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Session: Migrant Health
Room: Chydenius Rooms
Time: Thu 10:15-11:30

Presenter: Markus Lüngen (University Hospital Cologne. Institute of Health Economics and Clinical Epidemiology)

Abstract

Background: There are currently over 6 million people with dementia in the European Union and it is predicted that this number will double in the next 20 years along with the ageing of the population. Costs of illness for dementia in Europe in 2005 reached 57.3 billion Euros of direct costs and 72.7 billion Euros of indirect costs. The enormous consequences for society and social insurance institutions demand for an exact acquisition of resources. Therefore, a precise analysis of prevalences is necessary.
However, former studies indicate that dementia in migrants might often be misdiagnosed. The reasons for misdiagnoses are various, e.g. ethnic differences about ideas of the pathogenesis, or difficulties in the use of common diagnostic methods, which are unexcep-tional language based.
For the case of Germany, estimates of prevalence of dementia are mostly rather imprecise and estimates of dementia in migrants are not at all available. Nevertheless, migrants from Turkey and Russia are now reaching age cohorts most vulnerable for dementia disease. In this study, we collected and analyzed prevalence data of dementia in German and non-German insurants of the German statutory health insurance scheme. We then examined potential over- or underestimations in the prevalence of non-German insurants. We addi-tionally analyzed differences in dementia medication in German and non-German insurants.
Method: We compared the prevalence of dementia between German insurants and non-German insurants for the statutory health insurance in 2007. We included data from 8,485,097 insurants (8.14% Non-German). Dementia was defined by ICD-10 coding of physi-cians in non-hospital settings, including Alzheimer's disease, vascular dementia, dementia in other diseases and unspecified dementia (ICD-10 F00.0 to F03). We further included pre-scription of relevant medication, identified by Anatomical Therapeutic Chemical Classifica-tion System (ATC) N06 (DA02-04; DX01-02, DX13, DX18). We controlled all results according to age, sex and region.
Results: We found considerable discrepancies in the prevalence of dementia of German in-surants compared to non-German insurants. The prevalence rate of dementia for insurants between 70 and 90 years of age reaches 7.1% in German and 4.1% in non-German male in-surants (9.5% and 6.1% for women). Additionally, non-German insurants seem to receive significantly less medication of relevant anti-dementia drugs than German insurants do.
Discussion: Our study shows significant differences in the prevalence and medication of de-mentia between German and non-German insurants. We did not control for potential pre-ventive factors as lifestyles and living conditions, but since these factors are controversial and would rather suggest worse outcome in migrants in Germany, the observed discre-pancy in the prevalence of dementia seems to be a consequence of underestimation. Non-identification of dementia may lead to medical malpractice and exceeding burden for family caregivers. More effort in diagnosis of dementia in people with scarce language skills, culture sensitive care and treatment, and enlargement of information is essential to reach migrants in the future.

Key Terms

dementia, migration, prevalence, health insurance data

Authors:

Anna Marie Passon (University Hospital Cologne. Institute of Health Economics and Clinical Epidemiology) , Guido Büscher (University Hospital Cologne. Institute of Health Economics and Clinical Epidemiology) and Markus Lüngen (University Hospital Cologne. Institute of Health Economics and Clinical Epidemiology)

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