Sex differences in treatment patterns of six chronic diseases: an analysis from the German statutory health insurance

J Womens Health (Larchmt). 2008 Apr;17(3):343-54. doi: 10.1089/jwh.2007.0422.


Objective: The goal of this study was to investigate gender-specific differences in prevalence, healthcare costs, and treatment patterns in the German Statutory Health Insurance (SHI).

Methods: The study analyzed administrative claims data of over 26 million insured with respect to prevalence and cost of illness of six chronic diseases. Insured were identified using the ATC code for medication prescription and ICD-9 code for diagnosis. The influences of gender, age, and comorbidity on cost differences were analyzed via multivariate regression analysis.

Results: Adjusted for age and comorbidity, gender had a significant influence on both hospital and medication spending. Hospital costs on average were 17.1% (95% CI 14.1; 20.2) higher for men compared with women. Medication spending for men exceeded that for women on average by 13.8% (95% CI 10.9; 16.7). The diagnoses with the highest prevalence were hypertension and heart failure. Women had a higher prevalence of diabetes, coronary artery disease (CAD), heart failure, and hypertension. Medication costs were higher for men in three of five diagnoses and comparable for two diagnoses (diabetes and asthma). Women received more medication prescriptions than men, but on average prescriptions for men were 14%-26% more expensive than prescriptions for women. Regarding treatment patterns men were treated with different drug classes in cardiovascular disease (CVD) compared with women. Total medication spending stratified by diagnosis was highest for diabetes.

Conclusions: Gender differences for costs and prescribing patterns for chronic diseases vary disease specifically, but generally men had higher inpatient costs and more expensive medication prescriptions, whereas women had higher numbers of prescriptions.

MeSH terms

  • Adult
  • Aged
  • Asthma / economics
  • Breast Neoplasms / economics
  • Chronic Disease / economics*
  • Chronic Disease / epidemiology
  • Chronic Disease / therapy*
  • Coronary Artery Disease / economics
  • Delivery of Health Care / economics*
  • Diabetes Mellitus, Type 2 / economics
  • Female
  • Germany / epidemiology
  • Health Care Costs / statistics & numerical data*
  • Heart Failure / economics
  • Humans
  • Hypertension / economics
  • Insurance Claim Review / statistics & numerical data
  • Insurance, Health / economics*
  • Male
  • Men's Health / economics
  • Middle Aged
  • Patient Acceptance of Health Care / statistics & numerical data
  • Population Surveillance
  • Prevalence
  • Sex Distribution
  • Stroke / economics
  • Women's Health / economics