Degenerative Schultererkrankungen und Schulterverletzungen: Epidemiologie, ICD10-Codierverhalten und Versorgungsrealität – Datenanalyse von 4,9 Mio. Versicherten der AOK Baden-Württemberg

Despite the increasing number of cases in recent years, there are currently no data available on the disease and care situation for degenerative shoulder diseases and shoulder injuries, as well as on the ICD-10 coding behaviour of the treating physicians. This paper presents, for the first time, a descriptive analysis based on billing data from 2022 of coded shoulder diseases affecting 4.9 million insured individuals of a statutory health insurance in Baden-Württemberg. The study distinguishes between accident-related shoulder injuries and diseases caused by degenerative changes in the shoulder. In ICD-10 coding, a distinction is made between specific codes (using key numbers of the underlying disease) and non-specific codes that only encode the symptom. According to billing data, women were slightly more affected by shoulder diseases than men (7.3% vs. 6.9%), with women being significantly older on average at the time of diagnosis. For fractures, the gender difference averaged 20 years. The analysis of coding behaviour revealed that general practitioners coded non-specific shoulder diseases, such as joint pain or impingement syndrome, more frequently than other specialist groups. The analysis of the claiming of benefits showed that only one-third of the evaluated patients received imaging, and only 40% received a prescription for physiotherapy due to a shoulder diagnosis. The investigation of comorbidities found that patients with degenerative shoulder diseases were more frequently affected by metabolic diseases and hypertension than those without shoulder diseases. These results regarding the frequency of coded shoulder diseases in various health sectors demonstrate their importance in the Federal Republic of Germany for both men and women. In summary, the evaluations—despite methodological limitations—suggest that there may be potential for more specific coding in the diagnosis and prescription of therapeutic measures. A more precise understanding of the actual cause of claiming health services can be helpful for the provider to initiate specific diagnostic and therapeutic measures and identify a potentially increased need for care within the health system in the Federal Republic of Germany.