title: Analysing horizontal equity in enrolment in Disease Management Programmes for coronary heart disease in Germany 2008-2010.
abstract: BACKGROUND
  Disease Management Programmes (DMPs) have been introduced in Germany ten years ago with the aim to improve effectiveness and equity of care, but little is known about the degree to which enrolment in the programme meets the principles of equity in health care. We aimed to analyse horizontal equity in DMP enrolment among patients with coronary heart disease (CHD).
  
  
  METHODS
  Cross-sectional analysis of horizontal inequities in physician-reported enrolment in the DMP for CHD in a large population-based cohort-study in Germany (2008-2010). We calculated horizontal inequity indices (HII) and their 95% confidence intervals [95%CI] for predicted need-standardised DMP enrolment across two measures of socio-economic status (SES) (educational attainment, regional deprivation) stratified by sex. Need-standardised DMP enrolment was predicted in multi-level logistic regression models.
  
  
  RESULTS
  Among N = 1,280 individuals aged 55-84 years and diagnosed with CHD, DMP enrolment rates were 22.2% (women) and 35.0% (men). Education-related inequities in need-standardised DMP enrolment favoured groups with lower education, but HII estimates were not significant. Deprivation-related inequities among women significantly favoured groups with higher SES (HII = 0.086 [0.007 ; 0.165]. No such deprivation-related inequities were seen among men (HII = 0.014 [-0.048 ; 0.077]). Deprivation-related inequities across the whole population favoured groups with higher SES (HII estimates not significant).
  
  
  CONCLUSIONS
  Need-standardised DMP enrolment was fairly equitable across educational levels. Deprivation-related inequities in DMP enrolment favoured women living in less deprived areas relative to those living in areas with higher deprivation. Further research is needed to gain a better understanding of the mechanisms that contribute to deprivation-related horizontal inequities in DMP enrolment among women.
authors: Department of General Practice & Health Services Research, University Hospital Heidelberg, Heidelberg, Germany. kayvan.bozorgmehr@med.uni-heidelberg.de.
authors: Kayvan
authors: K
authors: Bozorgmehr
authors: Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden. miguel.sansebastian@epiph.umu.se.
authors: Miguel
authors: M
authors: San Sebastian
authors: Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany. h.brenner@Dkfz-Heidelberg.de.
authors: Hermann
authors: H
authors: Brenner
authors: Department of Epidemiology & International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany. oliver.razum@uni-bielefeld.de.
authors: Oliver
authors: O
authors: Razum
authors: Institute of Health Economics and Health Care Management, Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Neuherberg, Germany. werner.maier@helmholtz-muenchen.de.
authors: Werner
authors: W
authors: Maier
authors: Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany. k.saum@Dkfz-Heidelberg.de.
authors: Kai-Uwe
authors: KU
authors: Saum
authors: Saarland Cancer Registry, Saarbrücken, Germany. b.holleczek@gbe-ekr.saarland.de.
authors: Bernd
authors: B
authors: Holleczek
authors: Department of General Practice & Health Services Research, University Hospital Heidelberg, Heidelberg, Germany. antje.miksch@med.uni-heidelberg.de.
authors: Antje
authors: A
authors: Miksch
authors: Department of General Practice & Health Services Research, University Hospital Heidelberg, Heidelberg, Germany. joachim.szecsenyi@med.uni-heidelberg.de.
authors: Joachim
authors: J
authors: Szecsenyi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003327:Coronary Disease / Q000628:therapy; D003430:Cross-Sectional Studies; D019468:Disease Management; D005260:Female; D005858:Germany; D054625:Healthcare Disparities; D006801:Humans; D008297:Male