gms | German Medical Science

Background: The German Federal Statistical Office defines migration background as not having German citizenship or having at least one parent who is not a German citizen. In Germany, the number of people with a migration background was 18,6 million people in 2016, with ten percent being older than 65 years [1]. Although they often display worse health outcomes than people native to Germany [2], utilization of health care services is low in this population. Different reasons can be taken into account for this circumstance, e.g. language barriers, cultural differences in the understanding of health and disease or missing culture specific information and health care services [3], [4]. The alliance for people with dementia advises the health care system to gear their services individually towards people with a migration background. However, as of now little is known about the number and the situation of people with a migration background and dementia in Germany and their distribution on state level resulting in a challenge that is barely assessable for the health care system.

Objective: A depiction of dementia prevalence in people of different ethnicities in Germany and their distribution on the federal states.

Methods: We estimated the number of people with a migration background affected by dementia using country- and state-specific data on population, dementia frequency and age specific prevalence of dementia. The number of people affected were calculated by estimating country specific dementia prevalence and applying these prevalences on the ethnicities living in Germany. We accumulated these numbers to get the total amount of people affected in Germany and gauged their distribution on the federal states. Additionally we present the ethnicities with the highest rates of people impaired and the continents they are from.

Results: Of the 1,86 million people with a migration background that are 65 years or older living in Germany in 2016, approximately 96.500 persons (5,18%) have dementia. The majority is of European (84.490) heritage, more specifically Polish (13.960), Italian (8.920) or Turkish (8.840) heritage. North Rhine-Westphalia (26.000), Baden-Wuerttemberg (18.080) and Bavaria (16.710) presumably show the highest rates of people affected, while Brandenburg, Sachsen-Anhalt (both 649), Thüringen (531) and Mecklenburg-Western Pomerania (472) display the lowest rates.

Discussion: In Germany, people with a migration background and dementia represent a large target group for health care. Our analysis show the number of people with a migration background afflicted by dementia for various ethnicities and their distribution on the German federal states based on country specific prevalence rates, demonstrating that numbers and ethnicities affected differ considerably between states. Although it is to be expected that the number of people affected is higher because of dementia being under diagnosed and our use of prevalence rates that are not always congruent. It is not known yet how the situation of people with a migration background and dementia from the second generation will play out. They are born in Germany and grew up there, which may lead to the assumption that their health care needs and use of health care services will differ from people of the first generation. Although difficult to prove we assume that availability of culture specific facilities and services is not adequate and has to be improved in the future.

Practical Implications: Our analysis can be used by the health care system to assess the challenge they are facing and as a basis for state-specific health care planning of culture specific and culture sensitive services and cure. Thus, specific health care improvements can be achieved, which is crucial since especially North Rhine-Westphalia, Baden-Wuerttemberg and Bavaria will be confronted with a growing number of people with a migration background and dementia.