Examining morbidity and mortality trajectory profiles of hypertension, diabetes and dementia across healthcare systems: an analysis of Catalan and German administrative medical data for the years 2010 to 2019.

Abstract

Background: Hypertension, diabetes and dementia are prevalent morbidities in ageing populations and share complex relationships as risk factors and comorbidities. Understanding their temporal order is essential to understand health inequalities. Routinely collected medical data offers potential for cross-population comparisons, yet their feasibility for examining morbidity and mortality trajectories across healthcare systems remains underexplored.

Methods: We analyzed administrative medical data from a cohort of more than 1.5 million Catalans and a cohort of 250,000 Germans aged 50 years and above. Data from both cohorts covered the years 2005 to 2019. Efforts were made to harmonize the data from the two healthcare systems. Prevalence was estimated for hypertension, diabetes and dementia. Further analyses focused on individuals born between 1930 and 1954 with at least one of the three morbidities between 2010 and 2019. Morbidity and mortality trajectory profiles were identified using sequence and cluster analysis for large datasets, resulting in 11 distinct profiles per population. Birth cohort and sex-specific profile characteristics were evaluated by multinomial logistic regression.

Results: Age-standardized prevalence of the three morbidities was lower for Catalans (hypertension: 22.4%, CI [22.2-22.5%], diabetes: 8.1% [8.0-8.2%], dementia: 2.9% [2.8-2.9%]) compared to Germans (hypertension: 69.4% [69.0-69.8%]; diabetes: 29.4% [29.2-29.7%], dementia: 8.2% [8.1-8.4%]) at age 55 years and above in 2010. Prevalence differences may largely reflect differences in diagnostic recording and data-generation practices. Among 174,798 Catalans and 121,547 Germans born between 1930 and 1954 with at least one of the three morbidities, Catalans were more likely to be initially free from any of the three morbidities, whereas Germans were more likely to begin with hypertension and experienced a higher proportion of morbidity combinations. Profiles within each population showed differences based on birth cohort and sex.

Conclusions: Profound differences in prevalence as well as in morbidity and mortality trajectories existed between Catalonia and Germany between 2010 and 2019, reflecting more favorable health outcomes in Catalonia. Although administrative medical data yield meaningful insights for each population, comparing results across populations demands careful attention to variations in healthcare systems. To fully realize the potential of a European health data space, efforts are required to further harmonize data.