[Racism and discrimination in the context of health inequalities-a narrative review]

[Small-area and socially differentiated analyses of the utilization of screening examinations in the city of Hamburg: a secondary data analysis]

INTRODUCTION

Social reporting in Hamburg identifies existing inequalities at the urban area level. These social-contextual variations may potentially influence preventive health behaviors. The aim of this article is to examine correlations between the degree of social regional disadvantage of Hamburg's population and the utilization of regular screening examinations for children, adolescents, and adults through small-area analysis.

METHODS

The analyses are based on claims data from 2017 of insured individuals living in Hamburg from three cooperating statutory health insurance funds. A socially contextual indicator (1 = "very low" to 7 = "high") was assigned to the data at urban area level. Based on this, binary correlations between the social indicator and calculated utilization rates (stratified by gender and age) of early detection examinations were examined using Kendall's tau correlation analysis.

RESULTS

The study population included N = 433,053 individuals (53.7 % female) from the city of Hamburg. Strong positive associations were found between utilization rates and social contextual index classes for U7 to U9 examinations (r > 0.7; p-values < 0.05) as well as cervical cancer screening (r > 0.9; p-values = 0.002), indicating that utilization increases with the rising social status of the urban area level. Additionally, strong positive correlations can be observed in some subgroups for prostate cancer screening (> 59 years: r = 0.905, p-value = 0.004) and colorectal cancer screening (women aged 50-60 years: r = 0.905, p-value = 0.004). No significant correlations were found for other subgroups, as well as for skin cancer screening, breast cancer screening and the J1 examination (p-value > 0.05). Strong negative associations have only been detected for the general health check-up for individuals aged 35 to 59 (women: r = -0.810, p-value = 0.011; men: r = -0.714, p-value = 0.024).

DISCUSSION AND CONCLUSION

The results indicate inequalities in the use of early detection examinations provided by statutory health insurers for children and adults to the disadvantage of urban areas ranking lower in social status. This socially selective utilization may lead to an accumulation of health problems in urban areas that are already disadvantaged socially, which would result in an exacerbation of existing social and health inequalities. Small-scale and socially differentiated analyses of healthcare provision should be seen as a regular component of regional healthcare provision. They provide starting points for a more needs-oriented further development of the healthcare system and secondary prevention services.

[Strategies and Measures to Strengthen the Health Literacy of Migrants: An Online Survey of Primary Care Providers in Hessen]

BACKGROUND

Adequate health literacy is crucial for active participation in health-related decisions. Migrants are one of the population groups that can have more difficulties in finding and using relevant information to make their own decisions. Primary care providers in Germany are the main point of contact for health and disease-related questions and can therefore make an important contribution to strengthening the health literacy of this population group. It remains unclear which specific approaches they use for that purpose.

OBJECTIVES

This study aimed to examine which strategies and measures primary care providers in Hessen, Germany, use to strengthen the health literacy of migrants and which additional measures of support they consider important for that purpose.

MATERIALS AND METHODS

2,784 primary care providers in Hessen were invited by email between August 1, 2023 and October 24, 2023 to take part in a quantitative online survey. The data were analyzed descriptively.

RESULTS

The majority of respondents used multilingual information material, referred to reliable sources of information and contact persons and predominantly used native-speaking staff or digital translation tools to improve the health literacy of migrants. Resources to improve communication and information and an increase in staff were considered by healthcare providers to be helpful in promoting the health literacy of those affected. At the same time, it was emphasized that efforts should also be made on the part of migrant patients to acquire health literacy.

CONCLUSION

Although primary care providers already use strategies to support migrants in communication and decision-making, there is still room for improvement by taking steps to improve access and navigation within the doctor's office, by increasing collaboration with other stakeholders, and by integrating health literacy into the organizational structures of the office.

[Migration background and loneliness among middle-aged and older adults in Germany]

BACKGROUND

Currently, there is limited knowledge about the association between a migration background and loneliness among middle-aged and older individuals in Germany. The aim was therefore to examine the association between migration background and loneliness in this group.

METHODS

Data were taken from the German Ageing Survey (Wave 7, November 2020 to March 2021), a representative sample of middle-aged and older individuals. The sample comprised 4145 individuals, and the mean age was 63.8 years. Of the respondents, 93.2% had no migration background, approximately 5.9% had a migration background with personal migration experience, and 0.9% had a migration background but no personal migration experience. The De Jong Gierveld tool was used to quantify loneliness.

RESULTS

Multiple linear regressions showed that individuals with a migration background and their own migration experience have significantly higher levels of loneliness (β = 0.15, 95% confidence interval (CI): 0.004 to 0.30, p < 0.05) compared to individuals without a migration background, whereas individuals with a migration background without their own migration experience have significantly lower levels of loneliness (β = -0.27, 95% CI: -0.52 to -0.02 p < 0.05).

CONCLUSIONS

Individuals with a migration background and their own migration experience appear to represent a risk group for high loneliness among middle-aged and older adults in Germany. In this respect, this group should be given special consideration in corresponding measures. Against the background of current (and potential future) migration movements, the results are of great importance as these groups in particular could be affected by loneliness.

Determinants of Mental Health Inequalities Among People With Selected Citizenships in Germany

Objectives

Mental health is essential for overall health and is influenced by different social determinants. The aim of this paper was to examine which determinants are associated with mental health inequalities among people with selected citizenships in Germany.

Methods

Data were derived from the multilingual interview survey "German Health Update: Fokus (GEDA Fokus)" among adults with Croatian, Italian, Polish, Syrian, or Turkish citizenship (11/2021-05/2022). Poisson regressions were used to calculate prevalence ratios for symptoms of depression (PHQ-9) and anxiety disorder (GAD-7).

Results

Sociodemographic (sex, income, age, household size) and psychosocial (social support and self-reported discrimination) determinants were associated with symptoms of depression and/or anxiety disorder. The prevalence of mental disorders varied most by self-reported discrimination.

Conclusion

Our findings suggest mental health inequalities among people with selected citizenships living in Germany. To reduce these, social inequities and everyday discrimination need to be addressed in structural prevention measures as well as in interventions on the communal level. Protective factors (e.g., social support) are also important to reduce mental health inequalities on the individual and community level.

Prevalence and factors associated with probable depression among the oldest old during the Covid-19 pandemic: evidence from the large, nationally representative 'Old Age in Germany (D80+)' study

BACKGROUND

To date, most studies examining the prevalence and determinants of depression among individuals aged 80 and over have used geographically limited samples that are not generalisable to the wider population. Thus, our aim was to identify the prevalence and the factors associated with probable depression among the oldest old in Germany based on nationally representative data.

METHODS

Data were taken from the nationally representative 'Old Age in Germany (D80+)' study (n = 8386; November 2020 to April 2021) covering both community-dwelling and institutionalised individuals aged 80 and over. The Short Form of the Depression in Old Age Scale was used to quantify probable depression.

RESULTS

Probable depression was found in 40.7% (95% CI: 39.5% to 42.0%) of the sample; 31.3% were men (95% CI: 29.7% to 32.9%) and 46.6% women (95% CI: 44.9% to 48.3%). The odds of probable depression were positively associated with being female (odds ratio (OR): 1.55, 95% CI: 1.30 to 1.84), being divorced (compared to being married, OR: 1.33, 95% CI: 1.01 to 1.76), being widowed (OR: 1.14, 95% CI: 1.00 to 1.30), having a low education (e.g., medium education compared to low education, OR: 0.86, 95% CI: 0.74 to 0.99), living in an institutionalised setting (OR: 2.36, 95% CI: 1.84 to 3.02), living in East Germany (OR: 1.21, 95% CI, 1.05 to 1.39), not having German citizenship (German citizenship compared to other citizenship, OR: 0.55, 95% CI: 0.31 to 0.95), poor self-rated health (OR: 0.31, 95% CI: 0.28 to 0.34), and the number of chronic conditions (OR: 1.12, 95% CI: 1.09 to 1.14).

CONCLUSION

About four out of 10 individuals aged 80 and over in Germany had probable depression, underlining the importance of this challenge. Knowledge of specific risk factors for this age group may assist in addressing older adults at risk of probable depression.

Type 2 diabetes among people with selected citizenships in Germany: risk, healthcare, complications

Background

Migration-related factors, such as language barriers, can be relevant to the risk, healthcare and complications of type 2 diabetes in people with a history of migration. Diabetes-related data from people with selected citizenships were analysed on the basis of the nationwide survey German Health Update: Fokus (GEDA Fokus).

Methods

The diabetes risk of persons without diabetes (n = 4,698, 18 - 79 years), key figures on healthcare and secondary diseases of persons with type 2 diabetes (n = 326, 45 - 79 years) and on concomitant diseases (n = 326 with type 2 diabetes compared to n = 2,018 without diabetes, 45 - 79 years) were stratified according to sociodemographic and migration-related characteristics.

Results

Better German language proficiency is associated with a lower risk of diabetes. Diabetes-related organ complications are observed more frequently in persons who report experiences of discrimination in the health or care sector. Both persons with and without diabetes are more likely to have depressive symptoms when they reported experiences of discrimination. A stronger sense of belonging to the society in Germany is associated with reporting depressive symptoms less often in people without diabetes, but not in people with type 2 diabetes.

Conclusions

The differences according to migration-related characteristics indicate a need for improvement in the prevention and care of type 2 diabetes. Migration-sensitive indicators should be integrated into the surveillance of diabetes.

Utilisation of dental services by refugees in Germany: Results of the population-based RESPOND survey

Background

The utilisation of outpatient dental services is an important indicator for monitoring healthcare provision in Germany. In the general population, the 12-month prevalence of dental service utilization is 82.2 %. For refugees, this indicator has hardly been measured, although studies suggest an objectively high need for dental care.

Methodology

As part of the population-based cross-sectional RESPOND study (2018), self-reported health and healthcare, including the use of dental services, was assessed in three representative, random samples of refugees residing in reception and shared accommodation centres in Baden-Württemberg and Berlin.

Results

The indicator was available for 68.8 % (594) of the 863 surveyed refugees. Overall, 38.2 % of the respondents stated that they had utilised dental services in the previous 12 months, whereas 41.4 % had never used any dental care in Germany.

Conclusions

The utilisation of dental services among refugees is very low compared to the level of utilisation in the general population. It reflects a discrepancy between access and needs.