Consider Smaller Spatial Units
In addressing stroke incidence and care, the authors (1) use routinely available billing and quality assurance data from 36 districts and urban districts in Rhineland-Palatinate in an exemplary way to describe in detail and then to underscore the fact that health care also includes a social dimension.
The results show a clear connection between stroke incidence/stroke outcome and regional (and social) deprivation. The latter is described by the underlying German Index of Multiple Deprivation 2010 (GIMD 2010) (2). The GIMD comprises the factors of income, unemployment, education, district income, social capital, capital, environment, and security.
However, it can be argued that social deprivation should not only be considered at the district and city levels, as it is also a reality in much smaller regional and socio-economic units. Indeed, the findings of Grau et al. ring true in areas of every district/city. It would therefore be desirable in the next round of data analysis to go into an even more fragmented and therefore more detailed analyses (e.g., broken down into postcode districts), so that health policies in the municipalities and districts can be made in a more targeted manner.
In light of these results, it is all the more astonishing tha (for instance) private companies are trying to drive out the existing stroke units, which have excellent data in quality assurance and are already well-anchored in (problem) areas of regional care, by referring to rescue law issues yet setting aside medical considerations, and with the overall aim of establishing a supply monopoly. This certainly does not serve the well-being of the patient.
Prof. Dr. med. Hans-Jürgen von Giesen
Dr. med. Jens-Holger Moll
Klinik für Neurologie
Akademisches Lehrkrankenhaus der
Heinrich-Heine-Universität Düsseldorf, Germany
|1.||Grau AJ, Dienlin S, Bartig D, Maier W, Buggle F, Becher H: Regional deprivation, stroke incidence, and stroke care—an analysis of billing and quality assurance data from the German state of Rhineland–Palatinate. Dtsch Arztebl Int 2021; 118: 397–402 VOLLTEXT|
|2.||Bauer H; Maier W: GIMD 2010 – Ein Update des ‚German Index of Multiple Deprivation`. Berichte des Helmholtz Zentrums München 2018.|