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Analysing horizontal equity in enrolment in Disease Management Programmes for coronary heart disease in Germany 2008-2010

Bozorgmehr, Kayvan (författare)
San Sebastian, Miguel (författare)
Brenner, Hermann (författare)
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Razum, Oliver (författare)
Maier, Werner (författare)
Saum, Kai-Uwe (författare)
Holleczek, Bernd (författare)
Miksch, Antje (författare)
Szecsenyi, Joachim (författare)
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BioMed Central 2015
Ingår i: International Journal for Equity in Health. - 1475-9276. ; 14
  • swepub:Mat__t
Abstract Ämnesord
  • 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.


Medical and Health Sciences  (hsv)
Health Sciences  (hsv)
Public Health, Global Health, Social Medicine and Epidemiology  (hsv)
Medicin och hälsovetenskap  (hsv)
Hälsovetenskaper  (hsv)
Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi  (hsv)
Environmental Health and Occupational Health  (hsv)
Miljömedicin och yrkesmedicin  (hsv)


health services
horizontal inequity index
concentration index
regional deprivation
coronary heart disease

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