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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.

Self-medication among children and adolescents in Germany: results of the National Health Survey for Children and Adolescents (KiGGS)

AIMS Despite the widespread use of self-medication among the child population and the potential harm it can do, up-to-date epidemiological data on self-medication are sparse worldwide. The aim was to investigate the prevalence and correlates of self-medication use among non-institutionalized children in Germany, focusing on the paediatric self-medications that are most frequently used. METHODS All cases of last-week medicine use were recorded among 17 450 children aged 0-17 years who participated in the 2003-2006 German Health Interview and Examination Survey for Children and Adolescents. Self-medication was defined as the use of medicines that had either been bought over the counter or obtained from other sources (OS). The complex sample method was used to estimate the prevalence of, and factors associated with self-medication use. RESULTS During the previous week 25.2% of participants had used self-medication (17.0% used over-the-counter drugs and 9.9% other-sources drugs). Self-medication accounted for 38.5% of total medicine use and included all medication classes. These clustered among drugs acting on the respiratory system (32.1%), alimentary tract and metabolism (21.6%), skin (14.2%) and nervous system (11.3%), as well as homoeopathic preparations (8.6%). Vitamin preparations were most frequently used with a weighted user prevalence of 4.7% (5.2% vs. 4.1%, P < 0.001, boys vs. girls), followed by cough and cold medicines (CCMs) 4.4% (4.3 vs. 4.5, P > 0.05) and analgesics 3.7% (3.0% vs. 4.4%, P < 0.001, both boys vs. girls). Overall use of aspirin among children <12 years old was 0.3%; use of CCMs was substantial (4.4%), particularly among children <6 years old. Use of self-medication was closely related to older adolescent ages of between 14 and 17 years (odds ratio 1.16; 95% confidence interval 1.00, 1.33), children with a poor health status (1.29; 1.10, 1.52), with no immigration background (1.55; 1.33, 1.80), from families with a higher household income (1.23; 1.06, 1.42) and with mothers with a higher educational level (1.37; 1.19, 1.57). CONCLUSIONS Self-medication use is highly prevalent in Germany, particularly among children and adolescents from families with a higher socioeconomic status. Self-medication in younger children using such drugs as CCMs and aspirin suggested inappropriate drug use and potential risks. This should be closely monitored and warrants an education programme for parents in Germany.

Mundgesundheitsverhalten von Kindern und Jugendlichen in Deutschland

ZusammenfassungTrotz erfolgreicher Prävention und direkter Beeinflussbarkeit der Mundgesundheit durch individuelles Verhalten sind nach wie vor Kinder von Karies betroffen. Ziel des Beitrags ist es, anhand der Daten des Kinder- und Jugendgesundheitssurveys (KiGGS) die Prävalenz sowie soziale Einflussfaktoren ausgewählter Aspekte des Mundgesundheitsverhaltens zu ermitteln. Über einen Zeitraum von insgesamt 3 Jahren wurden in der bundesweiten KiGGS-Studie 17.641 Kinder und Jugendliche im Alter zwischen 0 und 17 Jahren repräsentativ für Deutschland untersucht. Im Rahmen einer schriftlichen Befragung und eines ärztlichen Interviews wurden auch Angaben zum Mundgesundheitsverhalten erfasst. 29% der befragten Kinder und Jugendlichen putzen nur einmal täglich oder seltener die Zähne. Dieses Zahnputzverhalten weist einen Schichtgradienten auf (niedrig: 39%, mittel: 28%, hoch: 22%) und ist bei Kindern mit Migrationshintergrund (45%) häufiger festzustellen als bei jenen ohne Migrationshintergrund (26%). Unterschiede manifestieren sich auch zwischen Mädchen und Jungen (Mädchen: 25%; Jungen: 33%). In nur 8% der Fälle machen Eltern die Angabe, dass ihre Kinder weniger als einmal im Jahr eine zahnärztliche Vorsorgeuntersuchung wahrnehmen. Allerdings weichen diese Angaben deutlich vom tatsächlichen Zahnarztbesuch ab. Auch hier zeigen sich Unterschiede bezüglich des Sozialstatus (niedrig: 12%; hoch: 6%) sowie Unterschiede in Abhängigkeit vom Migrationsstatus (Migranten: 16%; Nicht-Migranten: 6%). Nach Angaben der Eltern wenden 43% der 0- bis 2-Jährigen und 7% der 3- bis 6-Jährigen Arzneimittel zur Kariesprophylaxe an. Relevante Unterschiede lassen sich zwischen Migranten (5%) und Nicht-Migranten (8%) feststellen. Die Ergebnisse zeigen, dass vor allem ein schicht- und kulturspezifischer Präventionsbedarf besteht. Um Ansatzpunkte für wirksame Präventionsangebote aufzuzeigen, bedarf es einer systematischen Untersuchung der Gründe für diese Verhaltensdifferenzen.AbstractDespite successful prevention and the possibility to directly control oral health by individual behaviour, children are still affected by caries. Aim of this article is to determine the prevalence and the social factors influencing selected aspects of oral health behaviour based on data of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS). Over a period of three years, 17,641 children and adolescents aged 0 to 17 years – a representative sample for Germany – were examined in the nationwide KiGGS study. Based on a written survey and a medical interview, data on oral health behaviour were also collected. 29 % of the surveyed children and adolescents brushed their teeth only once daily or less frequently. This type of teeth brushing behaviour shows a social status gradient (low: 39 %, middle: 28 %, high: 22 %) and is more frequently found in children with a migration background (45 %) than in those without a migration background (26 %). Differences were also found between girls and boys (girls: 25 %; boys: 33 %). In only 8 % of cases, parents stated that their children have a dental check-up less than once a year. However, this information substantially differs from the actual visits to dentists. Here again, differences regarding social status (low: 12 %; high: 6 %) and migration status (migrants: 16 %; nonmigrants: 6 %) were found. According to the parents, 43 % of the 0-to-2-year-olds and 7 % of the 3-to-6-year-olds use pharmaceutical preparations for caries prevention. Relevant differences were found between migrants (5 %) and non-migrants (8 %). These results show that there is primarily a need for social status-specific and culture-specific prevention. To identify starting points for effectively offering preventative measures, a systematic study into the factors causing these behavioural differences is needed.

Arzneimittelanwendung von Erwachsenen in Deutschland

The first wave of the German Health Interview and Examination Survey for Adults, 2008-2011 (DEGS1), assesses current medicine use among participating adults aged 18-79 years in the 7 days prior to the medical examination as part of a standardised interview. About three quarters (74.4 %) of all men and women state that they used at least one preparation. Prevalence is highest among 70-79 year olds (men 94.9 %; women 96.3 %). Overall women have a significantly higher prevalence rate (85.4 %) than men (63.8 %). Preparations for the treatment of cardiovascular diseases are the most frequently used medicines (men 27.2 %; women 29.5 %). Polypharmacy (the use of 5 or more preparations) increases continuously with age and is observed significantly more often in women than in men in all age groups with the exception of the age group 70-79. Of the 20,084 recorded preparations, 71.8 % are prescribed by a doctor and 27.7 % are self-medicated. While there are no differences in overall medication linked to social status, a social gradient is observed in prescribed preparations and self-medication. The results presented here describe key indicators of medication use representative of the German adult population. Based on the extensive data of DEGS1, further analyses into aspects such as co- and multimedication will be addressed in the future. An English full-text version of this article is available at SpringerLink as supplemental.

Pain perceived in a national community sample of German children and adolescents

Background: Pain among children is common, yet far less studied compared to that among adults. Little has been reported regarding various types of pain in a national community sample of German children.

Paediatric homoeopathy in Germany: results of the German health interview and examination survey for children and adolescents (KiGGS)

Despite growing pressure against homoeopathy, an unexpected resurgence in the use of homoeopathy has been reported. It is of interest to examine the use of homoeopathy and user profiles among children in Germany.

[Self-medication with over-the-counter (OTC) preparations in Germany].

ZusammenfassungDie Selbstmedikation mit OTC-Präparaten gewinnt in Deutschland und international zunehmend an Bedeutung. In dieser Arbeit werden Prävalenz und Determinanten der Selbstmedikation mit OTC-Präparaten in einer repräsentativen Stichprobe der deutschen erwachsenen Wohnbevölkerung zwischen 18 und 79 Jahren untersucht. Zu diesem Zweck wurden im Arzneimittelsurvey als Teil des repräsentativen Bundes-Gesundheitssurveys (1998) 7.099 Teilnehmer ausführlich über ihre Arzneimittelanwendung während der letzten 7 Tage interviewt. Vollständige Informationen dazu liegen von 3.393 Männern und 3.594 Frauen vor. 17,6% der Männer und 10,8% der Frauen wenden ausschließlich selbst medizierte OTC-Arzneimittel an, während 12,3% bzw. 29,3% zusätzlich zu den OTC-Arzneimitteln ärztlich verordnete Arzneimittel anwenden. Determinanten der Selbstmedikation mit OTC-Arzneimitteln sind u. a. das Geschlecht, das Alter, der sozioökonomische Status und die Gemeindegröße. Am häufigsten werden Vitamine, Mineralstoffe und Analgetika eingesetzt. Die häufigste Selbstangabe zur Indikation der OTC-Medikation ist „Prävention“. Die Selbstmedikation mit OTC-Präparaten ist für Männer und Frauen in Deutschland von großer Bedeutung. Etliche Faktoren außerhalb des unmittelbar medizinischen Bereiches erscheinen hier wichtig. Der Aspekt eines gestiegenen Gesundheitsbewusstseins scheint für die Selbstmedikation relevant zu sein.AbstractSelf-medication with OTC drugs is attracting attention in developed countries. This study examines prevalence and determinants of OTC drug use in a representative sample of German adults aged 18–79 years. A total of 7099 participants of the Drug Utilisation Survey were interviewed regarding drug use including OTC use within the last 7 days prior to the interview. This survey is a part of the representative German National Health Interview and Examination Survey 1998. Complete information is available from 3393 men and 3594 women: 17.6% of men and 10.8% of women use self-medicated OTC drugs exclusively, whereas 12.3% and 29.3%, respectively, use OTC drugs in addition to prescribed drugs. Besides sex, factors such as age, socioeconomic status and community size determine self-medication with OTC drugs. The most commonly used self-medicated OTC drugs are vitamins, minerals and analgesics. The most commonly reported indication for self-medication with OTC drugs is “prevention”. Beside prescribed medication, self-medication with OTC drugs is an important part of drug usage for men and women in Germany. Health consciousness appears to be a significant factor to explain the prevalence OTC drug use.

Prevalence, determinants and spectrum of attention-deficit hyperactivity disorder (ADHD) medication of children and adolescents in Germany: results of the German Health Interview and Examination Survey (KiGGS).

Objective To investigate the prevalence, determinants and spectrum of attention-deficit hyperactivity disorder (ADHD) medication and its associations with socioeconomic status (SES), health-related behaviour and living conditions. Design Observational cross-sectional study. Setting Germany. Participants Representative population-based sample of non-institutionalised youth aged between 0 and 17 years (n=17 450) and examined between 2003 and 2006. Main outcome measure Prevalence and spectrum of ADHD medication (Anatomical Therapeutic Chemical (ATC) code N04BA) measured by standardised computer-assisted personal interview (CAPI) on drug use. Results The overall prevalence of ADHD medication (stimulants including atomoxetine) was 0.9% (95% CI 0.7% to 1.1%). Boys used these drugs (1.5%, 1.2% to 1.8%) five times more than girls 0.3% (0.2% to 0.5%). The highest prevalence rates were for boys aged 6–10 years (2.3%, 1.7% to 3.1%S) and 11–13 (2.7%, 2.0% to 3.7%). Boys from families with no immigration background used ADHD medication almost 6 times as frequently as boys with an immigration background (1.7% vs 0.3%). Multivariate analysis (binary logistic regression) showed boys (OR 5.16, 95% CI 3.15 to 8.47), 11-year-olds to 13-year-olds (2.24, 1.28 to 3.49), children in large cities (2.18, 1.13 to 4.22), children with no immigration background (3.06, 1.34 to 6.99), and children with only a good (vs excellent) parent-rated health status (1.91, 1.18 to 3.08) being more likely to be using ADHD medication. A visit to the doctor in the last month or last quarter was associated with a higher probability for ADHD medication (3.18, 1.29 to 7.95 and 3.59, 1.45 to 8.90, respectively). Conclusions Results show prevalence rates of ADHD medication use for the German child and adolescent population that are considerably lower than published prevalence rates from the USA, but comparable with those of western European and Scandinavian countries. Lower use rates in rural versus urban regions may point to differential healthcare access. The inverse association of ADHD medication use with immigration status suggests potentially restricted access to healthcare services for immigrants or may reflect culture-specific differences in attitudes towards symptoms of ADHD.

Selbstmedikation mit Over-the-Counter-(OTC-)Präparaten in Deutschland

ZusammenfassungDie Selbstmedikation mit OTC-Präparaten gewinnt in Deutschland und international zunehmend an Bedeutung. In dieser Arbeit werden Prävalenz und Determinanten der Selbstmedikation mit OTC-Präparaten in einer repräsentativen Stichprobe der deutschen erwachsenen Wohnbevölkerung zwischen 18 und 79 Jahren untersucht. Zu diesem Zweck wurden im Arzneimittelsurvey als Teil des repräsentativen Bundes-Gesundheitssurveys (1998) 7.099 Teilnehmer ausführlich über ihre Arzneimittelanwendung während der letzten 7 Tage interviewt. Vollständige Informationen dazu liegen von 3.393 Männern und 3.594 Frauen vor. 17,6% der Männer und 10,8% der Frauen wenden ausschließlich selbst medizierte OTC-Arzneimittel an, während 12,3% bzw. 29,3% zusätzlich zu den OTC-Arzneimitteln ärztlich verordnete Arzneimittel anwenden. Determinanten der Selbstmedikation mit OTC-Arzneimitteln sind u. a. das Geschlecht, das Alter, der sozioökonomische Status und die Gemeindegröße. Am häufigsten werden Vitamine, Mineralstoffe und Analgetika eingesetzt. Die häufigste Selbstangabe zur Indikation der OTC-Medikation ist „Prävention“. Die Selbstmedikation mit OTC-Präparaten ist für Männer und Frauen in Deutschland von großer Bedeutung. Etliche Faktoren außerhalb des unmittelbar medizinischen Bereiches erscheinen hier wichtig. Der Aspekt eines gestiegenen Gesundheitsbewusstseins scheint für die Selbstmedikation relevant zu sein.AbstractSelf-medication with OTC drugs is attracting attention in developed countries. This study examines prevalence and determinants of OTC drug use in a representative sample of German adults aged 18–79 years. A total of 7099 participants of the Drug Utilisation Survey were interviewed regarding drug use including OTC use within the last 7 days prior to the interview. This survey is a part of the representative German National Health Interview and Examination Survey 1998. Complete information is available from 3393 men and 3594 women: 17.6% of men and 10.8% of women use self-medicated OTC drugs exclusively, whereas 12.3% and 29.3%, respectively, use OTC drugs in addition to prescribed drugs. Besides sex, factors such as age, socioeconomic status and community size determine self-medication with OTC drugs. The most commonly used self-medicated OTC drugs are vitamins, minerals and analgesics. The most commonly reported indication for self-medication with OTC drugs is “prevention”. Beside prescribed medication, self-medication with OTC drugs is an important part of drug usage for men and women in Germany. Health consciousness appears to be a significant factor to explain the prevalence OTC drug use.

Differences in Menopausal Hormone Therapy Use among Women in Germany between 1998 and 2003

BackgroundTo examine the differences in menopausal hormone therapy (MHT) use and user profiles among women in Germany before and after the communication of the Womens Health Initiative (WHI) trial and other study results concerning the risks and benefits of MHT.MethodsCurrent MHT use was ascertained in two periodic German national health surveys conducted in 1997–1999 and 2003–2004. MHT prevalence and user profiles were assessed within each survey. The association of the survey period (2003–2004 vs. 1997–1999) with current MHT use was analyzed in weighted multivariable logistic regression (MLR) models, pooling data from both surveys.ResultsThe overall prevalence of current MHT use decreased by 40.2% from 16.9% of the sample in 1997–1999 to 10.1% in 2003–2004. The difference in prevalence between surveys varied with age decade with the smallest decreases among women 60–69 years of age (20.3% vs. 18.5%), compared to women of younger and older age groups (40–49: 10.7% vs. 3.9%; 50–59: 36.3% vs. 21.3%; 70–79: 5.7% vs. 3.2%). Variables independently associated with higher current MHT use in both health surveys included age category (curvilinear relationship with highest use among women 50–59 years) and residence in West vs. East Germany. A higher social status, lower body mass index, and more health-conscious behaviour were significantly associated with higher current MHT use in the 1997–1999 survey, but these associations were not found in the later survey. MLR analyses confirmed a significant decline in MHT use between the 1997–1999 and 2003–2004 surveys, however, the effect was modified by social status and was not significant among lowest social-status women.ConclusionCurrent MHT use considerably declined among women in Germany between the pre- and post-WHI era. A convergence of current MHT use among women of higher social status with pre-existing patterns of use among lower social-status women suggests that MHT in Germany is now less likely to be used for health promotion.