Kaitz index. The Difference‐in‐Differences estimations use data from a large household panel. We conclude that the Social Democrats were unsuccessful in regaining the confidence of the electorate through the introduction of the minimum wage.

Based on a large administrative database of German claims data, our study provides current estimates of the prevalence and incidence of primary open angle glaucoma (POAG) in Germany and describes selected outcomes for prevalent patients with POAG. To estimate the prevalence and incidence of POAG in Germany, to describe the patient population in terms of comorbidity burden, routine care, and overall healthcare resource utilization (HCRU) and associated costs, and to describe treatment patterns over time in patients undergoing relevant laser procedures. Based on anonymized German claims data, we carried out a retrospective, noninterventional study covering calendar years 2016-2021. For the adult German population (≥18y), we estimated a POAG 1-year prevalence of 1.70% and a 1-year incidence of 0.17% in 2018; both increased with age, peaking in 80- to 89-year-olds. Prevalence and incidence were lower in 2020 (1.65% and 0.16%, respectively), the first year of the SARS-CoV-2 pandemic. Most patients solely received topical treatment. Most surgically treated patients underwent laser trabeculoplasty, followed by laser iridotomy, trabeculectomy, and filtration operations with implant. In patients undergoing laser trabeculoplasty, the treatment regimen was nearly unchanged in the second year after, compared with 2 years before the procedure. Multimorbidity was commonly observed; 75.5% of patients had arterial hypertension and 50.0% had disorders of lipoprotein metabolism and other lipidemias, compared with 60.1% and 39.2%, respectively, in an age- and sex-matched control sample. Our study provides insights into epidemiology and routine care of POAG in Germany and HCRU in prevalent patients. There was little change in treatment regimens in patients who underwent laser trabeculoplasty, 2 years after the procedure. Most patients were multimorbid highlighting the need for comprehensive care.

SummaryOsteoporosis is the most common bone disorder. Our data gives an estimate of around 5.87 million cases of osteoporosis in the general German population in 2018. Only 30% of insured individuals who suffered an osteoporotic fracture and/or had a confirmed diagnosis of osteoporosis, received an appropriate prescription.PurposeOsteoporosis is the most common bone disorder. It particularly affects elderly people and increases the risk of atraumatic fractures. The aim of this study was to estimate the prevalence of osteoporosis in the general German population aged ≥ 50 years and to collect data on the frequency of prescription of osteoporosis-specific medication in order to assess the treatment gap.MethodsRetrospective analysis of anonymized data of individuals aged ≥ 50 years insured under statutory healthcare schemes from the database of the Institute for Applied Health Research Berlin (InGef) for 2018 (study population). Insured individuals with osteoporosis were identified based on osteoporosis diagnoses, osteoporosis-specific prescriptions, or osteoporotic fractures. Thus, we estimated the prevalence of osteoporosis in the general German population aged ≥ 50 years. The prevalence of diagnoses, fractures, and prescriptions was determined for the study population and stratified by age and gender.ResultsWithin the study population of 1,599,299 insured individuals, a prevalence of osteoporosis of 15.9% was determined. This estimated approximately 5.87 million cases of osteoporosis for the general German population. 81.6% of the cases were women. Osteoporosis-specific prescriptions were received by 30.0% of the insured individuals in the study population who had been diagnosed with osteoporosis and/or suffered an osteoporotic fracture.ConclusionsGermany has a high prevalence of osteoporosis. Only a small portion of individuals who may require osteoporosis-specific treatment actually receive it.