title: [Regional Deprivation in Germany: Nation-wide Analysis of its Association with Mortality Using the German Index of Multiple Deprivation (GIMD)].
abstract: BACKGROUND
  Deprivation indices are increasingly being used to assess the effects of contextual factors on health. In Germany, the recently developed 'German Index of Multiple Deprivation (GIMD)' integrates various dimensions of regional deprivation. We aim to assess the validity of the GIMD through a recalculation using more recent rural and urban district level data and by analysing its association with mortality at the national level.
  
  
  METHODS
  We calculated a new version of the GIMD based on data from 2007 to 2010 for all 412 rural and urban districts in Germany. Mortality was quantified using indirectly standardised mortality ratios (SMRs). Correlation analyses and Poisson regression analyses were used to assess the association between the GIMD scores and total mortality, as well as premature mortality (< 65 years).
  
  
  RESULTS
  Correlation analyses showed a positive association between the GIMD and both total mortality (p<0.001) and premature mortality (p<0.001). In the Poisson regression analyses, rural and urban districts in the quintile with the highest deprivation showed a significantly elevated risk of total mortality (RR: 1.29; 95% CI: 1.28-1.30) as well as premature mortality (RR: 1.50; 95% CI: 1.47-1.53), compared to the districts in the lowest quintile.
  
  
  CONCLUSIONS
  The association between regional deprivation and mortality has already been shown for the federal state of Bavaria. Using more recent data, this relationship could be confirmed here for Germany as a whole. The GIMD has been shown to be able to effectively assess regional deprivation. Concerning public health policy, the significant, positive and stable association between regional deprivation and mortality indicates an increased need for health care provision particularly in the most deprived districts. Further studies should examine, for example, whether and how the allocation of districts to quintiles of regional deprivation changes over time, and how this affects mortality.
authors.affiliation: Fakultät für Gesundheitswissenschaften, AG Epidemiologie & International Public Health, Universität Bielefeld, Bielefeld.
authors.forename: C
authors.initials: C
authors.lastname: Hofmeister
authors.affiliation: Helmholtz Zentrum München - Deutsches Forschungszentrum für Gesundheit und Umwelt, Institut für Gesundheitsökonomie und Management im Gesundheitswesen, Neuherberg.
authors.forename: W
authors.initials: W
authors.lastname: Maier
authors.affiliation: Helmholtz Zentrum München - Deutsches Forschungszentrum für Gesundheit und Umwelt, Institut für Gesundheitsökonomie und Management im Gesundheitswesen, Neuherberg.
authors.forename: A
authors.initials: A
authors.lastname: Mielck
authors.affiliation: Fakultät für Gesundheitswissenschaften, AG Epidemiologie & International Public Health, Universität Bielefeld, Bielefeld.
authors.forename: L
authors.initials: L
authors.lastname: Stahl
authors.affiliation: Fakultät für Gesundheitswissenschaften, AG Epidemiologie & International Public Health, Universität Bielefeld, Bielefeld.
authors.forename: J
authors.initials: J
authors.lastname: Breckenkamp
authors.affiliation: Fakultät für Gesundheitswissenschaften, AG Epidemiologie & International Public Health, Universität Bielefeld, Bielefeld.
authors.forename: O
authors.initials: O
authors.lastname: Razum
mesh_terms: D000328:Adult; D000368:Aged; D003467:Cultural Deprivation; D005260:Female; D005858:Germany / Q000453:epidemiology; D006304:Health Status; D054624:Health Status Disparities; D006305:Health Status Indicators; D006801:Humans; D008017:Life Expectancy; D008297:Male; D008875:Middle Aged; D009014:Morals; D061213:Mortality, Premature; D011204:Poverty Areas; D011610:Psychosocial Deprivation; D012307:Risk Factors; D012959:Socioeconomic Factors; D015996:Survival Rate; D055815:Young Adult