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Indizes Multipler Deprivation zur Analyse regionaler Gesundheitsunterschiede in Deutschland

Erfahrungen aus Epidemiologie und Versorgungsforschung

Indices of Multiple Deprivation for the analysis of regional health disparities in Germany

Experiences from epidemiology and healthcare research

  • Leitthema
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Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz Aims and scope

A Correction to this article was published on 16 November 2017

This article has been updated

Zusammenfassung

Hintergrund

Deprivationsindizes ermöglichen es, regionale materielle und soziale Unterschiede statistisch effizient und prägnant abzubilden und in gesundheitswissenschaftlichen Analysen einzusetzen. Mit dem „German Index of Multiple Deprivation“ (GIMD) sowie dessen regionalen Versionen stehen auch in Deutschland mittlerweile Indizes Multipler Deprivation (IMD) nach britischem Vorbild zur Verfügung. In dieser Arbeit sollen Erfahrungen aus der Anwendung dieser Indizes in gesundheitswissenschaftlichen Analysen vorgestellt werden.

Methode

Es wurden 7 Deprivationsdomänen definiert, die jeweils eine bestimmte Dimension abbilden (Einkommens‑, Beschäftigungs- und Bildungsdeprivation, kommunale Einnahmensdeprivation, Sozialkapital‑, Umwelt- und Sicherheitsdeprivation). Unter Verwendung von Daten der amtlichen Statistik wurden Indikatoren gebildet, die den jeweiligen Domänen zugeordnet wurden. Nach Gewichtung der einzelnen Domänen wurden diese zu einem Gesamtindex kombiniert. Die IMD für Deutschland wurden sowohl auf Ebene der Gemeinden als auch der Kreise erstellt.

Ergebnisse

Analysen unter Anwendung der IMD zeigen deutliche Zusammenhänge zwischen regionaler Deprivation sowie Mortalität, Morbidität und Fragestellungen aus der Versorgungsforschung. In Mehrebenenanalysen konnten von Individualfaktoren unabhängige, signifikante Zusammenhänge mit regionaler Deprivation demonstriert werden.

Schlussfolgerung

Mit diesen IMD stehen auch in Deutschland valide und effiziente Instrumente sowohl für den Einsatz in Epidemiologie und Versorgungsforschung, aber auch für gesundheitspolitische Zwecke zur Verfügung. Bei der Bildung von Deprivationsindizes sind verschiedene methodische Herausforderungen zu beachten.

Abstract

Background

Deprivation indices allow material and social differences at the regional level to be described in a statistically efficient and concise manner and to use these in health analyses. Following the British example, Indices of Multiple Deprivation (IMDs) are now available for Germany, the German Index of Multiple Deprivation (GIMD) as well as its regional versions. In this study, empirical experiences based on the use of these indices in health studies will be presented.

Method

The German IMDs consist of seven deprivation domains, which represent single aspects of deprivation (income, employment, and educational deprivation, municipal revenue deprivation, social capital deprivation, environment and security deprivation). Specific indicators were generated from data of official statistics and assigned to the deprivation domains. The weighted single domains were finally combined to an overall index. The German IMDs are available at a municipal level and at a district level.

Results

Analyses using the IMDs showed significant associations between regional deprivation and mortality, morbidity and aspects of health services research. Multilevel analyses showed significant associations with regional deprivation, independent of individual factors.

Conclusions

The German IMDs are valid and efficient tools for the use in epidemiology and health services research, but also for health policy. When constructing deprivation indices, several methodological challenges have to be considered.

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Change history

  • 16 November 2017

    Correction:

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Die Originalpublikation wurde überarbeitet. In der ursprünglichen Originalpublikation dieses Artikels wurde Abbildung 1 leider in der falschen Version publiziert.

A correction to this article is available online at https://doi.org/10.1007/s00103-017-2664-0.

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Maier, W. Indizes Multipler Deprivation zur Analyse regionaler Gesundheitsunterschiede in Deutschland. Bundesgesundheitsbl 60, 1403–1412 (2017). https://doi.org/10.1007/s00103-017-2646-2

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