Abstract
BACKGROUND: Endometriosis is the second most common gynecological condition among women of reproductive age. The most common symptoms include severe lower abdominal pain, heavy and irregular menstrual bleeding, and impaired fertility. Both diagnosis and treatment are often associated with surgical procedures. Therefore, patients with endometriosis still require inpatient care more frequently than women with other conditions. Understanding hospitalization trends can shed light on disease diagnosis, treatment, and management, as well as regional disparities in access to care. The present study examines hospitalization trends for endometriosis in Germany, focusing on regional differences at the federal state level. METHODS: Based on data from the German Federal Statistical Office, we analyzed annual hospitalizations for endometriosis (ICD-10 N80), for the period 2000 to 2023. Age-standardized hospitalization rates (ASHRs) per 100,000 women, using the 2013 European standard population, were examined. We applied joinpoint regression analysis to identify temporal trends and calculated Average Annual Percent Changes (AAPCs) with 95% confidence intervals. Descriptive statistics and choropleth maps were used to visualize regional variation, long-term trends, and relative changes in ASHRs between 2000 and 2023. RESULTS: All 16 federal states recorded increases in ASHRs over the 24-year period. In 2000, the national rate was 43.7 per 100,000 women, rising to 88.1 per 100,000 in 2023. Substantial regional differences in endometriosis hospitalization rates were observed across Germany’s federal states. For 2023, the highest rate was recorded in North Rhine-Westphalia with 112.4 hospitalizations per 100,000 women, followed closely by Saarland (103.1). In contrast, the lowest rates were seen in Hamburg (43.2) and Bremen (53.1). Also, increases in ASHRs over the study period varied considerably between states, with the largest increases observed in Berlin, Bavaria and Brandenburg (+ 196.2%, + 173.2% and + 165.6%, respectively) and the lowest observed in Bremen, Lower Saxony, Hamburg and Saarland (+ 36.5%, + 41.1%, + 52.1% and + 51.2%, respectively). CONCLUSIONS: The spatial patterns highlight considerable regional heterogeneity in the development of endometriosis-related hospitalizations over the past two decades and suggest the influence of structural, demographic, or healthcare system factors at the state level. Limited data hinders a comprehensive understanding of these differences, emphasizing the need for mixed-methods research.