title: Health care characteristics of basal cell carcinoma in Germany: the role of insurance status and socio-demographic factors.
abstract: BACKGROUND
  In Germany population-based data on health care of basal cell carcinoma (BCC) are rare.
  
  
  OBJECTIVE
  To analyze the relationship between socio-demographic and regional factors, health insurance status and clinical features of BCC.
  
  
  METHODS
  Data base was from a nationwide dermatopathology laboratory. All consecutive excisions from 2010 were analyzed regarding tumor-specific and socioeconomic characteristics of BCC.
  
  
  RESULTS
  9,467 histologically verified BCC derived from 7,116 patients (54.1 % male, mean age 70 years) were analyzed. 33 % of patients had multiple tumors. The average vertical depth of invasion of BCC was 1.27 mm. It was increased significantly (p ≤ 0.001) in men (1.33 mm vs. 1.19 mm in women) and in persons over 70 years of age (1.36 mm vs. 1.14 mm). Controlled for age and sex, members of agricultural health-insurances (LKK) and of German local public health insurances (AOK) showed the highest tumor depths (1.45 mm resp.1.42 mm). The lowest depths (1.17 mm) were found in insurees of the substitute health funds (Ersatzkassen) (p ≤ 0.001). Vertical depth of invasion was significantly increased for patients living in rural counties (1.34 mm) compared to patients from urban areas (1.21 mm). Furthermore, the distribution of BCC locations varied by type of health insurance.
  
  
  CONCLUSIONS
  Area of residence, health insurance status, age and gender are relevant determinants of BCC health care in Germany. Prevention programs and activities to improve early detection by health insurances should take this into account.
authors.affiliation: Competence Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Ines
authors.initials: I
authors.lastname: Schäfer
authors.forename: Michael
authors.initials: M
authors.lastname: Reusch
authors.forename: Julia
authors.initials: J
authors.lastname: Siebert
authors.forename: Christina
authors.initials: C
authors.lastname: Spehr
authors.forename: Matthias
authors.initials: M
authors.lastname: Augustin
mesh_terms: D017677:Age Distribution; D002280:Basal Cell Carcinoma / Q000453:epidemiology* / Q000473:pathology*; D004651:Employment / Q000706:statistics & numerical data*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D019458:Insurance Coverage / Q000145:classification / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D015995:Prevalence; D012307:Risk Factors; D017678:Sex Distribution; D012878:Skin Neoplasms / Q000453:epidemiology* / Q000473:pathology*; D012959:Socioeconomic Factors