SICK IN THE CITY? REGIONAL DIFFERENCES AND CAUSES OF SICK LEAVE IN GERMANY: CLAIMS DATA INSIGHTS AND ANALYTICAL OPPORTUNITIES
Author(s)
Jennifer Scarlet Haas, MSc1, Vukasin Viskovic, MA2, Timotheus Stremel, MSc1, Kathrin Gerchow, MPH1, Svitlana Schnaidt, MSc1, Dominik Obermüller, PhD2, Christian Jacob, PhD1.
1Cencora, Hannover, Germany, 2InGef - Institut für angewandte Gesundheitsforschung, Berlin, Germany.
1Cencora, Hannover, Germany, 2InGef - Institut für angewandte Gesundheitsforschung, Berlin, Germany.
OBJECTIVES: We aimed to assess sick leave data in terms of prevalence, sickness absence rates, and causes for sick leave across geographic dimensions including federal states and urban/rural classification among working-age individuals in Germany.
METHODS: Anonymized claims data from individuals of working age (16-67 years), with valid sick leave data, information on federal state, and with individual insurance from the Institute for Applied Health Research Berlin (InGef) in 2024 were used. Geographic area was classified at the district level using settlement structure types for urban: large cities and urban districts and rural: semi-urban or sparsely populated rural districts. Sick leave prevalence was defined as ≥1 sick leave episode in 2024. Sickness absence rate was calculated as sick leave days divided by insured days. Causes for sick leaves were assessed based on ICD-10 code chapters.
RESULTS: 3,556,793 individuals met the inclusion criteria, of whom 69.5% resided in urban districts. Sick leave prevalence was modestly higher in rural than urban areas (63.4% vs. 61.3%), with sickness absence rates following the same direction (4.5% vs. 4.2%). Federal-state differences exceeded the urban/rural gap, with prevalence ranging from 52.9% (Berlin) to 65.6% (Thuringia). Notably, both city-states, Berlin (52.9%) and Hamburg (55.1%), were below the urban average. The top 3 overall sick leave causes were respiratory diseases (J00-J99, 64.7%), musculoskeletal system and connective tissue (M00‑M99, 26.5%), and symptoms, signs, and abnormal clinical and laboratory findings (R00‑R99, 24.4%).
CONCLUSIONS: German sick leave claims data allow analyses in terms of geographic dimensions including federal states and urban/rural as well as sick leave causes. Well over half of all working-age insured individuals in Germany had ≥1 sick leave in 2024, with modestly higher prevalence and sickness absence rates in rural than urban areas. Substantial variation across federal states suggests regional differences in sickness-related work absence that warrant further investigation regarding structural causes.
METHODS: Anonymized claims data from individuals of working age (16-67 years), with valid sick leave data, information on federal state, and with individual insurance from the Institute for Applied Health Research Berlin (InGef) in 2024 were used. Geographic area was classified at the district level using settlement structure types for urban: large cities and urban districts and rural: semi-urban or sparsely populated rural districts. Sick leave prevalence was defined as ≥1 sick leave episode in 2024. Sickness absence rate was calculated as sick leave days divided by insured days. Causes for sick leaves were assessed based on ICD-10 code chapters.
RESULTS: 3,556,793 individuals met the inclusion criteria, of whom 69.5% resided in urban districts. Sick leave prevalence was modestly higher in rural than urban areas (63.4% vs. 61.3%), with sickness absence rates following the same direction (4.5% vs. 4.2%). Federal-state differences exceeded the urban/rural gap, with prevalence ranging from 52.9% (Berlin) to 65.6% (Thuringia). Notably, both city-states, Berlin (52.9%) and Hamburg (55.1%), were below the urban average. The top 3 overall sick leave causes were respiratory diseases (J00-J99, 64.7%), musculoskeletal system and connective tissue (M00‑M99, 26.5%), and symptoms, signs, and abnormal clinical and laboratory findings (R00‑R99, 24.4%).
CONCLUSIONS: German sick leave claims data allow analyses in terms of geographic dimensions including federal states and urban/rural as well as sick leave causes. Well over half of all working-age insured individuals in Germany had ≥1 sick leave in 2024, with modestly higher prevalence and sickness absence rates in rural than urban areas. Substantial variation across federal states suggests regional differences in sickness-related work absence that warrant further investigation regarding structural causes.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EPH266
Topic
Epidemiology & Public Health, Real World Data & Information Systems
Topic Subcategory
Public Health
Disease
No Additional Disease & Conditions/Specialized Treatment Areas