Original article
Arterial Hypertension: The Incidence of Diagnosed Hypertension, 24-Hour Blood Pressure Measurement and Pharmacotherapy
An analysis of routine health insurance data
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Background: Arterial hypertension is a major risk factor for morbidity and mortality in Germany. No current data are available on trends in the incidence of hypertension.
Methods: The incidence of diagnosed hypertension (ICD codes I10.- to I15.-) and the utilization of 24-hour ambulatory blood pressure measurement (ABPM) and antihypertensive drugs were determined in an analysis of anonymized routine data on 4.8 million persons covered by the statutory health insurance system in Germany. The data were linked to the German Index of Socioeconomic Deprivation on the basis of the subjects’ place of residence and evaluated with stratification by age group, sex, and regional socioeconomic deprivation.
Results: In 2017, the age-standardized incidence of diagnosed hypertension was 20.6 per 1000 persons. It fell in the first year of the COVID-19 pandemic, rose again in 2021, and reached 20.7 per 1000 in 2023. In 2023, the incidence of diagnosed hypertension was markedly higher in regions with high socioeconomic deprivation than in low-deprivation regions (24.6 versus 17.9 per 1000). Among persons who received a diagnosis of hypertension in 2023, 82.3% received medication and 30.1% underwent ABPM within one year of their diagnosis.
Conclusion: The high incidence of diagnosed hypertension underscores the need for a well-developed preventive strategy. The downward trend that was observed over the past decade is no longer evident. This matter should be investigated further with a nationwide investigative survey that also takes undiagnosed hypertension into account.
Cite this as: Reitzle L, Maier B, Hoebel J, Pawlowska-Phelan D, Ludwig M, Neuhauser H: Arterial hypertension: The incidence of diagnosed hypertension, 24-hour blood pressure measurement and pharmacotherapy. An analysis of routine health insurance data. Dtsch Arztebl Int 2025; 122: 681–6. DOI: 10.3238/arztebl.m2025.0174
High blood pressure is a major risk factor for coronary heart disease, heart failure, stroke, chronic kidney disease, and dementia (1). It is one of the leading preventable causes of cardiovascular mortality and overall disease burden (2). Early diagnosis, treatment, and control of high blood pressure (arterial hypertension) can significantly help prevent secondary cardiovascular complications (3). Hypertension is one of the most common diagnoses in medical practice. According to analyses of outpatient claims data, hypertension was documented for 26.2% of persons covered by the German statutory health insurance system in 2023 (4), while the AOK Research Institute reports a prevalence of 29.3% in 2023 among the general population aged 20 and older (5).
In addition to prevalence, the incidence of hypertension is an important measure, as it provides information on the frequency of new cases of high blood pressure and responds more sensitively to changes in risk factors and crisis situations. Thus, a cohort study in Italy detected an increase in the incidence of hypertension as a result of the COVID-19 pandemic (6). In Germany, no up-to-date data are available on trends in hypertension incidence.
The aim of the present study was to estimate the incidence of diagnosed hypertension between 2017 and 2023, based on routine data from the statutory health insurances (SHI) in Germany. Furthermore, the utilization of 24-hour ambulatory blood pressure monitoring (ABPM) and the prescription of antihypertensive drugs during the first year of treatment were also analyzed. The results were assessed over time and by sex, age group, and regional socioeconomic differences.
Methods
Data sources
The InGef research database (Institute for Applied Health Research Berlin [InGef]) was used to analyze newly diagnosed hypertension (administrative incidence). This database contains anonymized routine data on approximately nine million people covered by the statutory health insurance system (SHI) in Germany. A sample of around 4.8 million insured persons was drawn from this database, which corresponded to the age and sex distribution of the German population (7). The database contains information on sociodemographics, outpatient and inpatient diagnoses and services, as well as drug prescriptions. Diagnoses are coded using the International Statistical Classification of Diseases and Related Health Problems (ICD-10), and drugs are coded according to the Anatomic Therapeutic Chemical (ATC) classification system. In addition, for the years 2019 to 2023, the German Index of Socioeconomic Deprivation (GISD), Release 2022 v0.1 (8, 9), was linked to the place of residence of persons covered by health insurance at city and rural district levels using the Official Municipality Key. The GISD combines data on employment, education, and income into one key figure and classifies districts into quintiles of low (1st quintile), medium (2nd – 4th quintiles), and high (5th quintile) socioeconomic deprivation.
Study design and study population
The estimation of administrative incidence for the years 2017 to 2023 was conducted using a cross-sectional study design for each study year, similar to a previous study (10). Insured persons were included for each study year if they were insured for the entire year, from birth to December 31, or from January 1 to the date of death. Furthermore, information on diagnoses had to be available for two complete calendar years before the study year or from birth to December 31 of the year before the study year (pre-observation period). Excluded were persons with a confirmed outpatient diagnosis, or a primary or secondary inpatient diagnosis, of hypertension (ICD: I10.- to I15.-) in the pre-observation period.
Definition of outcomes
Newly diagnosed hypertension was assumed if either a primary inpatient diagnosis of hypertension (ICD: I10.- to I15.-) or a confirmed outpatient diagnosis was recorded in the study year and confirmed by a further diagnosis in the following three quarters (confirmed outpatient or inpatient diagnosis) or in the same quarter by a second physician. Inpatient secondary diagnoses were treated similarly to confirmed outpatient diagnoses. In addition, among persons with newly diagnosed hypertension, those with at least one prescription for an antihypertensive drug (ATC codes: C02, C03, C07, C08, or C09) within the first treatment year and those with ABPM (EBM [German Uniform Assessment Standard] codes: 03324, 04324, 13254, or 27324) within the first treatment year were analyzed.
Statistical analysis
The administrative incidence was estimated per study year as the number of persons with newly diagnosed hypertension relative to all included insured persons, and the 95% confidence intervals (95% CI) were calculated under the assumption of a binomial distribution. The results were stratified by age groups (<18, 18–29, 30–39, 40–49, 50–59, 60–69, 70–79, and >= 80 years), sex, and the quarter of the year in which the initial diagnosis was made, as well as for the years 2019 to 2023 by regional socioeconomic deprivation (categories: high, medium, low). In order to compensate for differences in age and sex distribution in comparison with the general population, the incidence was standardized using the population as of December 31 of the respective reporting year as the reference population (11). Furthermore, age-standardized incidence was calculated using the age and sex distribution of the German population as of December 31, 2023, as the standard population. The analyses were performed according to the recommendations for ensuring Good Epidemiological Practice (e1) and Good Practice of Secondary Data Analysis (e2). The trial protocol was published in advance (12). Statistical analyses were conducted using Microsoft R Open (version 4.0.2).
Results
Incidence of diagnosed hypertension (administrative incidence)
A total of 2.4 to 2.7 million insured persons were included per year (eTable 1). In 2023, the age-standardized incidence of diagnosed hypertension was 20.7 per 1000 persons (95% confidence interval: 20.6; 20.9), with a higher incidence for men (22.1 [21.9; 22.4]) than for women (19.4 [19.2; 19.6]). This corresponds to approximately 630 000 men and 570 000 women with newly diagnosed hypertension after extrapolation to the general population. The incidence of hypertension rose with increasing age and was the highest in the 80 years and over age group. Whereas in the age groups under 70 years the incidence of hypertension was consistently higher in men than in women over the years, there were hardly any differences in the 70 to 79 years age group, and the incidence in women over 80 years was at times higher than that in men (eFigure 1). In regions with high socioeconomic deprivation, the age-standardized incidence of 24.6 per 1000 [24,1; 25,1] was higher than in regions with medium (21.2 [20.9; 214]) and low deprivation (17.9 [17.6; 18.2]).
In 2017 and 2023, the incidence of diagnosed hypertension was comparable at 20.6 [20.4; 20.7] and 20.7 [20.6; 20.9] per 1000 persons, respectively (Figure 1, eTable 2). Only in the 80 years and over age group was a slight decrease evident over time. At the start of the COVID-19 pandemic, the incidence in 2020 fell by 7.0% in comparison with the previous year, followed by an increase of 13.3% in 2021. When examining the individual quarters of each pre-pandemic study year from 2017 to 2019, a consistent pattern emerged (eFigure 2). The incidence was the highest in the first quarter, declined in the second, and then levelled off. In 2020, the incidence in the first two quarters was below that of previous years, and in 2021 it was higher in the second quarter than in the preceding years. In 2022 and 2023, the patterns were comparable to those of the years 2017 to 2019. The pattern of a social gradient, reflected in higher incidence in more deprived regions, was evident in all study years (Figure 2, eFigure 3).
Management of patients with newly diagnosed hypertension
In 2023, 82.3% [81.9; 826] of patients with newly diagnosed hypertension received an antihypertensive during their first year of treatment, with similar proportions in women (82.8% [82.4; 83.3]) and men (81.7% [81.3; 82.2]). The proportion of persons on medication rose significantly with more advanced age at diagnosis (Figure 3). The proportion of those on medication remained relatively constant between 2017 and 2019, ultimately rising somewhat in 2022 and 2023 (eTable 3). In regions with low socioeconomic deprivation, this proportion in 2023 (81.2% [80.5; 81.9]) differed little from that in regions with medium (82.7% [82.3; 83.1]) and high deprivation (82,1 % [81,3; 82,9]) (eTable 4).
In 2023, 30.1% [29.7; 30.5] underwent ABPM during the first treatment year. This proportion was similar in women and men and was significantly higher in persons of a younger age at diagnosis of hypertension than in those of a more advanced age (Figure 4). This proportion remained constant at 30% over time (eTable 5). The proportion was slightly lower in regions with low socioeconomic deprivation (26.6% [25.8; 27.4]) than in regions with medium (31.0% [30.5; 31.5]) and high deprivation (31.5% [30.5; 32.4]) (eTable 6).
Discussion
The present analysis of SHI data shows that, when extrapolated to the whole German population, over one million people are newly diagnosed with hypertension every year. Unknown and undiagnosed new cases are not recorded. Hypertension is more often diagnosed in persons living in socioeconomically deprived regions than in those in more wealthy regions. Only minor differences were observed between deprived and wealthy regions with respect to medication and ABPM. Between 2017 and 2023, the age-standardized incidence of diagnosed hypertension remained stable at a high level.
The present study shows that the decrease observed in an analysis by the Central Research Institute of Ambulatory Health Care in Germany (Zi) for the years 2013 to 2021 was not maintained (13). According to the Zi analysis, the incidence declined between 2013 and 2018 and then remained constant until 2021, which is supported by our results. However, the Zi analysis estimates the incidence to be higher in absolute terms, presumably because it applied a different case definition that required only one outpatient diagnosis (m1Q). The marked, but temporary, decline in administrative hypertension incidence in the first year of the COVID-19 pandemic is similarly observed in the Zi analysis (13) and in a study based on routine data from selected general practitioners’ offices (14), and was likely attributable to reduced health care utilization (15). Long-term trends show a decrease in hypertension prevalence over several decades in many high-income countries, including Germany (16). However, in clinical practice, hypertension diagnoses have not fallen accordingly but have risen (17) because the diagnostic rate for hypertension has gone up (18). The trends across the various risk factors appear to differ. While the prevalence of obesity increased significantly over the last two decades, the prevalence of smoking and of alcohol consumption fell during the same period (19, 20, 21).
The diagnostic rate may also have an impact on the assessment of age- and sex-related differences. Cohort studies on the incidence of hypertension based on health examination surveys from Germany (22, 23), Switzerland (24), and Portugal (25) agree with the present results by showing an age-related rise in incidence, with men initially demonstrating a higher incidence of hypertension than women. Cohort studies show that the incidence among women approaches that of men from mid-adulthood onward and exceeds it from the sixth and seventh decades of life (22, 23, 25, 26). This pattern is also reflected for the incidence of diagnosed hypertension in routine health insurance data from Canada (27) and the region of Catalonia in Spain (28), but not in our results, which only show a higher incidence for women than for men in the 80-years and over age group. This could indicate a lower likelihood of hypertension being diagnosed in elderly and very elderly women.
The present study showed higher incidence rates in more deprived regions. Studies on the association between hypertension incidence and regional deprivation are still scarce, and none are available for Germany. A Canadian study from Quebec reported various associations, depending on the manner of case identification: a consistent association was found for inpatient but not for outpatient cases (29). A United States cohort study discovered a higher risk of hypertension in more deprived neighborhoods of the city of Dallas, Texas, even after adjusting for indicators of individual socioeconomic status (30). A systematic review reports an association between higher deprivation and increased hypertension prevalence (31). This was also confirmed in routine AOK data for parts of northeastern Germany (32), but not in a study involving industrial cities of western Germany (33). Overall, the association between regional socioeconomic deprivation and incidence of hypertension appears plausible, given that important risk factors, like obesity, smoking, and physical inactivity, are more common in more deprived regions (33, 34), and this pattern is also evident in individual socioeconomic status characteristics in Germany (35). To what extent regional socioeconomic deprivation independently affects the risk of hypertension remains unclear and warrants further research, for example, by using statistical multilevel models that additionally control for individual socioeconomic characteristics, such as highest educational attainment, job status, and income. The proportion of persons with newly diagnosed hypertension and ABPM remained constant at around 30% from 2017 to 2023. The German National Disease Management Guideline on Hypertension refers to ABPM as the gold standard for non-invasive diagnostics but points out that it is not always available or may even be rejected by some patients (3). Hardly any data have been available to date on how often ABPM is actually applied in Germany. An analysis of routine data from eight primary care practices showed that the proportion of patients undergoing ABPM was significantly lower than in the present analysis, although large differences were evident between practices and a differing case definition of hypertension rendered comparison difficult (14).
The proportion of persons with newly diagnosed hypertension who received antihypertensive drugs during the first year after diagnosis remained constant at around 80% from 2017 to 2023. This proportion was comparable to an analysis of data from eight primary care practices (2016–2019: 67.8%; 2019–2020: 84.5% receiving medication in the first 18 months) (14) and a study based on claims data of two million people insured under SHI (79.3% receiving medication in the first year) (36). The latter study showed that the proportion of persons with newly diagnosed hypertension who were not on medication and were possibly initially advised first to change their lifestyle fell as the length of the condition progressed (36).
Strengths and limitations
The present analysis is based on data from approximately 4.8 million SHI-insured persons and allows differentiated analyses of temporal trends and regional differences, stratified by regional socioeconomic deprivation. The population of the InGef Research Database, comprising persons insured with more than 50 specific trade guild and company health insurance funds, is on average younger, lives more often in urban areas, and has a lower age-standardized morbidity in comparison with the general population (37). It is possible to reduce these deviations by drawing a sample whose composition reflects the age and sex distribution of the German population (7); nevertheless, a potential underestimation of hypertension incidence still cannot be ruled out.
The present results refer explicitly to diagnosed hypertension and do not allow any conclusions to be drawn about the total incidence of hypertension, which also includes unknown, undiagnosed hypertension. The length of the diagnosis-free pre-observation period affects the estimation of disease incidence (38). This was also reflected in our preliminary analyses (eTable 7). A more extended pre-observation period, however, shortens the reporting period and can produce selection effects. Other studies reliably depict trends over a pre-observation period of two years (39), which is why this duration was selected for the present study. The analysis of the association of socioeconomic deprivation and hypertension was conducted at a regional aggregate level (ecological study design). An ecological fallacy occurs when an association between two characteristics observed at the aggregate level is interpreted as applying at the individual level, even though it does not.
Conclusion
With the overall very limited data from primary studies on the incidence of hypertension, annual routine data on newly diagnosed hypertension in Germany appear to be of great interest for the surveillance of non-communicable diseases. Furthermore, our results on newly diagnosed cases before, during, and after the pandemic also show that changes in healthcare provision during crisis situations can be detected in a timely fashion. The downward trend in newly diagnosed cases of hypertension observed in the past decade has not continued over the past seven years. Our results need to be further investigated in a population-based nationwide survey with standardized blood pressure measurements in order to fully evaluate this development.
Funding
The analysis was conducted at the Robert Koch Institute as part of the National Diabetes Surveillance project and was financed with grants from the Federal Ministry of Health (grant numbers: 2522DIA700, 2523DIA002).
Acknowledgments
We would like to thank Raeleesha Norris at the Institute for Applied Health Research Berlin for her support with data analysis and quality assurance of the results.
Conflict of interest statement
The authors declare that no conflict of interest exists.
Manuscript received on April 24, 2025, revised version accepted on 30 September 2025
Translated from the original German by Dr. Grahame Larkin
Corresponding author:
Dr. med. Lukas Reitzle
reitzlel@rki.de
InGef – Institute for Applied Health Research Berlin: Dr. rer. nat. Dorota Pawlowska-Phelan, Dr. rer. nat. Marion Ludwig
German Center for Cardio-vascular Research [DZHK], Berlin site: PD Dr. med. Hannelore Neuhauser
| 1. | Zhou B, Perel P, Mensah GA, Ezzati M: Global epidemiology, health burden and effective interventions for elevated blood pressure and hypertension. Nat Rev Cardiol 2021; 18: 785–802 CrossRef MEDLINE PubMed Central |
| 2. | GBD 2021 Risk Factors Collaborators: Global burden and strength of evidence for 88 risk factors in 204 countries and 811 subnational locations, 1990–2021: A systematic analysis for the Global Burden of Disease Study 2021. Lancet 2024; 403: 2162–203 CrossRef MEDLINE |
| 3. | Bundesärztekammer (BÄK), Kassenärztliche Bundesvereinigung (KBV), Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF): S3-Leitlinie Nationale VersorgungsLeitlinie Hypertonie—Langfassung, Version 1.0. https://register.awmf.org/de/leitlinien/detail/nvl-009 (last accessed on 31 March 2025). |
| 4. | Zentralinstitut für die kassenärztliche Versorgung (Zi): Dashboard Häufige Chronische Krankheiten. www.versorgungsatlas.de/dashboard/#/evaluation/999 (last accessed on 10 September 2025). |
| 5. | Wissenschaftliches Institut der AOK (WIdO): Gesundheitsatlas Deutschland: Bluthochdruck. www.gesundheitsatlas-deutschland.de/erkrankung/arterielle_hypertonie (last accessed on 10 September 2025). |
| 6. | Trimarco V, Izzo R, Pacella D, et al.: Incidence of new-onset hypertension before, during, and after the COVID-19 pandemic: A 7-year longitudinal cohort study in a large population. BMC Med 2024; 22: 127 CrossRef MEDLINE PubMed Central |
| 7. | Ludwig M, Enders D, Basedow F, Walker J, Jacob J: Sampling strategy, characteristics and representativeness of the InGef research database. Public Health 2022; 206: 57–62 CrossRef MEDLINE |
| 8. | Michalski N, Reis M, Tetzlaff F, et al.: German Index of Socioeconomic Deprivation (GISD): Revision, update and applications. J Health Monit 2022; 7: 2–23. |
| 9. | Michalski N, Soliman LO, Reis M, Tetzlaff F, Nowossadeck E, Hoebel J: German Index of Socioeconomic Deprivation (GISD). Zenodo. https://doi.org/10.5281/zenodo.14781119 |
| 10. | Reitzle L, Heidemann C, Jacob J, Pawlowska-Phelan D, Ludwig M, Scheidt-Nave C: Incidence of type 1 and type 2 diabetes before and during the COVID-19 pandemic in Germany: Analysis of routine data from 2015 to 2021. J Health Monit 2023; 8: 2–25. |
| 11. | Statistisches Bundesamt (Destatis): Fortschreibung des Bevölkerungsstandes (EVAS-Nr. 12411): Bevölkerung zum Stichtag. www-genesis.destatis.de/datenbank/online/statistic/12411 (last accessed on 1 September 2025). |
| 12. | Reitzle L, Neuhauser H, Maier B, Ludwig M, Pawlowska-Phelan D: OSF preregistration: Incidence of hypertension before and during the COVID-19 pandemic: An observational analysis of routine data between 2017–2022. https://doi.org/10.17605/OSF.IO/ABFK4. |
| 13. | Holstige J DL, Kohring C, Heuer J, Akmatov MK, Bätzing J: Bundesweite Inzidenztrends diagnostizierter Herzerkrankungen in den Jahren 2013 bis 2021. Zentralinstitut für die kassenärztliche Versorgung in Deutschland (Zi). Versorgungsatlas-Bericht Nr. 23/01. Berlin 2023. https://doi.org/10.20364/VA-23.01. |
| 14. | Strumann C, Engler NJ, von Meissner WCG, Blickle PG, Steinhäuser J: Quality of care in patients with hypertension: A retrospective cohort study of primary care routine data in Germany. BMC Prim Care 2024; 25: 54 CrossRef MEDLINE PubMed Central |
| 15. | Mangiapane S, Kretschmann J, Czihal T, von Stillfried D: Veränderung der vertragsärztlichen Leistungsinanspruchnahme während der COVID-Krise: Tabellarischer Trendreport bis zum Ende des Jahres 2021. www.zi.de/fileadmin/Downloads/Service/Publikationen/Zi-TrendReport_2021-Q4_2022-06-10.pdf (last accessed on 31 March 2025). |
| 16. | NCD Risk Factor Collaboration (NCD-RisC): Worldwide trends in blood pressure from 1975 to 2015: A pooled analysis of 1479 population-based measurement studies with 19.1 million participants. Lancet 2017; 389: 37–55 CrossRef MEDLINE PubMed Central |
| 17. | Holstige J AM, Steffen A, Bätzing J: Diagnoseprävalenz der Hypertonie in der vertragsärztlichen Versorgung—aktuelle deutschlandweite Kennzahlen. Zentralinstitut für die kassenärztliche Versorgung in Deutschland (Zi). Versorgungsatlas-Bericht Nr. 20/01. Berlin 2020. https://doi.org/10.20364/VA-20.01 (last accessed on 31 March 2025). |
| 18. | Neuhauser H, Diederichs C, Boeing H, et al.: Hypertension in Germany—data from seven population-based epidemiological studies (1994–2012). Dtsch Arztebl Int 2016; 113: 809–15 CrossRef MEDLINE PubMed Central VOLLTEXT |
| 19. | Starker A, Schienkiewitz A, Damerow S, Kuhnert R: Prevalence of obesity and smoking among adults in Germany—trends from 2003 to 2023. J Health Monit 2025; 10: e13038. |
| 20. | Kraus L, Möckl J, Lochbühler K, Rauschert C, Seitz NN, Olderbak S: Changes in the use of tobacco, alternative tobacco products, and tobacco alternatives in Germany. Dtsch Arztebl Int 2022; 119: 535–41 CrossRef VOLLTEXT |
| 21. | Möckl J, Rauschert C, Wilms N, Vetter B, Kraus L, Olderbak S: Kurzbericht Epidemiologischer Suchtsurvey 2021. Tabellenband: Trends der Prävalenz des (problematischen) Alkoholkonsums und episodischen Rauschtrinkens nach Geschlecht und Alter 1995–2021. www.esa-survey.de/fileadmin/user_upload/Literatur/Berichte/ESA_2021_Trends_Alkohol.pdf (last accessed on 14 July 2025). |
| 22. | Diederichs C, Neuhauser H: The incidence of hypertension and its risk factors in the German adult population: Results from the German National Health Interview and Examination Survey 1998 and the German Health Interview and Examination Survey for Adults 2008–2011. J Hypertens 2017; 35: 250–8 CrossRef MEDLINE |
| 23. | Lacruz ME, Kluttig A, Hartwig S, et al.: Prevalence and incidence of hypertension in the general adult population: Results of the CARLA-Cohort Study. Medicine (Baltimore) 2015; 94: e952 CrossRef MEDLINE PubMed Central |
| 24. | Fidalgo ASQ, Vollenweider P, Marques-Vidal P: Ten-year incidence of hypertension in a Swiss population-based sample incidence of hypertension in Switzerland. J Hum Hypertens 2019; 33: 115–22 CrossRef MEDLINE |
| 25. | Pereira M, Lunet N, Paulo C, Severo M, Azevedo A, Barros H: Incidence of hypertension in a prospective cohort study of adults from Porto, Portugal. BMC Cardiovasc Disord 2012; 12: 114 CrossRef MEDLINE PubMed Central |
| 26. | Dannenberg AL, Garrison RJ, Kannel WB: Incidence of hypertension in the Framingham Study. Am J Public Health 1988; 78: 676–9 CrossRef MEDLINE PubMed Central |
| 27. | Robitaille C, Dai S, Waters C, et al.: Diagnosed hypertension in Canada: Incidence, prevalence and associated mortality. CMAJ 2012; 184: E49–56 CrossRef MEDLINE PubMed Central |
| 28. | Bennett M, Pistillo A, Recalde M, Reyes C, Freisling H, Duarte-Salles T: Time trends in the incidence of cardiovascular disease, hypertension and diabetes by sex and socioeconomic status in Catalonia, Spain: A population-based cohort study. BMJ Open 2023; 13: e066404 CrossRef MEDLINE PubMed Central |
| 29. | Aubé-Maurice J, Rochette L, Blais C: Divergent associations between incident hypertension and deprivation based on different sources of case identification. Chronic Dis Inj Can 2012; 32: 121–30 CrossRef |
| 30. | Claudel SE, Adu-Brimpong J, Banks A, et al.: Association between neighborhood-level socioeconomic deprivation and incident hypertension: A longitudinal analysis of data from the Dallas heart study. Am Heart J 2018; 204: 109–18 CrossRef MEDLINE PubMed Central |
| 31. | Satapathy P, Khatib MN, Gaidhane S, et al.: Association of neighborhood deprivation and hypertension: A systematic review and meta-analysis. Curr Probl Cardiol 2024; 49: 102438 CrossRef MEDLINE |
| 32. | Kauhl B, Maier W, Schweikart J, Keste A, Moskwyn M: Exploring the small-scale spatial distribution of hypertension and its association to area deprivation based on health insurance claims in northeastern Germany. BMC Public Health 2018; 18: 121 CrossRef MEDLINE PubMed Central |
| 33. | Dragano N, Bobak M, Wege N, et al.: Neighbourhood socioeconomic status and cardiovascular risk factors: A multilevel analysis of nine cities in the Czech Republic and Germany. BMC Public Health 2007; 7: 255 CrossRef MEDLINE PubMed Central |
| 34. | Grundmann N, Mielck A, Siegel M, Maier W: Area deprivation and the prevalence of type 2 diabetes and obesity: Analysis at the municipality level in Germany. BMC Public Health 2014; 14: 1264 CrossRef MEDLINE PubMed Central |
| 35. | Lampert T: Smoking, physical inactivity, and obesity: Associations with social status. Dtsch Arztebl Int 2010; 107: 1–7 CrossRef VOLLTEXT |
| 36. | Beger C, Unger T, Haller H, Limbourg FP: Antihypertensive prescription patterns and cardiovascular risk in patients with newly diagnosed hypertension—an Analysis of statutory health insurance data in Germany. Blood Press 2020; 29: 357–61 CrossRef MEDLINE |
| 37. | Andersohn F, Walker J: Characteristics and external validity of the German Health Risk Institute (HRI) Database. Pharmacoepidemiol Drug Saf 2016; 25: 106–9 CrossRef MEDLINE |
| 38. | Abbas S, Ihle P, Köster I, Schubert I: Estimation of disease incidence in claims data dependent on the length of follow-up: A methodological approach. Health Serv Res 2012; 47: 746–55 CrossRef MEDLINE PubMed Central |
| 39. | Grobe TG, Frerk T, Vogelgesang F, Reitzle L, Jacobi F, Thom J: Schätzungen von Inzidenzen psychischer Störungen in GKV-Routinedaten: Methoden und Trends 2006 bis 2022. Bundesgesundheitsbl 2025. https://doi.org/10.1007/s00103-025-04080- CrossRef MEDLINE PubMed Central |
| e1. | Deutsche Gesellschaft für Epidemiologie (DGEpi): Leitlinien und Empfehlungen zur Sicherung von Guter Epidemiologischer Praxis (GEP). www.dgepi.de/assets/Leitlinien-und-Empfehlungen/Leitlinien_fuer_Gute_Epidemiologische_Praxis_GEP_vom_September_2018.pdf (last accessed on 31 March 2025). |
| e2. | Swart E, Gothe H, Geyer S, et al.: Gute Praxis Sekundärdatenanalyse (GPS): Leitlinien und Empfehlungen. Gesundheitswesen 2015; 77: 120–6 CrossRef MEDLINE |
