Heribert Stolzenberg

The challenge of comprehensively mapping children's health in a nation-wide health survey: Design of the German KiGGS-Study

BackgroundFrom May 2003 to May 2006, the Robert Koch Institute conducted the German Health Interview and Examination Survey for Children and Adolescents (KiGGS). Aim of this first nationwide interview and examination survey was to collect comprehensive data on the health status of children and adolescents aged 0 to 17 years.Methods/DesignParticipants were enrolled in two steps: first, 167 study locations (sample points) were chosen; second, subjects were randomly selected from the official registers of local residents. The survey involved questionnaires filled in by parents and parallel questionnaires for children aged 11 years and older, physical examinations and tests, and a computer assisted personal interview performed by study physicians. A wide range of blood and urine testing was carried out at central laboratories. A total of 17 641 children and adolescents were surveyed – 8985 boys and 8656 girls. The proportion of sample neutral drop-outs was 5.3%. The response rate was 66.6%.DiscussionThe response rate showed little variation between age groups and sexes, but marked variation between resident aliens and Germans, between inhabitants of cities with a population of 100 000 or more and sample points with fewer inhabitants, as well as between the old West German states and the former East German states. By analysing the short non-responder questionnaires it was proven that the collected data give comprehensive and nationally representative evidence on the health status of children and adolescents aged 0 to 17 years.

German health interview and examination survey for adults (DEGS) - design, objectives and implementation of the first data collection wave

BackgroundThe German Health Interview and Examination Survey for Adults (DEGS) is part of the recently established national health monitoring conducted by the Robert Koch Institute. DEGS combines a nationally representative periodic health survey and a longitudinal study based on follow-up of survey participants. Funding is provided by the German Ministry of Health and supplemented for specific research topics from other sources.Methods/designThe first DEGS wave of data collection (DEGS1) extended from November 2008 to December 2011. Overall, 8152 men and women participated. Of these, 3959 persons already participated in the German National Health Interview and Examination Survey 1998 (GNHIES98) at which time they were 18–79 years of age. Another 4193 persons 18–79 years of age were recruited for DEGS1 in 2008–2011 based on two-stage stratified random sampling from local population registries. Health data and context variables were collected using standardized computer assisted personal interviews, self-administered questionnaires, and standardized measurements and tests. In order to keep survey results representative for the population aged 18–79 years, results will be weighted by survey-specific weighting factors considering sampling and drop-out probabilities as well as deviations between the design-weighted net sample and German population statistics 2010.DiscussionDEGS aims to establish a nationally representative data base on health of adults in Germany. This health data platform will be used for continuous health reporting and health care research. The results will help to support health policy planning and evaluation. Repeated cross-sectional surveys will permit analyses of time trends in morbidity, functional capacity levels, disability, and health risks and resources. Follow-up of study participants will provide the opportunity to study trajectories of health and disability. A special focus lies on chronic diseases including asthma, allergies, cardiovascular conditions, diabetes mellitus, and musculoskeletal diseases. Other core topics include vaccine-preventable diseases and immunization status, nutritional deficiencies, health in older age, and the association between health-related behavior and mental health.

Der Kinder- und Jugendgesundheitssurvey (KiGGS): Datenmanagement

ZusammenfassungIm Rahmen des Kinder- und Jugendgesundheitssurveys (KiGGS) wurden erstmals umfassend und bundesweit repräsentative Daten zum Gesundheitszustand von Kindern und Jugendlichen in Deutschland erhoben. Im Laufe der 3-jährigen Erhebungsphase wurden 17.641 Probanden untersucht und befragt und ca. 1500 Items erfasst. Das Datenmanagement beschränkte sich nicht allein auf die Erfassung, Verwaltung und Qualitätssicherung der Erhebungsdaten, sondern ebenso auf die Bereitstellung von Werkzeugen zur Verwaltung und Kontrolle von Prozessdaten sowie zur Steuerung surveyspezifischer Geschäftsabläufe. Im Rahmen der KiGGS-Studie wurde eine Vielzahl von Komponenten zur Unterstützung der umfangreichen und komplexen Prozessabläufe für die Studienmitarbeiter entwickelt. Dies betraf in erster Linie die Aufgabenbereiche Probanden- und Sample-Point-Verwaltung, Terminplanung, Stichprobenziehung, Berichterstattung, Feldlogistik und Labordatenverwaltung. Die computergestützte Bearbeitung von Routineaufgaben im Rahmen der Feldorganisation führte zu einer deutlichen Arbeitserleichterung sowie zu einer verbesserten Projektablaufkontrolle. Teilweise konnten die KiGGS-spezifischen Komponenten mit minimalem Anpassungsaufwand bereits auf andere Studien übertragen werden. Beim Datenmanagement der Erhebungsdaten stand die Standardisierung der Verfahren ihrer Aufbereitung, Prüfung und Bereinigung im Vordergrund. Hier konnte auf einen breiten Erfahrungsschatz aufgebaut werden. Die etablierten Methoden zur Qualitätssicherung wurden weitgehend standardisiert und teilweise automatisiert und durch Datenbanktools zur Verwaltung und Dokumentation von Erhebungsinstrumenten und Qualitätssicherungsmaßnahmen ergänzt. Die Summe aller Maßnahmen ermöglichte es, den Datennutzern relativ schnell einen geprüften und bereinigten Enddatensatz einschließlich einer ausführlichen Dokumentation zur Verfügung zu stellen.AbstractIn 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 experien ces 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.

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/m2 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.

Messung des sozioökonomischen Status in der Studie zur Gesundheit Erwachsener in Deutschland (DEGS1)

ZusammenfassungDer sozioökonomische Status (SES) stellt eine zentrale Analysekategorie der epidemiologischen Forschung und Gesundheitsberichterstattung dar. Im Rahmen der Deutschen Herz-Kreislauf-Präventionsstudie 1984–1991 wurde zur Messung des SES ein mehrdimensionaler aggregierter Index entwickelt, der bis heute in vielen Studien verwendet wird. Für das Gesundheitsmonitoring am Robert Koch-Institut (RKI) wurde der Index nach einer kritischen Überprüfung grundlegend überarbeitet. Der Beitrag beschreibt, welche Überlegungen der Überarbeitung zugrunde lagen und wie diese in Bezug auf die „Studie zur Gesundheit Erwachsener in Deutschland“ (DEGS1) umgesetzt wurden. Zudem werden Ergebnisse zur alters- und geschlechtsspezifischen Verteilung der Werte des überarbeiteten SES-Index und zum Zusammenhang mit anderen Maßen des sozioökonomischen Status berichtet. Die Ergebnisse basieren auf den Daten von DEGS1 2012 und des Bundes-Gesundheitssurveys 1998 (BGS98).AbstractSocioeconomic 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.

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.

Body measurements of children and adolescents in Germany. Results of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS)

ZusammenfassungIm Rahmen des bundesweiten Kinder- und Jugendgesundheitssurveys (KiGGS) wurden bei 17.641 Jungen und Mädchen eine Reihe anthropometrischer Messgrößen standardisiert erhoben. Für den kompletten Altersbereich (0–17 Jahre) wurden hierzu Körpergröße und Körpergewicht, Kopfumfang und Oberarmlänge sowie 2 Hautfaltendicken (Trizeps, Subscapula) ermittelt; ab dem 6. Lebensjahr kam die Messung der Ellbogenbreite hinzu, ab 11 Jahren wurden zudem der Taillen- und Hüftumfang bestimmt. Für alle Parameter werden pro Alter (in Jahren) und Geschlecht Mittelwerte inklusive Konfidenzintervalle angegeben. Mediankurven veranschaulichen den Altersgang nach Geschlecht für jedes Körpermaß. Die komplexen Altersverläufe der Körpermaße, verbunden mit einer erheblichen Geschlechterspezifität, zeigen die ganze Dynamik der körperlichen Entwicklung bei Jungen und Mädchen. Auf Basis der Hautfaltenmessungen wurde der Körperfettanteil abgeschätzt. Dicke und Lage der Hautfalten sowie der berechnete Taille-Hüfte-Index wird als Indikator für die geschlechterspezifische Fettverteilung eingesetzt. Mit Hilfe des Frame-Indexes wird versucht, Aussagen über die Skelettrobustizität zu machen. Für die ermittelten Körpermaße sind kaum regionale Unterschiede nachweisbar. Dafür zeigen Kopfumfang, Frame-Index und alle Parameter, die einen starken Zusammenhang mit dem Körperfett aufweisen, einen signifikanten Sozialstatusgradienten. Kinder und Jugendliche mit Migrationshintergrund haben im Mittel eine geringere Körpergröße, einen größeren Taillenumfang und einen höheren Körperfettanteil.AbstractIn 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 agerelated 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.

Measurement of socioeconomic status in the German Health Interview and Examination Survey for Adults (DEGS1)

ZusammenfassungDer sozioökonomische Status (SES) stellt eine zentrale Analysekategorie der epidemiologischen Forschung und Gesundheitsberichterstattung dar. Im Rahmen der Deutschen Herz-Kreislauf-Präventionsstudie 1984–1991 wurde zur Messung des SES ein mehrdimensionaler aggregierter Index entwickelt, der bis heute in vielen Studien verwendet wird. Für das Gesundheitsmonitoring am Robert Koch-Institut (RKI) wurde der Index nach einer kritischen Überprüfung grundlegend überarbeitet. Der Beitrag beschreibt, welche Überlegungen der Überarbeitung zugrunde lagen und wie diese in Bezug auf die „Studie zur Gesundheit Erwachsener in Deutschland“ (DEGS1) umgesetzt wurden. Zudem werden Ergebnisse zur alters- und geschlechtsspezifischen Verteilung der Werte des überarbeiteten SES-Index und zum Zusammenhang mit anderen Maßen des sozioökonomischen Status berichtet. Die Ergebnisse basieren auf den Daten von DEGS1 2012 und des Bundes-Gesundheitssurveys 1998 (BGS98).AbstractSocioeconomic 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.

Körpermaße bei Kindern und Jugendlichen in Deutschland

ZusammenfassungIm Rahmen des bundesweiten Kinder- und Jugendgesundheitssurveys (KiGGS) wurden bei 17.641 Jungen und Mädchen eine Reihe anthropometrischer Messgrößen standardisiert erhoben. Für den kompletten Altersbereich (0–17 Jahre) wurden hierzu Körpergröße und Körpergewicht, Kopfumfang und Oberarmlänge sowie 2 Hautfaltendicken (Trizeps, Subscapula) ermittelt; ab dem 6. Lebensjahr kam die Messung der Ellbogenbreite hinzu, ab 11 Jahren wurden zudem der Taillen- und Hüftumfang bestimmt. Für alle Parameter werden pro Alter (in Jahren) und Geschlecht Mittelwerte inklusive Konfidenzintervalle angegeben. Mediankurven veranschaulichen den Altersgang nach Geschlecht für jedes Körpermaß. Die komplexen Altersverläufe der Körpermaße, verbunden mit einer erheblichen Geschlechterspezifität, zeigen die ganze Dynamik der körperlichen Entwicklung bei Jungen und Mädchen. Auf Basis der Hautfaltenmessungen wurde der Körperfettanteil abgeschätzt. Dicke und Lage der Hautfalten sowie der berechnete Taille-Hüfte-Index wird als Indikator für die geschlechterspezifische Fettverteilung eingesetzt. Mit Hilfe des Frame-Indexes wird versucht, Aussagen über die Skelettrobustizität zu machen. Für die ermittelten Körpermaße sind kaum regionale Unterschiede nachweisbar. Dafür zeigen Kopfumfang, Frame-Index und alle Parameter, die einen starken Zusammenhang mit dem Körperfett aufweisen, einen signifikanten Sozialstatusgradienten. Kinder und Jugendliche mit Migrationshintergrund haben im Mittel eine geringere Körpergröße, einen größeren Taillenumfang und einen höheren Körperfettanteil.AbstractIn 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 agerelated 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.

Nationally representative waist circumference percentiles in German adolescents aged 11.0–18.0 years

OBJECTIVE The aim of this study was to develop age- and sex-specific percentile curves for waist circumference (WC) in German adolescents. METHODS A cross-sectional population-based study (German Health Interview and Examination Survey for Children and Adolescents [KiGGS]) was carried out in a large nationally representative sample of 3 345 males and 3 221 females aged 11.0 to 18.0 years from May 2003 to May 2006. Smoothed percentile curves of WC were derived by the LMS method. RESULTS Girls had lower WC values than boys at any age and percentile. WC increased with age in both boys and girls. The curves show a fairly linear pattern for males, but for females they begin to level off after the age of 13 years. CONCLUSIONS The presented WC percentile curves are based on a representative sample of adolescents living in Germany and standardized measurements. We propose their use for clinical practice to monitor abdominal obesity in adolescents, although there is a need for future studies correlating cut-offs with health outcomes. The German curves could contribute to the feasibility of combining representative data from several countries to establish an international reference for WC.