Characteristics and external validity of the German Health Risk Institute (HRI) Database

Pharmacoepidemiol Drug Saf. 2016 Jan;25(1):106-9. doi: 10.1002/pds.3895. Epub 2015 Nov 3.


Purpose: The aim of this study was to describe characteristics and external validity of the German Health Risk Institute (HRI) Database.

Methods: The HRI Database is an anonymized healthcare database with longitudinal data from approximately six Mio Germans. In addition to demographic information (gender, age, region of residence), data on persistence of insurants over time, hospitalization rates, mortality rates and drug prescription rates were extracted from the HRI database for 2013. Corresponding national reference data were obtained from official sources.

Results: The proportion of men and women was similar in the HRI Database and Germany, but the database population was slightly younger (mean 40.4 vs 43.7 years). The proportion of insurants living in the eastern part of Germany was lower in the HRI Database (10.1% vs 19.7%). There was good accordance to German reference data with respect to hospitalization rates, overall mortality rate and prescription rates for the 20 most often reimbursed drug classes, with the overall burden of morbidity being slightly lower in the HRI database. From insurants insured on 1 January 2009 (N = 6.2 Mio), a total of 70.6% survived and remained continuously insured with the same statutory health insurance until 31 December 2013. This proportion increased to 77.5% if only insurants ≥40 years were considered.

Conclusions: There was good overall accordance of the HRI database and the German population in terms of measures of morbidity, mortality and drug usage. Persistence of insurants with the database over time was high, indicating suitability of the data source for longitudinal epidemiological analyses.

Keywords: Germany; data sources; external validity; healthcare databases; pharmacoepidemiology; secondary data.

MeSH terms

  • Adult
  • Databases, Factual*
  • Drug Prescriptions* / statistics & numerical data
  • Female
  • Germany
  • Health Status Indicators*
  • Hospitalization* / statistics & numerical data
  • Humans
  • Insurance, Health* / statistics & numerical data
  • Male
  • National Health Programs / organization & administration*
  • National Health Programs / statistics & numerical data
  • Rural Population / statistics & numerical data
  • Urban Population / statistics & numerical data