[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.

[Health-related quality of life of overweight and obese adolescents: what differences can be seen by socio-economic status and education?]. / Gesundheitsbezogene Lebensqualität von übergewichtigen und adipösen Jugendlichen : Welche Unterschiede zeigen sich nach Sozialstatus und Schulbildung?

In the present study the relation between overweight/obesity and health-related quality of life (HRQoL) in adolescence is analysed. Of special interest is the question, to what extent this relation varies by socio-economic status (SES) and education. Data base is a subsample of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS, n = 6,813, 11-17 years). For the assessment of overweight and obesity, body mass index (BMI) was calculated based on standardised body height and weight measurements. The HRQoL was collected using the KINDL-R-questionnaire, which allows statements concerning a total rating as well as 6 dimensions: physical well-being, emotional well-being, self-worth, family well-being, well-being in relation to friends/peers and school well-being. SES and education are analysed as moderating factors. The results show that obese boys as well as overweight and obese girls have a diminished HRQoL compared to normal weight peers. The analyses according to SES and education suggest that in girls this finding applies for all considered subgroups. Thus, in girls neither SES nor education has a moderating impact on the relation between overweight/obesity and HRQoL. In boys, only SES has a moderating impact on the relation between overweight and HRQoL in favour of the low status group. In terms of the relation between obesity and HRQoL, in boys also only SES has a moderating impact on the analysed relation, but here in favour of the high status group. Altogether, the results show that overweight and especially obese adolescents are affected in their HRQoL, this being almost independent of SES and education. Interventions to improve the HRQoL of overweight and obese adolescents should be independent of SES and education.

[Health Inequality among employed men and women - results of the German health update (GEDA) 2010]. / Gesundheitliche Ungleichheit bei erwerbstätigen Männern und Frauen - Ergebnisse der GEDA-Studie 2010.

BACKGROUND: The study is based on representative data and gives an overview on the extent of health inequalities in working men and women in Germany. METHODS: We use data of the study German Health Update (GEDA) 2010 to analyze health differences by occupational status for men and women. Occupational Status was measured using the "International Socio-, Economic Index of Occupational Status' (ISEI). Outcomes are self-rated health status, work/and commuting accidents, self-assessed health risks at work, days with physical or emotional problems and sick leave from work. RESULTS: Men and women with high occupational status are in a better health situation than those with low status in respect to all outcomes analyzed. The risk for a poor self-rated health status, high health risks at work and for the occurrence of accidents at work is significantly 2.4- to 4.6-fold (men) and 1.8- to 3.3-fold (women) increased after controlling for age and work hours. Further Analyses with regard to self-assessed health risks at work showed that occupational status differences with men and women do not differ significantly. In those analyses, about 50% of the status differences regarding risks at work could be explained for men and women by their qualification, working conditions and health behavior. CONCLUSION: The present findings show that significant and persistent health inequalities among the employed exist in Germany. The relationship proved equally strong in both men and women.

[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.

Workers with a chronic disease and work disability. Problems and solutions.

The prevalence of chronic diseases in the age group 18-65 years is high. Cardiometabolic conditions and musculoskeletal diseases are the most frequent chronic diseases. Depending on disease and comorbidity, the employment rates are considerably lower than for healthy individuals. Chronically ill workers may have problems in meeting job demands, they may experience physical, cognitive or sensory limitations, have fatigue or pain complaints or other disease symptoms. Psychological distress, depressive feelings, feelings of shame or guilt, lack of coping or communicative skills, and non-supportive colleagues and supervisors may add to work-related problems. The ICF Model (International Classification of Functioning, Disability and Health) of the WHO offers a framework for understanding and considering health-related problems at work and finding solutions. Interventions to prevent problems in functioning, sickness absence and work disability may focus on the worker, the workplace, or health care. Multidisciplinary vocational rehabilitation, exercise therapy, cognitive behavioural interventions, workplace interventions and empowerment are interventions with at least some evidence of effectiveness. Future policy could focus more on promotion of workers' health and future research should include the interests and motivations of employers concerning disability management, skills of line managers, the feasibility of interventions to prevent work disability and the context sensitivity of study outcomes.

[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.

[Regionalization of health indicators. Results from the GEDA-Study 2009]. / Regionalisierung von Gesundheitsindikatoren. Ergebnisse aus der GEDA-Studie 2009.

The representative health surveys conducted by the Department of Epidemiology and Health Reporting weren't used before to provide estimates for the spatial distribution of health outcomes. We are discussing the possibilities of providing these outcomes using methods for 'Small-Area-Estimation'. In the study we are using data of the "German Health Update 2009" (GEDA) to analyze regional inequalities for self-assessed health status, smoking and obesity on the district level in Germany. The small area estimates are provided by multilevel logistic regression models using additional regional statistical data from the official INKAR 2009 database of regional indicators for Germany. We are mapping the results of our analysis for the district level (NUTS-3) using simple thematic maps. Afterwards we compared the results of our small area models with conventional estimates that were based on the official German small scale census. The results showed that our estimates are in line with the prevalences of the census. Overall the results suggest that Small-Area-Estimation methods have a big potential to provide regionalized health indicators for the health reporting in Germany.

Area-level and individual correlates of active transportation among adults in Germany: A population-based multilevel study.

This study aimed at estimating the prevalence in adults of complying with the aerobic physical activity (PA) recommendation through transportation-related walking and cycling. Furthermore, potential determinants of transportation-related PA recommendation compliance were investigated. 10,872 men and 13,144 women aged 18 years or older participated in the cross-sectional 'German Health Update 2014/15 - EHIS' in Germany. Transportation-related walking and cycling were assessed using the European Health Interview Survey-Physical Activity Questionnaire. Three outcome indicators were constructed: walking, cycling, and total active transportation (≥600 metabolic equivalent, MET-min/week). Associations were analyzed using multilevel regression analysis. Forty-two percent of men and 39% of women achieved ≥600 MET-min/week with total active transportation. The corresponding percentages for walking were 27% and 28% and for cycling 17% and 13%, respectively. Higher population density, older age, lower income, higher work-related and leisure-time PA, not being obese, and better self-perceived health were positively associated with transportation-related walking and cycling and total active transportation among both men and women. The promotion of walking and cycling among inactive people has great potential to increase PA in the general adult population and to comply with PA recommendations. Several correlates of active transportation were identified which should be considered when planning public health policies and interventions.

[Social capital and health in Germany]. / Sozialkapital und Gesundheit in Deutschland.

The concept of social capital has been intensively discussed in public health during the last years. But there is only little empirical evidence regarding its association with health in Germany up to now. We have used data of the German Socio-Economic Panel (GSOEP) of 2003 to analyse the health utility of social capital. The results suggest a clear positive association among different forms of social capital (trust, norms of reciprocity, participation, social integration) and subjective health. Men and women who are poorly socially integrated regard their own health relatively often as limited. In contrast to these, men and women who hold any form of social capital rate their own health status to be noticeably better. In the multivariate analysis, socio-economic differences in subjective health could be traced back partly to the stock of social capital. In addition to its health utility, social capital may therefore make a contribution to understand the emergence of social inequalities in health. All in all, our results suggest that the concept of social capital should be considered even more in public health. Due to the present lack of empirical evidence, social capital has to be incorporated into more studies in Germany.

[Income differences in health and life expectancy--cross-sectional and longitudinal findings of the German Socio-Economic Panel (GSOEP)]. / Einkommensdifferenzen in der Gesundheit und Lebenserwartung - Quer- und Längsschnittbefunde des Sozio-oekonomischen Panels (SOEP).

Income is an important determinant of individual standards of living and participation in social life. Data from the German Socio-Economic Panel shows that the level of income also affects a person's health and life expectancy. People's self-assessment of their health and health-related quality of life follow a distribution pattern which can be described as a gradient: the lower the income, the more frequent the impairments to subjective health. Life expectancy statistics also reflect income differences, primarily due to premature deaths among lower-income groups. Clues for explaining income-related differences in health and life expectancy can be found in the results on health-related behaviour and use of the medical system: people in the lower income groups smoke more frequently, are slaker in sports and are less likely to go to a doctor when their health is impaired. Furthermore, work environment and job-specific influences, stress burdens and reactions, social comparison processes and disease-induced processes of declining social mobility and social exclusion are discussed as possible explanations.