at Google ScholarTitle data
Kreutzberg, Anika ; Tsatsaronis, Chrissa ; Quentin, Wilm ; Busse, Reinhard:
Regional variation in healthcare utilization among patients with depression in Germany: a multilevel analysis with PopGrouper-based multimorbidity adjustment.
In: Research in Health Services & Regions.
Vol. 5
(2026)
Issue 8
.
ISSN 2730-9827
DOI: https://doi.org/10.1007/s43999-026-00092-6
Abstract in another language
Background
Depression is associated with a substantial health and economic burden and shows pronounced regional variation in Germany. While socioeconomic and urban–rural differences in depression prevalence and service use are well documented, less is known about how regional socioeconomic deprivation and urbanization relate to healthcare utilization after accounting for multimorbidity.
Methods
We analyzed nationwide claims data from a large German sickness fund including adults with diagnosed depression (N = 1,083,319). Healthcare utilization in 2023 was measured as healthcare costs, days of sickness absence, any outpatient mental health specialist contact, and outpatient psychotherapy use. Multilevel regression models with individuals nested within 96 spatial planning regions were estimated, adjusting for age, sex, and multimorbidity using the PopGrouper. Regional socioeconomic deprivation was measured using the German Index of Socioeconomic Deprivation, and urbanization was classified as urban, semi-urban, or rural. Proportional variance component analyses quantified explained regional heterogeneity.
Results
Higher regional socioeconomic deprivation was significantly associated with more days of sickness absence (adjusted mean: 34.1 days in the least vs. 40.1 days in the most deprived regions) and a lower likelihood of receiving outpatient psychotherapy (17.9% vs. 16.3%). No significant associations were observed between deprivation and healthcare costs or mental health specialist contacts. Urban regions were associated with higher healthcare costs (2,284€ vs. 2,188€) and more frequent mental health specialist contacts (15.6% vs. 13.5%). Overall regional clustering was modest but most pronounced for mental health specialist contacts.
Conclusion
Regional socioeconomic deprivation is linked to higher sickness absence due to depression. Regional inequalities in access to mental health services are small but largely unexplained by deprivation, urbanization, and multimorbidity.
Further data
| Item Type: | Article in a journal |
|---|---|
| Refereed: | Yes |
| Keywords: | Depression; Socioeconomic inequalities; Regional analysis; Population classification; Claims data; Germany |
| Institutions of the University: | Faculties > Faculty of Law, Business and Economics > Chair Planetary and Public Health > Chair Planetary and Public Health - Univ.-Prof. Dr. med. Wilm Quentin Faculties Faculties > Faculty of Law, Business and Economics Faculties > Faculty of Law, Business and Economics > Chair Planetary and Public Health |
| Result of work at the UBT: | Yes |
| DDC Subjects: | 600 Technology, medicine, applied sciences > 610 Medicine and health |
| Date Deposited: | 13 Jun 2026 21:00 |
| Last Modified: | 15 Jun 2026 05:43 |
| URI: | https://eref.uni-bayreuth.de/id/eprint/98837 |