National Inpatient Burden, Treatment Patterns, and In-Hospital Mortality of Spinal Tuberculosis in Germany Amid Demographic Change: A Population-Based DRG Study, 2019-2025.

Abstract

Study DesignPopulation-based ecological study.ObjectivesTo quantify the national inpatient burden, treatment patterns, and in-hospital mortality of spinal tuberculosis (STB) in Germany, and to test whether demographic change is associated with STB hospitalisation rates.MethodsThe German InEK DRG browser was analysed for inpatient STB episodes (ICD-10-GM A18.0 as principal diagnosis with a secondary diagnosis from category M49.0-; n = 671; case years 2019-2025), integrated with national TB hospitalisation data (2015-2024), population statistics by nationality, and migration data. Joinpoint regression, Poisson and negative binomial (NB) modelling with population offset, age-standardized rates (ESP2013), and Kitagawa decomposition were applied, with sensitivity analyses including lagged migration denominators and COVID-period exclusion.ResultsSTB hospitalisation rates remained stable (ASR 0.11-0.14/100,000; annual percent change -3.1%, P = .14), while total TB declined 29% (joinpoint 2022, P = .022). Patients were predominantly male (70.3%) and aged 18-39 years (56%-69%). In-hospital case fatality was below 0.5%. Surgical DRG assignment varied from 13.5% to 42.2%. The temporal trend was flat (IRR 0.97 per year, 95% CI 0.92-1.02). Despite a 43% increase in the foreign-national population (P < .001), no increase in STB episodes was detectable, whether the population was modelled alongside calendar year (IRR 1.03 per million, 95% CI 0.55-1.92) or without it (IRR 0.93, 95% CI 0.84-1.04). Kitagawa decomposition (2019→2024) attributed the rate component to -10.5 episodes versus +0.5 from population growth. All sensitivity analyses confirmed these null findings.ConclusionsThe national inpatient STB burden is low but stable and decoupled from overall TB hospitalisation trends. No increase in STB hospitalisations was detectable during the observed demographic change, although individual-level associations with migration could not be assessed. Very low in-hospital mortality contrasts with pyogenic spondylodiscitis. Marked variation in surgical DRG assignment warrants standardized care pathways at specialized centers.