{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T19:27:52Z","timestamp":1772825272595,"version":"3.50.1"},"reference-count":41,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,9,28]],"date-time":"2021-09-28T00:00:00Z","timestamp":1632787200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,9,28]],"date-time":"2021-09-28T00:00:00Z","timestamp":1632787200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Public Health"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Research has shown that the risk for a severe course of COVID-19 is increased in the elderly population and among patients with chronic conditions. The aim of this study was to provide estimates of the size of vulnerable populations at high risk for a severe COVID-19 course in Germany based on the currently available risk factor data.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>We used nationwide outpatient claims data from the years 2010 to 2019 collected according to \u00a7 295 of the Code of Social Law V, covering data for all statutory health insurees (SHI) which is nearly 87% of the entire German population. We considered 15 chronic disorders based on the current state of knowledge about clinically relevant risk factors. Three risk groups for a severe COVID-19 course were defined: 1. individuals in the age group 15 to 59\u2009years with at least two comorbid disorders; 2. individuals aged 60 to 79\u2009years with at least one disorder and 3. all individuals 80\u2009years and older irrespective of the presence of chronic conditions. Regional analysis was conducted at the level of administrative districts (<jats:italic>n<\/jats:italic>\u2009=\u2009401).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Overall, 26% of individuals over 15\u2009years were at high risk for a severe COVID-19 course in 2019 amounting to a total number of nearly 18.5 million individuals in Germany. This included 3.8 million individuals in risk group 1, 9.2 million in risk group 2, and 5.4 million in risk group 3, corresponding to 8, 50 and 100% of German inhabitants in the respective age groups. On the level of the 17 administrative regions formed by the Association of SHI Physicians (ASHIP regions), the proportion of individuals at high risk ranged between 21% in Hamburg and 35% in Saxony-Anhalt. Small-area estimates varied between 18% in Freiburg (Baden-W\u00fcrttemberg) and 39% in the district Elbe-Elster (Brandenburg).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>The present study provides small-area estimates of populations at high risk for a severe COVID-19 course. These data are of particular importance for planning of preventive measures such as vaccination.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Trial registration<\/jats:title>\n                <jats:p>not applicable.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12889-021-11735-3","type":"journal-article","created":{"date-parts":[[2021,9,28]],"date-time":"2021-09-28T18:04:18Z","timestamp":1632852258000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Patients at high risk for a severe clinical course of COVID-19 \u2014 small-area data in support of vaccination and other population-based interventions in Germany"],"prefix":"10.1186","volume":"21","author":[{"given":"Jakob","family":"Holstiege","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Manas K.","family":"Akmatov","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Claudia","family":"Kohring","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lotte","family":"Dammertz","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Frank","family":"Ng","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas","family":"Czihal","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dominik","family":"von Stillfried","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J\u00f6rg","family":"B\u00e4tzing","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2021,9,28]]},"reference":[{"issue":"1","key":"11735_CR1","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1186\/s13690-020-00433-y","volume":"78","author":"GMA Wyper","year":"2020","unstructured":"Wyper GMA, Assuncao R, Cuschieri S, Devleeschauwer B, Fletcher E, Haagsma JA, et al. 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An ethical approval and informed consent are not required as this study used routinely collected anonymized data. Owner of the physicians claims data used in this study are the 17 regional Associations of Statutory Health Insurance Physicians (ASHIPs) in Germany according to \u00a7 295 of the SGB V. The Central Research Institute of Ambulatory Health Care (Zi) in Germany is a not-for-profit foundation under civil law created in 1973 by the 17 ASHIPs and the National Association of SHI-Physicians (KBV). Zi is financed by the 17 regional ASHIPs and conducts research on their behalf. The 17 ASHIPs have given their permission to use the claims data for the present study.The research was conducted in accordance with the Helsinki Declaration (in its current revised form: 64th WMA General Assembly, Fortaleza, Brazil, October 2013).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors reported no financial interests or potential conflicts of interest related to this study.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"1769"}}