Social disparities in disease management programmes for coronary heart disease in Germany: a cross-classified multilevel analysis

Bozorgmehr K, Maier W, Brenner H, Saum K-U, Stock C, Miksch A, Holleczek B, Szecsenyi J, Razum O (2015)
Journal of Epidemiology and Community Health 69(11): 1091-1101.

Journal Article | Published | English

No fulltext has been uploaded

Author
; ; ; ; ; ; ; ;
Abstract
Background Disease Management Programmes (DMPs) aim to improve effectiveness and equity of care but may suffer from selective enrolment. We analysed social disparities in DMP enrolment among elderly patients with coronary heart disease (CHD) in Germany, taking into account contextual effects at municipality and primary care practice levels. Methods Cross-sectional analysis of effects of educational attainment and regional deprivation on physician-reported DMP enrolment in a subsample of a large population-based cohort study in Germany, adjusting for individual-level, practice-level and area-level variables. We calculated OR and their 95% CIs (95% CI) in cross-classified, multilevel logistic regression models. Results Among N=1280 individuals with CHD (37.3% women), DMP enrolment rates were 22.2% (women) and 35% (men). The odds of DMP enrolment were significantly higher for male patients (OR=1.98 (1.50 to 2.62)), even after adjustment for potential confounding by individual-level, practice-level and area-level variables (range: OR=1.60 (1.08 to 2.36) to 2.16 (1.57 to 2.98)). Educational attainment was not significantly associated with DMP enrolment. Compared to patients living in least-deprived municipalities, the adjusted propensity of DMP enrolment was statistically significantly lower for patients living in medium-deprived municipalities (OR=0.41 (0.24 to 0.71)), and it also tended to be lower for patients living in the most-deprived municipalities (OR=0.70 (0.40 to 1.21)). Models controlling for the social situation (instead of health-related behaviour) yielded comparable effect estimates (medium-deprived/most-deprived vs least-deprived areas: OR=0.45 (0.26 to 0.78)/OR=0.68 (0.33 to 1.19)). Controlling for differences in comorbidity attenuated the deprivation effect estimates. Conclusions We found evidence for marked gender, but not educational disparities in DMP enrolment among patients with CHD. Small-area deprivation was associated with DMP enrolment, but the effects were partly explained by differences in comorbidity. Future studies on DMPs should consider contextual effects when analysing programme effectiveness or impacts on equity and efficiency.
Publishing Year
ISSN
eISSN
PUB-ID

Cite this

Bozorgmehr K, Maier W, Brenner H, et al. Social disparities in disease management programmes for coronary heart disease in Germany: a cross-classified multilevel analysis. Journal of Epidemiology and Community Health. 2015;69(11):1091-1101.
Bozorgmehr, K., Maier, W., Brenner, H., Saum, K. - U., Stock, C., Miksch, A., Holleczek, B., et al. (2015). Social disparities in disease management programmes for coronary heart disease in Germany: a cross-classified multilevel analysis. Journal of Epidemiology and Community Health, 69(11), 1091-1101.
Bozorgmehr, K., Maier, W., Brenner, H., Saum, K. - U., Stock, C., Miksch, A., Holleczek, B., Szecsenyi, J., and Razum, O. (2015). Social disparities in disease management programmes for coronary heart disease in Germany: a cross-classified multilevel analysis. Journal of Epidemiology and Community Health 69, 1091-1101.
Bozorgmehr, K., et al., 2015. Social disparities in disease management programmes for coronary heart disease in Germany: a cross-classified multilevel analysis. Journal of Epidemiology and Community Health, 69(11), p 1091-1101.
K. Bozorgmehr, et al., “Social disparities in disease management programmes for coronary heart disease in Germany: a cross-classified multilevel analysis”, Journal of Epidemiology and Community Health, vol. 69, 2015, pp. 1091-1101.
Bozorgmehr, K., Maier, W., Brenner, H., Saum, K.-U., Stock, C., Miksch, A., Holleczek, B., Szecsenyi, J., Razum, O.: Social disparities in disease management programmes for coronary heart disease in Germany: a cross-classified multilevel analysis. Journal of Epidemiology and Community Health. 69, 1091-1101 (2015).
Bozorgmehr, Kayvan, Maier, Werner, Brenner, Hermann, Saum, Kai-Uwe, Stock, Christian, Miksch, Antje, Holleczek, Bernd, Szecsenyi, Joachim, and Razum, Oliver. “Social disparities in disease management programmes for coronary heart disease in Germany: a cross-classified multilevel analysis”. Journal of Epidemiology and Community Health 69.11 (2015): 1091-1101.
This data publication is cited in the following publications:
This publication cites the following data publications:

Export

0 Marked Publications

Open Data PUB

Web of Science

View record in Web of Science®

Sources

PMID: 26082518
PubMed | Europe PMC

Search this title in

Google Scholar