- Benjamin Aretz
- Thema folgt.
- Alexander Barth
- Micro and macro level determinants of health in Europe.
- Anne Fink
- Preventation matters: The impact of modifyable risk factors on neurodegenerative diseases and long-term care need in the ageing population of Germany.
- Thomas Fritze
- Life-course aspects of poor cognitive functioning, dementia, and mortality with dementia.
- Daniela Georges
- Health and health inequalities in the context of migration.
- Daniel Kreft
- Regional disparities in health and health care in Germany.
- Michael Mühlichen
- Thema folgt.
- Michael Nerius
- Socio-demographic and therapeutic interventions in neurodegenerative diseases and long-term care need in the ageing population of Germ.
Throughout Europe, increasing life expectancy and population ageing shape the future demands on welfare systems and health care provision. Older persons more often suffer from one or more chronic diseases, tend to become less active and generally experience waning health. These consequences of ageing are associated with declining quality of life and a less independent lifestyle.
Within Europe, health outcomes and their impact on quality of life and functional limitations are not created equally. These processes occur within the framework of national welfare regimes. They influence the health status throughout the life course, from early life to working age and especially into retirement and old age. Since European welfare regimes differ markedly in many of their properties and the services they provide, they also differ in the outcomes they produce.
In this doctoral project, I aim to investigate several important aspects of the effects of different welfare regimes on individual health and wellbeing, e.g.
- Do different welfare regimes matter regarding the level of individual physical activity of older persons?
- Does the welfare regime affect the relationship between certain diseases and the risk of functional limitations in older age?
- To what degree do health inequalities exist among European countries and how strong are the effects of contextual welfare regime characteristics?
In the future, European welfare systems will need to cope with larger shares of the population in higher age. In this light, more knowledge on welfare regime influences on health and quality of life are important for policy decisions that can help to work towards a healthy future for the European population.
An Analysis of Data from the German Public Sickness Fund
Population ageing and the increasing life expectancy is one of the greatest success but also a big challenge for our society. Are the additional years of life lived in good health? What can we do to prevent illnesses and how to live long in good health? What are the risk factors of poor health or of a special disease like dementia? Many people achieve high ages where they face neurodegenerative diseases. Our society has to cope with changes in many areas. For a responsible planning in the field of Public Health and care need reliable information about the health status of a population, risk factors of poor health as well as the distribution of important disease like dementia in the population is required. There are the routine data of the public sickness funds which lend themselves to the analysis of health transitions and of risk factors of chronic diseases in Germany. Despite not covering many demographic variables they offer complete information on the use of medical treatment. It is therefore possible determining incidences and prevalences of diseases as well as identifying risk factors like other diseases or symptoms before the onset of a defined disease. Results of such studies are often used to decide about new public health and medical actions and have to be therefore very robust. This issue leads to the research question of my dissertation. Aim of the thesis is to validate the routine data of the public sickness funds regarding their possibilities to describe health and the prevalence and incidence of diseases in a defined population. The thesis is dedicated to the validation and the analysis of the routine data of the public sickness fund of AOK in Germany, the whole AOK population regarding dementia prevalences and a sample of 570,000 insured persons regarding dementia incidences and risk factors of dementia as well as transitions into care need, institutionalization and death after having received an incident dementia diagnosis. Before analyzing the data several steps of validation are necessary. Since the data of the public sickness funds have the purpose of recording the claims of physicians and hospitals rather than documenting the morbidity of the insured population the data has to be validated. Under the assumption that a chronic disease like dementia should more than once be diagnosed the data have to fulfill several validation criteria concerning reliability and occurrence.
Among the main challenges in health research in future years will be to gain greater knowledge of contextual effects on the health states of individuals, and to understand the trends in and causes of sub-national health and health care disparities. My doctoral thesis will attempt to tackle these challenges.
The main theses I will focus on in my doctoral project are the following:
- Do regional health (care) disparities exist, and do they change over time?
- If so, what individual and regional factors explain these disparities?
- Are these health disparities the result of societal, economic, or environmental inequalities; and what are the policy implications of addressing these disparities?
In the preceding analysis, which used data from the German 2005 Microcensus, we found strong regional disparities in health. Estimations based on logistic multilevel regression models allow us to conclude that regional economic performance and settlement structure have an effect on the individual’s health state. In the next steps of the dissertation project, the focus will be on the detailed analysis of the regional dispersion in the prevalence of the need for care across the regions of Germany by using the German care need statistics ("Pflegestatistik"). We also conduct an analysis of the linkage between recent findings in (cause-specific) mortality differentials and health (care) variations at the regional level. We expect our results to provide new insights into the mechanisms of regional health (care) variations that will be useful for community health research and policy maker.