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More hospital stays due to heart failure in East Germany
Even thirty years after reunification, there are still significantly more hospitalizations for heart failure in eastern Germany than in western Germany. A new investigation tried to find out what the reasons might be.
In a current study, researchers at the Greifswald University Medical Center have broken down the differences in hospital stays due to heart failure between eastern and western Germany. The European Society of Cardiology (ESC) reported in a press release on the study results that a significantly higher proportion of people develop heart failure in the east.
Heart failure is more common in eastern Germany
According to the results of previous studies, the absolute number of hospital admissions in connection with heart failure in Germany rose by an impressive 65 percent between 2000 and 2013. Despite a nationwide comparable health system, there were many more hospital stays due to heart failure in the eastern part of Germany.
Health system differences before reunification
Before reunification, East and West Germany not only had very different social and economic systems, but also different health systems. In East Germany, the system was operated almost entirely by the state and there was a considerable lack of technical equipment. However, the same health system and similar clinical care channels have been established since 1990, the researchers from the Greifswald University Medical Center report.
What did a change to a common health system do?
The current study looked at whether switching to a shared health system affected the number and length of hospital stays and overall hospital mortality from heart failure. In addition, it was analyzed whether the increase in hospital admissions for heart failure described above continued and whether it occurred equally in both parts of Germany. The basis was data from the years 2000 to 2017.
There was a higher increase in eastern Germany
From 2000 to 2017, the absolute number of hospitalizations for heart failure throughout Germany rose continuously by 93.9 percent, the team reports. However, the increase observed was significantly stronger in eastern Germany (+118.5 percent in eastern Germany compared to +88.3 percent in western Germany).
Heart failure: the main cause of disease-related admissions
Heart failure was the main cause of illness-related hospitalizations in Germany in 2017, again with clear differences between East and West Germany (increase from 1.5 percent to 2.9 percent in East Germany versus 1.4 percent to 2.2 percent in West Germany ). The total length of hospital stays decreased continuously over time, but the total number of hospital days related to heart failure increased by 50.6 percent in East Germany and by 34.6 percent in West Germany.
More deaths from heart failure in eastern Germany
In 2017, heart failure remained by far the leading cause of death in Germany, accounting for 8.2 percent of hospital deaths. Here, too, the rates of inpatient deaths in eastern Germany (64 and 65 deaths per 100,000 population in 2000 and 2017) were significantly higher than in western Germany (39 and 43 deaths per 100,000 population in 2000 and 2017).
What impact did average age have?
The differences observed could not be explained by the different age structures in East and West. The average age of the population in eastern Germany was four years higher than in western Germany, but the differences in parameters related to heart failure were similar after age standardization.
Other diseases also occur more frequently in eastern Germany
A possible explanation for the findings could lie in the different rate of risk factors that influence the development and progression of heart failure, the researchers report. Other studies have already shown that high blood pressure, diabetes and obesity are much more common in eastern Germany than in western Germany.
Furthermore, according to the researchers, existing differences in the structure of patient care can at least partially provide an explanation.
Further investigation required
Further research is needed to better understand the differences between East and West Germany. In addition, it should be examined whether similar regional differences also occur in other European countries. Ultimately, the goal must be to develop and implement effective solutions that improve care for heart failure throughout Europe, according to Professor Marcus Dörr of the Greifswald University Medical Center. (as)
Author and source information
This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.
- East and West Germany exhibit health disparities 30 years after reunification, European Society of Cardiology (published 01.07.2020), ESC