Elena von der Lippe

Data Resource Profile: German Health Update (GEDA)—the health interview survey for adults in Germany

The German Health Update (GEDA) study is one component of the recently established nationwide health monitoring system administered by the Robert Koch Institute. The repeated cross-sectional GEDA surveys aim to provide current data on health and disease, health determinants and time trends in health and morbidity in the adult population in Germany. This forms the basis for planning requirements and recommendations for public health policy.Between 2008 and 2013, three GEDA waves were carried out, involving a total of 62,606 computer-assisted telephone interviews with adults in Germany, living in private household, and reachable via landline.A core set of indicators was used in all GEDA waves to gather information on subjective health and health-related quality of life, chronic diseases, injuries, impairment to health and disabilities, mental health, health behaviours, social determinants, use of health services and socio-demographic characteristics.The data from the GEDA surveys are provided for public use and epidemiological research. After submitting an application form, the data are accessible from: [http://www.rki.de/EN/Content/Health_Monitoring/Public_Use_Files/public_use_file_node.htm].

Mode differences in a mixed-mode health interview survey among adults

BackgroundHealth interview surveys are important data sources for empirical research in public health. However, the diversity of methods applied, such as in the mode of data collection, make it difficult to compare results across surveys, time, or countries. The aim of this study was to explore whether the prevalence rates of health-related indicators amongst adults differ when self-administered paper mail questionnaires (SAQ-Paper), self-administered web surveys (SAQ-Web), and computer-assisted telephone interviews (CATI) are used for data collection in a health survey.MethodsData were obtained from a population-based mixed-mode health interview survey of adults in Germany carried out within the ‘German Health Update’ (GEDA) study. Data were collected either by SAQ-Paper (n = 746), SAQ-Web (n = 414), or CATI (n = 411). Predictive margins from logistic regression models were used to estimate the prevalence rates of chronic conditions, subjective health, mental health, psychosocial factors, and health behaviours, adjusted for the socio-demographic characteristics of each mode group.ResultsSocio-demographic characteristics were found to differ significantly between study participants who responded by SAQ-Paper, SAQ-Web, and CATI. Crude prevalence rates for health-related indicators also showed significant variation across all three survey modes. After adjusting for socio-demographic factors though, significant differences in prevalence rates between the two self-administered modes (SAQ-Paper and SAQ-Web) were found in only 2 out of the 19 health-related indicators studied. The differences between CATI and the two self-administered modes remained significant however, especially for indicators of mental and psychosocial health and self-reported sporting activity.ConclusionsThe findings of this study indicate that prevalence rates obtained from health interview surveys can vary with the mode of data collection, primarily between interviewer and self-administered modes. Hence, the type of survey mode used should be considered when comparing results from different health surveys. Mixing self-administered modes, such as paper-based questionnaires and web surveys, may be a combination to minimize mode differences in mixed-mode health interview surveys.

Does Breastfeeding Help to Reduce the Risk of Childhood Overweight and Obesity? A Propensity Score Analysis of Data from the KiGGS Study

Background Current studies suggest that the beneficial effect of breastfeeding on overweight and obesity may have been largely overestimated. We examined the relationship between >4 months of full breastfeeding and overweight/obesity in children living in Germany. Methods We analyzed retrospectively collected data on breastfeeding from children aged 3–17 years who participated in the German Health Interview and Examination Survey for Children and Adolescents (KiGGS baseline study) between 2003 and 2006 (n = 13163). To minimize confounding, we applied propensity score matching and multivariate logistic regression analyses to estimate the effect of breastfeeding on childhood overweight and obesity. Results Adjusted analyses of the matched dataset (n = 8034) indicated that children who were breastfed for <4 months had a significant reduction in the odds of overweight (OR 0.81 [95% CI 0.71–0.92]) and obesity (OR 0.75 [95% CI 0.61–0.92]) compared to children who were not breastfed or who were breastfed for a shorter duration. Further analyses stratified by age group showed that the association was strongest in children aged 7–10 years (OR 0.67 [95% CI 0.53–0.84] for overweight and OR 0.56 [95% CI 0.39–0.81] for obesity), while no significant effect could be seen in other age groups. Discussion Our findings support the hypothesis that breastfeeding does have a beneficial effect on childhood overweight and obesity, although the effect seems to be strongest in children of primary school age.

Association of partner, parental, and employment statuses with self-rated health among German women and men

The association of partner, parental, and employment statuses with health is usually discussed in terms of either the multiple role burden hypothesis or the multiple role attachment hypothesis. The first hypothesis states that combining work and family roles increases the burden of responsibility, which in turn increases the pressure and stress associated with competing roles, leading to poorer health. The multiple role attachment hypothesis argues that multiple responsibilities provide attachment to broader networks, which then provide social support and resources that enhance health. We analyzed pooled data from the German Health Update carried out by the Robert Koch Institute in 2009, 2010, and 2012. The data were collected by computer-assisted telephone interviews. The sample comprised 28,086 people aged 30–54 years. The data were assessed with logistic regression analysis and interaction models. The gender-differentiated analysis of partnership, parenthood, and employment, after adjusting for social and demographic characteristics, revealed small interaction effects among all three social roles with self-rated health in women and men. Non-employment showed the strongest relationship with poor self-rated health. It was significantly associated with lower self-rated health in both men and women in most of the family arrangements. These associations were higher in men than in women. Furthermore, in all family arrangements, female part-time employees were as healthy as female fulltime employees. A more subtle association was found in men: the odds of reporting poorer self-rated health were greater among non-parents employed part time than among those employed full time, but lower than among those who were non-employed. Among fathers, part-time employees did not have statistically better health than full-time employees.The findings support somewhat the multiple role attachment hypothesis, rather than the multiple role burden hypothesis. Because employment has great importance for both womens and mens health, the compatibility of work and family roles should be improved.

Prevalence of smoking in the adult population of Germany

Although various tobacco control measures have been implemented in Germany in the recent years, smoking is still widespread and constitutes a considerable health risk for the population. According to the data of the German Health Interview and Examination Survey for Adults (DEGS1), which was conducted by Robert Koch Institute from 2008 to 2011, 29.7% of the 18 to 79-year old population smokes (women = 26.9%, men = 32.6%). The proportion of women and men who smoke 20 or more cigarettes a day amounts to 6.0% and 10.6% respectively. Smoking is mostly widespread among young adults, as well as among persons with low social status who are also overrepresented among the heavy smokers. Comparison with data from previous health surveys indicates that the proportion of smokers has reduced slightly over the last 10 years. An English full-text version of this article is available at SpringerLink as supplemental.

The health of single mothers and fathers in Germany

In every fifth family in Germany, one parent lives alone with children in the household. Life as a single parent is often marked by challenges that include adopting sole responsibility for the child’s education and care, alongside employment commitments, and the difficulties of reconciling work and family life. Moreover, despite comparatively high employment rates, single parents – and their children – are greatly affected by poverty. This paper compares the health of single parents and parents living in partnership and analyses the extent to which single parents’ health varies according to their socio-economic and employment status, and social support. The analysis was conducted using data from the German Health Update (GEDA) study in 2009, 2010 and 2012 on fair or poor self-rated general health, as well as depression, back pain, obesity, smoking, sporting inactivity and the non-utilization of dental check-ups. The analyses are based on data from 9,806 women and 6,279 men living in a household with at least one child under the age of 18. The study identified a significantly higher prevalence for all health indicators (apart from obesity) among single mothers compared to mothers living with a partner. In the case of single fathers, higher prevalences were found for depression, smoking and the non-utilization of dental check-ups. On average, the lower socio-economic status of women can explain a certain proportion of the health impairment of single parents, but not for men. However, a lower socio-economic status or social support do not account for the health impairments of single parents. Therefore, the higher prevalence of health impairments among single parents cannot simply be attributed to differences in employment status or to lower levels of social support; rather, certain health indicators show a cumulative effect between single-parents status and the social factors mentioned above. The results presented here provide a differentiated view of the relationship between the health and social situation of single parents. Improving the financial position of one-parent families and making it easier to reconcile work and family life are important steps that would help improve the health of single parents. SINGLE PARENTS · SINGLE-PARENT FAMILIES · PARTNERSHIP · HEALTH · HEALTH-RELATED BEHAVIOUR Journal of Health Monitoring · 2017 2(4) DOI 10.17886/RKI-GBE-2017-123 Robert Koch Institute, Berlin

Stillmonitoring in Deutschland –Welchen Beitrag können die KiGGS-Daten leisten?

Ein kontinuierliches Stillmonitoring ist erforderlich, um Aussagen uber Anderungen des Stillverhaltens machen zu konnen. Die Studie zur Gesundheit von Kindern und Jugendlichen in Deutschland (KiGGS) des Robert Koch-Instituts erhebt in regelmasigen Abstanden bevolkerungsbezogene Daten zur gesundheitlichen Lage der in Deutschland lebenden Kinder und Jugendlichen, darunter auch Daten zum Stillen. KiGGS wird als eine mogliche Datenquelle fur ein Stillmonitoring in einem Konzept der Nationalen Stillkommission aufgefuhrt. Die Daten aus KiGGS sind geeignet, retrospektiv fur Geburtsjahrgange, Indikatoren zum Stillen zu bilden. Sie zeigen, dass die Pravalenz jeglichen Stillens zwischen den Geburtsjahrgangen 2001/2002 und 2007/2008 tendenziell angestiegen ist; in Bezug auf die Stilldauer sind in den Jahrgangen 2001 – 2008 keine wesentlichen Anderungen zu erkennen. Aufgrund der Periodizitat der KiGGS-Wellen konnen keine regelmasigen Aussagen zum Stillverhalten aktueller Geburtsjahrgange getroffen werden, welche fur ein Stillmonitoring jedoch erwartet werden. Daher sollten deutschlandweite Erhebungen von Stilldaten im Rahmen von Vorsorgeuntersuchungen sowie regelmasige prospektive Untersuchungen zu unmittelbaren Umfeld- und Einflussfaktoren auf das Stillen weitere Instrumente eines Stillmonitorings sein.

Proceedings of the International Workshop ‘From Global Burden of Disease Studies to National Burden of Disease Surveillance'

Table of contentsI1 Introduction and aims of the workshop Christa Scheidt-Nave, Thomas Ziese, Judith Fuchs, Dietrich PlassS1 History, concept, and current results of GBD for GermanyTom Achoki, Katherine Leach-Kemon, Peter Speyer, William E. Heisel, Emmanuela Gakidou, Theo VosS2 Methodology of the GBD 2013 Study–Mortality, Morbidity, Risk-FactorsMohammad Hossein ForouzanfarS3 National burden of disease surveillance examples of good practice: the case of Public Health EnglandJürgen C. SchmidtS4 Critical aspects of the burden of disease methodology and country-specific challengesClaudia E. SteinS5 Non-communicable disease surveillance in Germany – public health and data challengesChrista Scheidt-Nave, Elena von der Lippe, Benjamin Barnes, Markus Busch, Nina Buttmann-Schweiger, Judith Fuchs, Christin Heidemann, Klaus Kraywinkel, Enno Nowossadeck, Thomas ZieseS6 Different approaches in estimating the burden of communicable diseases using the examples of the healthcare associated infections and influenzaUdo Buchholz, Matthias an der Heiden, Tim Eckmanns, Sebastian HallerS7 Behavioral and environmental attributable risk estimationMohammad Hossein ForouzanfarS8 Environmental Burden of Disease (EBD) in Germany – past achievements and future perspectivesDietrich Plass, Myriam Tobollik, Dagmar Kallweit, Dirk WintermeyerC1 Conclusions of the workshopChrista Scheidt-Nave, Thomas Ziese, Judith Fuchs, Dietrich Plass

Socioeconomic status and health

ZusammenfassungAnalysiert wird der Zusammenhang zwischen dem sozioökonomischen Status (SES) und 5 exemplarisch ausgewählten Gesundheitsoutcomes in der 18- bis 79-jährigen Bevölkerung Deutschlands. Die Datenbasis wird durch die „Studie zur Gesundheit Erwachsener in Deutschland“ (DEGS1) gebildet, die das Robert Koch-Institut im Zeitraum von 2008 bis 2011 durchgeführt hat (n = 8152). Der sozioökonomische Status wird über einen mehrdimensionalen Index erfasst, in den Informationen zum Bildungsniveau, zur beruflichen Stellung und zum Netto-Äquivalenzeinkommen eingehen. Die Ergebnisse zeigen, dass Personen mit niedrigem sozioökonomischem Status im Vergleich zu denen mit mittlerem und hohem sozioökonomischem Status ihren allgemeinen Gesundheitszustand schlechter einschätzen und häufiger an Diabetes erkrankt sind. Außerdem ist bei ihnen das Risiko für eine depressive Symptomatik, Adipositas und sportliche Inaktivität erhöht. Die Ergebnisse machen deutlich, dass die Gesundheitschancen und Erkrankungsrisiken nach wie vor sehr ungleich verteilt sind. Sie unterstreichen damit die Bedeutung von politischen Interventionen zur Verringerung der gesundheitlichen Ungleichheit.AbstractThe 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.

Risk-health behavior Patterns in Germany. Results from the GEDA 2009 survey

Objective: Lifestyle-related risks are known to have a strong impact on health. Health outcomes also depend on many other factors, such as environmental pollution and the use of public health services, but another very important factor is lifestyle. In our study we investigate peoples health-risk behavior and distinguish between possible behavior patterns in the German population. For our study we make a selection of four human behavior risks and take into account the daily consumption of fruit or vegetables, sporting activity, smoking and risky alcohol consumption. Data and Methods: The empirical analysis is based on the data from the German Health Update 2009. Our analysis is carried out in two stages. At first we use hierarchical cluster analysis to define the different patterns of health-risk behavior in the German population. At the second stage we use a logistic regression model to determine the factors that most influence the individuals behavior, using the already defined clusters of risk-health behavior. Results: Five main groups of health-risk behavior are defined with the help of the cluster analysis. Our results showed that individual healthbehavior patterns are influenced by many demographic factors, but also by peoples state of health and by social factors. Peoples healthrelated behavior is driven to a large extend by their state of health – the healthier they feel, the riskier the behavior they tend to adopt. Good state of health and a young age, together with gender are important preconditions for risky health-related behaviors. Conclusions: Certainly, the health-related behavior is a part of the dynamic and interactive processes of daily living. The changes in a persons individual health-related behavior in the course if his or her life involves looking back over previous experience and anticipating future experience, often in terms of stereotypical realities. The aim of the health preventive programs should be to achieve a high level of health awareness and consciousness among young population and to reduce gender differences in health.