Grobe Thomas G, Frerk Timm, Vogelgesang Felicitas, Reitzle Lukas, Jacobi Frank, Thom Julia
Abteilung Gesundheitsberichterstattung und Biometrie, aQua-Institut, Maschmühlenweg 8-10, 37073, Göttingen, Deutschland.
Abteilung für Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, Berlin, Deutschland.
Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2025 Jun 5. doi: 10.1007/s00103-025-04080-y.
Routine data from statutory health insurance (SHI) are to be used for the surveillance of non-communicable diseases (NCDs) at the Robert Koch Institute (RKI), including for the estimation of administrative incidences of mental disorders. The aim of the study is to identify a methodology that is as sensitive and practicable as possible.
Using data available from 2005 onwards from the BARMER health insurance fund, with which approximately 10% of the German population was insured, cumulative incidences were determined for the years 2006 to 2022 after gradual exclusion of persons with previous diagnoses in 1 to 17 previous years for depression, anxiety disorders, schizophrenia spectrum disorders, and mental disorders with uniform population-based standardization by gender, age, and region of residence.
With an extension of the prior observation period, a similar relative decline in the incidence estimates can be observed for all four diagnostic groups in different observation years. From a prior observation period of two years, the values of the incidence estimators differ with further extension of the prior observation period, but relative changes and thus trends are depicted almost identically. A large proportion of the persons identified as incident already had diagnoses of other mental disorders in previous years.
For the estimation of administrative incidence rates, the exclusion of persons with a previous diagnosis in two previous years appears to be sufficient to depict trends. Comparisons and interpretations of incidence estimates should only ever be made with similar prior observation and methodology. Further methodological aspects and results for the four diagnosis groups are discussed.
法定医疗保险（SHI）的常规数据将用于罗伯特·科赫研究所（RKI）对非传染性疾病（NCD）的监测，包括用于估计精神障碍的行政发病率。本研究的目的是确定一种尽可能敏感且切实可行的方法。
利用2005年起可获取的来自BARMER健康保险基金的数据（约10%的德国人口参保于此），在逐步排除前1至17年曾有过抑郁症、焦虑症、精神分裂症谱系障碍以及精神障碍诊断的人群后，按性别、年龄和居住地区进行统一的基于人群的标准化，确定了2006年至2022年的累积发病率。
随着既往观察期的延长，在不同观察年份中，所有四个诊断组的发病率估计值均呈现出类似的相对下降。从两年的既往观察期开始，发病率估计值会随着既往观察期的进一步延长而有所不同，但相对变化以及趋势几乎相同。很大一部分被确定为新发病例的人在之前的年份已有其他精神障碍的诊断。
对于行政发病率的估计，排除前两年有过诊断的人群似乎足以描述趋势。发病率估计值的比较和解读应仅在类似的既往观察和方法下进行。还讨论了四个诊断组的进一步方法学方面和结果。
