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Analysing horizontal equity in enrolment in Disease Management Programmes for coronary heart disease in Germany 2008-2010
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.ORCID iD: 0000-0001-7234-3510
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2015 (English)In: International Journal for Equity in Health, ISSN 1475-9276, Vol. 14, 28Article in journal (Refereed) Published
Abstract [en]

Background: Disease Management Programmes (DMPs) have been introduced in Germany ten years ago with the aim to improve effectiveness and equity of care, but little is known about the degree to which enrolment in the programme meets the principles of equity in health care. We aimed to analyse horizontal equity in DMP enrolment among patients with coronary heart disease (CHD). Methods: Cross-sectional analysis of horizontal inequities in physician-reported enrolment in the DMP for CHD in a large population-based cohort-study in Germany (2008-2010). We calculated horizontal inequity indices (HII) and their 95% confidence intervals [95% CI] for predicted need-standardised DMP enrolment across two measures of socio-economic status (SES) (educational attainment, regional deprivation) stratified by sex. Need-standardised DMP enrolment was predicted in multi-level logistic regression models. Results: Among N = 1,280 individuals aged 55-84 years and diagnosed with CHD, DMP enrolment rates were 22.2% (women) and 35.0% (men). Education-related inequities in need-standardised DMP enrolment favoured groups with lower education, but HII estimates were not significant. Deprivation-related inequities among women significantly favoured groups with higher SES (HII = 0.086 [0.007; 0.165]. No such deprivation-related inequities were seen among men (HII = 0.014 [-0.048; 0.077]). Deprivation-related inequities across the whole population favoured groups with higher SES (HII estimates not significant). Conclusion: Need-standardised DMP enrolment was fairly equitable across educational levels. Deprivation-related inequities in DMP enrolment favoured women living in less deprived areas relative to those living in areas with higher deprivation. Further research is needed to gain a better understanding of the mechanisms that contribute to deprivation-related horizontal inequities in DMP enrolment among women.

Place, publisher, year, edition, pages
BioMed Central, 2015. Vol. 14, 28
Keyword [en]
equity, health services, horizontal inequity index, concentration index, regional deprivation, coronary heart disease
National Category
Public Health, Global Health, Social Medicine and Epidemiology Environmental Health and Occupational Health
URN: urn:nbn:se:umu:diva-101591DOI: 10.1186/s12939-015-0155-1ISI: 000350726300001OAI: diva2:804932
Available from: 2015-04-14 Created: 2015-04-07 Last updated: 2015-04-29Bibliographically approved

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San Sebastian, Miguel
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