This cohort study examined the impact of the lengths of lookback and confirmation periods as well as the definition of confirmatory events on the number of incident cancer cases identified and age-standardized cumulative incidences (ACI) estimated in administrative data using German cancer registry data as a benchmark. ACI per 100,000 insured persons for breast, prostate and colorectal cancer were estimated using BARMER Statutory Health Insurance claims data. Incident cancer cases were defined as having an in- or outpatient diagnosis in 2013, no diagnosis in a lookback period of 1 year and a second diagnosis (or death) in a confirmation period of 1 quarter. We varied lookback periods from 1 to 7 years, confirmation periods from 1 to 4 quarters as well as the definition of confirmatory events and compared ACI estimates to cancer registry data. ACI were higher for breast (138.7) and prostate (103.6) but lower for colorectal cancer (42.1) when compared to cancer registries (119.3, 98.0 and 45.5, respectively). Extending the lookback period to 7 years reduced ACI to 129.0, 95.1 and 38.3. An extended confirmation period of 4 quarters increased ACI to 151.3, 114.9 and 46.8. Including breast and colorectal surgeries as a confirmatory event reduced ACI to 114.9 and 37.1, respectively. The choice of lookback and confirmation periods and the definition of confirmatory events have considerable impact on the number of incident cancer cases identified and ACI estimated. Researchers need to be aware of potential misclassification when identifying incident cancer cases in administrative data. Further validation studies as well as studies using administrative data to estimate cancer incidences should consider several choices of the lookback and confirmation periods and the definition of confirmatory events to show how these parameters impact the validity and robustness of their results.

To describe and compare the objective and subjective oral health of older nursing home residents and home care recipients, and to investigate whether oral health is associated with sociodemographic characteristics and the long-term care (LTC) setting. In two German studies, the oral health of 246 nursing home residents and 90 home care recipients aged ≥60 years was assessed objectively using the Oral Health Assessment Tool (OHAT) and subjectively using the Oral Health Impact Profile (OHIP). OHAT and OHIP scores were compared between both settings. Multivariable logistic regressions were applied to investigate whether oral health is associated with sex, age group, LTC grade, and LTC setting. OHAT and OHIP mean scores in the home care setting were higher compared to the nursing home setting (OHAT: 3.13 vs. 1.28, p < .0001; OHIP: 7.81 vs. 2.15, p < .0001). The adjusted odds ratios for poor objective and subjective oral health for home care recipients vs. nursing home residents were 6.71 (95 % confidence interval 3.29-13.69) and 4.92 (2.77-8.76). No significant associations with sociodemographic characteristics were found. Oral health was poor in both settings, but home care recipients were more likely to have poor oral health than nursing home residents. Interventions to improve oral health are needed in the nursing home setting and, even more importantly, in the home care setting. Oral health among older people in need of LTC is poor and should be improved. From a health policy perspective, home care recipients may need more attention.

Background: Elderly in need of long-term care tend to have worse health and have higher need of medical care than elderly without need for long-term care. Yet, characteristics associated with long-term care need can impede health care access: Higher levels of long-term care need come with physical and cognitive decline such as frailty and memory loss. Yet, it has not been investigated whether level of long-term care need is related to medical care utilization.Methods: We investigated the association between the level of long-term care and medical specialist utilization among nursing home residents and home care recipients. We applied zero-inflated Poisson regression with robust standard errors based on a sample of statutory health insurance members. The sample consisted of 100.000 elderly over age 60. We controlled for age, gender, morbidity and mortality, residential density, and general practitioner utilization.Results: We found a strong gradient effect of the level of long-term care for 9 out of 12 medical specialties: A higher level of long-term care need was associated with a lower probability of having a medical specialist visit. Yet, we did not find clear effects of the level of long-term care need on the intensity of medical specialist care. These findings were similar for both the nursing home and home care setting.Conclusion: The findings indicate that inequalities in medical specialist utilization exist between elderly with differing levels of long-term care need because differences in morbidity were controlled for. Elderly with higher need of long-term care might face more access barriers to specialist medical care.

Background: Most older people, and especially those in need of long-term care, suffer from one or more chronic diseases. Consequently, older people have an increased need of medical care, including specialist care. There is little evidence as yet whether older people with greater medical care needs obtain adequate medical care because existing studies do not sufficiently control for differences in morbidity. In this study we investigate whether differences in medical specialist utilization exist between older people with and without assessed long-term care need in line with Book XI of the German Social Code, while at the same time controlling for individual differences in morbidity. Methods: We used data from the 11 German AOK Statutory Health and Long-term Care Insurance funds of 100,000 members aged 60 years or over. Zero-inflated Poisson regression analyses were applied to investigate whether the need for long-term care and the long-term care setting are associated with the probability and number of specialist visits. We controlled for age, gender, morbidity and mortality, residential density, and general practitioner (GP) utilization. Results: Older people in need of long-term care are more likely to have no specialist visit than people without the need for long-term care. This applies to nearly all medical specialties and for both care settings. Yet, despite these differences in utilization probability the number of specialist medical care visits between older people with and without the need for long-term care is similar. Conclusion: Older people in need of long-term care might face access barriers to specialist care. Once a contact is established, however, utilization does not differ considerably between those who need long-term care and those who don’t; this indicates the importance of securing an initial contact.