Regional differences in medical needs and care for skin cancer across Bavaria: confronting the gap

Abstract

Background

The management of keratinocyte carcinoma (KC) and actinic keratosis (AK) as well as the number of dermatologists differ across the Bavarian counties in Germany.

Objectives

To determine regions with low utilization rates of dermatological care and a high medical need due to AK and KC burden.

Materials and Methods

A cross-sectional study of 2,483 people was carried out during the Munich Oktoberfest in September 2016. Participants from urban, semi-urban and rural areas completed a questionnaire and received a medical examination on site by dermatologists.

Results

The rate of previous skin cancer screening and previous treatment by dermatologists ranged from 18.8% to 58.6% and from 34.3% to 75.4% for all regions, respectively. Over 60% of people living in the environs or rural areas would consult a dermatologist first if they found a visible skin condition. Thus, people living in urban areas were twice as likely as people living in rural areas to consult a dermatologist first (odds ratio = 2.16; 95% CI: 1.38–3.39). Comparing the three different locations, dermatologists detected the highest AK burden among people living in rural areas (27.3% of the participants) and the highest KC burden among people living in urban areas (3.4% of the participants).

Conclusion

In rural areas, a high AK burden coupled with a low utilization rate of dermatological care was observed. To effectively address these problems, a broader implementation of alternative medical resources, such as teledermatology, might improve access to health care.

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References

  1. 1.

    Madan V, Lear JT, Szeimies R-M. Non-melanoma skin cancer. Lancet 2010; 375: 673–85.

    CAS  Article  Google Scholar 

  2. 2.

    Nehal KS, Bichakjian CK. Update on keratinocyte carcinomas. N Engl J Med 2018; 379: 363–74.

    CAS  Article  Google Scholar 

  3. 3.

    Xiang F, Lucas R, Hales S, Neale R. Incidence of nonmelanoma skin cancer in relation to ambient UV radiation in white populations, 1978–2012: empirical relationships. JAMA Dermatol 2014; 150: 1063–71.

    Article  Google Scholar 

  4. 4.

    Zink A. Trends in the treatment and prevention of keratinocyte carcinoma (non-melanoma skin cancer). Curr Opin Pharmacol 2019; 46: 19–23.

    CAS  Article  Google Scholar 

  5. 5.

    Augustin J, Kis A, Sorbe C, Schäfer I, Augustin M. Epidemiology of skin cancer in the German population: impact of socioeconomic and geographic factors. J Eur Acad Dermatol Venereol 2018; 32: 1906–13.

    CAS  Article  Google Scholar 

  6. 6.

    Eder J, Prillinger K, Korn A, Geroldinger A, Trautinger F. Prevalence of actinic keratosis among dermatology outpatients in Austria. Br J Dermatol 2014; 171: 1415–21.

    CAS  Article  Google Scholar 

  7. 7.

    Schäfer I, Mohr P, Zander N, Fölster-Holst R, Augustin M. Association of atopy and tentative diagnosis of skin cancer — results from occupational skin cancer screenings. J Eur Acad Dermatol Venereol 2017; 31: 2083–7.

    Article  Google Scholar 

  8. 8.

    Stockfleth E. The importance of treating the field in actinic keratosis. J Eur Acad Dermatol Venereol 2017; 31: 8–11.

    Article  Google Scholar 

  9. 9.

    Hommel T, Szeimies R-M. Actinic keratoses. Hautarzt 2016; 67: 867–75.

    CAS  Article  Google Scholar 

  10. 10.

    Schmitt J, Seidler A, Diepgen TL, Bauer A. Occupational ultraviolet light exposure increases the risk for the development of cutaneous squamous cell carcinoma: a systematic review and meta-analysis. Br J Dermatol 2011; 164: 291–307.

    CAS  Article  Google Scholar 

  11. 11.

    Diepgen TL. New developments in occupational dermatology. J Dtsch Dermatol Ges 2016; 14: 875–89.

    PubMed  Google Scholar 

  12. 12.

    Zink A, Tizek L, Schielein MC, Böhner A, Biedermann T, Wildner M. Different outdoor professions have different risks — a cross-sectional study comparing non-melanoma skin cancer risk among farmers, gardeners and mountain guides. J Eur Acad Dermatol Venereol 2018; 32: 1695–701.

    CAS  Article  Google Scholar 

  13. 13.

    Zink A, Hänsel I, Rotter M, Spinner CD, Böhner A, Biedermann T. Impact of gliding on the prevalence of keratinocyte carcinoma and its precursors: a cross-sectional study among male pilots in Bavaria. Acta Derm Venereol 2017; 97: 393–4.

    Article  Google Scholar 

  14. 14.

    Kornek T, Augustin M. Skin cancer prevention. J Dtsch Dermatol Ges 2013; 11: 283–96.

    PubMed  Google Scholar 

  15. 15.

    Ziehfreund S, Schuster B, Zink A. Primary prevention of keratinocyte carcinoma among outdoor workers, the general population and medical professionals: a systematic review updated for 2019. J Eur Acad Dermatol Venereol 2019; 33: 1477–95.

    CAS  Article  Google Scholar 

  16. 16.

    Zink A, Thomé F, Schielein MC, Spinner CD, Biedermann T, Tizek L. Primary and secondary prevention of skin cancer in mountain guides: attitude and motivation for or against participation. J Eur Acad Dermatol Venereol 2018; 32: 2153–61.

    CAS  Article  Google Scholar 

  17. 17.

    Tizek L, Krause J, Biedermann T, Zink A. Satisfaction of mountain guides with high sun protection as a tool to prevent non-melanoma skin cancer. J Eur Acad Dermatol Venereol 2017; 31: 1825–7.

    CAS  Article  Google Scholar 

  18. 18.

    Zink A, Wurstbauer D, Rotter M, Wildner M, Biedermann T. Do outdoor workers know their risk of NMSC? Perceptions, beliefs and preventive behaviour among farmers, roofers and gardeners. J Eur Acad Dermatol Venereol 2017; 31: 1649–54.

    CAS  Article  Google Scholar 

  19. 19.

    Grandahl K, Ibler KS, Laier GH, Mortensen OS. Skin cancer risk perception and sun protection behavior at work, at leisure, and on sun holidays: a survey for Danish outdoor and indoor workers. Environ Health Prev Med 2018; 23: 47.

    Article  Google Scholar 

  20. 20.

    Hansen H, Pohontsch NJ, Bole L, Schäfer I, Scherer M. Regional variations of perceived problems in ambulatory care from the perspective of general practitioners and their patients — an exploratory focus group study in urban and rural regions of northern Germany. BMC Fam Pract 2017; 18: 68.

    CAS  Article  Google Scholar 

  21. 21.

    Augustin J, Erasmi S, Reusch M, Augustin M. Methods of analyzing regional dermatological care as exemplified by the city of Hamburg. J Dtsch Dermatol Ges 2015; 13: 661–73.

    PubMed  Google Scholar 

  22. 22.

    Koller D, Eisele M, Kaduszkiewicz H, et al. Ambulatory health services utilization in patients with dementia — Is there an urban-rural difference? Int J Health Geogr 2010; 9: 59.

    Article  Google Scholar 

  23. 23.

    Boehmer D, Schuster B, Krause J, Darsow U, Biedermann T, Zink A. Prevalence and treatment of allergies in rural areas of Bavaria, Germany: a cross-sectional study. World Allergy Organ J 2018; 11: 36.

    Article  Google Scholar 

  24. 24.

    Schielein MC, Tizek L, Rotter M, Konstantinow A, Biedermann T, Zink A. Guideline-compliant prescription of biologicals and possible barriers in dermatological practices in Bavaria. J Eur Acad Dermatol Venereol 2018; 32: 978–84.

    CAS  Article  Google Scholar 

  25. 25.

    Tille F, Gibis B, Balke K, Kuhlmey A, Schnitzer S. Sociodemographic and health-related determinants of health care utilisation and access to primary and specialist care: results of a nationwide population survey in Germany (2006–2016). Z Evid Fortbild Qual Gesundhwes 2017; 126: 52–65.

    Article  Google Scholar 

  26. 26.

    Kassenärztliche Vereinigung Bayerns. Versorgungsatlas Hautärzte: Darstellung der regionalen Versorgungssituation sowie der Altersstruktur in Bayern 2018. Available at: https://www.kvb.de/fileadmin/kvb/dokumente/UeberUns/Versorgung/KVB-Versorgungsatlas_Hautaerzte.pdf (accessed 12 Dec 2018).

  27. 27.

    Schäfer I, Augustin M, Krensel M, Augustin J. Real world data sources for health services research on skin cancer. Hautarzt 2019; 70: 29–35.

    Article  Google Scholar 

  28. 28.

    Leiter U, Keim U, Eigentler T, et al. Incidence, mortality, and trends of nonmelanoma skin cancer in Germany. J Invest Dermatol 2017; 137: 1860–7.

    CAS  Article  Google Scholar 

  29. 29.

    Tizek L, Schielein MC, Seifert F, Biedermann T, Böhner A, Zink A. Skin diseases are more common than we think: screening results of an unreferred population at the Munich Oktoberfest. J Eur Acad Dermatol Venereol 2019; 33: 1421–8.

    CAS  Article  Google Scholar 

  30. 30.

    Tizek L, Schielein MC, Spinner CD, et al. New perspectives on health prevention. Prevalence of hypertension, hypacusis and balance disorders at the Munich Oktoberfest 2016. MMW Fortschr Med 2019; 161: 9–14.

    Article  Google Scholar 

  31. 31.

    Federal Institute for Research on Building, Urban Affairs and Spatial Development. Siedlungsstrukturelle Kreistypen — Laufende Raumbeobachtung — Raumabgrenzungen 2018. Available at: http://www.bbsr.bund.de/cln_032/nn_1067638/BBSR/DE/Raumbeobachtung/Raumabgrenzungen/Kreistypen4/kreistypen.html (accessed 06 Mar 2018).

  32. 32.

    Kis A, Augustin M, Augustin J. Regional healthcare delivery and demographic change in Germany — scenarios for dermatological care in 2035. J Dtsch Dermatol Ges 2017; 15: 1199–209.

    PubMed  Google Scholar 

  33. 33.

    Federal Agency for Cartography and Geodesy. Administrative areas. Available at: http://www.geodatenzentrum.de/geodaten/gdz_rahmen.gdz_div?gdz_spr=deu&gdz_akt_zeile=5&gdz_anz_zeile=1&gdz_unt_zeile=0&gdz_user_id=0 (accessed 07 Jul 2018).

  34. 34.

    Eissing L, Schäfer I, Strömer K, et al. Perception of statutory skin cancer screening in the general population: current findings on participation, knowledge and evaluation. Hautarzt 2017; 68: 371–6.

    CAS  Article  Google Scholar 

  35. 35.

    Tizek L, Schielein MC, Rüth M, et al. Interest in skin cancer in urban populations: a retrospective analysis of Google search terms in nine large German cities. Acta Derm Venereol 2019; 99: 797–804.

    Article  Google Scholar 

  36. 36.

    Schuster B, Ziehfreund S, Tizek L, Krause J, Biedermann T, Zink A. Is the Bavarian population open for teledermatology? Across-sectional study in rural and urban regions of Bavaria, Germany. Gesundheitswesen 2019. PMID: 31529446 [Epub ahead of print].

  37. 37.

    Statisitche Ämter des Bundes und der Länder. Regionaldatenbank Deutschland 2019. Available at: https://www.regionalstatistik.de/genesis/online/data;sid=76B5D8A3A4F6A5D29D8101735542F7F8.reg1?operation=abruftabelleBearbeiten&levelindex=2&levelid=1568900863868&auswahloperation=abruftabelleAuspraegung-Auswaehlen&auswahlverzeichnis=ordnungsstruktur&auswahlziel=werteabruf&selectionname=12411-07-01-4&auswahltext=&werte-abruf=Werte-abruf (accessed 23 Sep 2019).

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Correspondence to Alexander Zink.

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Disclosure

Financial support: This work was supported by unrestricted research grants from Beiersdorf Dermo Medical GmbH and Novartis Pharma GmbH. Conflicts of interests: none.

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Tizek, L., Schielein, M.C., Berger, U. et al. Regional differences in medical needs and care for skin cancer across Bavaria: confronting the gap. Eur J Dermatol 30, 119–126 (2020). https://doi.org/10.1684/ejd.2020.3752

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Key words

  • keratinocyte carcinoma
  • actinic keratosis
  • dermatologists
  • Bavaria
  • Germany
  • care
  • burden
  • urban
  • rural