INDICA research project

Project title: Intersectional Vulnerabilities in Diabetes Health Care: Identifying and Addressing Health Disparities in Lower Saxony

General information

Funding program: zukunft.niedersachsen (Lower Saxony Ministry of Science and Culture and Volkswagen Foundation)

Funding amount: 699 545 EUR

Project duration: 2025-2029

Project management: PD Dr. Jelena Epping and PD Dr. Johannes Beller

Project staff: Deborah Hauser, Rieke Kell

Brief description

The INDICA research project is dedicated to the investigation of health inequalities in diabetes care in Lower Saxony and pursues an innovative intersectional approach. In Germany, about 8.9 million people are affected by type 2 diabetes, but only about half of them participate in disease management programs (DMP), although these have been shown to improve the quality of treatment. This discrepancy raises important questions about the underlying causes and possible barriers.

The study focuses on two main questions: Which intersectional vulnerabilities influence participation in DMP programs? And how do the health and socioeconomic outcomes differ between people who participate in these programs and those who do not? To answer these complex questions, the research team analyzes anonymized health insurance data from around 3 million AOK policyholders. Eight different dimensions of social identity are taken into account: Gender, age, education, income, employment, nationality, place of residence and disability.

The methodological approach of the project is divided into two work packages and is characterized by the comparison of different statistical analysis methods. Particularly noteworthy is the application of MAIHDA analysis (Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy) and tree analysis, which enable a differentiated view of the interactions between different vulnerability factors. These innovative methods make it possible to precisely capture the complexity of intersectional identities and their influence on diabetes care.

INDICA is the first intersectional analysis of internal health insurance data that applies eight dimensions of vulnerability and systematically compares different statistical methods to advance intersectionality research in healthcare. In addition to medical outcomes, the study also takes into account the socio-economic consequences of DMP participation for a holistic understanding of the healthcare situation.

The results promise scientific and practical relevance: they identify vulnerable patient groups, enable targeted intervention strategies and can sustainably improve diabetes care in Lower Saxony. The project could also serve as a model for other regions. Results will be made widely available (publications, lectures) in order to promote dialog on equal opportunities in diabetes care.