[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.

[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.

[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.

[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.

Body mass index percentiles for children and adolescents in Germany based on a nationally representative sample (KiGGS 2003-2006).

OBJECTIVE: To present body mass index (BMI) percentiles representative for children in Germany and to compare them with the currently used percentiles by Kromeyer-Hauschild (KH) and international percentiles of the World Health Organisation (WHO) and the International Obesity Task Force (IOTF). METHODS: Representative examination survey of 17 641 children and adolescents aged 0-17 years living in Germany (KiGGS 2003-2006 study, response rate 67%) with standardized measurement of height and weight. RESULTS: Generally, BMI in KiGGS was higher than in the reference populations from previous decades. KiGGS shows an asymmetric upward shift of the BMI distribution from about age 6 years and an earlier adiposity rebound compared with KH. The BMI peak in the first year of life is shown by KiGGS and WHO, but much less by KH. The cut-offs for overweight and obesity determined with the IOTF methodology in KiGGS (percentiles corresponding to BMI 25 and 30 kg/m(2) at 18 years of age) were similar to IOTF cut-offs from age 18 to 10 years but systematically lower for younger children. CONCLUSIONS: The KiGGS BMI percentiles appear more valid for Germany than present alternatives and should be used for population monitoring. Despite their methodological limitations, the general shape of the older German KH references is confirmed by KiGGS for the ages 2-17 years. In order not to obscure the increase in obesity rates in the last decades, we therefore propose to continue using KH for individual diagnosis and estimation of the prevalence of overweight and obesity in this age range.

[Body measurements of children and adolescents in Germany. Results of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS)]. / Körpermasse bei Kindern und Jugendlichen in Deutschland. Ergebnisse des Kinder- und Jugendgesundheitssurveys (KiGGS).

In the nationwide German Health Interview and Examination Survey for Children and Adolescents (KiGGS), a number of anthropometric parameters were assessed in a standardised way in 17,641 boys and girls. To this end, body weight and height, head circumference and upper arm length, as well as two skinfold thicknesses (triceps, subscapular) were measured for the entire age range (0-12 years); starting from 6 years of age, elbow breadth and from 11 years of age waist and hip circumference were measured in addition. For all parameters, means with confidence intervals are reported per age (in years) and gender. Median graphs depict the changes with increasing age according to gender for each body measurement. The complex age-related anthropometric developments along with significant gender specificity show the full range of the dynamic physical development in boys and girls. Based on skinfold measurement data, the body fat percentage was estimated. Thickness and location of the skinfolds, as well as the calculated waist-to-hip ratio is used as an indicator for gender-specific fat distribution. Using the frame index, it is attempted to estimate skeletal robustness. For the anthropometric parameters studied, hardly any regional differences were found. However, head circumference, frame index and all parameters strongly associated with body fat show a significant social status gradient. Children and adolescents with migration background have on average a lower height, larger waist circumference and higher percentage of body fat.

[The German Health Interview and Examination Survey for Children and Adolescents (KiGGS): data management]. / Der Kinder- und Jugendgesundheitssurvey (KiGGS): Datenmanagement.

In the German Health Interview and Examination Survey for Children and Adolescents (KiGGS), comprehensive, nationwide representative data on the state of health of children and adolescents were collected for the first time. During the 3-year data collection phase of the survey, 17,641 subjects were examined and interviewed and approx. 1,500 items were recorded. Data management was not limited to survey data collection, administration and quality assurance alone, but also comprised the provision of tools for the management and control of process data, as well as for managing survey-specific business processes. In the context of the KiGGS study, numerous components for supporting the extensive and complex processes were developed for the study staff. Here the primary focus was on subject and sample point administration, scheduling, sampling, reporting, field logistics and laboratory data management. Thanks to the computer-based processing of routine tasks involved in the organisation of the field work, ease of work and project progress control were enhanced significantly. To some extent, KiGGS-specific components have already been used in other studies and only minor adaptations were needed for the transfer. The main emphasis with regards to survey data management was on the standardisation of methods for data processing, data control and data cleaning. Here, a wealth of previous experiences was available as a starting point. The established quality assurance methods were standardised to a large extent and partly automated and complemented by data base tools for the management and documentation of survey instruments and quality assurance measures. All these measures combined made it possible to provide data users with a controlled and cleaned final data set, including a detailed documentation.

[Sociodemographic characteristics in the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) - operationalisation and public health significance, taking as an example the assessment of general state of health]. / Messung soziodemographischer Merkmale im Kinder- und Jugendgesundheitssurvey (KiGGS) und ihre Bedeutung am Beispiel der Einschätzung des allgemeinen Gesundheitszustands.

The German Health Interview and Examination Survey for Children and Adolescents (KiGGS) was conducted from May 2003 to May 2006 by the Robert Koch Institute in 167 communities representative of Germany. By collecting comprehensive and nationally representative data on the health status of children and adolescents aged 0 to 17 years, the study aimed to fill a longstanding evidence gap. Data from 17,641 study participants will be analysed in a timely and systematic manner by the Robert Koch Institute. Initially mainly descriptive analyses as presented in the current special issue on the KiGGS study, provide information on the distribution of main health characteristics according to sociodemographic key variables, including age, sex, region of residence (former East/West Germany), social status, and migrant background. We report here the rationale for a standard set of stratifying variables and the operationalisation of composite variables. Furthermore, we illustrate the public health relevance of the observed group differences using the example of an important health indicator: parents' evaluation of their children's general state of health.

[Social class index in the Federal Health Survey]. / Der Sozialschichtindex im Bundes-Gesundheitssurvey.

Since the first scaling of social status for the German National Health Interview and Examination Survey, relevant socio-economical circumstances and constraints have changed. This prompted an examination of relevant developments such as changes in income distribution and increasing income in the West and since 1990 in the East of Germany, changes in educational levels, and changes in social prestige of professional groups. In spite of these changes we must assume that the relations between social strata remained constant over time. The task is to assess how and to what extend the developments mentioned above have been reflected and to examine the necessity of bringing social status scaling in line with these developments, as well as to adjust social status scaling.

[Conceptualization and operationalization of social inequality in The Child and Adolescent Health Survey]. / Konzeptualisierung und Operationalisierung sozialer Ungleichheit im Kinder- und Jugendgesundheitssurvey.

Poverty and social disadvantages are often accompanied by long-lasting social and psychosocial strain on the well-being and health of children and adolescents. From a health policy point of view the rising poverty quotas among young people indicate a high need for action. The status of empirical research is insufficient, so that it is difficult to plan and undertake political measures. The National Health Survey for Children and Adolescents will provide data permitting differentiated analysis of relations between poverty, social inequality and health in the adolescent generation. To get a first impression of possible analyses, the present article demonstrates which information on the living situation will be ascertained in the National Health Survey for Children and Adolescents, and which theoretical and methodological considerations have been playing a role.

National trends in risk factors for cardiovascular disease in Germany.

BACKGROUND: National representative health surveys for Germany were conducted for the first time in 1984/85 and again in 1987/88 and 1990/91. METHODS: Data from these three independent population samples (ages 25-69 years) are used to describe national trends in cardiovascular risk factors. In addition, national cardiovascular disease mortality rates during this time period are presented. RESULTS: A net rise in median total serum cholesterol level of 0.17 mmol/liter (6.6 mg/dl) for men and 0.08 mmol/liter (3.1 mg/dl) for women was observed. Also observed was an increase in high-density lipoprotein (HDL) cholesterol of 0.04 mmol/liter (1.5 mg/dl) for men and of 0.09 mmol/liter (3.5 mg/dl) for women. This resulted in a favorable increase in the HDL/total cholesterol quotient. There were no statistically significant changes in systolic and diastolic blood pressure, with the exception of a net increase of 2 mm Hg in systolic blood pressure for women. A net rise of 0.3 kg/m2 for men and 0.4 kg/m2 for women in body mass index was observed. The prevalence of male smokers declined during the observed period while the prevalence of female smokers increased. CONCLUSIONS: Most of the measured risk factors increased in both sexes during the study period. This is not reflected in cardiovascular mortality, which has shown a steady downward trend for more than 20 years.

[The Federal Health Survey: response, composition of participants and non-responder analysis]. / Bundes-Gesundheitssurvey: Response, Zusammensetzung der Teilnehmer und Non-Responder-Analyse.

The first German Health Survey was carried out from October 1997 to March 1999. In the survey, 7,124 subjects of a representative sample of the residential population aged between 18 and 79 years were interviewed and medically examined. The response rate was 61.4%; 0.4% of the sample participated only partly in the study. Moreover, 16.0% of the non-respondents filled in a short questionnaire. This results in (although partly limited) information from 77.8% of the sample. The sample also comprises aliens living in Germany. More than 15% of the non-respondents could not be addressed to participate in the study because they were never reached personally. According to the statements in the short questionnaire, non-respondents and respondents differ in particular items such as e.g. education. The differences between the individual answers concerning the important question of the general health status can be classified as negligible. Weighting factors were calculated to arrive at representative information on the 18 to 79 year-old population.

Reduction of coronary heart disease risk factors in the German cardiovascular prevention study.

BACKGROUND: In six regions of former West Germany, a community-oriented prevention program for coronary heart disease (CHD) was conducted over a 7-year period. METHODS: In the intervention regions, CHD prevention activities were performed with special emphasis on healthy nutrition, increased physical activity, and reduction of smoking, hypertension, and hypercholesterolemia. The impact of these activities on CHD risk factor trends was observed in three independent samples of the intervention regions. Three independent representative samples of the total West German population were used as a reference. Linear regression models with interaction terms to represent the intervention effects were used to test for differences in risk factor trends. RESULTS: In the pooled intervention regions, a net reduction in mean values of systolic (-2.0%) and diastolic (-2.0%) blood pressure, total serum cholesterol (-1.8%), as well as the percentage of smokers (-6.7%) was observed compared with the nationwide trend. From the major CHD risk factors, only body mass index was not influenced in the intervention population. CONCLUSIONS: The community-oriented German Cardiovascular Prevention program can effectively be used to reduce CHD risk factors in a broad population.