Regionale Deprivation und Mortalität in Bayern. Entwicklung eines, Index Multipler Deprivation auf Gemeindeebene

Deprivationsindizes stellen wertvolle Instrumente zur Analyse regionaler Effekte auf die Gesundheit der Bevolkerung dar. Bei fehlenden soziookonomischen Individualdaten konnen diese Indizes auch als Surrogat verwendet werden. Im Vereinigten Konigreich sind derartige regionale Deprivationsindizes fester Bestandteil der Public Health – Diskussion, in Deutschland dagegen steht diese Entwicklung erst am Anfang. Unser Ziel war es, auf Grundlage einer etablierten britischen Methode einen kleinraumigen und mehrdimensionalen Index Multipler Deprivation (IMD) fur Deutschland zu entwickeln. Als Modellregion wahlten wir das Bundesland Bayern mit seinen n=2 056 Gemeinden. Unter Verwendung soziodemografischer, soziookonomischer und umweltrelevanter Daten der amtlichen Statistik entwickelten wir hierfur einen Bayerischen Index Multipler Deprivation (BIMD). Um die Eignung dieses Index fur epidemiologische Analysen zu prufen, fuhrten wir anschliesend sowohl eine Korrelationsanalyse (Korrelationskoeffizient nach Spearman) als auch eine Poisson-Regression unter Verwendung von Daten zur vorzeitigen Mortalitat (Altersgruppe Die Korrelationsanalyse zeigte einen positiven signifikanten Zusammenhang zwischen regionaler Deprivation und Mortalitat. Die Poisson-Regression ergab einen klaren Gradienten, d. h. das Mortalitatsrisiko stieg mit zunehmender regionaler Deprivation stufenweise an. Verglichen mit den Gemeinden im Quintil mit der niedrigsten Deprivation war das relative Risiko bei den Gemeinden mit der hochsten Deprivation deutlich groser, sowohl bei der vorzeitigen Mortalitat [RR 1,49 (95% KI: 1,42 − 1,57)] als auch der Gesamtmortalitat [RR 1,21 (95% KI: 1,18 − 1,25)]. Unter Verwendung des neu gebildeten Index konnte am Beispiel Bayerns gezeigt werden, dass hohere regionale Deprivation mit hoherer Mortalitat assoziiert ist. Dieser Index stellt somit ein neues und potentiell sehr nutzliches Werkzeug fur gesundheitswissenschaftliche Studien in Deutschland dar.

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