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Abstract
Background Demographic factors such as sex, socioeconomic position and migration status may be associated with poor health care outcomes. Measures implemented by health care providers aiming to reduce these disparities are not always successful. The present study provides empirical insights from Germany focusing on patients with systemic connective tissue disorders and illustrates the need for evaluated diversity-sensitive measures.
Methods The analysis is based on a 10% random sample of routine data on completed rehabilitative treatments among patients with systemic connective tissue disorders (ICD-10 M30-M36) in Germany during 2006–2016 (n=1.819). Of these, 2.6% had polyarteritis nodosa and related conditions (M30), 10.4% had other necrotizing vasculopathies (M31), 19.0% had systemic lupus erythematosus (M32), 6.0% had dermatopolymyositis (M33), 10.4% had systemic sclerosis (M34) and 51.0% had other systemic involvement of connective tissue (M35). The outcome of interest was the persistence of impairment after treatment. It was compared between sex, nationality and occupational/employment groups used as SES measures. Logistic regression was applied to adjust for other demographic confounders. Differences in disparities over time and diagnostic groups were examined by means of interaction analysis.
Results As compared to German nationals, non-Germans had a 81% higher chance of impairment despite treatment (adjusted odds ratio [aOR]=1.81; 95%-CI=1.17–2.78) (table 1). Also, patients who worked in a semi-skilled or unskilled position had a 40% higher chance of a poor outcome than those in skilled occupational positions (aOR=1.40; 95%-CI=1.02–1.92). Disparities did not significantly differ between the years in which services were utilized. There were also no difference between men and women, between different age or diagnostic groups.
Conclusions The study illustrates disparities in health care outcomes associated with different diversity characteristics, which likely result from different obstacles some disadvantaged population groups encounter in the health system. This heterogeneity must be taken into account through strategies of diversity-sensitive health care provision.
Results of the multivariable logistic regression model with persistence of mental and physical impairment after rehabilitation as the dependent variable. Adjusted odds ratios (aOR) and 95% confidence intervals [95%-CI] (10% random sample of patients with systemic connective tissue disorders who completed medical rehabilitation in the years 2006–2008, 2010–2014 and 2016 granted by the German Statutory Pension Insurance Scheme; n=1.819). Main effects model. No interaction effects included
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