Shifting Tides: Unveiling the Burden of Demographic Change in Germany Through Administrative Hospital Data

OBJECTIVES: The aim of the study was to investigate how the demographic change in Germany is reflected in German hospital data and whether the disease burden of the population is changing.

METHODS: Retrospective German federal population and hospital data (GBE, Destatis, InEK) was used for this study. Data on age groups of the total German population, patients admitted to hospital, and the associated primary diagnoses for the years 1994 to 2022 were analyzed and compared. For the corresponding years, comorbidity scores (Charlson Comorbidity Index [CCI], updated Charlson Comorbidity Index [uCCI], Elixhauser Comorbidity Score [ECI]) were calculated for the inpatient population. In addition, the primary diagnoses from 2000 and 2019 were compared and the largest differences were identified using absolute differences (AD).

RESULTS: The largest change in hospital rates occurred in the ≥75-year-old age group, which accounted for 14.76% of hospitalized patients in 1994 and 28.48% in 2021. On the other hand, the hospitalization rates in age groups younger than 55 years declined, except for the age group younger than 1 year. The calculation of comorbidity scores showed an increase of 24.29% for the CCI comparing the years 2005 and 2019, 27.67% for the uCCI, and 36.92% for the ECI. The largest differences in AD between 2000 and 2019 among primary diagnoses were seen in the reduction of ICD-10-GM code I25 "Chronic ischemic heart disease" (AD=2.17) from a 3.17% to a 1.00% share. The biggest increase could be seen for the ICD-10-GM I50 code “Heart failure” (AD=1.06) from a 1.39% to a 2.45% share.

CONCLUSIONS: Demographic change in society is already clearly evident in German hospital data in the period we considered. The changing age structure of hospitalized patients and disease burden should be considered for planning of the future healthcare system and inpatient capacities.