Jens Hoebel

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.

[Subjective social status and health-related quality of life among adults in Germany. Results from the German General Social Survey (ALLBUS 2010)].

Background: The impact of subjective perception of social status on health has been analysed in international health research for several years. However, in Germany the empirical analysis of the relation between subjective social status (SSS) and health is still in the very early stages. This study investigates if health-related quality of life (HRQoL) in German adults is associated with SSS over and above conventional measures of social status. Methods: The results are based on the German General Social Survey (ALLBUS 2010), a representative cross-sectional survey of the adult resident population in Germany (n=2827). HRQoL was assessed with 4 items referring to self-rated health (SRH) and impairment of well-being due to bodily pain, depressiveness, and loneliness. SSS was measured with a 10-point scale where participants rated their status in society. The impact of SSS on HRQoL was analysed separately for men and women using logistic regression models adjusted for age, school education, net equivalent household income, and occupational position. Results: Poorer SRH, bodily pain, depressiveness, and loneliness occurred significantly more often in men and women with low SSS compared to those with higher SSS. After adjusting for age, education, income, and occupation, the effects of SSS on SRH and depressiveness remained significant in men and women (SRH: men: OR=4.76; 95% CI=2.52―8.99; women: OR=2.95; 95% CI=1.74―4.99; depressiveness: men: OR=2.86; 95% CI=1.60―5.10; women: OR=2.75; 95% CI=1.65―4.56). The effects of SSS on bodily pain and loneliness were observed only in women after adjustment for objective status indicators (OR=1.75; 95% CI=1.07―2.86 and OR=3.03; 95% CI=1.43―6.42, respectively). Conclusion: These findings indicate that self-perception of social disadvantage affects HRQoL in German adults independently and partly gender-specifically. Hence, complementary to objective status indicators the SSS offers additional potential for describing and explaining health inequalities.BACKGROUND The impact of subjective perception of social status on health has been analysed in international health research for several years. However, in Germany the empirical analysis of the relation between subjective social status (SSS) and health is still in the very early stages. This study investigates if health-related quality of life (HRQoL) in German adults is associated with SSS over and above conventional measures of social status. METHODS The results are based on the German General Social Survey (ALLBUS 2010), a representative cross-sectional survey of the adult resident population in Germany (n=2 827). HRQoL was assessed with 4 items referring to self-rated health (SRH) and impairment of well-being due to bodily pain, depressiveness, and loneliness. SSS was measured with a 10-point scale where participants rated their status in society. The impact of SSS on HRQoL was analysed separately for men and women using logistic regression models adjusted for age, school education, net equivalent household income, and occupational position. RESULTS Poorer SRH, bodily pain, depressiveness, and loneliness occurred significantly more often in men and women with low SSS compared to those with higher SSS. After adjusting for age, education, income, and occupation, the effects of SSS on SRH and depressiveness remained significant in men and women (SRH: men: OR=4.76; 95% CI=2.52-8.99; women: OR=2.95; 95% CI=1.74-4.99; depressiveness: men: OR=2.86; 95% CI=1.60-5.10; women: OR=2.75; 95% CI=1.65-4.56). The effects of SSS on bodily pain and loneliness were observed only in women after adjustment for objective status indicators (OR=1.75; 95% CI=1.07-2.86 and OR=3.03; 95% CI=1.43-6.42, respectively). CONCLUSION These findings indicate that self-perception of social disadvantage affects HRQoL in German adults independently and partly gender-specifically. Hence, complementary to objective status indicators the SSS offers additional potential for describing and explaining health inequalities.

Social Status and Participation in Health Checks in Men and Women in Germany

BACKGROUND Representative data for Germany were used to determine whether a persons social-status characteristics affect the likelihood of having a check-up for the early detection of disease. METHODS The analyses reported here were performed on data obtained in the Robert Koch Institutes German Health Update (GEDA) in 2009 and 2010. The survey responses of 26 555 people about whether they had had a check-up were evaluated. For inclusion, participants were required to be over age 35 and covered by statutory health insurance. To study the potential links between social status and check-up participation rates, a multidimensional social-status index was used in addition to three individual components of social status (highest educational level attained, occupational status, income). RESULTS 50.8% of the men and 49.8% of the women surveyed had had a check-up in the two years before the survey. Low social status was associated with a lower rate of check-ups for both sexes (for men, odds ratio [OR] 0.59, 95% confidence interval [CI] 0.50-0.70, p<0.001; for women, OR 0.63, 95% CI 0.55-0.72, p<0.001). For both men and women, occupational status and income each had independent effects on check-up participation, while educational level was not found to have any independent effect. CONCLUSION These findings indicate that socially disadvantaged persons are less likely to have check-ups than others. Efforts to increase check-up rates should take account of the demonstrated effects of income level and occupational status.

Gesundheitskompetenz von Erwachsenen in Deutschland

ZusammenfassungHintergrundIn modernen Informationsgesellschaften wird Gesundheitskompetenz (GK) als wichtige Fähigkeit zur Gesunderhaltung und Krankheitsbewältigung erachtet. Hierfür sind verschiedene kognitive und soziale Fähigkeiten für den Umgang mit Gesundheitsinformationen grundlegend.Ziel der ArbeitZiele der Studie sind die Beschreibung der Verteilung von GK in der Erwachsenenbevölkerung Deutschlands und die Ermittlung von Assoziationen der GK mit Gesundheitsverhalten und -zustand.Material und MethodenDie Analysen basieren auf Daten der Studie „Gesundheit in Deutschland aktuell“ (GEDA), einer Querschnittsbefragung der deutschsprachigen Wohnbevölkerung ab 18 Jahren, die von Oktober 2013 bis Juni 2014 durchgeführt wurde. Die GK wurde mit der Kurzform des European Health Literacy Questionnaire (HLS-EU-Q16) erhoben, zusammen mit Fragen zur Soziodemografie, zum Gesundheitsverhalten und -zustand. Für 4845 Befragte konnte der HLS-EU-Q16-Index berechnet werden.ErgebnisseMehr als die Hälfte der Erwachsenen hat nach den Kriterien des HLS-EU-Q16 eine „ausreichende“ GK (55,8 %). Für fast jede dritte Person ist eine „problematische“ (31,9 %) und für nahezu jede achte Person eine „inadäquate“ GK (12,3 %) zu verzeichnen. Es wurden signifikante Unterschiede bezüglich Bildung, aber nicht für Geschlecht und Alter gefunden. Bestimmte Gesundheitsverhalten waren positiv mit Gesundheitskompetenz assoziiert. Ein niedriger GK-Level ging mit einer schlechteren körperlichen sowie psychischen Gesundheit einher.DiskussionDie Ergebnisse weisen auf Handlungsbedarf zur Verbesserung der GK in der Erwachsenenbevölkerung hin. Die Stärkung von GK sollte dabei nicht allein auf die Förderung individueller Fähigkeiten abzielen, sondern auch der Entwicklung von gesundheitskompetenten Lebenswelten einen hohen Stellenwert beimessen.AbstractBackgroundIn today’s information society, health literacy (HL) is considered important for health maintenance and disease management. In this context, dealing with health information is fundamental and requires different cognitive and social skills.ObjectivesThe aim of this study was to investigate the distribution of HL levels in the adult population of Germany, and to identify associations with health behaviours and health status.Materials and methodsThe analyses were based on data from the German Health Update (GEDA) study, a cross-sectional survey of the German-speaking adult population of Germany, which was conducted from October 2013 to June 2014. Health literacy was assessed with the short form of the European Health Literacy Questionnaire (HLS EU-Q16), along with questions about socio-demographics, health behaviours, and health status. The HLS-EU-Q16 index could be calculated for 4845 respondents.ResultsAccording to the criteria of the HLS-EU-Q16, more than half of the adults had “adequate” HL (55.8 %). Every third person (31.9 %) had “problematic” and almost every eighth person (12.3 %) had “inadequate” HL. We found significant differences in HL by educational level, but no differences in HL by sex and age group. Certain health behaviours were positively associated with health literacy. A low HL level was associated with poorer physical and mental health.ConclusionThe results point to a need for action to improve HL in the adult population. The strengthening of health literacy should not solely aim at the promotion of individual skills, but also give high priority to the development of health-literate settings.

Social Inequalities and Depressive Symptoms in Adults: The Role of Objective and Subjective Socioeconomic Status

Background There is substantial evidence that lower objective socioeconomic status (SES)—as measured by education, occupation, and income—is associated with a higher risk of depression. Less is known, however, about associations between perceptions of social status and the prevalence of depression. This study investigated associations of both objective SES and subjective social status (SSS) with depressive symptoms among adults in Germany. Methods Data were obtained from the 2013 special wave of the German Health Update study, a national health survey of the adult population in Germany. Objective SES was determined using a composite index based on education, occupation, and income. The three single dimensions of the index were also used individually. SSS was measured using the MacArthur Scale, which asks respondents to place themselves on a 10-rung ‘social ladder’. Regression models were employed to examine associations of objective SES and SSS with current depressive symptoms, as assessed with the eight-item Patient Health Questionnaire depression scale (PHQ-8 sum score ≥10). Results After mutual adjustment, lower objective SES and lower SSS were independently associated with current depressive symptoms. The associations were found in both sexes and persisted after further adjustment for sociodemographic factors, long-term chronic conditions, and functional limitations. Mediation analyses revealed a significant indirect relationship between objective SES and depressive symptoms through SSS. When the three individual dimensions of objective SES were mutually adjusted, occupation and income were independently associated with depressive symptoms. After additional adjustment for SSS, these associations attenuated but remained significant. Conclusions The findings suggest that perceptions of low social status in adults may be involved in the pathogenesis of depression and play a mediating role in the relationship between objective SES and depressive symptoms. Prospective studies are needed to establish the direction of effects and to address questions of causality.

Trends in absolute and relative educational inequalities in adult smoking since the early 2000s: the case of Germany

Introduction Since the early 2000s, several tobacco control policies have been implemented in Germany. Current research is inconsistent about how strengthening tobacco control can affect social inequalities in smoking. This study examines whether educational inequalities in adult smoking have widened in Germany since 2003. Methods Data were used from four cross-sectional national health surveys conducted between 2003 and 2012 (n = 54,197; age = 25-69 years). Participants who smoked daily or occasionally were classified as smokers. The regression-based Slope Index of Inequality and Relative Index of Inequality (RII) were calculated to estimate the extent of absolute and relative educational inequalities in smoking, respectively. Results In each survey year, smoking was associated with lower education. Overall, crude and age-standardized smoking rates declined over time. Stratified by education, trends of declining smoking rates were observed only in the high and medium education groups, whereas no statistically significant trend was found in the low education group. Relative educational inequalities in smoking increased significantly in men (2003: RII=1.74, 95% confidence interval 1.46 to 2.07; 2012: RII = 2.25, 95% confidence interval 1.90 to 2.67; p-trend = .019). Absolute educational inequalities in smoking were not found to have changed significantly during the study period. Conclusions In the course of declining smoking rates, educational inequalities in smoking persisted in both absolute and relative terms. In men, relative inequalities in smoking may even have widened within only 9 years. Tobacco control policies should not only be targeted at the entire population but also attempt to reduce social inequalities in smoking by focusing more on socially disadvantaged groups. Implications Smoking is associated with lower education in most European countries and contributes to social inequalities in health. Since the beginning of the 2000s, Germany has implemented a variety of tobacco control policies to reduce smoking in the population. This study reveals that despite a general decline in adult smoking, educational inequalities in smoking have persisted and even widened in Germany since 2003. The findings emphasize that more targeted efforts are needed to tackle smoking-induced inequalities in health.

Socioeconomic Status and Use of Outpatient Medical Care: The Case of Germany.

Background Socially disadvantaged people have an increased need for medical care due to a higher burden of health problems and chronic diseases. In Germany, outpatient care is chiefly provided by office-based general practitioners and specialists in private practice. People are free to choose the physician they prefer. In this study, national data were used to examine differences in the use of outpatient medical care by socioeconomic status (SES). Methods The analyses were based on data from 6,754 participants in the Robert Koch Institute’s German Health Interview and Examination Survey for Adults (DEGS1) aged between 18 and 69 years. The number of outpatient physician visits during the past twelve months was assessed for several medical specializations. SES was determined based on education, occupation, and income. Associations between SES and physician visits were analysed using logistic regression and zero-truncated negative binomial regression for count data. Results After adjusting for sociodemographic factors and health indicators, outpatients with low SES had more contacts with general practitioners than outpatients with high SES (men: incidence rate ratio [IRR] = 1.25; 95% confidence interval [CI] = 1.08–1.46; women: IRR = 1.20; 95% CI = 1.07–1.34). The use of specialists was lower in people with low SES than in those with high SES when sociodemographic factors and health indicators were adjusted for (men: odds ratio [OR] = 0.68; 95% CI = 0.51–0.91; women: OR = 0.56; 95% CI = 0.41–0.77). This applied particularly to specialists in internal medicine, dermatology, and gynaecology. The associations remained after additional adjustment for the type of health insurance and the regional density of office-based physicians. Conclusion The findings suggest that socially disadvantaged people are seen by general practitioners more often than the socially better-off, who are more likely to visit a medical specialist. These differences may be due to differences in patient preferences, physician factors, physician-patient interaction, and potential barriers to accessing specialist care.

Messung des subjektiven sozialen Status in der Gesundheitsforschung mit einer deutschen Version der MacArthur Scale

ZusammenfassungKlassischerweise wird der sozioökonomische Status (SES) in der Gesundheitsforschung mit objektiven Indikatoren (Bildung, Beruf, Einkommen) bestimmt. Ergänzend wird seit einigen Jahren zunehmend auch der subjektive soziale Status (SSS) erfasst, meist mithilfe der MacArthur Scale. In diesem Beitrag wird die Konstruktvalidität einer deutschsprachigen Version dieses Instruments untersucht. Zudem wird der Frage nachgegangen, ob der SSS über den objektiven SES hinaus mit der gesundheitlichen Lage zusammenhängt. Für die Analysen werden Daten einer bevölkerungsbasierten Pilotstudie herangezogen, die im Rahmen der Studie „Gesundheit in Deutschland aktuell“ (GEDA) vom Robert Koch-Institut durchgeführt wurde (n = 1571; Alter: 18−79 Jahre). Der SSS wurde mit der 10-stufigen MacArthur Scale erfasst. Dabei konnten sich die Befragten selbst auf der „sozialen Stufenleiter“ platzieren. Am stärksten korrelierte der SSS mit konstruktverwandten Indikatoren wie einem mehrdimensionalen SES-Index und den objektiven SES-Einzelindikatoren Einkommen, berufliche Stellung und Bildungsgrad (r = 0,32−0,60; p < 0,001). Schwächere Korrelationen waren zwischen dem SSS und den konstruktfremden Indikatoren soziale Unterstützung, seelisches Wohlbefinden, Depressivität und Body-Mass-Index festzustellen (r = − 0,29−0,30; p < 0,001). Faktorenanalysen ließen keine nennenswerten Fremdladungen des SSS auf die Faktoren Wohlbefinden und Depressivität erkennen. Nach Kontrolle für Alter, Bildung, Beruf und Einkommen blieb ein niedrigerer SSS signifikant mit einem schlechteren Gesundheitszustand assoziiert (p < 0,05). Die Ergebnisse sprechen für die konvergente und diskriminante Validität des Instruments und weisen darauf hin, dass der Selbstwahrnehmung von sozialer Benachteiligung eine eigenständige Bedeutung für die gesundheitliche Lage zukommt.AbstractIn health research, socio-economic status (SES) is traditionally assessed using objective indicators (education, occupation, income). For a couple of years, there has been a growing body of studies that additionally assess the subjective social status (SSS) of respondents, mostly using the MacArthur Scale. The aim of this study was to examine the construct validity of a German-language version of this instrument and to investigate whether SSS is associated with health over and above objective SES. Analyses were based on data from a population-based pilot study carried out within the ‘German Health Update’ (GEDA) study conducted by the Robert Koch Institute (n = 1,571; age: 18−79 years). SSS was measured with the MacArthur scale asking respondents to place themselves on a 10-rung “social ladder”. The strongest correlations to SSS were found with measures of similar constructs such as a multidimensional index of objective SES, income level, occupational position and educational attainment (r = 0.32−0.60; p < 0.001). Weaker correlations were found between SSS and measures of dissimilar constructs such as social support, mental well-being, depressiveness, and body-mass-index (r = − 0.29−0.30; p < 0.001). Factor analysis did not show considerable loadings of SSS on factors of mental well-being and depressiveness. After adjusting for age, education, occupation, and income, lower SSS remained significantly associated with higher odds of adverse health (p < 0.05). The findings of this study provide support for the convergent and discriminant validity of the MacArthur Scale and indicate that self-perceptions of social disadvantage may have health implications beyond the impact of objective SES.

Environmental Noise Annoyance and Mental Health in Adults: Findings from the Cross-Sectional German Health Update (GEDA) Study 2012

The health implications of environmental noise, especially cardiovascular effects, have been studied intensively. Research on associations between noise and mental health, however, has shown contradictory results. The present study examined associations between individual levels of noise annoyance due to noise from various sources in the living environment and mental health of adults in Germany. It evaluated whether these associations persisted after adjusting for potential covariates. Data were obtained from the cross-sectional “German Health Update” study 2012 (GEDA 2012), a national health interview survey among adults in Germany conducted by the Robert Koch Institute (n = 19,294). Noise annoyance questions referred to overall noise and that from road traffic, neighbours, and air traffic. Mental health was measured with the five-item Mental Health Inventory. Bivariate analysis showed associations between high levels of noise annoyance and impaired mental health for all noise sources except air traffic. After adjusting for covariates (sociodemographic factors, chronic disease, and social support), both men and women who reported high overall noise annoyance showed more than doubled odds of impaired mental health compared to those who were not annoyed. The odds of impaired mental health in the highest noise annoyance category from road traffic and neighbours were also significantly increased. These findings indicate that high noise annoyance is associated with impaired mental health and that this association can vary with the source of environmental noise. Further research on covariates of this association is necessary. Particularly, longitudinal data are required to establish the direction of associations and to address questions of causality.