GSB 7.1 Standardlösung

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Ambulatory care-sensitive hospitalisations

Complications related to diabetes and its management including hypo- or hyperglycaemia can require hospital treatment. This indicator has been established on an international level and is published by OECD statistics every two years as part of an international comparison of the quality of ambulatory care (OECD, 2017). Following OECD guidelines, only hospitalisations with diabetes as the main diagnosis are considered. While inpatient hospitalisations with diabetes as a secondary diagnosis are not taken into account, these make up a large number of hospitalisations due to the fact that diabetes prevalence increases with age (Lehmann et al., 2019).

Key messages

  • In 2020, in the context of the COVID-19 pandemic, a sharp decline in ambulatory care-sensitive hospitalisations due to diabetes is evident.
  • The rate of ambulatory care-sensitive hospitalisations is particularly high in the federal states with high diabetes prevalence and regions with high socioeconomic deprivation.

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By state


  • By gender


  • By age


  • By regional socioeconomical deprivation



Between 2015 and 2019, rates of hospitalisation with diabetes as the main diagnosis per 100,000 residents is relatively constant with a slight decrease. Subsequently, the rate drops sharply from 248 per 100,000 residents in 2019 to 207 in 2020. For women, the rate drops from 193 to 155 and for men from 305 to 261 per 100,000 residents. The decline is also evident in all federal states. Rates in Mecklenburg-Western Pomerania and Saxony-Anhalt were significantly higher (274 and 243 for women; 438 and 404 for men per 100,000 residents) than in Schleswig-Holstein (women: 122; men: 223) and Hamburg (women: 96.8; men: 200). For both men and women, the highest rates of ambulatory care-sensitive hospitalisations due to diabetes are found in regions with the highest socioeconomic deprivation.


Between 2015 and 2019, the rate of ambulatory care-sensitive hospitalisations due to the indication diabetes decreases slightly. In 2020, there is a sharp decline, which must be interpreted in the context of the COVID-19 pandemic. An analysis by the Leibniz Institute for Economic Research (RWI) shows a sharp decline in all outpatient-sensitive hospital cases - also due to diabetes - from the beginning of the pandemic in March 2020 ("Leistungsgeschehen von Krankenhäusern in der Corona-Krise" in German only). By the middle of the year, hospital cases are increasing again, but remain below the previous year's level. Overall, women show significantly lower rates compared to men. The regional results show the highest rates for ambulatory care-sensitive hospital cases in the federal states with already high prevalence of diabetes (fact sheet “Prevalence of documented diabetes”). Regions with high socioeconomic deprivation are also associated with higher diabetes prevalence (Grundmann et al. 2014), which contributes to the higher rates of ambulatory care-sensitive hospital cases in these regions. The present analysis does not include rates of hospitalisation for patients with diabetes as a secondary diagnosis.

Show more information on methodology and data sources


The indicator Ambulatory care-sensitive hospitalisations is defined as the number of inpatient cases with diabetes as the main diagnosis (E10.-/E11.-/E13.-/E14.-) per 100,000 residents (aged 15 years and over) per year.

Reference population

All hospital cases that are billed in accordance with the DRG remuneration system.

Data source

Diagnosis-related groups statistics (DRG statistics) that include all approximately 19 million inpatient cases per year in Germany.


  • Observed values: The number of hospitalisations in relation to 100,000 residents.
  • Age standardisation: Direct age standardisation used five-year age groups for the ages 15 to 19 until 80-84, and a separate group for the ages 85 and over. The resident population of Germany as of 31 December 2020 was used as the reference population.
  • Stratification: The stratification by federal state is based on place of residence. Stratification by regional socioeconomic deprivation is based on the German Index of Socioeconomic Deprivation (GISD, Revision 2020) (Kroll et al. 2017). The index provides information on all rural and urban districts and divides them into quintiles ranging from lowest to highest socioeconomic deprivation. The hospitalisation rate was calculated stratified for each quintile after linkage of the GISD with hospitalisations at the district level (ecological correlation).

Data quality

Diagnosis-related Groups (DRG) statistics contain information on all hospitalisations in Germany. They include main and secondary diagnoses, operations and other procedures, as well as information on patients’ age, sex and place of residence. The data are documented on a case by case basis, which means that a person hospitalised more than once will be classified as several cases. Data quality depends on coding practices and other aspects of documentation.