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Problematic and pathological gambling have emerged as substantial problems in many countries. One potential accelerating factor for this phenomenon during recent years is the Internet, which offers different kinds of games and online applications for gambling that are faster, more attractive due to a variety of design and marketing options, less costly and potentially more addictive than terrestrial gambling opportunities. However, the contributing role of the Internet for problematic gambling has not been analyzed sufficiently so far and remains inconclusive. The current study is based on a representative sample with 15,023 individuals from Germany. With a new concept of assessing online gambling with its relative fraction of total gambling activities and a control-function approach to account for possible endogeneity of online gambling, we estimate the impact of online gambling on gambling behavior while additionally controlling for a rich set of important covariates, like education, employment situation and family status. The results show that, on average, replacing 10% of offline gambling with online gambling increases the likelihood of being a problematic gambler by 8.8-12.6%. This increase is equivalent to 139,322 problematic gamblers and 27.24 million € per year of additional expenditures in the German health sector. Our findings underpin the necessity to keep online gambling restricted to prevent further developments of problematic and pathological gambling in Germany. [ABSTRACT FROM AUTHOR]

Hazardous alcohol consumption in Germany is a main threat to health. By using insurance claim data from the German Statutory Health Insurance and a classification strategy based on ICD10 diagnoses-codes we analyzed a sample of 146,000 subjects with more than 19,000 hazardous alcohol consumers. Employing different regression models with a control function approach, we calculate life years lost due to alcohol consumption, annual direct and indirect health costs, and the burden of pain and suffering measured by the Charlson-Index and assessed pain diagnoses. Additionally, we simulate the net accumulated premium payments over expenses in the German Statutory Health Insurance and the Statutory Pension Fund for hazardous alcohol consumers from a lifecycle perspective. In total, €39.3 billion each year result from hazardous alcohol consumption with an average loss of 7 years in life expectancy. Hazardous alcohol consumers clearly do not "pay their way" in the two main German social security systems and also display a higher intangible burden according to our definitions of pain and suffering. [ABSTRACT FROM AUTHOR]

With the steadily growing health burden of obesity in Germany, the measuring and quantification of its costs and relevant economic consequences have become increasingly important. The usual quantifications via previous cost-of-illness approaches mostly have several weaknesses, e.g., applying "indirect methods" by using "population-attributable fractions" to identify parts of costs that can be accrued to obesity, second using highly aggregated data and third often only displaying part of the costs. This article presents a new approach and a new estimation of the cost and consequences of obesity in Germany using claims data from a German health insurance company. A sample of 146,000 individuals was analyzed with both a prevalence and a life-cycle focus on the cost and consequences of obesity. With additional data sets, we calculate the deaths per year due to obesity, the excess costs per year and several intangible consequences usually referred to as "pain and suffering". Our results show that the cost estimations of obesity in Germany so far have been largely underestimated. The annual direct costs of obesity in Germany amount to approximately €29.39 billion and the indirect costs to an additional €33.65 billion. A total of 102,000 subjects die prematurely each year because of obesity, and there is a significant excess of unemployment, long-term nursing care, and pain and suffering due to obesity. From a lifetime perspective, every obese man is equal to an additional burden of €166,911 and each woman of €206,526 for the social security system in Germany. Obesity due to unhealthy eating is thus about to replace tobacco consumption in terms of costs and consequences as the main hazardous lifestyle factor and thus should be more intensively focussed by public health policy. [ABSTRACT FROM AUTHOR]