Corrigendum: Health in Germany: Establishment of a population-based health panel.

[This corrects the article DOI: 10.25646/11992.2.].

Erratum: Health in Germany: Establishment of a population-based health panel.

[This corrects the article on p. 2,21 in vol. 9, PMID: 38282983.].

A longitudinal analysis of health inequalities from adolescence to young adulthood and their underlying causes.

Research suggests that children of low-educated parents face greater health burdens during the passage from adolescence to young adulthood, as they are more likely to become low-educated themselves, establish behavioural and psychosocial disadvantages, or being exposed to unhealthy working conditions. However, studies examining the development and drivers of health inequalities during this particular life stage are limited in number and have produced varied results. This study investigates trajectories of self-rated health and overweight from 14 to 25 years of age, stratified by parental education, and explores the role of potential mediators (educational achievement, health behaviours, psychosocial factors, working conditions). We rely on prospective cohort data from the National Educational Panel Study (NEPS), a representative sample of 14,981 German ninth graders interviewed yearly from 2011 to 2021 (n = 90,096 person-years). First, we estimated random-effects growth curves for self-rated health and overweight over participants' age and calculated the average marginal effect of high versus low parental education. Second, a series of simulation-based mediation analyses were performed to test how much of health inequalities were explained by children's educational attainment (years of school education, years in university), health behaviours (smoking, alcohol, physical inactivity), psychosocial factors (number of grade repetitions, years in unemployment, chronic stress, self-esteem) and working conditions (physical and psychosocial job demands). We accounted for potential confounding by controlling for age, sex, migration background, residential area, household composition, and interview mode. Results show that higher parental education was related to higher self-rated health and lower probabilities of being overweight. Interaction between parental education and age indicated that, after some equalisation in late adolescence, health inequalities increased in young adulthood. Furthermore, educational attainment, health behaviours, psychosocial factors, and early-career working conditions played a significant role in mediating health inequalities. Of the variables examined, the level of school education and years spent in university were particular strong mediating factors. School education accounted for around one-third of the inequalities in self-rated health and one-fifth of the differences in overweight among individuals. Results support the idea that the transition to adulthood is a sensitive period in life and that early socio-economic adversity increases the likelihood to accumulate health disadvantages in multiple dimensions. In Germany, a country with comparatively low educational mobility, intergenerational continuities in class location seem to play a key role in the explanation of health inequalities in youth.

Utilisation of dental services by refugees in Germany: Results of the population-based RESPOND survey.

Background: The utilisation of outpatient dental services is an important indicator for monitoring healthcare provision in Germany. In the general population, the 12-month prevalence of dental service utilization is 82.2 %. For refugees, this indicator has hardly been measured, although studies suggest an objectively high need for dental care. Methodology: As part of the population-based cross-sectional RESPOND study (2018), self-reported health and healthcare, including the use of dental services, was assessed in three representative, random samples of refugees residing in reception and shared accommodation centres in Baden-Württemberg and Berlin. Results: The indicator was available for 68.8 % (594) of the 863 surveyed refugees. Overall, 38.2 % of the respondents stated that they had utilised dental services in the previous 12 months, whereas 41.4 % had never used any dental care in Germany. Conclusions: The utilisation of dental services among refugees is very low compared to the level of utilisation in the general population. It reflects a discrepancy between access and needs.

Socioeconomic Differences in SARS-CoV-2 Infection and Vaccination in Germany: A Seroepidemiological Study After One Year of COVID-19 Vaccination Campaign.

Objective: To evaluate the socioeconomic patterns of SARS-CoV-2 antigen contacts through infection, vaccination or both ("hybrid immunity") after 1 year of vaccination campaign. Methods: Data were derived from the German seroepidemiological Corona Monitoring Nationwide study (RKI-SOEP-2; n = 10,448; November 2021-February 2022). Combining serological and self-report data, we estimated adjusted prevalence ratios (PR) of SARS-CoV-2 infection, COVID-19 vaccination, basic immunization (at least two SARS-CoV-2 antigen contacts through vaccination and/or infection), and three antigen contacts by education and income. Results: Low-education groups had 1.35-times (95% CI 1.01-1.82) the risk of SARS-CoV-2 infection compared to high-education groups. COVID-19 vaccination (at least one dose) and basic immunization decreased with lower education and income. Low-education and low-income groups were less likely to have had at least three antigen contacts (PR low vs. high education: 0.74, 95% CI 0.65-0.84; PR low vs. high income: 0.66, 95% CI 0.57-0.77). Conclusion: The results suggest a lower level of protection against severe COVID-19 for individuals from low and medium socioeconomic groups. Pandemic response and vaccination campaigns should address the specific needs and barriers of these groups.

Health inequalities among young workers: the mediating role of working conditions and company characteristics.

OBJECTIVE: Few studies have investigated health inequalities among young workers. The objectives of this study are to assess the extent of health inequalities in a sample of job starters and to explore the contribution of job demands and organisational factors. METHODS: We analyze data from the BIBB/BAuA Youth Employment Survey 2012. The cross-sectional survey includes a representative sample of 3214 German employees, apprentices, and trainees aged 15-24 years. Individuals were grouped by their years of schooling into low (< 12 years) and high levels of education (≥ 12 years). Regression analysis estimated the link between education and four health outcomes: self-rated health, number of health events, musculoskeletal symptoms, and mental health problems over the last 12 months. Counterfactual mediation analysis tested for indirect effects of education via working conditions (i.e., physical and psychosocial job demands) and company characteristics (i.e., company size, health prevention measures, financial situation, downsizing). All analyses were adjusted for age, sex, nationality, region, working hours, job tenure, employment relationship, and economic sector. RESULTS: Highly educated workers reported better self-rated health (b = 0.24, 95% CI 0.18-0.31) and lower numbers of health events (Rate Ratio (RR) = 0.74, 95% CI 0.67-0.82), musculoskeletal symptoms (RR = 0.73, 95% CI 0.66-0.80) and mental health problems (RR = 0.84, 95% CI 0.76-0.93). Total job demands explained between 21.6% and 87.2% of the educational differences (depending on health outcome). Unfavourable company characteristics were associated with worse health, but showed no or only small mediation effects. CONCLUSIONS: Health inequalities are already present at the early working career due to socio-economically stratified working hazards. To enhance prevention measures that aim at reducing inequalities in workplace health, we propose shifting attention towards earlier stages of life.

[Racism and discrimination in the context of health inequalities-a narrative review]. / Rassismus und Diskriminierung im Kontext gesundheitlicher Ungleichheit ­ ein narratives Review.

Racism and discrimination as social determinants of health are becoming increasingly recognised in public health research in Germany. Studies show correlations with physical and mental health and even changes at the cellular level. In addition to the adverse health effects of interpersonal and direct discrimination, the relevance of structural and institutional racism for health inequalities has been little explored. This narrative review synthesises and critically discusses relevant and recent research findings and makes recommendations for action in research and practice.Structural and institutional aspects of discrimination and racism are closely linked to health. Systemic discrimination in education, employment, housing and healthcare affects overall, mental and physical health, access to prevention and care, and health behaviour.An analysis of the relationship between living, housing and working conditions and the health situation of people with (and without) a history of migration - in general and in relation to racism and discrimination - seems necessary in order to derive targeted measures for structural prevention, rather than focusing on purely behavioural prevention. In addition to practical interventions (trainings, education, and community-based approaches), the further development of methodological aspects in the field of data collection and analysis is important in order to address this issue comprehensively in research and practice.

[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.

Social differences in COVID-19 vaccination status - Results of the GEDA 2021 study.

Background: The COVID-19 vaccination is a key measure to contain the pandemic. It aims to restrict new infections and to reduce severe courses of the disease. This paper examines the influence of various social determinants on COVID-19 vaccination status. Methods: The analyses are based on data from the study German Health Update (GEDA 2021), a nationwide telephone-based survey of the adult population in Germany, which was conducted between July and December 2021. In addition to bivariate analyses, the association between the COVID-19 vaccination status and the social determinants was examined using Poisson regression. Results: A total of 86.7% of people aged 18 years and older who participated in GEDA 2021 have been received at least one dose of COVID-19 vaccine. Social differences are evident: The proportion of people vaccinated against COVID-19 increases with age, income and higher education group. Lower vaccination rates are found among people with a history of migration, people living in rural areas and people from East Germany. An age-differentiated analysis shows that the social differences in COVID-19 vaccination uptake are lower among those aged 60 years and older. Conclusions: The presented results should be considered when designing targeted interventions to overcome potential barriers to COVID-19 vaccination uptake. Further research is needed regarding the explanatory factors for the social differences in vaccination behaviour, such as structural and group-specific barriers or psychological determinants.

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.

Migration and health: moving towards a diversity-oriented public health monitoring at the Robert Koch Institute.

Summarizing categories, such as migration background or history of migration, do not reflect the diversity and heterogeneity of the population living in Germany and their health. A differentiated description of the health situation of people with a history of migration should consider migration-related, social, and structural determinants of health as well as their interactions. The findings obtained in the 'Improving Health Monitoring in Migrant Populations (IMIRA)' projects will help to improve the inclusion of people with a history of migration in future studies as well as in the RKI panel. This will enable an adequate description of the health situation of people with a history of migration and therefore of the general population in Germany. In future studies, the health status of people who have not been well included in health surveys so far, such as people who are not listed at the registration office, should be monitored. For this purpose, continuous development of sampling and survey methods is necessary.

Do family characteristics contribute to a socioeconomic gradient in overweight in early childhood? - Single mediation analyses of data from German preschool children.

Children's overweight is strongly associated with family socioeconomic position (SEP) and family characteristics (FC). There is limited research on the extent to which FC account for a socioeconomic gradient in childhood overweight. This study examined whether FC explain SEP differences in the prevalence of overweight. The study used baseline data of preschool-aged children from the German 'PReschool INtervention Study'. The sample (n = 872, 48% girls) was recruited at kindergartens in Baden-Württemberg, Germany. Data included children's measured weight status and parents' reports on socioeconomic indicators (e.g., school education, vocational education, income) and FC. Variables represent main determinants of overweight (nutrition: sweets consumption in front of TV, soft drink consumption, regular breakfast, child sets table; physical activity: outdoor sports; parental role model). In single mediation analyses indirect effects of SEP on overweight were analysed (OR[95%CI]). Preschool girls and boys with low parental education had higher odds for overweight than children with high parental education. Among boys, low levels of parental education contributed to the odds of overweight via indirect effects by both factors 'sweets consumption in front of TV' (OR = 1.31[1.05-1.59]) and 'no sports' (OR = 1.14[1.01-1.38]). Among girls, FC measured did not explain SEP differences in overweight. Family nutrition and parental/family physical activity contribute to inequalities in overweight among preschool boys, but not girls. Research is needed to identify FC that explain inequalities in overweight for both.

SARS-CoV-2 infections in migrant populations in Germany: results from the COVID-19 snapshot monitoring survey.

OBJECTIVES: Research shows that there is an increased risk of SARS-CoV-2 infection in migrants and ethnic minorities. However, increasing evidence indicates that socio-economic factors, such as employment, education and income, contribute to the association between migrant status and SARS-CoV-2 infection. This study aimed to examine the association between migrant status and the risk of SARS-CoV-2 infection in Germany and to discuss potential explanations for these associations. STUDY DESIGN: This was a cross-sectional study. METHODS: Data from the German COVID-19 Snapshot Monitoring online survey were analysed, and hierarchical multiple linear regression models were used to calculate the probabilities of self-reported SARS-CoV-2 infection. Predictor variables were integrated in a stepwise method as follows: (1) migrant status (defined by own or parental country of birth other than Germany); (2) gender, age and education; (3) household size; (4) household language; and (5) occupation in the health sector, including an interaction term of migrant status (yes) and occupation in the health sector (yes). RESULTS: Of 45,858 participants, 3.5% reported a SARS-CoV-2 infection, and 16% were migrants. Migrants, participants in large households, those speaking a language other than German in their household and those working in the health sector were more likely to report SARS-CoV-2 infection. The probability of reporting SARS-CoV-2 infection was 3.95 percentage points higher for migrants than non-migrants; this probability decreased when integrating further predictor variables. The strongest association of reporting a SARS-CoV-2 infection was observed for migrants working in the health sector. CONCLUSIONS: Migrants and health sector employees, and especially migrant health workers, are at an increased risk of SARS-CoV-2 infection. The results show that the risk of SARS-CoV-2 infection is determined by living and working conditions rather than migrant status.

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.