[Impact of the SARS-CoV-2 Pandemic on the Utilization of Cancer Rehabilitation: a Difference-in-Differences Analysis]. / Auswirkungen der SARS-CoV-2-Pandemie auf die Inanspruchnahme der onkologischen Rehabilitation: eine Difference-in-Differences-Analyse.

PURPOSE: Restricted access to rehabilitative care due to the SARS-CoV-2 pandemic may affect the participation of cancer survivors and risks progression of the underlying disease. The aim of our analyses was to examined the extent to which cancer rehabilitations in Germany decreased due to the SARS-CoV-2 pandemic. METHODS: Data were retrieved from the German Pension Insurance which is the main provider for medical rehabilitation in Germany. We used monthly cross-sectional data on the utilization of cancer rehabilitation (Ca-rehab-services according to section 15 for working-aged people or section 31 social security code VI for pensioners) in 2019 and 2020. We used a difference-in-differences model to determine the reduction in rehabilitation utilization attributable to the pandemic and reported incidence rate ratios (IRR). RESULTS: We included 146,924 cancer rehabilitations in 2019 and 113,117 cancer rehabilitations in 2020. Compared to the previous year, the nationwide decline in cancer rehabilitations was greatest in April 2020 (63.2%). Utilization of cancer rehabilitation was reduced by 11.5% for benefits according to section 15 social security code VI (IRR=0.885; 95% CI: 0.864 to 0.906) and by 26.5% for benefits according to section 31 (IRR=0.735; 95% CI: 0.717 to 0.754) due to the pandemic. For pensioners the decline in utilization was more pronounced in Western Germany than in Eastern Germany and greater for non-post-acute rehabilitations than for post-acute rehabilitations. CONCLUSION: The analyses show a pandemic-related decline in cancer rehabilitations, especially in cancer rehabilitation services for pensioners. Failure to seek medical rehabilitation, through which physical and psychological recovery and relief from disease and treatment side effects can be achieved, will have a lasting impact on the participation for many cancer survivors. Repeated monitoring of work ability and health of chronically ill people could generate necessary data to clarify why people in need of rehabilitation have avoided seeking medical rehabilitation and how they can be supported.

Utilisation of rehabilitation due to mental disorders during the SARS-CoV-2 pandemic: a difference-in-differences analysis.

BACKGROUND: Our analyses examined the extent to which the use of rehabilitation for patients with mental disorders decreased due to the COVID-19 pandemic in Germany. METHODS: We used monthly cross-sectional administrative data on rehabilitation utilisation due to mental disorders in 2019 and 2020 and estimated a difference-in-differences model to determine the reduction in rehabilitation utilisation attributable to the pandemic. RESULTS: We included 151,775 rehabilitations in 2019 and 123,229 rehabilitations in 2020 in our analysis. The number of rehabilitations decreased from April to December by 14.2% due to the pandemic (March to December: 21.8%). The decline was more pronounced for women than for men and varied regionally. Temporal and regional differences in utilisation were moderately associated with the decrease in mobility in the pandemic year. In the first phase of the pandemic, i.e., March and April 2020, the decline was strongly associated with the regional incidence of SARS-CoV-2 infection. CONCLUSION: Due to the pandemic, significantly fewer rehabilitations due to mental disorders occurred in Germany in 2020 than in 2019. The likely increasing need for rehabilitation for people with mental disorders should be addressed by making rehabilitation access and delivery more flexible.

Unemployment due to the SARS-CoV-2-pandemic among people with and without severe disabilities: a difference-in-differences analysis.

OBJECTIVES: Unemployment reduces health and impairs participation in important areas of life, especially for people with severe disabilities, who tend to have a longer duration of unemployment and are less likely to find new employment than their counterparts without such constraints. Our analysis examines the increase in unemployment due to the SARS-CoV-2 pandemic among people with and without severe disabilities in Germany. METHODS: Monthly cross-sectional data on unemployment for 2019 and 2020 were provided by the Federal Employment Agency. We used a difference-in-differences model to estimate the increase in unemployment attributable to the pandemic. The months April to December 2020 represented the months of exposure to the pandemic. Incidence rate ratios (IRRs) are reported. RESULTS: The increase in unemployment among people with severe disabilities due to the pandemic is 11.2% (IRR 1.112; 95% CI 1.107 to 1.117). People with severe disabilities receiving unemployment benefits due to unemployment lasting less than a year (Social Code III: short-term unemployment) and women have been most affected. Among people without severe disabilities, unemployment has increased by 24.8% due to the pandemic (IRR 1.248; 95% CI 1.246 to 1.249), while people receiving unemployment benefits according to social code III and men have been most affected. Both groups show a varying increase in unemployment depending on the region of residency. CONCLUSIONS: The findings show a particularly significant increase in unemployment among people without severe disabilities. People with severe disabilities might be less impacted due to the special legal protection against their dismissal. The clear regional differences in the increase in unemployment suggest a strong influence of regional economics.

Reduced Requests for Medical Rehabilitation Because of the SARS-CoV-2 Pandemic: A Difference-in-Differences Analysis.

OBJECTIVE: To examine the extent to which medical rehabilitation requests decreased because of the pandemic in Germany. DESIGN: Data were retrieved from the German Pension Insurance, which is the main provider for rehabilitation of working-age people in Germany. Our data represented all medical rehabilitation requests in 2019 and 2020. These requests have to be approved to use a rehabilitation program. We used a difference-in-differences model to determine the reduction in rehabilitation requests attributable to the pandemic. SETTING: General community. PARTICIPANTS: We included 1,621,840 rehabilitation requests from working-age people across Germany in 2019 and 1,391,642 rehabilitation requests in 2020 (N=3,013,482). INTERVENTION: Medical rehabilitation in inpatient or outpatient facilities. MAIN OUTCOME MEASURES: Number of medical rehabilitation requests. RESULTS: The number of medical rehabilitation requests decreased by 14.5% because of the pandemic (incidence rate ratio, 0.855; 95% confidence interval, 0.851-0.859). The decline in requests was more pronounced among women and in Western Germany than among men and in Eastern Germany. The reduction in requests affected non-postacute rehabilitations more clearly than postacute rehabilitation services. After the pandemic declaration by the German Bundestag in March 2020, the reduction in requests was initially strongly associated with the regional incidence of infection. This association weakened in the following months. CONCLUSIONS: The reduction in requests will have a significant effect on the number of completed rehabilitation services. For many people with chronic diseases, failure to provide medical rehabilitation increases the risk of disease progression.