Augustin J, Sorbe C, Augustin M, Zander N, Kis A
Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
J Eur Acad Dermatol Venereol. 2020 Aug;34(8):1736-1743. doi: 10.1111/jdv.16228. Epub 2020 May 8.
Due to the increasing incidence of skin cancer, programmes for the prevention of skin cancer have been developed and implemented in Germany. However, utilization of skin cancer screenings shows marked regional differences. Reasons and predictors of such variations are unclear.
The objective of the study is to identify predictors for regional use of skin cancer screening variations in Germany.
Analysis of the population set of ambulatory claims data (2009-2015) of the statutory health insurances (SHI) in Germany (70.2 million people in 2015). Skin cancer screening utilization rate was determined on county level. Descriptive, cluster and multivariate analyses were performed to identify spatial patterns in skin cancer screening utilization.
Overall, 6.5-7.9 million people participated in skin cancer screenings. Utilization rates of people ≥35 years of age were 9.74% (2009) and 10.96% (2015). Marked regional variations were identified between the counties. Dermatologists in Saxony and Westphalia-Lippe as well as general practitioners in Lower Saxony and North Rhine showed particularly high utilization rates. Multiple regression analyses demonstrated e.g. positive associations between the skin cancer screening utilization rates and employees with higher vocational qualifications and shorter travel time by car to the nearest major urban centre.
Utilization rates of skin cancer screening vary largely in Germany with specific spatial patterns. Multivariate analyses demonstrate associations with socio-economic and geographical determinants. The results indicate the importance of health policy measures. These should be used in a more targeted manner in the regions in order to increase utilization of skin cancer screening.
由于皮肤癌发病率不断上升，德国已制定并实施了皮肤癌预防计划。然而，皮肤癌筛查的利用率存在显著的地区差异。此类差异的原因和预测因素尚不清楚。
本研究的目的是确定德国皮肤癌筛查地区差异使用情况的预测因素。
对德国法定医疗保险（SHI）的门诊索赔数据总体（2009 - 2015年）进行分析（2015年有7020万人）。在县级层面确定皮肤癌筛查利用率。进行描述性、聚类和多变量分析，以确定皮肤癌筛查利用率的空间模式。
总体而言，650万至790万人参加了皮肤癌筛查。35岁及以上人群的利用率在2009年为9.74%，2015年为10.96%。各郡县之间存在显著的地区差异。萨克森州和威斯特法伦 - 利珀的皮肤科医生以及下萨克森州和北莱茵的全科医生的利用率特别高。多元回归分析表明，例如，皮肤癌筛查利用率与具有较高职业资格的员工以及驾车前往最近主要城市中心的较短出行时间之间存在正相关。
德国皮肤癌筛查的利用率在很大程度上存在差异，且具有特定的空间模式。多变量分析表明与社会经济和地理决定因素有关。结果表明卫生政策措施的重要性。这些措施应在各地区更有针对性地使用，以提高皮肤癌筛查的利用率。
