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We are grateful for the appreciative assessment of our work (1). Our colleagues are absolutely right in their assessment that, in order to analyze the impact of regional material and social deprivation on health, smaller spatial units (such as city districts) should also be considered. The deprivation index used (German Index of Multiple Deprivation [GIMD] 2010; [2]) is available for rural district and municipal (community) levels; unfortunately, however, there are no comprehensive data for city districts (parts of towns).

For reasons of data availability in our analysis, we opted to use the district level, i.e., rural districts and whole cities. As we explained in the Discussion of our article (1), the effects of deprivation on stroke incidence can be assumed to be somewhat underestimated in such a relatively large-scale analysis, as the areas analysed (as also explained by Giesen and Moll) are themselves heterogeneous.

The care of acute stroke is extremely time-critical, so the need for stroke units must be determined according to regional accessibility criteria in order to ensure optimal care. Due to the differences in incidence associated with regional deprivation (described in our work), care in disadvantaged regions must be planned more intensively and on a smaller scale. Required stroke units must not be displaced.

DOI: 10.3238/arztebl.m2022.0025

On behalf of the authors:

Prof. Dr. med. Armin J. Grau

Neurologische Klinik

Klinikum der Stadt Ludwigshafen am Rhein, Germany

graua@klilu.de

Conflict of interest statement:

The authors of the contributions declare that no conflict of interest exists.

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.
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.

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