Incidence of arterial hypertension in Germany 2009–2018 based on prevalence data from 70 million patients from the statutory health insurance

Abstract Background Hypertension is an important risk factor for cardiovascular diseases, morbidity and mortality. In Germany, elevated systolic blood pressure is associated with more than half of all cardiovascular deaths. Despite the importance of arterial hypertension, comprehensive incidence data in Germany are very limited, and no data on the mortality rate ratio (MRR) of hypertension have been reported. Our study is the first to provide estimates for all statutory health insurance members in Germany. The aim of this study was to determine the age-specific incidence of hypertension in men and women in Germany for the first time using this large prevalence dataset. Methods We estimated the incidence of arterial hypertension from 2009 to 2018 using the Illness-death model (IDM) and a partial differential equation (PDE) based on aggregated prevalence and mortality data. The dataset used comprised age- and sex-specific prevalence data from the Central Institute for Statutory Health Insurance (Zi) with about 70 million insured individuals, as well as mortality data from the Human Mortality Database. To obtain the parameters needed for calculating age- and sex-specific incidence curves, we repeatedly re-sampled the data (1,000 times; bootstrapping) and estimated these parameters in each run. This procedure ensured that the parameters - which form the basis of the incidence estimation - were stable and reliable, and it allowed us to quantify statistical uncertainty. Incidence rates for men and women were reported as median values with 95% confidence intervals. Results At every age, men showed higher incidence rates than women. The maximum incidence (median of 1,000 bootstrap samples) was 763.34 per 10,000 person-years (95%-CI: 761.00-765.71) for men and 634.73 (95%-CI: 633.01-636.61) per 10,000 person-years for women in the middle of the 85–89 age interval. Conclusion This study provides the first nationwide incidence estimates of arterial hypertension in Germany based on highly aggregated health data. The findings confirm higher incidence rates in men than in women across all ages.