gms | German Medical Science

Introduction: Hypertension and diabetes mellitus are considered ambulatory care-sensitive conditions (ACSC), i.e. conditions for which hospitalisations are potentially avoidable by ambulatory care measures. Timely and appropriate access to and quality of ambulatory care should reduce the need for inpatient care for these diseases. Hospital admissions for diabetes is used as a marker of quality and access to primary care by the Diabetes-Surveillance at the Robert Koch Institute [1]. Hospital admissions for both diabetes and hypertension are included as indicators in OECD health statistics [2].

Methods: Based on the hospital statistics (diagnosis related groups; DRG) [3] of the year 2022 we included hospitalisations of persons aged 15 years or older with a main diagnosis of diabetes (E10.- to E14.-) or hypertension (I10.-, I11.9, I12.9, I13.9, exclusion criteria according to OECD definition), respectively. Hospitalisation rates were calculated per 100,000 residents and age-adjusted (5-year age groups) with the standard population of Europe at December 31, 2013 as reference. By linkage of the German Index of Socioeconomic Deprivation (GISD Release 2022 v0.2) to the DRG statistics on district level, results were stratified by regional socioeconomic deprivation.

Results: In 2022, the hospitalisation rates were nearly the same for hypertension (190 per 100,000 residents) and for diabetes mellitus (189 per 100,000 residents). For diabetes mellitus, the rates in men (256 per 100,000 residents) were higher than in women (129 per 100,000 residents) whereas the contrary was true for hypertension (137 in men, 230 in women). The hospitalisation rates for both hypertension and diabetes mellitus increased with higher age in both sexes and they were higher in districts with high socioeconomic deprivation than in districts with low socioeconomic deprivation in both men and women (for diabetes by a factor of approximately 1.5 in men and 0.5 in women, for hypertension by a factor of approximately 2 in men and in women).

Discussion: The sex differences in hospitalisation rates for diabetes and for hypertension are in line with the data published by the OECD for previous years. For hypertension the female predominance in hospitalisations is likely to be driven by the higher prevalence of hypertension in women in higher age groups including elderly and very old persons, while for the higher diabetes hospitalisations in men both the higher prevalence of diabetes and of diabetes complications among men may contribute. Further analyses are needed to assess to which extent the rates calculated for the regions with varying degrees of socioeconomic deprivation correspond to the regional differences in prevalence.

The authors declare that they have no competing interests.

The authors declare that an ethics committee vote is not required.