Projected number of people with diagnosed Type 2 diabetes in Germany in 2040.

AIMS: To project the number of people with Type 2 diabetes in Germany between 2015 and 2040. METHODS: Based on data from 65 million insurees of the German statutory health insurance, we projected the age-specific prevalence of diabetes using mathematical relations between prevalence, incidence rate and mortality. We compared several scenarios regarding temporal trends in the incidence and mortality rate. The projected age-specific prevalence was applied to the projected age structure of the German population between 2015 and 2040 to calculate the number of people with Type 2 diabetes. RESULTS: Application of current age-specific prevalence estimates to the projected age structure in 2040, although ignoring temporal trends in incidence and mortality, yielded an increase in the number of Type 2 diabetes cases from 6.9 million in 2015 to 8.3 million (+21%) in 2040. More realistic scenarios that account for decreasing mortality rates and different trends in the incidence rates project between 10.7 million (+54%) and 12.3 million (+77%) Type 2 diabetes cases in 2040. CONCLUSIONS: For the first time, we projected the number of future Type 2 diabetes cases for the whole adult population in Germany. The results indicate a relative increase in the number of Type 2 diabetes cases of between 54% and 77% from 2015 to 2040. Temporal trends in the incidence rate are the main drivers of this increase. Simply applying current age-specific prevalence to the future age structure probably underestimates the future number of Type 2 diabetes cases.

Corrigendum: Limitations in activities of daily living in old age in Germany and the EU - Results from the European Health Interview Survey (EHIS) 2.

[This corrects the article on p. 48-56 in vol. 4.].

Glycaemic status and depressive symptoms among adults in Germany: results from the German Health Interview and Examination Survey for Adults (DEGS1).

AIMS: To examine the association between glycaemic status and depressive symptoms in a nationwide sample of the adult population in Germany. METHODS: We conducted a cross-sectional analysis of data from 6385 participants aged 18-79 years in the nationwide German Health Interview and Examination Survey for Adults 2008-2011 (DEGS1). Glycaemic status was classified as follows: diagnosed diabetes (self-reported diagnosis or receiving antidiabetes medication); undiagnosed diabetes (HbA1c ≥48 mmol/mol [≥6.5%]); prediabetes (HbA1c 39-47 mmol/mol [5.7-6.4%]); or normoglycaemia (HbA1c <39 mmol/mol [<5.7%]). Current depressive symptoms were measured using the Patient Health Questionnaire depression scale (PHQ-9) and defined as elevated depressive symptoms (PHQ-9 score ≥10 points; dichotomous variable) and severity of depressive symptoms (PHQ-9 score, range 0-27 points; continuous variable). Associations of glycaemic status and HbA1c with both depressive symptoms variables were analysed using multivariable logistic (elevated depressive symptoms) and linear (severity of depressive symptoms) regression models. RESULTS: Compared with normoglycaemia, diagnosed diabetes, but not prediabetes or undiagnosed diabetes, was associated with elevated depressive symptoms (odds ratio 1.55, 95% CI 1.00-2.41) and severity of depressive symptoms (ß coefficient 0.71, 95% CI 0.23-1.19) in models adjusting for sociodemographics and health behaviours. Associations were similar among people with diagnosed diabetes taking and not taking antidiabetes medication. Among people without diagnosed diabetes, no associations between HbA1c and depressive symptoms were found. CONCLUSIONS: Diagnosed diabetes, but not prediabetes, undiagnosed diabetes or HbA1c , was associated with depressive symptoms among adults in Germany. Studies examining psychosocial and biological mechanisms that may potentially explain relationships between diagnosed diabetes and depressive symptoms are needed.

Changes in physical functioning among men and women aged 50-79 years in Germany: an analysis of National Health Interview and Examination Surveys, 1997-1999 and 2008-2011.

BACKGROUND: This study examines changes in physical functioning among adults aged 50-79 years in Germany based on data from two German National Health Interview and Examination Surveys conducted in 1997-1999 (GNHIES98) and 2008-2011 (DEGS1). METHODS: Using cross-sectional data from the two surveys (GNHIES98, n = 2884 and DEGS1, n = 3732), we examined changes in self-reported physical functioning scores (Short Form-36 physical functioning subscale (SF-36 PF)) by sex and age groups (50-64 and 65-79 years). Covariables included educational level, living alone, nine chronic diseases, polypharmacy (≥5 prescribed medicines), body mass index, sports activity, smoking and alcohol consumption. Multimorbidity was defined as ≥2 chronic diseases. Multivariable models were fitted to examine consistency of changes in physical functioning among certain subgroups and to assess changes in mean SF-36 PF scores, adjusting for changes in covariables between surveys. RESULTS: Mean physical functioning increased among adults aged 50-79 years between surveys in unadjusted analyses, but this change was not as marked among men aged 65-79 years who experienced rising obesity (20.6 to 31.5%, p = 0.004) and diabetes (13.0 to 20.0%, p = 0.014). Prevalence of multimorbidity and polypharmacy use increased among men and women aged 65-79 years. In sex and age specific multivariable analyses, changes in physical functioning over time were consistent across subgroups. Gains in physical functioning were explained by improved education, lower body mass index and improved health-related behaviours (smoking, alcohol consumption, sports activity) in women, but less so among men. CONCLUSIONS: Physical functioning improved in Germany among adults aged 50-79 years. Improvements in the population 65-79 years were less evident among men than women, despite increases in multimorbidity prevalence among both sexes. Changes in health behaviours over time differed between sexes and help explain variations in physical functioning. Targeted health behaviour interventions are indicated from this study.

Temporal changes in the prevalence of diagnosed diabetes, undiagnosed diabetes and prediabetes: findings from the German Health Interview and Examination Surveys in 1997-1999 and 2008-2011.

AIMS: Nationally representative data on temporal changes in the prevalence of diagnosed diabetes, as well as undiagnosed diabetes and prediabetes, have been lacking in Germany as in most other European countries. We aimed to fill this gap using data from nationwide examination surveys of German adults. METHODS: The study population comprised 18-79-year-old participants from the German Health Interview and Examination Surveys in 1997-1999 (GNHIES98, n = 6655) and 2008-2011 (DEGS1, n = 7017). Participants were classified as having diagnosed diabetes based on self-reported physician-diagnosed diabetes or the use of anti-diabetes agents. Among those without diagnosed diabetes, HbA1c measures were used to define undiagnosed diabetes [≥ 48 mmol/mol (≥ 6.5%)] or prediabetes [39-47 mmol/mol (5.7-6.4%)]. RESULTS: Although the age- and sex-standardized prevalence of total diabetes remained stable between 1997-1999 at 9.3% (95% CI 8.3-10.5%) and 2008-2011 at 9.2% (8.3-10.3%), the prevalence of diagnosed diabetes increased from 5.6% (4.9-6.3%) to 7.2% (6.5-8.0%), whereas the prevalence of undiagnosed diabetes decreased from 3.8% (3.1-4.6%) to 2.0% (1.5-2.7%), resulting in a decreased proportion of undiagnosed diabetes (40.9% vs. 21.7%). Over the same period, the prevalence of prediabetes decreased from 27.7% (25.6-29.8%) to 20.8% (18.2-23.7%). Observed temporal changes were not explained by changes in BMI, sport activity and educational level. CONCLUSIONS: The two nationwide surveys indicate a shift from undiagnosed to diagnosed diabetes. However, the unchanged prevalence of total diabetes and the considerably high proportion of prediabetes strongly call for a continued and concerted effort in diabetes prevention among German adults.

Changes in body weight and obesity status in German adults: results of seven population-based prospective studies.

BACKGROUND/OBJECTIVES: The objective of this study was to quantify body weight changes in German adult populations during the past decades. SUBJECTS/METHODS: Longitudinal analysis of seven cohort studies covering different age ranges between 18 and 83 years. Baseline examinations were between 1994 and 2007 and follow-up durations between 4.0 and 11.9 years. For each study, mean change in body weight per year and 10-year change in body mass index (BMI) classification were analyzed. For the middle age group of 45-64 years, meta-analysis was conducted to obtain an overall estimate for Germany. RESULTS: Among men weight gain was highest in the youngest participants and decreased with advancing age. Among women weight gain was on a stable high level among those younger than 45 years and decreased at older age. Within 10 years, 30-40% of middle-aged participants with normal baseline weight became pre-obese or obese and 20-25% of those with pre-obesity at baseline became obese, whereas >80% of persons who were obese at baseline remained obese over time. The estimated average weight change in adults aged 45-64 years was 0.25 (95% confidence interval (CI): 0.18-0.33) kg/year among men and 0.24 (0.17-0.30) kg/year among women. CONCLUSIONS: We could observe a moderate weight gain over the past years in German middle-aged populations of 0.25 kg/year. Obesity prevention needs to be targeted to specific subgroups in the population, especially to younger adults, who seem to be most vulnerable for gaining weight. Obesity intervention needs to be improved, as the majority of obese adults remained obese over time.

[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.

Residential traffic and incidence of Type 2 diabetes: the German Health Interview and Examination Surveys.

AIMS: To investigate whether an indicator of overall traffic intensity is related to the risk of Type 2 diabetes in a nationwide cohort. METHODS: The study population comprised 3604 adults aged 18-79 years and without diabetes from the German National Health Interview and Examination Survey (GNHIES98, 1997-1999) who participated again in a follow-up survey (DEGS1, 2008-2011). The association between the participants' reported traffic intensity at their residential address and Type 2 diabetes incidence was examined using logistic regression models. RESULTS: During a mean of 12.1 years of follow-up, 252 of the participants included in the study developed Type 2 diabetes. Compared with people living in traffic-calmed areas, odds ratios were 1.15 (95% CI 0.80-1.67) for people living on moderately busy side streets, 1.11 (95% CI 0.69-1.80) for people living on considerably busy side streets, 1.41 (95% CI 0.96-2.08) for people living on heavily busy roads, and 1.97 (95% CI 1.07-3.64) for people living on extremely busy roads, after adjusting for age, sex, active and passive smoking, type of heating, education, BMI, waist circumference, sport activity and parental diabetes history. CONCLUSIONS: The twofold higher risk of Type 2 diabetes observed for people exposed to intense traffic in this nationwide cohort extends the limited evidence from previous selected populations. Although the underlying traffic-related components and their biological mechanisms still need to be unravelled, traffic exposure control should be considered in public health strategies to reduce the global burden of diabetes.

[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.

[Prevalence and temporal trend of known diabetes mellitus: results of the German Health Interview and Examination Survey for Adults (DEGS1)]. / Prävalenz und zeitliche Entwicklung des bekannten Diabetes mellitus: Ergebnisse der Studie zur Gesundheit Erwachsener in Deutschland (DEGS1).

The first wave of the "German Health Interview and Examination Survey for Adults" (DEGS1, 2008-2011) allows for up-to-date, representative prevalence estimates of known diabetes amongst the 18- to 79-year-old resident population of Germany. Temporal trends can be shown by comparing the survey findings with those of the "German National Health Interview and Examination Survey 1998" (GNHIES98). The definition of known diabetes was based on self-reports in physician-administered interviews that asked respondents if they had ever been diagnosed with diabetes by a doctor or were on anti-diabetic medication. Overall, diabetes had been diagnosed in 7.2 % of the adults (7.4 % of the women; 7.0 % of the men). The prevalence increased substantially with advancing age and was higher in persons of low than of high socioeconomic status. Prevalence varied depending on the type of health insurance held and was highest amongst those insured with AOK health insurance funds. In comparison with GNHIES98, there was a 38 % increase in prevalence, of which approximately one third is to be attributed to demographic ageing. In the context of other nationwide studies, the results indicate a figure of at least 4.6 million 18- to 79-year-olds having been diagnosed with diabetes at some point. Planned analyses of undiagnosed diabetes will contribute to the interpretation of the observed increase in the prevalence of known diabetes. An English full-text version of this article is available at SpringerLink as supplemental.

[Prevalence of selected musculoskeletal conditions in Germany: results of the German Health Interview and Examination Survey for Adults (DEGS1)]. / Prävalenz ausgewählter muskuloskelettaler Erkrankungen: Ergebnisse der Studie zur Gesundheit Erwachsener in Deutschland (DEGS1).

The term musculoskeletal condition (MSKC) comprises inflammatory and degenerative diseases of joints and bones. They are among the most common conditions in older age and cause of severe long-term pain, physical disability, and decrease in quality of life. Data from the German Health Interview and Examination Survey for Adults (DEGS1) were used to estimate the life-time prevalence of osteoarthritis, rheumatoid arthritis (RA) and osteoporosis in Germany. A total of 7,988 persons aged 18-79 years (osteoporosis 50-79 years) were asked to report doctor-diagnosed MSKC in face-to-face interviews. Women were more likely to report all MSKC and all prevalences increase with age. Osteoarthritis is reported by 22.3 % of women and 18.1 % of men, RA by 3.2 % of women and 1.9 % of men, and osteoporosis by 13.1 % of women and 3.2 % of men. MSKC are of great relevance for older adults in Germany. Data from DEGS1 provide a lot of information along to MSKC and hereby allow a closer description of the health situation of older adults. An English full-text version of this article is available at SpringerLink as supplemental.

[Prevalence of hysterectomy in women 18 to 79 years old: results of the German Health Interview and Examination Survey for Adults (DEGS1)]. / Prävalenz von Hysterektomien bei Frauen im Alter von 18 bis 79 Jahren: Ergebnisse der Studie zur Gesundheit Erwachsener in Deutschland (DEGS1).

In many countries, hysterectomy is one of the most frequently performed surgical procedures in gynaecology. The aim of this study is to analyse the prevalence of hysterectomy in Germany by socio-demographic factors and factors of (reproductive) health. Analyses are based on data from the "German Health Interview and Examination Survey for Adults (DEGS1)", which is part of the health monitoring of the Robert Koch Institute (RKI). The prevalence of hysterectomy among participating women (18-79 years old) was 17.5% (n = 689). Most women (49.1%) were 40-49 years old when surgery was performed. 6.1% of hysterectomised women had cancer of the uterus or ovaries, and 19.7% underwent a simultaneous oophorectomy. There were significant differences in the prevalence of hysterectomy regarding social status, place of residence in 1988, number of live births, and body weight. DEGS1 is the first study showing the prevalence of hysterectomy in a representative sample of the German population. More detailed analyses of the DEGS data, among other data sources, are needed to evaluate the importance of the described associations and to assess trends. An English full-text version of this article is available at SpringerLink as supplemental.

[Physical and cognitive capabilities among persons aged 65-79 years in Germany: results of the German Health Interview and Examination Survey for Adults (DEGS1)]. / Körperliche und geistige Funktionsfähigkeit bei Personen im Alter von 65 bis 79 Jahren in Deutschland: Ergebnisse der Studie zur Gesundheit Erwachsener in Deutschland (DEGS1).

In older age, physical and cognitive capabilities play an important role for independent living. For this reason, the German Health Interview and Examination Survey for Adults (DEGS1) included the Timed Up and Go test (TUG) and a chair-rise test, balance tests, a measurement of hand grip strength and the Digit Symbol Substitution Test (DSST) in order to representatively describe physical and cognitive performance of older people in Germany. Among 1,853 persons 65-79 years of age who came to the study centre more than 90 % participated in the performance tests. The average time needed to complete the TUG and chair-rise tests were 10.7 and 11.8 s, respectively. On average, participants reached 3.9 of a maximum of 5 points in the balance tests (FICSIT4 protocol). Mean maximum grip strength was 32.3 kg. The mean number of correctly assigned symbols in the DSST was 43.8. In all functional capacity areas tested, performance declined with increasing age. There were differences by sex in the chair-rise test, hand grip strength and DSST. The objective measurement of physical and cognitive capabilities in DEGS1 contributes to describe the health status of older people with implications for health promotion and prevention. An English full-text version of this article is available at SpringerLink as supplemental.

[Chronic stress among adults in Germany: results of the German Health Interview and Examination Survey for Adults (DEGS1)]. / Chronischer Stress bei Erwachsenen in Deutschland : Ergebnisse der Studie zur Gesundheit Erwachsener in Deutschland (DEGS1).

The "German Health Interview and Examination Survey for Adults" (DEGS1) was conducted from 2008 to 2011 and comprised interviews, examinations and tests. The target population was the resident population of Germany aged 18 to 79 years. A total of 8152 persons participated. Chronic stress was assessed to examine its effects on health and mental wellbeing. The Screening Scale of the Trier Inventory for the Assessment of Chronic Stress was used to assess stress burden among participants up to the age of 64 years (N = 5850). High levels of stress are significantly more often reported by women (13.9%) than by men (8.2%). The prevalence of high stress levels decreases with a higher socioeconomic status (SES); it falls from 17.3% with low SES to 7.6% with high SES. High chronic stress levels are particularly common (26.2%) in persons who report low levels of social support. Depressive symptoms, burnout syndrome and sleep disturbances are more common in people who have high levels of chronic stress than in those without high levels of stress. The results confirm the importance of chronic stress as a health risk and underline the public health relevance of chronic stress. 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.

[Social inequities regarding annoyance to noise and road traffic intensity: results of the German Health Interview and Examination Survey for Adults (DEGS1)]. / Soziale Ungleichheit von Lärmbelästigung und Straßenverkehrsbelastung: Ergebnisse der Studie zur Gesundheit Erwachsener in Deutschland (DEGS1).

To study the associations of annoyance to noise and exposure to residential traffic with sociodemographic, socioeconomic and regional characteristics as well as housing conditions, a population-based sample of 7,988 adults 18-79 years of age was studied in the German Health Interview and Examination Survey for Adults (DEGS1). Annoyance to noise and exposure to residential traffic were assessed by self-administered questionnaires. A total of 6.3 % of the participants reported a high to very high exposure to residential traffic noise, 3.7 % to neighbourhood noise and 2.1 % to aircraft noise. An excessive exposure to residential traffic was reported by 21.3 % of the participants. A high annoyance to traffic and neighborhood noise was associated with a lower equivalised disposable income and poor housing conditions. Additionally annoyance to neighborhood noise was associated with low socioeconomic and occupational status. A high annoyance to aircraft noise was only associated with a low equivalised disposable income and living in apartment blocks. Exposure to residential traffic was associated with all investigated indicators. At present in Germany environmental exposures are social unequally distributed and may lead to negative health consequences in social disadvantaged groups. An English full-text version of this article is available at SpringerLink as supplemental.

[National health target "healthy ageing". Medical, psychosocial and nursing care for elderly people]. / Nationales Gesundheitsziel "Gesund älter werden". Handlungsfeld II: Medizinische, psychosoziale und pflegerische Versorgung älterer Menschen.

What kind of health targets should be pursued concerning the health care of elderly people? What kind of activities should be implemented to ensure good health care with regard to future challenges? The Association for the Continuous Development of the National Health Target Process, health-targets.de, deals with these issues under the new national health target "Healthy Ageing". We develop concrete objectives and proposals for practical implementation in the areas of "outpatient and inpatient care", "nursing" and "rehabilitation in old age". health-targets.de supports a common health target process and initiates interventions in the field of health care for elderly people.

[Possibilites and limitations of retrospective research on cause of death within the framework of a nationwide epidemiological study]. / Möglichkeiten und Grenzen retrospektiver Todesursachenrecherchen im Rahmen bundesweiter epidemiologischer Studien.

Cause-specific mortality is an important endpoint in longitudinal epidemiological studies to research causal health links and carry out individual process analyses. As in Germany no national mortality register exists, state-specific data-protection conditions for and approaches to cause of death studies were researched and tested within the framework of a pilot project. The database was provided by a sample of deceased study participants from the 1998 nationwide health survey. Under the given conditions, cause of death research in a nationwide epidemiological study is possible in principle, but requires a great deal of time and effort. In Rhineland-Palatinate research needs to be carried out in a timely manner as the health authorities' retention period for death certificates is limited to minimum of 5 years. In Berlin the research situation is particularly difficult as, while the death certificates are held 3 years by the statistics bureau, this department cannot release any pseudonymous data. In Berlin it is possible to research the cause of death for some of the deceased through the doctors and hospitals that issued the death certificates and through the GKR Berlin-Brandenburg (in keeping with the special data protection measures of the cancer registry). In North Rhine Westphalia the written consent obtained during people's lifetimes, including an explicit release from medical confidentiality, is required to carry out cause of death research. In all other German states exceptions are possible, in all cases requiring the consent of the state's data protection commissioners. The results of the pilot project underline the need for a national mortality register. Until this is established the approach used in the pilot study can be used and, working together with the state and national data protection authorities and with the highest national health authorities, can be further optimized in order to avoid losing data and to use resources efficiently.

Prevalence and patterns of morbidity among adults in Germany. Results of the German telephone health interview survey German Health Update (GEDA) 2009.

To describe the prevalence and patterns of morbidity among adults in Germany, we collected self-reported information on 22 chronic health conditions in a nationally representative health survey among 21,262 participants (51.5% women, aged 18-100 years). Age- and sex-specific prevalences were calculated for single health conditions, disease categories, the most prevalent disease dyads and triads, and for multimorbidity defined by condition count. In both sexes, hypertension, hyperlipidemia, chronic back pain, obesity, and osteoarthritis were the most prevalent single health conditions and significantly increased with age. Cardiometabolic and musculoskeletal conditions were the two most prevalent disease categories in all age and sex groups. The most prevalent disease category dyads and triads included combinations between cardiometabolic conditions, cardiovascular and musculoskeletal disease, depression, sensory limitations, and cancer. The prevalence and magnitude of multimorbidity strongly increased with age in both sexes. Among German adults, the prevalence of chronic health conditions varies greatly by age and sex. In contrast, patterns of morbidity and comorbidity differ according to age, but are highly consistent between men and women. The predominant role of cardiometabolic conditions in all groups underlines the need for preventive efforts. The co-occurrence of chronic health conditions among older is highly prevalent and this calls for tailoring health care towards specific disease combinations.