Daniel Kreft , University of Rostock
Gabriele Doblhammer, German Center for Neurodegenerative Diseases (DZNE)
This study aims to investigate the role of economic and socio-structural characteristics of the living region on the incidence of severe disability, and whether there is an interplay with selected severe cardiovascular diseases. We analysed quarterly recorded health claims about in- and out-patient diagnoses and basic demographic data of 250,000 randomly sampled members of the largest German health insurance, the AOK, at age 50+. Combined with administrative indicators of economic performance and medical infrastructure, competing risk regression adjusting for mortality were performed to identify the risk factors of general and severe long-term care. The analyses revealed a disability advantage of persons in very wealthy compared to persons in very poor regions in the risk of general long-term care need (10% lower risk, p<0.001). In case of severe long-term care need, there was an advantage of persons in highly urbanised regions compared to persons in rural areas (14% lower risk, p<0.001). These gradients were stable after adjusting for cardiovascular diseases. Almost all selected cardiovascular diseases were significantly associated with a higher risk of long-term care. The incidence of general long-term care may be highly sensitive to direct financial or indirect opportunity costs – represented by the wealth indicator - of the caring partners and relatives (material and decisional approach). The structure of (acute) medical and care facilities of a region – indicated by population density - may be an indicator for the potential resources to avoid severe long-term care need or for the attraction of persons with specific health-related characteristics.
Presented in Session P2. Poster Session Ageing, Health and Mortality