Schulz M, Czihal T, Erhart M, Stillfried D
Zentralinstitut für die kassenärztliche Versorgung, Berlin.
Gesundheitswesen. 2016 May;78(5):290-7. doi: 10.1055/s-0034-1396888. Epub 2015 Feb 9.
Besides the known determinants age, sex, and morbidity, regional sociodemographic factors may be important for the level of health care needs. This study proposes a possible characterisation of area-level sociodemographic patterns and proves their association to variation in morbidity, mortality and health service utilisation.
We used the 412 counties of Germany as unit of analysis. To describe area-level sociodemographic patterns a factor analysis was conducted on a set of 27 indicators from official statistics. Two factors were retained and rotated according to the Varimax criteria, which explained 34.2 and 33.0% of variance. Mortality, utilisation of inpatient health services as well as parameters of the nationwide outpatient claims data [relative risk score (RRS) and the level of health care use (LB)] served as determinants of need for medical care and were correlated to the extracted factors.
Factor 1 describes regional disparities in socio-economic and health status variables and is called socio-economic health index (SGX). Factor 2 characterises the spatial distribution of interregional migration and household size and is called urbanity index (UX). There was a strong positive correlation between SGX and RRS (r=0.77), mortality (r=0.68 and r=0.78 for overall and premature death rate) and inpatient health care use (r=0.62). UX was not correlated with RRS but weakly inversely correlated with inpatient health care use (r=-0.28). Both SGX and UX were significantly correlated to the level of outpatient health care use (r=0.39 and r=0.40). Stratification of LB by type of practitioner revealed that SGX was mainly associated with health care provided by general practitioners while UX was linked to health care provided by specialists, particularly psychotherapists.
The extracted factors to describe area-level sociodemographic patterns showed distinct correlations to indicators for medical care use. While SGX was mainly associated with overall morbidity, UX showed consistent relations with specific medical care needs, which may be linked to urban living conditions. Therefore, UX may refer to need for care independently from overall morbidity on the one hand and to structural specifics in health care services on the other hand. The meaning of SGX and UX needs to be further investigated taking additional determining factors into account.
除了已知的决定因素年龄、性别和发病率外，区域社会人口因素可能对医疗保健需求水平很重要。本研究提出了一种地区层面社会人口模式的可能特征描述，并证明了它们与发病率、死亡率和医疗服务利用差异之间的关联。
我们将德国的412个县作为分析单位。为了描述地区层面的社会人口模式，对官方统计的一组27项指标进行了因子分析。保留了两个因子，并根据方差最大化标准进行旋转，这两个因子解释了34.2%和33.0%的方差。死亡率、住院医疗服务利用率以及全国门诊索赔数据的参数[相对风险评分（RRS）和医疗保健使用水平（LB）]作为医疗保健需求的决定因素，并与提取的因子相关。
因子1描述了社会经济和健康状况变量的区域差异，称为社会经济健康指数（SGX）。因子2描述了区域间迁移和家庭规模的空间分布，称为城市化指数（UX）。SGX与RRS（r = 0.77）、死亡率（总体死亡率和过早死亡率的r分别为0.68和0.78）以及住院医疗保健使用（r = 0.62）之间存在很强的正相关。UX与RRS无相关性，但与住院医疗保健使用呈弱负相关（r = -0.28）。SGX和UX均与门诊医疗保健使用水平显著相关（r = 0.39和r = 0.40）。按从业者类型对LB进行分层显示，SGX主要与全科医生提供的医疗保健相关，而UX与专科医生，特别是心理治疗师提供的医疗保健相关。
提取的用于描述地区层面社会人口模式的因子与医疗保健使用指标显示出明显的相关性。虽然SGX主要与总体发病率相关，但UX与特定医疗保健需求存在一致的关系，这可能与城市生活条件有关。因此，UX一方面可能独立于总体发病率指代护理需求，另一方面可能与医疗保健服务的结构特点有关。需要进一步考虑其他决定因素来研究SGX和UX的意义。
