Assoziation von Krankenversicherung und soziodemografischen Faktoren mit der Versorgung maligner Melanome
Standard
Assoziation von Krankenversicherung und soziodemografischen Faktoren mit der Versorgung maligner Melanome. / Schäfer, Ines; Reusch, Michael; Siebert, Julia; Hilbring, Caroline; Augustin, Matthias.
In: GESUNDHEITSWESEN, Vol. 79, No. 1, 01.2017, p. 21-27.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
Harvard
APA
Vancouver
Bibtex
}
RIS
TY - JOUR
T1 - Assoziation von Krankenversicherung und soziodemografischen Faktoren mit der Versorgung maligner Melanome
AU - Schäfer, Ines
AU - Reusch, Michael
AU - Siebert, Julia
AU - Hilbring, Caroline
AU - Augustin, Matthias
N1 - © Georg Thieme Verlag KG Stuttgart · New York.
PY - 2017/1
Y1 - 2017/1
N2 - Objective: To analyze the relationship between socio-demographic and regional factors, health insurance status and clinical features of malignant melanoma (MM). Methods: Primary data from a nationwide dermato-histopathologic laboratory on all consecutive excisions with proven diagnosis of MM over the 5-year period 2009-2013 were analyzed regarding tumor-specific and socioeconomic characteristics. The tumor depth (Breslow index) being a predictor of invasive MM progression and mortality was defined as a major indicator for early detection and intervention, thus reflecting quality of health care. Results: N=4 840 histologically verified MM samples from 4 583 patients were analyzed; of these, 2 537 (52.4%) were invasive MM. The tumor depth, which was 1.09 mm on average, increased with age from 1.00 mm in the lowest to 1.56 mm in the highest age group, p<0.001). Controlled for age and sex, the members of agricultural health insurances (LKK) and of German local public health insurances (AOK) showed significantly increased tumor depths (1.67 resp. 1.20 mm). The lowest average levels were found in members of the substitute health funds (e. g. Barmer GEK 0.93 mm) and in privately insured persons (0.99 mm). Based on a regional 4-step classification, there was a gradient in MM depth from more populated to more rural areas, ranging from 1.05 mm in nucleated cities to 1.22 in small rural communities. Distribution of MM locations varied significantly by health insurance: The highest proportion of MM in the head/neck area was seen in members of the agricultural (52.3%) and of the local public health insurances (30.2%) vs. 18.5% in patients from the substitute health funds. In contrast, MM located on the trunk and lower extremities was more prevalent in private, substitute and company health insurance funds. Conclusion: Age, gender and health insurance status are relevant determinants of MM health care and progression risk in Germany. Prevention and early detection programs by health insurances should take this into account.
AB - Objective: To analyze the relationship between socio-demographic and regional factors, health insurance status and clinical features of malignant melanoma (MM). Methods: Primary data from a nationwide dermato-histopathologic laboratory on all consecutive excisions with proven diagnosis of MM over the 5-year period 2009-2013 were analyzed regarding tumor-specific and socioeconomic characteristics. The tumor depth (Breslow index) being a predictor of invasive MM progression and mortality was defined as a major indicator for early detection and intervention, thus reflecting quality of health care. Results: N=4 840 histologically verified MM samples from 4 583 patients were analyzed; of these, 2 537 (52.4%) were invasive MM. The tumor depth, which was 1.09 mm on average, increased with age from 1.00 mm in the lowest to 1.56 mm in the highest age group, p<0.001). Controlled for age and sex, the members of agricultural health insurances (LKK) and of German local public health insurances (AOK) showed significantly increased tumor depths (1.67 resp. 1.20 mm). The lowest average levels were found in members of the substitute health funds (e. g. Barmer GEK 0.93 mm) and in privately insured persons (0.99 mm). Based on a regional 4-step classification, there was a gradient in MM depth from more populated to more rural areas, ranging from 1.05 mm in nucleated cities to 1.22 in small rural communities. Distribution of MM locations varied significantly by health insurance: The highest proportion of MM in the head/neck area was seen in members of the agricultural (52.3%) and of the local public health insurances (30.2%) vs. 18.5% in patients from the substitute health funds. In contrast, MM located on the trunk and lower extremities was more prevalent in private, substitute and company health insurance funds. Conclusion: Age, gender and health insurance status are relevant determinants of MM health care and progression risk in Germany. Prevention and early detection programs by health insurances should take this into account.
KW - Female
KW - Germany
KW - Humans
KW - Insurance, Health
KW - Male
KW - Melanoma
KW - Middle Aged
KW - Neoplasm Invasiveness
KW - Prevalence
KW - Quality of Health Care
KW - Risk Factors
KW - Skin Neoplasms
KW - Socioeconomic Factors
KW - Survival Rate
KW - Journal Article
U2 - 10.1055/s-0035-1564164
DO - 10.1055/s-0035-1564164
M3 - SCORING: Zeitschriftenaufsatz
C2 - 26619219
VL - 79
SP - 21
EP - 27
JO - GESUNDHEITSWESEN
JF - GESUNDHEITSWESEN
SN - 0941-3790
IS - 1
ER -
