Implementation of the European health interview survey (EHIS) into the German health update (GEDA).

BACKGROUND: This methodological paper describes the integration of the 'European Health Interview Survey wave 2' (EHIS 2) into the 'German Health Update' 2014/2015 (GEDA 2014/2015-EHIS). METHODS: GEDA 2014/2015-EHIS is a cross-sectional health survey. A two-stage stratified cluster sampling approach was used to recruit persons aged 15 years and older with permanent residence in Germany. Two different modes of data collection were used, self-administered web questionnaire and self-administered paper questionnaire. The survey instrument implemented the EHIS 2 modules on health status, health care use, health determinants and social background variables and additional national questions. Data processing was conducted according to the quality and validation rules specified by Eurostat. RESULTS: In total, 24,824 questionnaires were completed. The response rate was 27.6%. The two-stage cluster sample method seems to have been successful in achieving a sample with high representativeness. The final micro data file was inspected, approved and certified by Eurostat. Access to micro data of the EHIS 2 can be provided by Eurostat via research contract and to the GEDA 2014/2015-EHIS public use file by the Research Data Centre of the Robert Koch Institute. First EHIS 2 results are available at the Eurostat website. CONCLUSIONS: Integrating a multinational health survey into an existing national health monitoring system was a challenge in Germany. The national survey methodology for conducting the survey had to be further developed in order to meet the overarching goal of harmonizing the health information from national statistical offices and public health research institutes across the European Union. The harmonized EHIS 2 data source will profoundly impact international public health research in the near future. The next EHIS wave 3 will be conducted around 2019.

[Measuring subjective social status in health research with a German version of the MacArthur Scale]. / Messung des subjektiven sozialen Status in der Gesundheitsforschung mit einer deutschen Version der MacArthur Scale.

In health research, socio-economic status (SES) is traditionally assessed using objective indicators (education, occupation, income). For a couple of years, there has been a growing body of studies that additionally assess the subjective social status (SSS) of respondents, mostly using the MacArthur Scale. The aim of this study was to examine the construct validity of a German-language version of this instrument and to investigate whether SSS is associated with health over and above objective SES. Analyses were based on data from a population-based pilot study carried out within the 'German Health Update' (GEDA) study conducted by the Robert Koch Institute (n = 1,571; age: 18-79 years). SSS was measured with the MacArthur scale asking respondents to place themselves on a 10-rung "social ladder". The strongest correlations to SSS were found with measures of similar constructs such as a multidimensional index of objective SES, income level, occupational position and educational attainment (r = 0.32-0.60; p < 0.001). Weaker correlations were found between SSS and measures of dissimilar constructs such as social support, mental well-being, depressiveness, and body-mass-index (r = - 0.29-0.30; p < 0.001). Factor analysis did not show considerable loadings of SSS on factors of mental well-being and depressiveness. After adjusting for age, education, occupation, and income, lower SSS remained significantly associated with higher odds of adverse health (p < 0.05). The findings of this study provide support for the convergent and discriminant validity of the MacArthur Scale and indicate that self-perceptions of social disadvantage may have health implications beyond the impact of objective SES.

[Influenza, tetanus, and pertussis vaccination coverage among adults in Germany]. / Impfquoten unter Erwachsenen in Deutschland für die Impfungen gegen saisonale Influenza, Tetanus und Pertussis.

In order to be adequately protected throughout life and to protect specific risk groups from particular diseases, regular booster or specific indicator vaccinations are also recommended during adulthood. Adults should be vaccinated against seasonal influenza (annually, e.g., persons with underlying chronic diseases and persons aged ≥ 60 years), tetanus (every 10 years), and pertussis (as a one-time vaccination with the next due tetanus vaccine and, e.g., when people have close contact to newborn babies). The aim of this study was to provide an overview of the current status of vaccination uptake among adults living in Germany, focusing on these three vaccines. In line with nationwide continuous health monitoring, the Robert Koch Institute conducted the representative study "German Health Update" (GEDA 2012) between 2012 and 2013. The survey is conducted regularly and adults are asked questions relating to their vaccination status through computer-assisted telephone interviews. Overall, 19,294 interviews were held. In 2010/2011 and 2011/2012, seasonal influenza uptake among persons aged ≥ 60 years was 54.3 and 52.6 % and among individuals with underlying chronic diseases 46.2 and 42.9 %. 7.6 and 75.6 % of participants reported up-to-date pertussis and tetanus vaccination, respectively. 22 % of people living with a baby in one household were vaccinated against pertussis. In general, vaccination rates against seasonal influenza, pertussis, and tetanus among adults are still low, but differ depending on the specific vaccination. The required aim of the European Commission to reach influenza vaccination coverage by the 2014/2015 winter season of 75 % of higher age groups has not yet been reached. The low pertussis vaccination coverage among persons in close household contact to infants poses a big challenge to the implementation of the cocooning strategy to protect the very vulnerable newborns. To emphasize the importance of a complete vaccination schedule and to increase vaccination uptake, tailored interventions should be provided for both physicians and adults.

[Measurement of socioeconomic status in the KiGGS study: first follow-up (KiGGS Wave 1)]. / Messung des sozioökonomischen Status in der KiGGS-Studie : Erste Folgebefragung (KiGGS Welle 1).

This article describes the measurement of socioeconomic status in the first follow-up of the KiGGS study (KiGGS Wave 1) conducted from 2009 to 2012. A multidimensional index score was used. The score is the sum of three metric components: Education and Occupational Qualification, Occupational Status, and Net Income. Compared with the approach in the KiGGS baseline study, some modifications were made in accordance with changes in the other components of the health-monitoring program at the Robert Koch Institute, i.e., the German Health Update (GEDA) and the German Health Interview and Examination Survey for Adults (DEGS1). These changes facilitate the analysis of temporal developments and trends, ensure international comparability of the data, and support the transfer of the results into politics and practice. In order to demonstrate the application of the revised instrument, we report on exemplary results of KiGGS Wave 1 regarding the relationship between socioeconomic status and the general health status of children and adolescents aged 3-17 years.

[Pertussis vaccination coverage among adults in Germany]. / Pertussis-impfquoten bei erwachsenen in Deutschland.

BACKGROUND: Pertussis vaccination for risk-groups (e. g. healthcare workers, employees of communal facilities, or persons with close contact to infants) has been recommended in Germany since 2001. In 2009, single-dose acellular pertussis (ap) vaccination was recommended for all adults at the next tetanus-diphtheria (Td) booster. Study aims were to assess 1) pertussis vaccination coverage in adults, and 2) use of tetanus-containing combination vaccines in hospitals. METHODS: For 1) we analysed data from two population-based telephone surveys conducted among adults in Germany in 2009/2010 (GEDA09: n = 21,262; GEDA10: n = 22,050). Factors associated with vaccination were identified by logistic regression analyses. For 2) a questionnaire survey of 133 hospital pharmacies serving 454 German hospitals was undertaken for the year 2007. RESULTS: Overall, 5.9% (95% confidence interval [CI] 5.5-6.3%) of GEDA10 participants reported up-to-date pertussis vaccination (ap-vaccination in past 10 years). In risk-groups, vaccination coverage was 10.7% (95%-CI 9.8-11.7%). Residence in former East-Germany and younger age were independently associated with an adequate vaccination status. Contrary to prevailing recommendations, ~75% of tetanus vaccines were administered as monovalent rather than Td- (or Tdap-)combination vaccines in hospitals. CONCLUSIONS: In light of high pertussis-incidence and low vaccination coverage in German adults, improvement of pertussis vaccine uptake is vital, e. g. through awareness campaigns targeting both physicians in private practice and hospitals.

[Measurement of socioeconomic status in the German Health Interview and Examination Survey for Adults (DEGS1)]. / Messung des sozioökonomischen Status in der Studie zur Gesundheit Erwachsener in Deutschland (DEGS1).

Socioeconomic status (SES) constitutes a central analysis category of epidemiological research and health reporting. As part of the German cardiovascular disease prevention study 1984-1991, a multi-dimensional aggregated index was developed for the purpose of measuring SES. This index continues to be used in numerous studies to this day. For the purpose of health monitoring at the Robert Koch Institute (RKI), the index was fundamentally revised following critical assessment. This article describes the basic concepts underlying the revision and how they were implemented in relation to the "German health interview and examination survey for adults" (DEGS1). In addition, the results of the age and sex-specific distribution of the values of the revised SES index and those relating to the connection with other measurements of socioeconomic status are reported. The results are based on the data of DEGS1 2012 and the German national health interview and examination survey 1998 (GNHIES98). An English full-text version of this article is available at SpringerLink as supplemental.

[Physical activity: results of the German Health Interview and Examination Survey for Adults (DEGS1)]. / Körperliche Aktivität : Ergebnisse der Studie zur Gesundheit Erwachsener in Deutschland (DEGS1).

Regular physical activity can have a positive effect on health at any age. Today's lifestyles, however, can often be characterised as sedentary. Therefore, the promotion of physical activity and sports has become an integral part of public health measures. The representative data of adults aged 18 to 79 years in Germany obtained from the "German Health Interview and Examination Survey for Adults" (DEGS1) provide an overview of self-estimated current physical activity behaviour. The results show that one third of the adult population claims to pay close attention to reaching a sufficient level of physical activity and one fourth participates in sports for at least 2 h/week on a regular basis. Thus, the percentage of adults regularly engaged in sports has increased compared to the previous "German National Health Interview and Examination Survey 1998". Still, four out of five adults do not achieve at least 2.5 h/week of moderate-intensity physical activity as recommended by the World Health Organisation. Consequently, future individual-level and population-level interventions should focus on target group-specific measures while continuing to promote regular physical activity in all segments of the population. An English full-text version of this article is available at SpringerLink as supplemental.

[Prevalence of smoking in the adult population of Germany: results of the German Health Interview and Examination Survey for Adults (DEGS1)]. / Verbreitung des Rauchens in der Erwachsenenbevölkerung in Deutschland: Ergebnisse der Studie zur Gesundheit Erwachsener in Deutschland (DEGS1).

Although various tobacco control measures have been implemented in Germany in the recent years, smoking is still widespread and constitutes a considerable health risk for the population. According to the data of the German Health Interview and Examination Survey for Adults (DEGS1), which was conducted by Robert Koch Institute from 2008 to 2011, 29.7% of the 18 to 79-year old population smokes (women = 26.9%, men = 32.6%). The proportion of women and men who smoke 20 or more cigarettes a day amounts to 6.0% and 10.6% respectively. Smoking is mostly widespread among young adults, as well as among persons with low social status who are also overrepresented among the heavy smokers. Comparison with data from previous health surveys indicates that the proportion of smokers has reduced slightly over the last 10 years. An English full-text version of this article is available at SpringerLink as supplemental.

[Socioeconomic status and health: results of the German Health Interview and Examination Survey for Adults (DEGS1)]. / Sozioökonomischer Status und Gesundheit : Ergebnisse der Studie zur Gesundheit Erwachsener in Deutschland (DEGS1).

The analysis focuses on the connection between socioeconomic status (SES) and five health outcomes in the 18 to 79-year-old population of Germany. It uses data from the "German Health Interview and Examination Survey for Adults" (DEGS1) which the Robert Koch Institute conducted in the period from 2008 to 2011 (n=8152). Socioeconomic status is recorded via a multidimensional index which includes information on education attainment, occupational status and household income. The results show that persons with a low socioeconomic status have a self-rated health status which is worse than that of persons with a medium or high socioeconomic status, and that they have diabetes more frequently. They also have a higher risk of depressive symptoms, obesity and physical inactivity. The results illustrate that health chances and the risk of illness are still very socially uneven distributed, thus emphasising the significance of political interventions to reduce health inequalities. An English full-text version of this article is available at SpringerLink as supplemental.

[Measurement of cardiorespiratory fitness in the German Health Interview and Examination Survey for Adults (DEGS1)]. / Messung der kardiorespiratorischen Fitness in der Studie zur Gesundheit Erwachsener in Deutschland (DEGS1).

A state of good fitness is related to a better health state and a lower mortality risk. In the German Health Interview and Examination Survey for Adults (DEGS1), aerobic fitness was measured among adults between 18 and 64 years old using a submaximal cycle ergometry test. The total sample comprised 5,263 persons, amongst those 3,111 were categorized as being test-qualified according to the Physical Activity Readiness-Questionnaire. There were 3,030 persons who absolved a submaximal exercise test according to the exercise protocol of the WHO (25/25/2). The test-participation rate was 57.2 % in relation to the total sample and 97.4 % among test-qualified persons. Apart from the continuous heart-rate monitoring, capillary blood was taken prior to starting the test and at the end of each workload stage for performing blood lactate analyses. The test ended when 85 % of the age-predicted maximal heart rate was exceeded. In all 11.9 % of the tests were terminated earlier, the mean exercise duration was 10.8 min, and the anticipated submaximal exertion in the highest workload stage was on average achieved with a mean of 15 on the 20-point RPE scale. The nationwide data can now be used for the national health monitoring system, epidemiological research and for the calculation of reference values. An English full-text version of this article is available at SpringerLink as supplemental.

[Subjective social status and health-related quality of life among adults in Germany. Results from the German General Social Survey (ALLBUS 2010)]. / Subjektiver Sozialstatus und gesundheitsbezogene Lebensqualität bei Erwachsenen in Deutschland. Ergebnisse der Allgemeinen Bevölkerungsumfrage der Sozialwissenschaften (ALLBUS 2010).

BACKGROUND: The impact of subjective perception of social status on health has been analysed in international health research for several years. However, in Germany the empirical analysis of the relation between subjective social status (SSS) and health is still in the very early stages. This study investigates if health-related quality of life (HRQoL) in German adults is associated with SSS over and above conventional measures of social status. METHODS: The results are based on the German General Social Survey (ALLBUS 2010), a representative cross-sectional survey of the adult resident population in Germany (n=2 827). HRQoL was assessed with 4 items referring to self-rated health (SRH) and impairment of well-being due to bodily pain, depressiveness, and loneliness. SSS was measured with a 10-point scale where participants rated their status in society. The impact of SSS on HRQoL was analysed separately for men and women using logistic regression models adjusted for age, school education, net equivalent household income, and occupational position. RESULTS: Poorer SRH, bodily pain, depressiveness, and loneliness occurred significantly more often in men and women with low SSS compared to those with higher SSS. After adjusting for age, education, income, and occupation, the effects of SSS on SRH and depressiveness remained significant in men and women (SRH: men: OR=4.76; 95% CI=2.52-8.99; women: OR=2.95; 95% CI=1.74-4.99; depressiveness: men: OR=2.86; 95% CI=1.60-5.10; women: OR=2.75; 95% CI=1.65-4.56). The effects of SSS on bodily pain and loneliness were observed only in women after adjustment for objective status indicators (OR=1.75; 95% CI=1.07-2.86 and OR=3.03; 95% CI=1.43-6.42, respectively). CONCLUSION: These findings indicate that self-perception of social disadvantage affects HRQoL in German adults independently and partly gender-specifically. Hence, complementary to objective status indicators the SSS offers additional potential for describing and explaining health inequalities.

[Measurement of the socioeconomic status within the German Health Update 2009 (GEDA)]. / Messung des sozioökonomischen Status in der Studie "Gesundheit in Deutschland aktuell" (GEDA).

The socioeconomic status (SES) is a central analytical concept for epidemiologic research and health reporting in Germany. Within the German Cardiovascular Prevention Study (GCP), a multidimensional aggregated index of SES has been developed, which is used to this date. We have revised this index critically and reworked it according to the necessities of German health monitoring at the Robert Koch Institute (RKI). The main changes involve the operationalization and categorization of the status-constituting dimensions education, occupation, and income as well as the categorization of the resulting socioeconomic status groups. This paper explains the steps of the revision process and the ideas behind it. In addition, it provides empirical evidence on the association of the revised index with three important health outcomes (self-rated health, obesity, and smoking) using data of the German Health Update 2009 (GEDA) study. It is planned to apply the revised SES concept in all studies on German health monitoring at the RKI, i.e., not only to GEDA but also to the German Health Interview and Examination Survey for Adults (DEGS) and the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) in the same way.

[Physical and sporting activity among adults in Germany. Results from the "German Health Update 2009" survey]. / Körperlich-sportliche Aktivität bei Erwachsenen in Deutschland. Ergebnisse der Studie "Gesundheit in Deutschland aktuell 2009"

The study analyses the distribution of physical and sporting activity among the adult population in Germany. The data came from the "German Health Update 2009" survey, which is based on 21,262 telephone interviews conducted by the Robert Koch Institute between July 2008 and June 2009. The study shows that 56% of men aged 18 and over and 38% of women in the same age group engaged in physical activity with an intensity that made them sweat or be out of breath for at least 2.5 h/week. In addition, 64% of both men and women stated that they had actively engaged in sporting activities over the previous 3 months. Comparing 1998 and 2003, participation in sport was observed to have increased among men and women in all age groups over time. Furthermore, socio-economic differences were observed, indicating lower physical activity among higher-status groups and lower sporting activity among lower-status groups. Measures to promote physical activity and sport prove to be especially necessary for people who are not physically active (19% of men and 26% of women) or who do not engage in sport at all (36% of both men and women).

[Who enrolls in a general practitioner model? The behavioral model of health services use and general practitioner-centered care in Germany]. / Wer wählt den Hausarzt zum "Gatekeeper"? Eine Anwendung des Verhaltensmodells von Andersen zur Beschreibung der Teilnahme an Hausarztmodellen in Deutschland.

Since July 2009, statutory health insurance companies in Germany are obliged to offer a so-called general practitioner model. By strengthening the general practitioner's position, these models should optimize healthcare especially for people with higher demands for health services. So far, little is known about which patients participate in the model. Our study's aim was to describe correlates of enrollment based on the behavioral model of health services use. The data were obtained from the Robert Koch Institute's 2006 telephone health survey. Variables influencing enrollment in the general practitioner models were determined through logistic regression models. Main indicators for enrollment were age above 60 years, lower social status, lower income status, and living in less populated areas. Insured persons with a higher demand for medical services were more often enrolled in general practitioner models. Most of them had consulted their general practitioner very frequently even before the general practitioner model was introduced.

[Subjective health as predictor for mortality]. / Subjektive Gesundheit als Prädiktor für Mortalität.

In the last two decades self-rated health has received growing interest in international studies because of its consistent prediction for mortality. However, for Germany there are no studies confirming a long-term effect independent from objective health indicators in comparison of different follow-up. On the basis of the Life-Expectancy-Study (1984/86 - 1998) from the Federal Institute for Population Research it was possible to analyze the association between subjective health and mortality in relation to the length of observation. A stronger correlation between bad self-rated health and objective health status could be indicated because of a better prediction for mortality in a short-term follow-up. The evidence of a significant effect between self-rated health and mortality in the long-term follow-up not including the deaths from the short-term follow-up indicates that the mechanisms between subjective health and mortality are more complex than those between objective health status and death.