Current Zi study on nationwide incidence trends of diagnosed heart diseases in the years 2013-2021 published

24.04.2023 17:30

The risk of having to be treated by a contractual doctor due to newly occurring heart diseases is decreasing in Germany. In particular, there was a significant decrease in incidence between 2013 and 2021 for the common disease groups coronary heart disease (CHD) and heart failure. As the most common causes of death, alongside tumor diseases, these two groups of diseases are of outstanding importance for population health.

The declining incidence of CHD and heart failure corresponds to a decrease in mortality rates in the population between 2011 and 2020, which are 20 and 40 percent, respectively. The incidence of the very rare disease group acute rheumatic fever also fell sharply.

Strongest relative decline observed for acute rheumatic fever.

The incidence of diagnosed heart disease and the cardiovascular risk factor hypertension varied between 0.13 (acute rheumatic fever) and 30.6 (hypertension) per 1,000 people in 2021. Between 2013 and 2021, the age- and gender-standardized incidence per disease group mostly showed a gradual decline. The largest relative decline between 2013 (0.20 new cases per 1,000 people) and 2021 (0.13/1,000) was observed for acute rheumatic fever (−35 percent). This was followed by CHD (incidence in 2013: 12.71/1,000, 2021: 9.52/1,000) and heart failure (2013: 10.49/1,000, 2021: 8.09/1,000) with relative declines of −25 percent or −23 percent. Only for the disease group pericarditis was an increased incidence found in 2021 (0.44/1,000) compared to 2013 (0.41/1,000), with this change being particularly noticeable compared to 2020.

Patients with the newly diagnosed cardiovascular risk factor hypertension and newly diagnosed other cardiac diseases had a balanced gender ratio in 2021. A lower proportion of sick women has been observed for CHD (47 percent) as well as myocarditis and cardiomyopathy (40 percent). All other diseases, however, showed a higher proportion of newly diagnosed women than of newly diagnosed men. The highest proportion of women was achieved at 67 percent for acute rheumatic fever, followed by chronic rheumatic heart disease (60 percent). These are the central results of a current care atlas study by the Central Institute for Statutory Health Insurance (Zi) on “Nationwide incidence trends of diagnosed heart diseases in the years 2013 to 2021”.

Significant regional differences in new cases

“The billing data we evaluated also show that there are clear regional differences in the rates of new cases in the chronic disease groups coronary heart disease and heart failure, which are particularly important from a public health perspective, even after age structures are taken into account. There tends to be an east-west divide with an increased disease burden in the new federal states. This follows survey results on health behavior. Survey data show an increased prevalence of lifestyle-related risk factors for cardiovascular diseases in the eastern German regions - including physical inactivity, increased alcohol consumption and obesity. “Our study sharpens our focus on small-scale variations in disease-specific risk, which can serve as a starting point for future investigations into the disease genesis of potentially relevant environmental factors,” said Zi CEO Dr. Dominik von Stillfried.

Heart disease is the most common cause of death in Germany and worldwide. With a total of 121,462 deaths in 2020, CHD including myocardial infarction is the most important single disease in German cause of death statistics. A further 82,096 deaths in the same year were due to heart failure, heart valve disease and cardiac arrhythmias. However, a steady decline in age- and gender-standardized mortality rates for heart disease in Germany has been observed over the last two decades.

The data basis for the present evaluations is the nationwide pseudonymized, cross-health insurance billing data from statutory health insurance providers in accordance with Section 295 SGB V. New occurrences of ten cardiac disease groups and the risk factor hypertension were recorded each year in the period 2013 to 2021 in cohorts of statutory health insurance patients who were registered within a minimum period of time were observed over a period of four years. The new occurrence of a disease group was assumed if a “confirmed” diagnosis was coded by a contractual doctor for the first time after a diagnosis-free preliminary observation period of three years in a quarter of the reporting year.