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.

[Mortality follow-up of the German Health Interview and Examination Survey for Adults (DEGS) : methods and first results]. / Mortalitäts-Follow-up der Studie zur Gesundheit Erwachsener in Deutschland (DEGS) : Methodik und erste Ergebnisse.

OBJECTIVES: Within the framework of the German Health Interview and Examination Survey for Adults (DEGS), the Robert Koch Institute (RKI) conducted a nationwide mortality follow-up study. As there is no national mortality register in Germany, mortality and causes of death were investigated individually and under observance of state-specific data protection conditions. METHODS: The German Health Interview and Examination Survey 1998 (GNHIES98) provided the database including 7,124 participants aged 18-79 years. A total of 6,979 participants of GNHIES98 (98 %) who consented to be re-contacted were invited between October 2008 and October 2011 to also participate in the first data collection wave of DEGS (DEGS1). In this context, the vital status and the causes of death for deceased participants were assessed. Age- and sex-specific probabilities of survival and death rates were calculated and grouped by main causes of death according to ICD-10 groups. RESULTS: A total of 671 individuals (285 women, 386 men) died between the two survey contacts. For all deceased persons the date of death and for 539 (80.3 %) the causes of death could be determined. With a median follow-up time of 12.0 years, 8,0742.5 person years were available for survival analysis. The crude overall death rate amounted to 8.3 per 1,000 persons-years (women: 7.2; men: 9.5). Among 539 persons with available information on causes of death, 209 (38.8 %) were attributable to cardiovascular diseases, 188 (34.9 %) to cancer, 135 (25.0 %) to other causes, and seven (1.3 %) could not be unambiguously assigned. CONCLUSIONS: A mortality follow-up was successfully integrated in the longitudinal component of DEGS as part of the national health monitoring at the RKI. Death rates and cause-specific mortality in relation to highly prevalent chronic diseases and risk factors provide essential information for assessing the potential of prevention and quality of care among adults in Germany. This requires a regular and complete conduction of mortality follow-ups.

[Use of routine data from statutory health insurances for federal health monitoring purposes]. / Nutzungsmöglichkeiten von Routinedaten der Gesetzlichen Krankenversicherung in der Gesundheitsberichterstattung des Bundes.

Federal health monitoring deals with the state of health and the health-related behavior of populations and is used to inform politics. To date, the routine data from statutory health insurances (SHI) have rarely been used for federal health monitoring purposes. SHI routine data enable analyses of disease frequency, risk factors, the course of the disease, the utilization of medical services, and mortality rates. The advantages offered by SHI routine data regarding federal health monitoring are the intersectoral perspective and the nearly complete absence of recall and selection bias in the respective population. Further, the large sample sizes and the continuous collection of the data allow reliable descriptions of the state of health of the insurants, even in cases of multiple stratification. These advantages have to be weighed against disadvantages linked to the claims nature of the data and the high administrative hurdles when requesting the use of SHI routine data. Particularly in view of the improved availability of data from all SHI insurants for research institutions in the context of the "health-care structure law", SHI routine data are an interesting data source for federal health monitoring purposes.

[Prevalence of dyslipidemia among adults in Germany: results of the German Health Interview and Examination Survey for Adults (DEGS 1)]. / Verbreitung von Fettstoffwechselstörungen bei Erwachsenen in Deutschland: Ergebnisse der Studie zur Gesundheit Erwachsener in Deutschland (DEGS1).

Interview and laboratory data from the first wave of the German health interview and examination survey for adults (DEGS1) from 2008 to 2011 were used to provide current estimates of the prevalence of dyslipidemia which are representative of the population in Germany 18 to 79 years of age. A total of 56.6 % of men and 60.5 % of women 18 to 79 years have elevated serum total cholesterol concentrations in excess of the currently recommended threshold of 190 mg/dL; 17.9 % of men and 20.3 % of women have highly elevated total cholesterol concentrations ≥ 240 mg/dL. A total of 19.3 % of men and 3.6 % of women have high density lipoprotein cholesterol concentrations below 40 mg/dL. The overall prevalence of dyslipidemia (total cholesterol ≥ 190 mg/dL or medical diagnosis of dyslipidemia) is 64.5 % for men and 65.7 % for women. Of these, more than half of both men and women have previously undiagnosed dyslipidemia. Among persons with known dyslipidemia, 30.8% take lipid-lowering medication. Dyslipidemia is widely prevalent among adults in Germany. More in-depth analyses will examine time trends in the prevalence of dyslipidemia in Germany and in an international comparison. An English full-text version of this article is available at SpringerLink as supplemental.

[Overweight and obesity in Germany: results of the German Health Interview and Examination Survey for Adults (DEGS1)]. / Übergewicht und Adipositas in Deutschland: Ergebnisse der Studie zur Gesundheit Erwachsener in Deutschland (DEGS1).

The increase in overweight and obesity is a worldwide health problem. The first wave of the "German Health Interview and Examination Survey for Adults" (DEGS1), conducted from 2008 through 2011, provides current data about overweight and obesity among adults in Germany. Within DEGS1, a representative sample of the 18- to 79-year-old population was interviewed with regard to health relevant issues and physically examined (n = 7,116). From measurements of body height and weight, the body mass index (BMI) was calculated, which was used to define overweight (BMI ≥ 25 kg/m(2)) and obesity (BMI ≥ 30 kg/m(2)). Results are stratified for gender, age group, socioeconomic status and region and compared with results from the German National Health Interview and Examination Survey 1998 (GNHIES98) and the National Examination Surveys 1990/92. According to DEGS1, 67.1% of men and 53.0% of women are overweight. The prevalence of overweight has not changed compared to GNHIES98. The prevalence of obesity, however, has risen substantially, especially among men: in GNHIES98, 18.9% of men and 22.5% of women were obese, in DEGS1, these figures were 23.3% and 23.9%, respectively. The increase in obesity occurred especially among young adults. An English full-text version of this article is available at SpringerLink as supplemental.

Screening for Menière's disease in the general population - the needle in the haystack.

CONCLUSION: Based on clinical history alone, 98.4% of the population with vestibular vertigo do not qualify for a diagnosis of Menière's disease (MD). Although frequent in dizziness clinics, MD is rare in the general population. OBJECTIVE: To narrow down the prevalence of MD in the general population. SUBJECTS AND METHODS: A representative sample adult population sample (n=4869) was screened for moderate or severe dizziness/vertigo. Subsequently, 1003 participants completed a validated neurotologic telephone interview on vestibular vertigo (VV). Prevalence of MD was determined by stepwise application of clinical criteria according to the AAO (1995): (1) at least two vertigo attacks of > or =20 min duration, (2) unilateral hearing loss, and (3) accompanying cochlear symptoms. RESULTS: Lifetime prevalence of VV was 7.4%. Of 243 participants with VV, 51 (21%) had recurrent vertigo lasting > or =20 min. Of these, nine reported unilateral hearing loss, and four had accompanying cochlear symptoms (1.6% of VV patients, population prevalence 0.12%).

Epidemiology of benign paroxysmal positional vertigo: a population based study.

OBJECTIVES: To examine the prevalence and incidence, clinical presentation, societal impact and comorbid conditions of benign paroxysmal positional vertigo (BPPV) in the general population. METHODS: Cross-sectional, nationally representative neurotological survey of the general adult population in Germany with a two stage sampling design: screening of 4869 participants from the German National Telephone Health Interview Survey 2003 (response rate 52%) for moderate or severe dizziness or vertigo, followed by validated neurotological interviews (n = 1003; response rate 87%). Diagnostic criteria for BPPV were at least five attacks of vestibular vertigo lasting <1 min without concomitant neurological symptoms and invariably provoked by typical changes in head position. In a concurrent validation study (n = 61) conducted in two specialised dizziness clinics, BPPV was detected by our telephone interview with a specificity of 92% and a sensitivity of 88% (positive predictive value 88%, negative predictive value 92%). RESULTS: BPPV accounted for 8% of individuals with moderate or severe dizziness/vertigo. The lifetime prevalence of BPPV was 2.4%, the 1 year prevalence was 1.6% and the 1 year incidence was 0.6%. The median duration of an episode was 2 weeks. In 86% of affected individuals, BPPV led to medical consultation, interruption of daily activities or sick leave. In total, only 8% of affected participants received effective treatment. On multivariate analysis, age, migraine, hypertension, hyperlipidaemia and stroke were independently associated with BPPV. CONCLUSION: BPPV is a common vestibular disorder leading to significant morbidity, psychosocial impact and medical costs.

Migrainous vertigo: prevalence and impact on quality of life.

OBJECTIVE: To investigate the epidemiology of migrainous vertigo (MV) in the general population by assessing prevalence, clinical features, comorbid conditions, quality of life, and health care utilization. METHODS: We screened a representative sample of the adult population in Germany (n = 4,869) for moderate or severe dizziness/vertigo and followed up with validated neurotologic telephone interviews (n = 1,003). Diagnostic criteria for MV were as follows: 1) recurrent vestibular vertigo; 2) migraine according to the International Headache Society; 3) migrainous symptoms during at least two vertiginous attacks (migrainous headache, photophobia, phonophobia, or aura symptoms); and 4) vertigo not attributed to another disorder. In a concurrent validation study (n = 61) the interviews had a sensitivity of 84% and a specificity of 94% for vestibular vertigo and 81% and 100% for migraine. RESULTS: The lifetime prevalence of MV was 0.98% (95% CI 0.70 to 1.37), the 12-month prevalence 0.89% (95% CI 0.62 to 1.27). Spontaneous rotational vertigo was reported by 67% of participants with MV while 24% had positional vertigo. Twenty-four percent always experienced headaches with their vertigo. Logistic regression analysis comparing participants with MV with dizziness-free migraineurs showed an independent association with coronary heart disease but not with sex, age, migrainous aura, education, stroke, hypertension, hyperlipidemia, body mass index, or depression. Age-adjusted health-related quality of life scores (SF-8 Health Survey) were consistently lower in participants with MV compared to dizziness-free controls. Two thirds of participants with MV had consulted a doctor but only 20% of these were diagnosed with MV. CONCLUSIONS: Migrainous vertigo is relatively common but underdiagnosed in the general population and has considerable personal and healthcare impact.

[Sport and health among adults in Germany]. / Sport und Gesundheit bei Erwachsenen in Deutschland.

Regularly participating in sports activities can have a positive effect on people's health and is therefore an important area of health promotion. Data of the Telephone Health Survey 2003 indicate that until now there is an unexploited potential for programmes promoting sports: in total 37.3% of men aged 18 years and above and 38.4% of equally aged women do not participate in sports at all; another 20.9% of men and 28.4% of women only engage in sports activities for up to 2 h/week. The highest prevalence of sports activity is seen among young adults, whereas it is lowest among older people. However, the latter slightly increased their sports activity during the last 10 years, while the trend observed among younger adults seems to point rather in the opposite direction. Also relevant for the planning and implementation of group-specific interventions is the observation that persons with low socioeconomic status tend to engage less often in sports than people with middle or high status do. The present study underlines the health relevance of sports participation by presenting inverse relationships between sports activity and behaviour-related health risks such as smoking and obesity as well as a positive effect of sports on self-assessed health.

[The German Telephone Health Survey 2003: an instrument of federal health reporting]. / Der telefonische Gesundheitssurvey 2003 als Instrument der Gesundheitsberichterstattung des Bundes.

The Robert Koch Institute has carried out health surveys at irregular intervals since the 1980s . Internationally telephone surveys have been used to supplement examination surveys for some time. Health interview surveys by telephone provide a timely and inexpensive possibility to build up a time series on health while being flexible enough to cover new health aspects. Health telephone surveys will also serve as a module of a coming health-monitoring system in Germany, which is currently under discussion. From September 2002 to March 2003, 8,313 German-speaking people randomly selected from the resident population aged 18 years and over were asked about topics such as chronic diseases, health behaviour and the extent to which they make use of health care services and others.

[Chronic back pain in the general population in Germany 2002/2003: prevalence and highly affected population groups]. / Chronische Rückenschmerzen in der Allgemeinbevölkerung in Deutschland 2002/2003: Prävalenz und besonders betroffene Bevölkerungsgruppen.

Back pain is one of the most common complaints in the general population and chronic back pain is a major Public Health burden. However, the prevalence of chronic back pain in Germany is not known. The aim of our study was to determine the prevalence of chronic back pain in the general adult population in Germany and to identify highly affected population groups. A nation-wide computer-assisted telephone interview (CATI) survey was conducted with 8,318 men and women aged 18 years and older residing in German households. Participants were selected using the Gabler-Häder telephone sampling method and the next-birthday method. The one-year prevalence of chronic back pain defined as daily or almost daily back pain over a period of three months was 16 % in men and 22 % in women, the lifetime prevalence 24 % in men and 30 % in women. The 12-months prevalence of any back pain was 66 % in women and 58 % in men. Back pain on the day preceding the interview was reported by 18 % of men and 27 % of women and had a median intensity on a 1 - 10 point scale of 5 in women and 4 in men. Factors independently associated with chronic back pain in the past 12 months were age, female sex, a history of arthritis, self-reported depression, lower educational level, current unemployment, overweight or obesity, no sports, smoking and living with a partner. In conclusion, chronic back pain is a highly prevalent complaint in the general population in Germany. The association not only with bone and joint diseases but also with depression, a lower level of education and with certain lifestyle behaviours emphasises that back pain should not be viewed only in the context of the spine.

Epidemiology of vestibular vertigo: a neurotologic survey of the general population.

OBJECTIVE: The purpose of this study was to determine the prevalence and incidence of vestibular vertigo in the general population and to describe its clinical characteristics and associated factors. METHODS: The neurotologic survey had a two-stage general population sampling design: nationwide modified random digit dialing sampling for participation in the German National Telephone Health Interview Survey 2003 (response rate 52%) with screening of a random sample of 4,869 participants for moderate or severe dizziness or vertigo, followed by detailed neurotologic interviews developed through piloting and validation (n = 1,003, response rate 87%). Diagnostic criteria for vestibular vertigo were rotational vertigo, positional vertigo, or recurrent dizziness with nausea and oscillopsia or imbalance. Vestibular vertigo was detected by our interview with a specificity of 94% and a sensitivity of 84[corrected]% in a concurrent validation study using neurotology clinic diagnoses as an accepted standard (n = 61). RESULTS: The lifetime prevalence of vestibular vertigo was 7.4[corrected]%, the 1-year prevalence was 4.9[corrected]%, and the incidence was 1.4[corrected]%. In 80% of affected individuals, vertigo resulted in a medical consultation, interruption of daily activities, or sick leave. Female sex, age, lower educational level, and various comorbid conditions, including tinnitus, depression, and several cardiovascular diseases and risk factors, were associated with vestibular vertigo in the past year in univariate analysis. In multivariable analysis, only female sex, self-reported depression, tinnitus, hypertension, and dyslipidemia had an independent effect on vestibular vertigo. CONCLUSIONS: Vestibular vertigo is common in the general population, affecting [corrected] 5% of adults in 1 year. The frequency and health care impact of vestibular symptoms at the population level have been underestimated.

[Health monitoring on a federal level. Approaches and perspectives]. / Gesundheitsmonitoring auf Bundesebene Ansätze und Perspektiven.

An assessment of the existing elements of a health monitoring system in Germany is given. Based on the analysis of deficits, the necessity for a comprehensive health monitoring system is recognised. The authors suggest starting points for the development of such a system in Germany by integrating different actors and taking into account different interests. The proposed system is based on a modular principle and allows for continuity as well as flexibility. As one key element in this monitoring system, a longitudinal health study is suggested, which allows the observation of developments in health matters as well as the evaluation of health policy actions. A plan for the step-wise development and testing of the health monitoring system is presented. Cooperation and data networking are essential elements. Whereas the flexible parts of the monitoring system should be financed by interested partners and customers, a basic sustainable financial support is a prerequisite. This paper provides arguments for the implementation of a health monitoring system and the need for long-term funding.

[The new indicator set for health reporting activities in the German States]. / Der neue Länderindikatorensatz für die Gesundheitsberichterstattung.

In May 2003, the third revised version of the indicator set for health reporting activities was confirmed by the health ministries of all German States (Bundesländer). Modeled on the restructured indicator set which has been annotated with meta-data descriptions, most Bundesländer have now started to collect data for their specific health reporting activities. Thanks to the support provided by national data holders and the Federal Statistical Office, it has been possible to further enlarge the database and for the first time also ensure access via the Federal Statistical Office. In this contribution the authors describe the methodological and statistical principles of the indicator set. Another aspect is the benefit of the indicator set for the health reporting activities in the German States.

[The "Spandau Public Health" test--description of study]. / Der Spandauer Gesundheitstest--Beschreibung der Studie.

In 2002 the "Spandauer Gesundheitstest" ("Spandau Public Health" Test), a prospective cohort study of the Robert Koch-Institute in Berlin has been successfully going on for two decades. Ten waves of follow-up of this study are now available, in which approximately 7 000 adults were interviewed and examined. Approximately 770 participants have taken part in all ten follow-up waves. The "Spandauer Gesundheitstest" is carried out to provide information on changes in health state at the individual level over time. The main epidemiological aim of the study is to follow up the development and course of chronic disease together with changes in health care needs and utilisation. A questionnaire, blood and urine examinations and a medical interview are parts of the study design in every wave. Since the beginning of this study more than 900 participants died. A mortality follow-up is carried out regularly to investigate the cause of death of the participants. The data are available for analysis.

Benefits of leisure-time physical activity on the cardiovascular risk profile at older age.

BACKGROUND: Intensity, frequency and duration of physical activity may contribute in different ways to the maintenance of cardiovascular health. Their relative importance may also change at different stages in life and this should be taken into account for activity recommendations. METHODS: The relationship of frequency and duration of leisure-time physical activities with cardiovascular risk factors was studied in 4942 male and 5885 female participants aged 50-69, of the German Cardiovascular Prevention Study (1984-1991). RESULTS: After adjustment for several possible confounders, women with modest levels (2-12 times per month, 0.5-2 h per week) of moderate-to-vigorous activity (> or =5 kcal/kg/h) had significantly lower systolic blood pressure (-1.8%), resting heart rate (-3.1%) and body mass index (-3.2%) values than sedentary women. Beneficial differences increased with frequency and duration of activity. Light activities (3-4.5 kcal/kg/h), conducted > or =5 times a week, were significantly associated with favourable lower diastolic blood pressure (-1.4%), resting heart rate (-2.3%) among women, and body mass index (women -2.9%, men -2.2%) among both genders. Recommended activity levels (> or =5 times, > or =3.5 h weekly) were associated with a lower prevalence of multiple risk factors (odds ratio [OR] = 0.55, 95% CI: 0.41-0.75 for men and OR = 0.44 95% CI: 0.31-0.63 for women). CONCLUSIONS: For sedentary elderly, even less physical activity than currently recommended, is likely to improve the cardiovascular risk profile.

Epidemiological explanation of an outbreak of gastro-enteritis in Sweden in the absence of detailed microbiological information.

Waterborne gastroenteritis outbreaks have often gone undetected or been incompletely defined in terms of source and extent. Methods which allow detection or clarification of such events are therefore useful. We describe the methods used to detect and investigate such an outbreak. In autumn 1996 high school absence rates and the rate of parents absent from work to care for sick children suggested a health problem in a Swedish town which had a history of unexplained outbreaks of gastrointestinal disease. A systematic sample of 300 households was surveyed by post. Respondents represented 10% of the total population of the town. Questions concerning symptoms and exposures were included. The same questionnaire was used in a nearby town as a control. Sixty four percent of respondents reported an acute gastrointestinal illness during a two month period. Diarrhoea (90%) and abdominal pain (88%) were the most frequent symptoms among the sick. Two percent of those sick sought medical care. Exposures associated with disease were being a member of a large household, young age, and consumption of water from the community water supply. Attack rate showed a dose response relationship with increasing frequency of water consumption. The peak incidence of gastrointestinal illness occurred shortly after raw water quality control data had shown a rise in indicator bacteria. Further analysis, dividing those infected into groups according to when they became ill and whether they were the first member of their household to fall ill, supported the hypothesis of primary cases being infected from the water supply with some secondary person to person spread.

An outbreak of sheep-associated Q fever in a rural community in Germany.

In spring 1996, an outbreak of Q fever occurred among residents of a rural town (population: 300) in Germany. A retrospective cohort study was conducted to ascertain the extent of the outbreak and to assess potential risk factors for illness. In July 1996, all residents > or =15 years received a self-administered questionnaire and were offered Coxiella burnetii antibody testing. Residents were considered to have probable Q fever if they had a positive result for IgM C. burnetii antibodies by ELISA or possible Q fever if they had fever > or =39 degrees C lasting >2 days and > or =3 symptoms (chills, sweats, severe headache, cough, aching muscles/joints, back pain, fatigue, or feeling ill) after 1 January 1996. Two hundred (84%) of the 239 residents aged > or =15 years either completed the questionnaire or submitted blood for antibody testing. Forty-five (23%) of these 200 met the probable or possible case definitions. Onsets of illness occurred in January-June 1996. Cases were geographically distributed throughout the town. Persons reporting contact with sheep (32% vs 18%, RR: 1.8, 95% CI: 1.1-2.9) and walking near a large sheep farm located next the town (34% vs 8%, RR: 4.5, 95% CI: 1.7-12.2) were more likely to have met the case definition than those without these exposures. Fifteen of 20 samples from the large sheep flock were positive for C. burnetii antibodies. The sheep had lambed outdoors in December 1995-January 1996 while the weather was extremely dry. The timing of the outbreak after lambing, the uniform distribution of cases throughout the town and the absence of risk factors among most case-persons suggest airborne transmission of C. burnetii from the large sheep farm.

Outbreak of Q fever in Lohra-Rollshausen, Germany, spring 1996.

Q fever is an acute (and sometimes chronic) febrile illness caused by the rickettsial organism Coxiella burnetii. The commonest animal reservoirs for C. burnetiiare cattle, sheep, and goats. Infected animals shed the organisms, which resist desiccation, i