Outpatient Health Service Utilization Among Adults with Diabetes, Hypertension and Cardiovascular Disease During the COVID-19 Pandemic – Results of Population-Based Surveys in Germany from 2019 to 2021

Figures & data

Table 1 Characteristics of the Study Population from the Nationwide Surveys GEDA 2019–2021 by Different Phases of the COVID-19 Pandemic in Germany

Pandemic Phase	Pre-Pandemic Phase	1st Pandemic Wave	Summer Plateau 2020	4th Pandemic Wave	Total
Available calendar weeks (wk), year	14^th wk, 2019–9^th wk, 2020	10^th-20^th wk, 2020	21^st-36^th wk, 2020	26^th-52^th wk, 2021
N	13,706	3,874	5,357	5,030	27,967
	% [95% CI]	% [95% CI]	% [95% CI]	% [95% CI]	% [95% CI]
Sex
Men	49.0 [47.7–50.3]	48.5 [46.0–50.9]	49.4 [47.0–51.7]	49.0 [46.9–51.1]	49.0 [48.1–49.9]
Women	51.0 [49.7–52.3]	51.5 [49.1–54.0]	50.6 [48.3–53.0]	51.0 [48.9–53.1]	51.0 [50.1–51.9]
Age group, years
16–29	17.1 [16.1–18.2]	16.4 [14.4–18.6]	16.5 [14.7–18.6]	16.3 [14.5–18.2]	16.8 [16.0–17.5]
30–44	21.9 [20.8–23.0]	21.5 [19.4–23.7]	22.4 [20.3–24.7]	22.4 [20.6–24.3]	22.0 [21.2–22.9]
45–64	34.7 [33.6–35.9]	35.1 [32.8–37.5]	34.4 [32.2–36.6]	35.0 [33.0–37.0]	34.8 [33.9–35.6]
65–79	18.2 [17.3–19.1]	18.6 [16.9–20.4]	18.6 [17.0–20.2]	17.7 [16.4–19.2]	18.2 [17.6–18.9]
80+	8.1 [7.4–8.9]	8.4 [7.0–10.0]	8.1 [7.0–9.4]	8.6 [7.5–9.7]	8.2 [7.7–8.7]
Educational level
Primary	18.7 [17.5–19.9]	19.4 [17.1–21.9]	18.3 [16.2–20.6]	18.7 [16.7–20.9]	18.7 [17.8–19.6]
Middle	56.5 [55.3–57.8]	56.2 [53.8–58.7]	56.6 [54.2–58.9]	56.0 [53.8–58.1]	56.4 [55.5–57.3]
High	24.8 [24.0–25.7]	24.4 [22.7–26.1]	25.2 [23.5–26.9]	25.3 [23.9–26.8]	24.9 [24.3–25.6]
Chronic disease in the last 12 months
Hypertension	26.5 [25.4–27.7]	26.4 [24.3–28.6]	26.8 [24.8–28.9]	28.5 [26.7–30.4]	26.9 [26.1–27.7]
Major CVD	4.6 [4.0.5.2]	3.4 [2.6–4.4]	4.1 [3.3–5.2]	3.5 [2.8–4.3]	4.1 [3.8.4.5]
Diabetes	8.9 [8.2–9.7]	8.3 [7.0–9.8]	9.3 [8.1–10.7]	7.7 [6.7–8.9]	8.7 [8.2–9.2]

Notes: Major cardiovascular diseases (CVD): any myocardial infarction/stroke or chronic complaints as a result of myocardial infarction/stroke in the last 12 months. Missing data for educational level n=85 (0.3%), hypertension n=86 (0.3%), major CVD n=38 (0.1%), diabetes n=38 (0.1%).

Table 2 Outpatient Health Service Utilization Among Adults by Sociodemographic Characteristics and Selected Chronic Diseases Based on the Nationwide Surveys GEDA 2019–2021

	Visiting A General Practitioner In The Past 4 Weeks	Visiting A Specialist In The Past 4 Weeks
	% [95% CI]	% [95% CI]
Sex
Men	33.5 [32.2–34.7]	21.1 [20.1–22.2]
Women	37.8 [36.5–39.0]	28.3 [27.1–29.4]
Age group, years
16–29	27.1 [24.8–29.5]	17.4 [15.5–19.4]
30–44	27.6 [25.7–29.6]	20.1 [18.5–21.8]
45–64	37.7 [36.2–39.1]	27.5 [26.2–28.8]
65–79	45.7 [43.8–47.6]	31.3 [29.5–33.1]
80+	45.3 [42.1–48.5]	26.9 [24.3–29.8]
Educational level
Primary	40.7 [38.0–43.4]	23.5 [21.3–25.9]
Middle	35.4 [34.3–36.6]	24.5 [23.5–25.5]
High	32.4 [31.2–33.6]	26.1 [25.1–27.2]
Chronic disease in the last 12 months
Hypertension	50.6 [48.9–52.4]	32.2 [30.7–33.9]
No hypertension	30.1 [29.1–31.1]	22.0 [21.2–22.9]
Major CVD	65.0 [60.4–69.3]	38.3 [34.0–42.8]
No major CVD	34.4 [33.5–35.3]	24.2 [23.4–25.0]
Diabetes	62.9 [59.8–65.8]	36.0 [33.1–39.0]
No diabetes	33.0 [32.1–33.9]	23.7 [22.9–24.5]

Notes: Major cardiovascular diseases (CVD): any myocardial infarction/stroke or chronic complaints as a result of myocardial infarction/stroke in the last 12 months. Missing data for educational level n=85 (0.3%), hypertension n=86 (0.3%), major CVD n=38 (0.1%), diabetes n=38 (0.1%).

Table 3 Outpatient Health Service Utilization Among Adults Overall and Adults with Selected Chronic Diseases by Different Phases of the COVID-19 Pandemic in Germany Based on the Nationwide Surveys GEDA 2019–2021

	Pandemic Phase	Pre-Pandemic Phase	1st Pandemic Wave 2020	Summer Plateau 2020	4th Pandemic Wave 2021
	Available calendar weeks (wk), year	14^th wk, 2019–9^th wk, 2020	10^th-20^th wk, 2020	21^st-36^th wk, 2020	26^th-52^th wk, 2021
		OR [95% CI]	OR [95% CI]	OR [95% CI]	OR [95% CI]
Visiting a general practitioner in the past 4 weeks	Overall (N=27,967)	reference	0.82 [0.72–0.92]	0.84 [0.75–0.94]	0.95 [0.86–1.06]
	Hypertension (n=8,449)	reference	0.75 [0.60–0.93]	0.85 [0.70–1.05]	0.85 [0.71–1.02]
	Major CVD (n=1,136)	reference	0.57 [0.32–1.01]	1.09 [0.63–1.89]	1.01 [0.60–1.72]
	Diabetes (n=2,497)	reference	0.91 [0.62–1.34]	1.07 [0.75–1.54]	0.79 [0.55–1.12]
Visiting a specialist in the past 4 weeks	Overall (N=27,967)	reference	0.68 [0.60–0.78]	0.75 [0.66–0.85]	0.97 [0.87–1.09]
	Hypertension (n=8,449)	reference	0.60 [0.48–0.76]	0.83 [0.68–1.03]	0.99 [0.82–1.20]
	Major CVD (n=1,136)	reference	0.46 [0.26–0.81]	0.66 [0.39–1.12]	0.93 [0.57–1.51]
	Diabetes (n=2,497)	reference	0.51 [0.35–0.76]	0.78 [0.54–1.13]	0.82 [0.58–1.15]

Notes: Major cardiovascular diseases (CVD): any myocardial infarction/stroke or chronic complaints as a result of myocardial infarction/stroke in the last 12 months. Odds ratios (OR) with 95% CI (confidence intervals) were derived from logistic regression models adjusted for sex, age groups, educational level and federal states, and weighted to the German national population of people aged ≥16 years. Bold figures denote statistical significance at p <0.05 in comparison with pre-pandemic phase.

Figure 1 Outpatient health service utilization among adults overall and adults with selected chronic diseases by different phases of the COVID-19 pandemic in Germany based on the nationwide surveys GEDA 2019—2021.

Notes: Percentages and 95% confidence intervals were adjusted for sex, age groups, educational level and federal states and weighted to the German national population of people aged ≥16 years. Major cardiovascular diseases (CVD): any myocardial infarction/stroke or chronic complaints as a result of myocardial infarction/stroke in the last 12 months.