Regional variation in trends of years lived with disability in Germany: an exploratory analysis

Background

Years lived with disability (YLD) quantify the morbidity-related gap between the ideal and actual population health in terms of years of healthy life lost and can serve as a key indicator for healthcare planning. Given regional differences in healthcare provision, we examined overall and regional trends in disease burden.

Methods

YLD were estimated using disease frequencies stratified by health conditions and weighted with disability weights. Frequencies were derived from claims data of Germany’s largest statutory health insurer (AOK) and extrapolated to 96 spatial planning regions (SPRs). Age-standardised YLD (preliminary) were calculated for 2017–2022 for dementia, ischaemic heart disease (IHD), Parkinson’s disease, chronic obstructive pulmonary disease (COPD), diabetes, asthma, and lung cancer. Average annual percentage changes (95% CIs) were estimated using linear mixed-effects models with log-transformed YLD, controlling for sex.

Results

YLD declined annually by 4.3% (95% CI: 4.1–4.5) for dementia, by 4.0% (95% CI: 3.8–4.2) for IHD, by 2.6% (95% CI: 2.4–2.8) for Parkinson’s disease, and by 1.3% (95% CI: 1.1–1.5) for COPD. In contrast, YLD increased by 0.5% per year (95% CI: 0.3–0.7) for diabetes, by 1.3% (95% CI: 1.0–1.5) for asthma, and by 2.0% (95% CI: 1.6–2.3) for lung cancer. Regional variation in trends (minimum to maximum across SPRs) was greatest for dementia (–5.8% to –2.3%), followed by Parkinson’s disease (–3.9% to –1.3%), IHD (–5.1% to –2.9%), and COPD (–2.4% to –0.6%). Asthma and lung cancer showed less regional variation, while diabetes exhibited mixed trends, with both increases and decreases.

Conclusions

YLD trends differed by disease and region, largely reflecting variations in disease frequencies from claims data. Non-uniform trends highlight the need for regionally disaggregated burden analyses. Further ecological analyses are required to identify explanatory factors.

Key messages

• YLD trends diverge: declines for dementia, IHD, Parkinson’s and COPD, but increases for diabetes, asthma, and lung cancer.

• YLD trends vary regionally, underscoring the need for disaggregated analyses.