TY  - JOUR
AB  - BACKGROUND: Intersectionality has contributed to novel insights in epidemiology. However, participants of epidemiological studies have rarely been characterised from an intersectional perspective. We aimed to show the gained insights of an intersectionality-informed approach to describing a study population by comparing it to a conventional approach. METHODS: We used data of the German National Cohort (NAKO), which recruited 205,415 participants between 2014 and 2019. In the conventional approach, marginal proportions of educational level, cohabitation status, and country of birth were compared between the study populations of the NAKO and the German census survey (MZ) of 2014. In the intersectionality-informed approach, so-called intersectional population strata were constructed by cross-classifying educational level, cohabitation status, and country of birth. Proportions of these strata were also compared between NAKO and MZ. All analyses were stratified by sex and age group. RESULTS: The conventional approach showed that the proportion of people with low education was lower in the NAKO compared to the MZ in all sex and age strata. Similarly, proportions of all intersectional population strata with low education were lower in the NAKO. Concerning cohabitation, the conventional approach showed that the proportion of those living without a partner was lower in the NAKO than in the MZ for women under 60 and men. The intersectionality-informed approach revealed that the proportions of some subgroups of those living without a partner were higher in the NAKO than in the MZ. These were intersectional population strata who lived without a partner, had a high level of education and were born in Germany. The intersectionality-informed approach revealed similar within-group heterogeneity for country of birth, showing that not all proportions of foreign-born people were lower in the NAKO compared to the MZ. Proportions of foreign-born with high education who lived with a partner were higher. CONCLUSIONS: Our results showed that heterogeneity within social categories can be revealed by applying the concept of intersectionality when comparing study participants with an external population. This way, an intersectionality-informed approach contributes to describing social complexity among study participants more precisely. Furthermore, results can be used to reduce participation barriers in a more targeted way.
AU  - Jaehn, P.*
AU  - Rach, S.*
AU  - Bolte, G.*
AU  - Mikolajczyk, R.*
AU  - Merz, S.*
AU  - Herrera-Espejel, P.S.*
AU  - Brand, T.*
AU  - Führer, A.*
AU  - Berger, K.*
AU  - Teismann, H.*
AU  - Bohn, B.*
AU  - Koch-Gallenkamp, L.*
AU  - Brenner, H.*
AU  - Klett-Tammen, C.J.*
AU  - Castell, S.*
AU  - Ebert, N.*
AU  - Emmel, C.*
AU  - Schmidt, B.*
AU  - Gastell, S.*
AU  - Schulze, M.B.*
AU  - Obi, N.*
AU  - Harth, V.*
AU  - Holleczek, B.*
AU  - Jaskulski, S.*
AU  - Katzke, V.*
AU  - Kaaks, R.*
AU  - Willich, S.N.*
AU  - Keil, T.*
AU  - Weber, A.*
AU  - Leitzmann, M.*
AU  - Wirkner, K.*
AU  - Meinke-Franze, C.*
AU  - Schipf, S.*
AU  - Schikowski, T.*
AU  - Schneider, A.E.
AU  - Slesinski, S.C.
AU  - Moreno-Velásquez, I.*
AU  - Pischon, T.*
AU  - Holmberg, C.*
C1  - 74806
C2  - 57600
CY  - Campus, 4 Crinan St, London N1 9xw, England
TI  - What can we learn from an intersectionality-informed description of study participants? Results from the German National Cohort.
JO  - Int. J. Equity Health
VL  - 24
IS  - 1
PB  - Bmc
PY  - 2025
ER  - 

TY  - JOUR
AB  - BACKGROUND: The topic of this paper is related to equity in health within a country. In public health care sectors of many countries decisions on priority setting with respect to treatment of different types of diseases or patient groups are implicitly or explicitly made. Priorities are realized by allocation decisions for medical resources where moral judgments play an important role with respect to goals and measures that should be applied. The aim of this study is to explore the moral intuitions held in the German society related to priorities in medical treatment. METHODS: We use an experimental questionnaire method established in the Empirical Social Choice literature. Participants are asked to make decisions in a sequence of distributive problems where a limited amount of treatment time has to be allocated to hypothetically described patients. The decision problems serve as an intuition pump. Situations are systematically varied with respect to patients' initial health levels, their ability to benefit from treatment time, and the amount of treatment time available. Subjects are also asked to describe their deliberations. We focus on the acceptance of different allocation principles including equity concepts and utilitarian properties. We investigate rule characteristics like order preservation or monotonicity with respect to resources, severity, or effectiveness. We check the consistency of individual choices with stated reasoning. RESULTS: The goals and allocation principles revealed show that the moral intuitions held by our experimental subjects are much more complex than the principles commonly applied in health economic theory. Especially, cost-utility principles are rarely applied, whereas the goal of equality of health gain is observed more often. The principle not to leave any patient untreated is very dominant. We also observe the degrees to which extent certain monotonicity principles, known from welfare economics, are followed. Subjects were able to describe their moral judgments in written statements. We also find evidence that they followed their respective intuitions very consistently in their decisions. CONCLUSIONS: Findings of the kind presented in this paper may serve as an important input for the public and political discussion when decisions on priorities in the public health care sector are formed.
AU  - Ahlert, M.*
AU  - Schwettmann, L.
C1  - 51449
C2  - 42999
TI  - Allocating health care resources: A questionnaire experiment on the predictive success of rules.
JO  - Int. J. Equity Health
VL  - 16
IS  - 1
PY  - 2017
ER  - 

TY  - JOUR
AB  - 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.  
AU  - Bozorgmehr, K.*
AU  - San Sebastian, M.*
AU  - Brenner, H.*
AU  - Razum, O.*
AU  - Maier, W.
AU  - Saum, K.U.*
AU  - Holleczek, B.*
AU  - Miksch, A.*
AU  - Szecsenyi, J.*
C1  - 43862
C2  - 36614
TI  - Analysing horizontal equity in enrolment in Disease Management Programmes for coronary heart disease in Germany 2008–2010.
JO  - Int. J. Equity Health
VL  - 14
IS  - 1
PY  - 2015
ER  - 

TY  - JOUR
AB  - Introduction Quality of care could be influenced by individual socio-economic status (SES) and by residential area deprivation. The objective is to synthesize the current evidence regarding inequalities in health care for patients with Type 2 diabetes mellitus (Type 2 DM). Methods The systematic review focuses on inequalities concerning process (e.g. measurement of HbA1c, i.e. glycolised haemoglobin) and intermediate outcome indicators (e.g. HbA1c level) of Type 2 diabetes care. In total, of n = 886 publications screened, n = 21 met the inclusion criteria. Results A wide variety of definitions for ‘good quality diabetes care’, regional deprivation and individual SES was observed. Despite differences in research approaches, there is a trend towards worse health care for patients with low SES, concerning both process of care and intermediate outcome indicators. Patients living in deprived areas less often achieve glycaemic control targets, tend to have higher blood pressure (BP) and worse lipid profile control. Conclusion The available evidence clearly points to the fact that socio-economic inequalities in diabetes care do exist. Low individual SES and residential area deprivation are often associated with worse process indicators and worse intermediate outcomes, resulting in higher risks of microvascular and macrovascular complications. These inequalities exist across different health care systems. Recommendations for further research are provided.  
AU  - Grintsova, O.*
AU  - Maier, W.
AU  - Mielck, A.
C1  - 42799
C2  - 35340
TI  - Inequalities in health care among patients with type 2 diabetes by individual Socio-Economic Status (SES) and regional deprivation: A systematic literature review.
JO  - Int. J. Equity Health
VL  - 13
PY  - 2014
ER  - 

TY  - JOUR
AB  - BACKGROUND: Socioeconomic disparities in survival after acute myocardial infarction (AMI) have been found in many countries. However, population-based results from Germany are lacking so far. Thus, the objective of this study was to examine the association between educational status and long-term mortality in a population-based sample of people with AMI. METHODS: The sample consisted of 2,575 men and 844 women, aged 28-74 years, hospitalized with a first-time AMI between 1 January 2000 and 31 December 2008, recruited from a population-based AMI registry. Patients were followed up until December 2011. Data on education, risk factors and co-morbidities were collected by individual interviews; data on clinical characteristics and AMI treatment by chart review. Cox proportional hazards models were used to assess the relationship between educational status and long-term mortality. RESULTS: During follow-up, 19.1% of the patients with poor education died compared with 13.1% with higher education. After adjustment for covariates, no effect of education on mortality was found for the total sample and for patients aged below 65 years. In older people, however, low education level was significantly associated with increased mortality (hazard ratio (HR) 1.44, 95% confidence interval (CI) 1.05-1.98, p = 0.023). Stratified analyses showed that women older than 64 years with poor education were significantly more likely to die than women in the same age group with higher education (HR 1.57, 95% CI 1.02-2.41, p = 0.039). CONCLUSIONS: Elderly, poorly educated patients with AMI, and particularly women, have poorer long-term survival than their better educated peers. Further research is required to illuminate the reasons for this finding.
AU  - Kirchberger, I.
AU  - Meisinger, C.
AU  - Golüke, H.
AU  - Heier, M.
AU  - Kuch, B.*
AU  - Peters, A.
AU  - Quinones, P.A.
AU  - von Scheidt, W.*
AU  - Mielck, A.
C1  - 30790
C2  - 33870
TI  - Long-term survival among older patients with myocardial infarction differs by educational level: Results from the MONICA/KORA myocardial infarction registry.
JO  - Int. J. Equity Health
VL  - 13
IS  - 1
PY  - 2014
ER  - 

TY  - JOUR
AB  - BACKGROUND: Mortality exhibits seasonal variations, which to a certain extent can be considered as mid-to long-term influences of meteorological conditions. In addition to atmospheric effects, the seasonal pattern of mortality is shaped by non-atmospheric determinants such as environmental conditions or socioeconomic status. Understanding the influence of season and other factors is essential when seeking to implement effective public health measures. The pressures of climate change make an understanding of the interdependencies between season, climate and health especially important. METHODS: This study investigated daily death counts collected within the Sample Vital Registration System (VSRS) established by the Bangladesh Bureau of Statistics (BBS). The sample was stratified by location (urban vs. rural), gender and socioeconomic status. Furthermore, seasonality was analyzed for all-cause mortality, and several cause-specific mortalities. Daily deviation from average mortality was calculated and seasonal fluctuations were elaborated using non parametric spline smoothing. A seasonality index for each year of life was calculated in order to assess the age-dependency of seasonal effects. RESULTS: We found distinctive seasonal variations of mortality with generally higher levels during the cold season. To some extent, a rudimentary secondary summer maximum could be observed. The degree and shape of seasonality changed with the cause of death as well as with location, gender, and SES and was strongly age-dependent. Urban areas were seen to be facing an increased summer mortality peak, particularly in terms of cardiovascular mortality. Generally, children and the elderly faced stronger seasonal effects than youths and young adults. CONCLUSION: This study clearly demonstrated the complex and dynamic nature of seasonal impacts on mortality. The modifying effect of spatial and population characteristics were highlighted. While tropical regions have been, and still are, associated with a marked excess of mortality in summer, only a weakly pronounced secondary summer peak could be observed for Bangladesh, possibly due to the reduced incidence of diarrhoea-related fatalities. These findings suggest that Bangladesh is undergoing an epidemiological transition from summer to winter excess mortality, as a consequence of changes in socioeconomic conditions and health care provision.
AU  - Burkart, K.*
AU  - Khan, M.H.*
AU  - Krämer, A.*
AU  - Breitner-Busch, S.
AU  - Schneider, A.E.
AU  - Endlicher, W.R.*
C1  - 6762
C2  - 29225
TI  - Seasonal variations of all-cause and cause-specific mortality by age, gender, and socioeconomic condition in urban and rural areas of Bangladesh.
JO  - Int. J. Equity Health
VL  - 10
IS  - 1
PB  - BioMed Central
PY  - 2011
ER  -