gms | German Medical Science

Objective: It has been reported that the incidence of malignant brain tumors is associated with the patients’ socioeconomic position, including education, occupation, and marital status, among others [1]. In this study we test the hypothesis that the incidence of brain tumors, for patients in our hospital, is associated with their health insurance status (private or public).

Methods: Our cohort consisted of patients treated for the first time at our hospital for a malignant neoplasm of brain (ICD-10: C71) in the years 2000 to 2016. The patients were grouped according to their health insurance status. The general population in Germany was also grouped according to the same criterion. The data on general population was obtained from the Federal Statistical Office (Destatis) and from the commercial data provider Statista. We assumed the fraction of the privately insured persons to be constant over the time and approximated the number of privately and publicly insured persons by their respective means over the available years (2007–2015). The relative incidences of brain neoplasms in the two groups were compared using Fisher’s exact test.

Results: Of the 1978 patients with the specified diagnosis, 524 (26%) were privately insured. In the general population, the fraction was much lower: Only some 9 million persons, out of the total population of 81 million (11%, varying between 10.6% and 11.5% over the years), were privately insured. The odds ratio (OR) for brain tumor was 2.88 (95% CI: 2.59–3.19, p<10^-15) for the privately insured patients.

Conclusion: At least for patients in our hospital, there is a very strong association between the insurance status and brain tumor incidence. Possible confounders are: 1. insurance status of the population within our catchment area is not representative for the German population; 2. outside the catchment area, privately insured patients are more likely be referred to our hospital; 3. age, which is a predictive factor for both the insurance status and brain tumor, was not taken into account. Nevertheless, our findings are in line with the above quoted study based on Swedish data. Due to regulations pertaining to health insurance in Germany, the insurance status is also associated with the socioeconomic position. The underlying cause for the higher tumor incidence in privately insured patients (and, likely, having a higher socioeconomic position) remains unclear and requires further investigation.