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      Exploring the small-scale spatial distribution of hypertension and its association to area deprivation based on health insurance claims in Northeastern Germany

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          Abstract

          Background

          Hypertension is one of the most frequently diagnosed chronic conditions in Germany. Targeted prevention strategies and allocation of general practitioners where they are needed most are necessary to prevent severe complications arising from high blood pressure. However, data on chronic diseases in Germany are mostly available through survey data, which do not only underestimate the actual prevalence but are also only available on coarse spatial scales. The discussion of including area deprivation for planning of healthcare is still relatively young in Germany, although previous studies have shown that area deprivation is associated with adverse health outcomes, irrespective of individual characteristics. The aim of this study is therefore to analyze the spatial distribution of hypertension at very fine geographic scales and to assess location-specific associations between hypertension, socio-demographic population characteristics and area deprivation based on health insurance claims of the AOK Nordost.

          Methods

          To visualize the spatial distribution of hypertension prevalence at very fine geographic scales, we used the conditional autoregressive Besag–York–Mollié (BYM) model. Geographically weighted regression modelling (GWR) was applied to analyze the location-specific association of hypertension to area deprivation and further socio-demographic population characteristics.

          Results

          The sex- and age-adjusted prevalence of hypertension was 33.1% in 2012 and varied widely across northeastern Germany. The main risk factors for hypertension were proportions of insurants aged 45–64, 65 and older, area deprivation and proportion of persons commuting to work outside their residential municipality. The GWR model revealed important regional variations in the strength of the examined associations.

          Conclusion

          Area deprivation has only a significant and therefore direct influence in large parts of Mecklenburg-West Pomerania. However, the spatially varying strength of the association between demographic variables and hypertension indicates that there also exists an indirect effect of area deprivation on the prevalence of hypertension. It can therefore be expected that persons ageing in deprived areas will be at greater risk of hypertension, irrespective of their individual characteristics. The future planning and allocation of primary healthcare in northeastern Germany would therefore greatly benefit from considering the effect of area deprivation.

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          Most cited references 51

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          A spatial scan statistic

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            Cardiovascular, inflammatory, and metabolic consequences of sleep deprivation.

            That insufficient sleep is associated with poor attention and performance deficits is becoming widely recognized. Fewer people are aware that chronic sleep complaints in epidemiologic studies have also been associated with an increase in overall mortality and morbidity. This article summarizes findings of known effects of insufficient sleep on cardiovascular risk factors including blood pressure, glucose metabolism, hormonal regulation, and inflammation with particular emphasis on experimental sleep loss, using models of total and partial sleep deprivation, in healthy individuals who normally sleep in the range of 7 to 8 hours and have no sleep disorders. These studies show that insufficient sleep alters established cardiovascular risk factors in a direction that is known to increase the risk of cardiac morbidity.
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              Multicollinearity and correlation among local regression coefficients in geographically weighted regression

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                Author and article information

                Contributors
                boris.kauhl@nordost.aok.de
                werner.maier@helmholtz-muenchen.de
                schweikart@beuth-hochschule.de
                andrea.keste@nordost.aok.de
                marita.moskwyn@nordost.aok.de
                Journal
                BMC Public Health
                BMC Public Health
                BMC Public Health
                BioMed Central (London )
                1471-2458
                10 January 2018
                10 January 2018
                2018
                : 18
                Affiliations
                [1 ]AOK Nordost – Die Gesundheitskasse, Department of Medical Care, Berlin, Germany
                [2 ]ISNI 0000 0000 9738 8195, GRID grid.440921.a, Beuth University of Applied Sciences, Department III, Civil Engineering and Geoinformatics, ; Berlin, Germany
                [3 ]Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Neuherberg, Germany
                Article
                5017
                10.1186/s12889-017-5017-x
                5761146
                29321032
                © The Author(s). 2018

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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                Research Article
                Custom metadata
                © The Author(s) 2018

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