Lars Eric Kroll

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.

Die Messung des sozioökonomischen Status in sozialepidemiologischen Studien

Seit etwa 20 Jahren lasst sich ein standig wachsendes Interesse der epidemiologischen Forschung und der Gesundheitsberichterstattung am Einfluss des soziookonomischen Status auf die Gesundheit und Lebenserwartung feststellen. Mit der Sozialepidemiologie hat sich inzwischen eine eigene Fachrichtung etabliert, die sich schwerpunktmasig mit der sozial ungleichen Verteilung von Gesundheitschancen und Krankheitsrisiken, die auch auf den Begriff der „gesundheitlichen Ungleichheit“ gebracht wird, befasst (Mielck & Bloomfield 2001). Die vorliegenden Studien zeigen in groser Uberstimmung, dass Menschen mit niedrigem soziookonomischen Status haufiger von Krankheiten, Beschwerden, Behinderungen und Unfallverletzungen betroffen sind, die eigene Gesundheit und gesundheitsbezogene Lebensqualitat schlechter einschatzen und zu einem groseren Anteil vorzeitig sterben. Auch in Risiko- und Belastungsexpositionen, gesundheitsrelevanten Einstellungen und Verhaltensweisen sowie in der Bewaltigung von Gesundheitsproblemen treten deutliche soziookonomische Unterschiede hervor (Ubersichten zum Forschungsstand z.B. bei Mielck 2000, 2005, Helmert 2003, Lampert et al. 2005).

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.

Unemployment, Social Support and Health Problems: Results of the GEDA Study in Germany, 2009

BACKGROUND It is well documented that the unemployed have more health problems than the employed, and that social support facilitates coping with unemployment. The association of unemployment and social support with health was examined on the basis of representative data derived from a German study. METHODS The GEDA study (Gesundheit in Deutschland Aktuell [Current Health in Germany]) was conducted in 2008/09 by the Robert Koch Institute, the nationwide governmental public health agency in Germany. For this paper, we analyzed data from the GEDA study that were obtained from 12022 persons aged 30 to 59. We used health indicators taken from the Four-Item Healthy Days Core Module of the Centers for Disease Control (CDC), and we measured social support on the Oslo Three-Item Social Support Scale. We report the findings on impairment in three distinct areas (physical, emotional, and functional) and the results of a multivariate statistical analysis. RESULTS Unemployed persons aged 30 to 59 years suffer physical, emotional, and functional impairment more commonly than employed persons. Men and women with little social support are more likely to be impaired in these three areas whether they are employed or not. Regression analysis reveals that unemployment and social support have significant, independent effects on both the incidence of such impairments (OR(unemployed)= 1.2-1.7, OR(supported)= 0.4-0.9) and on their duration (IRR(unemployed)= 1.3-1.8, IRR(supported)=0.6-0.8) after age, income, and education have been controlled for. CONCLUSION Physicians should be mindful of the deleterious effect of unemployment on health and should encourage unemployed patients to participate in social networks, as the evidence shows that social support can have health benefits.

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.

Prevalence of known diabetes in German adults aged 25-69 years: results from national health surveys over 15 years.

Aims  The few studies examining the secular trend in diabetes prevalence in Germany have yielded conflicting results. Therefore, using nationally representative samples of adults, we investigated whether the prevalence of known diabetes has changed over 15 years.

Area level deprivation is an independent determinant of prevalent type 2 diabetes and obesity at the national level in Germany. Results from the National Telephone Health Interview Surveys 'German Health Update' GEDA 2009 and 2010.

Objective There is increasing evidence that prevention programmes for type 2 diabetes mellitus (T2DM) and obesity need to consider individual and regional risk factors. Our objective is to assess the independent association of area level deprivation with T2DM and obesity controlling for individual risk factors in a large study covering the whole of Germany. Methods We combined data from two consecutive waves of the national health interview survey ‘GEDA’ conducted by the Robert Koch Institute in 2009 and 2010. Data collection was based on computer-assisted telephone interviews. After exclusion of participants <30 years of age and those with missing responses, we included n = 33,690 participants in our analyses. The outcome variables were the 12-month prevalence of known T2DM and the prevalence of obesity (BMI ≥30 kg/m2). We also controlled for age, sex, BMI, smoking, sport, living with a partner and education. Area level deprivation of the districts was defined by the German Index of Multiple Deprivation. Logistic multilevel regression models were performed using the software SAS 9.2. Results Of all men and women living in the most deprived areas, 8.6% had T2DM and 16.9% were obese (least deprived areas: 5.8% for T2DM and 13.7% for obesity). For women, higher area level deprivation and lower educational level were both independently associated with higher T2DM and obesity prevalence [highest area level deprivation: OR 1.28 (95% CI: 1.05–1.55) for T2DM and OR 1.28 (95% CI: 1.10–1.49) for obesity]. For men, a similar association was only found for obesity [OR 1.20 (95% CI: 1.02–1.41)], but not for T2DM. Conclusion Area level deprivation is an independent, important determinant of T2DM and obesity prevalence in Germany. Identifying and targeting specific area-based risk factors should be considered an essential public health issue relevant to increasing the effectiveness of diabetes and obesity prevention.

Messung des sozioökonomischen Status in der KiGGS-Studie

This article describes the measurement of socioeconomic status in the first follow-up of the KiGGS study (KiGGS Wave 1) conducted from 2009 to 2012. A multidimensional index score was used. The score is the sum of three metric components: Education and Occupational Qualification, Occupational Status, and Net Income. Compared with the approach in the KiGGS baseline study, some modifications were made in accordance with changes in the other components of the health-monitoring program at the Robert Koch Institute, i.e., the German Health Update (GEDA) and the German Health Interview and Examination Survey for Adults (DEGS1). These changes facilitate the analysis of temporal developments and trends, ensure international comparability of the data, and support the transfer of the results into politics and practice. In order to demonstrate the application of the revised instrument, we report on exemplary results of KiGGS Wave 1 regarding the relationship between socioeconomic status and the general health status of children and adolescents aged 3-17 years.

Sozioökonomischer Status und Gesundheit

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.

Measurement of the socioeconomic status within the German Health Update 2009 (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.