[Health of people with selected citizenships in Germany: prevalence of non-communicable diseases and associated social as well as migration-related factors]. / Gesundheit von Menschen mit ausgewählten Staatsangehörigkeiten in Deutschland: Prävalenzen nichtübertragbarer Erkrankungen und damit assoziierte soziale sowie migrationsbezogene Faktoren.

BACKGROUND: Health chances and risks of people with a history of migration vary according to a wide range of factors. This paper aims to describe the health of people with selected citizenships on the basis of four non-communicable diseases (chronic disease or long-term health problem in general, coronary heart disease, diabetes mellitus, depression) and to identify associated social and migration-related factors. METHODS: Analyses are based on data from the multilingual and multimodal interview survey "German Health Update: Fokus" (GEDA Fokus), which was conducted among 18- to 79-year-olds with Croatian, Italian, Polish, Syrian, or Turkish citizenship living in Germany (November 2021 to May 2022). Poisson regressions were used to calculate prevalence ratios and 95% confidence intervals to examine the association between the individual indicators and social as well as migration-related characteristics. RESULTS: In particular, a low sense of belonging to the society in Germany and self-reported experiences of discrimination in everyday life are associated with higher prevalence of a chronic disease or long-term health problem and - according to self-reported medical diagnoses - with depression and partly with coronary heart disease and diabetes. DISCUSSION: Given the importance of subjective sense of belonging to the society in Germany and self-reported experience of discrimination for the health outcomes studied, the results point to health inequalities among people with selected citizenships that may indicate mechanisms of social exclusion.

[People with a history of migration in the COVID-19 pandemic : Associations between life satisfaction and indirect socioeconomic effects of the pandemic]. / Menschen mit Migrationsgeschichte in der COVID-19-Pandemie : Zusammenhänge zwischen der Lebenszufriedenheit und indirekten sozioökonomischen Pandemiefolgen.

INTRODUCTION: It is not only the risks of SARS-CoV­2 infection and severe to fatal courses of the disease that are socially unequally distributed, but also job and income losses as a result of the containment measures. People with a history of migration are at increased risk of being affected by such indirect socio-economic effects of the pandemic as well. The aim of this article is to investigate the associations between indirect socio-economic effects of the pandemic and life satisfaction among people with selected citizenships. METHODS: We analysed data from the multilingual and multimodal interview survey German Health Update Fokus (Gesundheit in Deutschland aktuell: Fokus; GEDA Fokus), which was conducted from November 2021 to May 2022 among people all over Germany with Croatian, Italian, Polish, Syrian or Turkish citizenship. Using multivariable Poisson regression, we analysed associations between sex, age, education, income, German language proficiency and job as well as income losses and life satisfaction. RESULTS: Of the 4114 participants, 64.4% reported a high life satisfaction. While a higher income showed positive associations with life satisfaction, negative associations were found for lower self-assessed German language proficiency and for job and income losses that are anticipated or have already occurred. DISCUSSION: This article shows that life satisfaction, which is relevant for multiple health outcomes, is lower among those that are affected by job and income losses. Structural causes of socio-economic disadvantages need to be reduced to address health inequalities and to be better prepared for future crises.

COVID-19 vaccination status among people with selected citizenships: results of the study GEDA Fokus.

Background: the COVID-19 vaccination offers protection against severe disease progression. Data show that people with a history of migration are less likely to be vaccinated against COVID-19 than people without a history of migration, but are at increased risk of infection. Methods: Data were used from the GEDA Fokus interview survey (November 2021 - May 2022), which included people living in Germany with Croatian, Italian, Polish, Syrian or Turkish citizenship (n=5,495). In addition to bivariate analyses, Poisson regressions were used to examine the association between uptake of at least one COVID-19 vaccination and sociodemographic, health- and migration-related factors. Results: 90.0% of participants reported having received at least one COVID-19 vaccination. Having visited a general practitioner or specialist in the past 12 months, living in Germany for 31 years or more, and having a greater sense of belonging to society in Germany were associated with vaccination uptake in bivariate analyses. Regression analysis showed that older people and those with higher education were more likely to be vaccinated. Conclusions: Sociodemographic factors are associated with uptake of the COVID-19 vaccine among individuals with selected citizenships. Low-threshold information and vaccination offers are important to ensure equal access to vaccination.

Recommendations for collecting and analysing migration-related determinants in public health research.

Background: According to the definition of the German Federal Statistical Office, about every fourth person living in Germany has a so-called migration background (MB), i.e., the person or at least one of their parents was born without German citizenship. However, MB has been defined differently in many studies. Also, the MB summarises people in different living situations, making differentiated analysis in health science more difficult. This article formulates recommendations for the collection and analysis of migration-related, as well as social and structural, determinants of health. Indicators for capturing relevant determinants of health: As part of the Improving Health Monitoring in Migrant Populations project (IMIRA), the previous approaches to operationalise and measure migration-related determinants were revised based on literature research and exchange formats, such as workshops, meetings, congress contributions, etc. Instead of MB, the country of birth of the respondents and their parents, duration of residence, citizenship(s), residence status, and German language proficiency should be recorded as minimum indicators and analysed as individual variables. Further social and structural determinants, such as socioeconomic position, working and housing conditions, or self-reported discrimination, should be included. Conclusions: In order to describe health inequalities and to specifically identify the needs of people with a history of migration, a mutual and differentiated consideration of migration-related and social determinants of health is essential.

Health of people with selected citizenships: results of the study GEDA Fokus.

Background: The health situation of people with a history of migration is influenced by a variety of factors. This article provides an overview of the health of people with selected citizenships using various indicators. Methods: The analyses are based on the survey 'German Health Update: Fokus (GEDA Fokus)', which was conducted from November 2021 to May 2022 among people with Croatian, Italian, Polish, Syrian and Turkish citizenship. The prevalence for each health outcome is presented and differentiated by sociodemographic and migration-related characteristics. Poisson regressions were performed to identify relevant factors influencing health situation. Results: Self-assessed general health, the presence of depressive symptoms, prevalence of current smoking and the utilisation of general and specialist healthcare differed according to various factors considered here. In addition to sociodemographic determinants, the sense of belonging to society in Germany and self-reported experiences of discrimination were particularly associated with health outcomes. Conclusions: This article highlights the heterogeneity of the health situation of people with a history of migration and points to the need for further analyses to identify the reasons for health inequalities.

German Health Update Fokus (GEDA Fokus) among Residents with Croatian, Italian, Polish, Syrian, or Turkish Citizenship in Germany: Protocol for a Multilingual Mixed-Mode Interview Survey.

BACKGROUND: Germany has a long history of migration. In 2020, more than 1 person in every 4 people had a statistically defined, so-called migration background in Germany, meaning that the person or at least one of their parents was born with a citizenship other than German citizenship. People with a history of migration are not represented proportionately to the population within public health monitoring at the Robert Koch Institute, thus impeding differentiated analyses of migration and health. To develop strategies for improving the inclusion of people with a history of migration in health surveys, we conducted a feasibility study in 2018. The lessons learned were implemented in the health interview survey German Health Update (Gesundheit in Deutschland aktuell [GEDA]) Fokus, which was conducted among people with selected citizenships representing the major migrant groups in Germany. OBJECTIVE: GEDA Fokus aimed to collect comprehensive data on the health status and social, migration-related, and structural factors among people with selected citizenships to enable differentiated explanations of the associations between migration-related aspects and their impact on migrant health. METHODS: GEDA Fokus is an interview survey among people with Croatian, Italian, Polish, Syrian, or Turkish citizenship living in Germany aged 18-79 years, with a targeted sample size of 1200 participants per group. The gross sample of 33,436 people was drawn from the residents' registration offices of 99 German municipalities based on citizenship. Sequentially, multiple modes of administration were offered. The questionnaire was available for self-administration (web-based and paper-based); in larger municipalities, personal or phone interviews were possible later on. Study documents and the questionnaire were bilingual-in German and the respective translation language depending on the citizenship. Data were collected from November 2021 to May 2022. RESULTS: Overall, 6038 respondents participated in the survey, of whom 2983 (49.4%) were female. The median age was 39 years; the median duration of residence in Germany was 10 years, with 19.69% (1189/6038) of the sample being born in Germany. The overall response rate was 18.4% (American Association for Public Opinion Research [AAPOR] response rate 1) and was 6.8% higher in the municipalities where personal interviews were offered (19.3% vs 12.5%). Overall, 78.12% (4717/6038) of the participants self-administered the questionnaire, whereas 21.88% (1321/6038) took part in personal interviews. In total, 41.85% (2527/6038) of the participants answered the questionnaire in the German language only, 16.69% (1008/6038) exclusively used the translation. CONCLUSIONS: Offering different modes of administration, as well as multiple study languages, enabled us to recruit a heterogeneous sample of people with a history of migration. The data collected will allow differentiated analyses of the role and interplay of migration-related and social determinants of health and their impact on the health status of people with selected citizenships. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/43503.

The concept of acculturation in epidemiological research among migrant populations: A systematic review.

•Acculturation is a widely used concept in epidemiological research.•There are various ways to measure acculturation using proxies or scales; often an acculturation score is calculated.•Studies often show inconsistencies in operationalization and measurement of the concept of acculturation.•The exact outcome is often unclear; this creates a lack of comparability, generalizability and transferability of the results.•Health relevant proxies such as language skills or feeling of belonging should be measured without calculating a score.

[Improving access to migrant populations for epidemiological research-guided interviews with German experts]. / Zugangswege zu Menschen mit Migrationshintergrund für die epidemiologische Forschung ­ eine Befragung von Expertinnen und Experten.

BACKGROUND: In Germany, reliable information on the health of people with migration background (PMB) is scarce. Therefore, the Robert Koch Institute initiated the project "Improving health monitoring in migrant populations (IMIRA)" to improve the inclusion of PMB into the federal health monitoring. OBJECTIVE: The objective of this article is to identify challenges and strategies in accessing migrant populations with epidemiological research. MATERIAL AND METHODS: A total of 24 guided interviews with experts from Germany were conducted. Experts were scientists from various disciplines with a research focus on migration, civil servants in the area of migration, and experts from the field. The interview focused on challenges and strategies regarding access to migrants in research. The written summaries of the interviews were analyzed. RESULTS: Challenges in accessing PMB include language, sociodemographic and cultural barriers, fears, structural, and practical difficulties. Further challenges arise from the heterogeneity and motivation of the groups. Strategies to increase accessibility among PMB can be found in the research process, methods, communication, and diversity-sensitive research culture. Confidence-building is considered significant. DISCUSSION: Experts report a variety of strategies that focus on addressing and including PMB directly: strengthening of participatory approaches, new forms of translation, and measures to increase trust in research should be the focus of future efforts. The willingness to participate in epidemiological research can be increased with appropriate strategies and thus data on the health of migrant populations can be improved sustainably.

Concepts for migration-sensitive health monitoring.

According to microcensus data, nearly one quarter of the German population has a migration background. This means that either themselves or at least one parent was born without German citizenship. Based on the currently available data and due to the underrepresentation of specific population groups, representative findings on the health of the total population residing in Germany are only possible to a limited degree. Against this backdrop, the Robert Koch Institute initiated the Improving Health Monitoring in Migrant Populations (IMIRA) project. The project aims to establish a migration-sensitive health monitoring system and to better represent people with a migration background in health surveys conducted by the Robert Koch Institute. In this context it is crucial to review and further develop relevant migration-sensitive concepts and appropriate surveying instruments. To achieve this, the concepts of acculturation, discrimination, religion and subjective social status were selected. This article theoretically embeds these concepts. Furthermore, we describe their application in epidemiology as well as provide a proposal on how to measure and operationalise these concepts. Moreover, recommendations for action are provided regarding the potential application of these concepts in health monitoring at the Robert Koch Institute.