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Baumert J, Heidemann C, Paprott R, Du Y, Scheidt-Nave C. Zusammenhang von Gelegenheitsglukose und Mortalitätsrisiko: Ergebnisse des Mortalitäts-Follow-ups des Bundesgesundheitssurveys (BGS98). DAS GESUNDHEITSWESEN 2017. [DOI: 10.1055/s-0037-1605844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Gaertner B, Martus P, Fuchs J, Scheidt-Nave C, Busch MA. Kontaktmodus und Teilnahmerate an einer Gesundheitsstudie für Personen ab 65 Jahren: Eine randomisierte kontrollierte Studie. DAS GESUNDHEITSWESEN 2017. [DOI: 10.1055/s-0037-1605750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Baumert J, der Lippe E, Du Y, Paprott R, Heidemann C, Scheidt-Nave C. Lebenserwartung ohne gesundheitliche Einschränkungen mit und ohne Diabetes – Ergebnisse aus den bundesweiten Gesundheitssurveys des RKI. DAS GESUNDHEITSWESEN 2017. [DOI: 10.1055/s-0037-1606011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Gaertner B, Fuchs J, Grube M, Martus P, Scheidt-Nave C. Akzeptanz und Auswirkungen des Hausbesuchsangebots auf die Zusammensetzung der Studienpopulation einer Gesundheitsstudie ab 65 Jahren. DAS GESUNDHEITSWESEN 2017. [DOI: 10.1055/s-0037-1605751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Paprott R, Scheidt-Nave C, Thiele S, Heidemann C. Modifizierbare Determinanten einer Veränderung im glykämischen Status bei Personen mit Prädiabetes. DAS GESUNDHEITSWESEN 2017. [DOI: 10.1055/s-0037-1605815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Du Y, Heidemann C, Paprott R, Baumert J, Teti A, Scheidt-Nave C. Sex differences in diabetes prevalence and diabetes care among adults aged 40 – 79 years in Germany. DAS GESUNDHEITSWESEN 2017. [DOI: 10.1055/s-0037-1605963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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der Lippe E, Baumert J, Scheidt-Nave C. Beitrag von spezifischen Krankheiten zu gesundheitlichen Einschränkungen – Ergebnisse des bundesweiten GEDA 2014/15-EHIS-Studie. DAS GESUNDHEITSWESEN 2017. [DOI: 10.1055/s-0037-1605991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Paprott R, Mensink GBM, Schulze MB, Thiele S, Mühlenbruch K, Scheidt-Nave C, Heidemann C. Temporal changes in predicted risk of type 2 diabetes in Germany: findings from the German Health Interview and Examination Surveys 1997-1999 and 2008-2011. BMJ Open 2017; 7:e013058. [PMID: 28694339 PMCID: PMC5541581 DOI: 10.1136/bmjopen-2016-013058] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE Over time, prevalence changes in individual diabetes risk factors have been observed for Germany and other European countries. We aimed to investigate the temporal change of a summary measure of type 2 diabetes risk in Germany. DESIGN Comparison of data from two cross-sectional surveys that are about 12 years apart. SETTING Two nationwide health examination surveys representative for the non-institutionalised population aged 18-79 years in Germany. PARTICIPANTS The study included participants without diagnosed diabetes from the national health examination surveys in 1997-1999 (n=6457) and 2008-2011 (n=6095). OUTCOME MEASURES Predicted 5-year type 2 diabetes risk was calculated using the German Diabetes Risk Score (GDRS), which considers information on age, anthropometry, lifestyle factors, hypertension and family history of diabetes. RESULTS Between the two survey periods, the overall age- and sex-standardised predicted 5-year risk of type 2 diabetes decreased by 27% from 1.5% (95% CI 1.4% to 1.6%) to 1.1% (1.0% to 1.2%). The decrease in red meat intake and waist circumference had the highest impact on the overall decrease in diabetes risk. In stratified analyses, diabetes risk decreased among both sexes and within strata of age and body mass index. Diabetes risk also decreased among highly educated persons, but remained unchanged among persons with a middle or low educational level. CONCLUSIONS Monitoring type 2 diabetes risk by a summary measure such as the GDRS could essentially contribute to interpret the dynamics in diabetes epidemiology.
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Grube M, Fuchs J, Meyer G, Lahmann N, Zank S, Gaertner B, Wetzstein M, Koschollek C, Scheidt-Nave C. [Developing a framework for a public health monitoring of the population aged 65 years and older : Results of the IMOA workshop on concepts and indicators]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2017. [PMID: 28631028 DOI: 10.1007/s00103-017-2573-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Main goal of the Improving Health Monitoring in Older Age (IMOA) project is to provide a framework for an indicator-based public health monitoring of the population aged 65 years and older. The workshop served as a forum to discuss and agree upon relevant concepts with gerontologists, nursing care and public health scientists.
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Truthmann J, Mensink GBM, Bosy-Westphal A, Hapke U, Scheidt-Nave C, Schienkiewitz A. Physical health-related quality of life in relation to metabolic health and obesity among men and women in Germany. Health Qual Life Outcomes 2017; 15:122. [PMID: 28601090 PMCID: PMC5466792 DOI: 10.1186/s12955-017-0688-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 05/17/2017] [Indexed: 12/20/2022] Open
Abstract
Background This study examined sex-specific differences in physical health-related quality of life (HRQoL) across subgroups of metabolic health and obesity. We specifically asked whether (1) obesity is related to lower HRQoL independent of metabolic health status and potential confounders, and (2) whether associations are similar in men and women. Methods We used cross-sectional data from the German Health Interview and Examination Survey 2008–11. Physical HRQoL was measured using the Short Form-36 version 2 physical component summary (PCS) score. Based on harmonized ATPIII criteria for the definition of the metabolic health and a body mass index ≥ 30 kg/m2 to define obesity, individuals were classified as metabolically healthy non-obese (MHNO), metabolically unhealthy non-obese (MUNO), metabolically healthy obese (MHO), and metabolically unhealthy obese (MUO). Sex-specific analyses including multivariable linear regression analyses were based on PCS as the dependent variable, metabolic health and obesity category as the independent variable with three categories and MHNO as the reference, and age, education, lifestyle and comorbidities as confounders. Results This study included 6860 participants (3298 men, 3562 women). Compared to MHNO, all other metabolic health and obesity categories had significantly lower PCS in both sexes. As reflected by the beta coefficients [95% confidence interval] from bivariable linear regression models, a significant inverse association with PCS was strongest for MUO (men: −7.0 [−8.2; −5.8]; women: −9.0 [−10.2; −7.9]), intermediate for MUNO (men: −4.2 [−5.3; −3.1]; women: −5.6 [−6.8; −4.4]) and least pronounced for MHO (men: −2.2 [−3.6; −0.8]; women −3.9 [−5.4; −2.5]). Differences in relation to MHNO remained statistically significant for all groups after adjusting for confounders, but decreased in particular for MUNO (men:–1.3 [−2.3; −0.3]; women: −1.5 [−2.7; −0.3]. Conclusions Obesity was significantly related to lower physical HRQoL, independent of metabolic health status. Potential confounders including age, educational status, health-related behaviors, and comorbidities explained parts of the inverse relationship. Associations were evident in both sexes and consistently more pronounced among women than men. Electronic supplementary material The online version of this article (doi:10.1186/s12955-017-0688-7) contains supplementary material, which is available to authorized users.
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Schmidt C, Bätzing-Feigenbaum J, Bestmann A, Brinks R, Dreß J, Goffrier B, Hagen B, Laux G, Pollmanns J, Schröder H, Stahl T, Baumert J, Du Y, Gabrys L, Heidemann C, Paprott R, Scheidt-Nave C, Teti A, Ziese T. [Integration of secondary data into national diabetes surveillance : Background, aims and results of the secondary data workshop at the Robert Koch Institute]. BUNDESGESUNDHEITSBLATT, GESUNDHEITSFORSCHUNG, GESUNDHEITSSCHUTZ 2017. [PMID: 28466131 DOI: 10.20364/va-17.07] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Epidemiological data provide evidence that diabetes mellitus is a highly relevant public health issue in Germany as in many other countries. The Robert Koch Institute (RKI) is in the process of building a national diabetes surveillance system that is aimed at establishing indicator-based public health monitoring of diabetes population dynamics using primary and secondary data. The purpose of the workshop was to conduct an inventory of available secondary data sources and to discuss data contents, data access, data analysis examples in addition to the options for ongoing data use for diabetes surveillance.
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Knopf HC, Busch MA, Du Y, Truthmann J, Schienkiewitz A, Scheidt-Nave C. [Changes in the prevalence of statin use in Germany - findings from national health interview and examination surveys 1997-1999 and 2008-2011]. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2017; 122:22-31. [PMID: 28511896 DOI: 10.1016/j.zefq.2017.04.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 04/03/2017] [Accepted: 04/04/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Evidence-based guideline recommendations on lipid lowering drug treatment, in particular statin treatment, play an essential role in the management of dyslipidemias and in the prevention of cardiovascular disease events. In Germany, statutory health insurance data provide information on time trends in the prescription of lipid lowering drugs. However, population-based data regarding changes in user prevalence according to socio-demographic and health-related characteristics are lacking. Based on data from national health interview and examination surveys for adults in Germany 1997-1999 (GNHIES98) and 2008-2010 (DEGS1), the present analysis aims to close this information gap with a particular focus on the use of statins. METHODS The study population consisted of 7,099 participants (GNHIES98) and 7,091 participants (DEGS1) aged 18 to 79 years at the time of the respective surveys. Primary data on medication use within 7 days prior to the survey were collected using standardized medication interviews and brown-bag drug review. Unique product identifiers on original drug containers were scanned and coded according to the latest version of the Anatomical Therapeutic Chemical (ATC) classification system. Medical history was obtained in computer-assisted personal interviews. A history of stroke or coronary heart disease (CHD) was assessed among persons aged 40 to 79 years only, and previous stroke or CHD were defined as cardiovascular disease. Obesity was defined as a body mass index (BMI) of ≥ 30kg/m2) based on calculation from standardized measures of body weight and height. Information on socio-demographic variables and type of health insurance was collected using standardized self-administered questionnaires. In cross-sectional descriptive analyses we calculated the prevalence of statin use (ATC codes: C10AA, C10BA, C10BX) by survey as well as the changes between surveys stratified according to relevant preexisting diseases and other co-variables. The association between survey period and statin use was analyzed in multivariable binary logistic regression models among persons aged 40 to 79 years. All results were weighted and standardized for the population of 2010. RESULTS Between the two survey periods 1997-1999 and 2008-2011, the prevalence of statin use increased from 3.2 % to 8.8 %. The increase was most pronounced for the age group 65 to 79 years (7.2 % vs. 26.9 %) and among persons with relevant preexisting conditions, such as CHD (19.1 % vs. 54.9 %), stroke (17.1 % vs. 50.1 %), diabetes mellitus (10.5 % vs. 33.2 %), and dyslipidemia (12.6 % vs. 27.8 %). Among persons aged 40 to 79 years, the prevalence of statin use significantly increased between the two surveys, independent of co-variables (Odds Ratio: 3.70; 95 % confidence interval [CI]: 2.92 to 4.70). This applied to persons with cardiovascular disease (5.17; 3.50 to 7.64) and without cardiovascular disease (2.76; 2.07 to 3.67). CONCLUSION The increase in the prevalence of statin use in Germany between the two national health surveys (1997-1999 and 2008-2011) reflects the implementation of current guideline recommendations without evidence for inequalities according to gender, education, type of health insurance or region of residence. These population-based data add to information on statin prescription obtained from statutory health insurance data. Limitations of survey-based information derive from potential misclassification and selection bias as well as large time gaps between the survey periods. Further studies are needed to examine why the observed prevalence of statin use among persons with cardiovascular morbidity lags behind current guideline recommendations for secondary cardiovascular prevention.
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Schunk M, Reitmeir P, Rückert-Eheberg IM, Tamayo T, Schipf S, Meisinger C, Peters A, Scheidt-Nave C, Ellert U, Hartwig S, Kluttig A, Völzke H, Holle R. Longitudinal change in health-related quality of life in people with prevalent and incident type 2 diabetes compared to diabetes-free controls. PLoS One 2017; 12:e0176895. [PMID: 28467489 PMCID: PMC5415190 DOI: 10.1371/journal.pone.0176895] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 03/24/2017] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE The objective of this analysis is to compare people with prevalent type 2 diabetes, incident type 2 diabetes and without diabetes with respect to longitudinal change in health-related quality of life (HRQOL) when adjusting for baseline determinants of HRQOL. RESEARCH DESIGN AND METHODS Primary baseline and follow-up data from three regional and one national population-based cohort studies in Germany were pooled for analysis. HRQOL was measured using physical and mental health summary scores (PCS and MCS) from the German version of the Short Form Health Survey with 36 or 12 items. Mean score change per observation year was compared between the three groups (prevalent diabetes, incident diabetes, no diabetes) based on linear regression models. RESULTS The analysis included pooled data from 5367 people aged 45-74 years at baseline. Of these, 85.5% reported no diabetes at baseline and follow-up, 6.3% reported diabetes at both baseline and follow-up (prevalent diabetes), and 8.2% reported diabetes only at follow-up (incident diabetes). Over a mean observation period of 8.7 years, annual decline in HRQOL scores is pronounced at 0.27-0.32 (PCS) and 0.34-0.38 (MCS) in the group with prevalent diabetes compared with people without diabetes. Those with incident diabetes showed intermediate values but did not differ significantly from people without diabetes after adjustment for covariates in the full model. CONCLUSION Compared with data from cross-sectional analysis, the HRQOL loss associated with prevalent diabetes appears to be much larger than previously assumed.
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Scheidt-Nave C, Neuhauser H. In Reply. DEUTSCHES ARZTEBLATT INTERNATIONAL 2017; 114:212. [PMID: 28407846 PMCID: PMC5397895 DOI: 10.3238/arztebl.2017.0212b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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Gabrys L, Schmidt C, Heidemann C, Baumert J, Du Y, Paprott R, Teti A, Wolf IK, Ziese T, Scheidt-Nave C. Diabetes Surveillance in Germany - Background, concept and prospects. JOURNAL OF HEALTH MONITORING 2017; 2:83-95. [PMID: 37168685 PMCID: PMC10165556 DOI: 10.17886/rki-gbe-2017-022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Diabetes mellitus is a chronic disease that is associated with serious health problems and high costs. According to estimates gained from nationally representative health surveys conducted by the Robert Koch Institute (RKI), 4.6 million adults aged 18 to 79 suffer from diabetes in Germany. In addition, around 1.3 million adults have undetected diabetes. A surveillance system is currently being established at the RKI in order to gather the data sources available on diabetes in Germany and to provide reliable and comparable findings on time trends covering the frequency, progress of treatment, prevention and care of the disease. Next to identifying trends, diabetes surveillance also needs to detect differences in epidemiology that are related to social status or geographic region. Diabetes surveillance at the RKI is being undertaken in close cooperation with stakeholders involved in science, health-care provision, health policy and health-system self-governance. Furthermore, its progress is accompanied by an interdisciplinary scientific advisory board. Diabetes surveillance involves the following key elements: 1) the development of a research-based conceptual framework that uses indicators to appropriately measure developments in the disease; 2) the establishment of standards for the use of existing data sources and the identification of barriers to data usage and gaps in the data; and 3) the implementation of focused health reporting that is geared towards the target group. In addition to policy consultations, diabetes surveillance must guarantee the provision of timely and continuous information to the public together with the Federal Agency for Health Education. The implementation of a diabetes surveillance in Germany should act as a model and serve as a basis with which to establish the surveillance of other non-communicable diseases. In principle, indicator-based diabetes monitoring at the population level can be viewed as providing the body for evidence-based policy consultation and focused health policy. In turn, this should enable the implementation of effective disease prevention measures and high-quality care for all groups within the population.
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Teti A, Gabrys L, Ziese T, Scheidt-Nave C, Heidemann C, Gabrys L, Schmidt C, Teti A, Wolf IK, Du Y, Paprott R, Baumert J, Ziese T, Scheidt-Nave C, Gregg EW, Geiss L, Mainz J, Jørgensen M, Johnson J, Carinci F, Wild S. Proceedings of the International Workshop ‘Development of a National Diabetes Surveillance System in Germany – Core Indicators and Conceptual Framework’. BMC Proc 2017. [PMCID: PMC5356042 DOI: 10.1186/s12919-016-0070-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Gaksch M, Jorde R, Grimnes G, Joakimsen R, Schirmer H, Wilsgaard T, Mathiesen EB, Njølstad I, Løchen ML, März W, Kleber ME, Tomaschitz A, Grübler M, Eiriksdottir G, Gudmundsson EF, Harris TB, Cotch MF, Aspelund T, Gudnason V, Rutters F, Beulens JWJ, van ‘t Riet E, Nijpels G, Dekker JM, Grove-Laugesen D, Rejnmark L, Busch MA, Mensink GBM, Scheidt-Nave C, Thamm M, Swart KMA, Brouwer IA, Lips P, van Schoor NM, Sempos CT, Durazo-Arvizu RA, Škrabáková Z, Dowling KG, Cashman KD, Kiely M, Pilz S. Vitamin D and mortality: Individual participant data meta-analysis of standardized 25-hydroxyvitamin D in 26916 individuals from a European consortium. PLoS One 2017; 12:e0170791. [PMID: 28207791 PMCID: PMC5312926 DOI: 10.1371/journal.pone.0170791] [Citation(s) in RCA: 190] [Impact Index Per Article: 27.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 12/16/2016] [Indexed: 01/15/2023] Open
Abstract
Background Vitamin D deficiency may be a risk factor for mortality but previous meta-analyses lacked standardization of laboratory methods for 25-hydroxyvitamin D (25[OH]D) concentrations and used aggregate data instead of individual participant data (IPD). We therefore performed an IPD meta-analysis on the association between standardized serum 25(OH)D and mortality. Methods In a European consortium of eight prospective studies, including seven general population cohorts, we used the Vitamin D Standardization Program (VDSP) protocols to standardize 25(OH)D data. Meta-analyses using a one step procedure on IPD were performed to study associations of 25(OH)D with all-cause mortality as the primary outcome, and with cardiovascular and cancer mortality as secondary outcomes. This meta-analysis is registered at ClinicalTrials.gov, number NCT02438488. Findings We analysed 26916 study participants (median age 61.6 years, 58% females) with a median 25(OH)D concentration of 53.8 nmol/L. During a median follow-up time of 10.5 years, 6802 persons died. Compared to participants with 25(OH)D concentrations of 75 to 99.99 nmol/L, the adjusted hazard ratios (with 95% confidence interval) for mortality in the 25(OH)D groups with 40 to 49.99, 30 to 39.99, and <30 nmol/L were 1.15 (1.00–1.29), 1.33 (1.16–1.51), and 1.67 (1.44–1.89), respectively. We observed similar results for cardiovascular mortality, but there was no significant linear association between 25(OH)D and cancer mortality. There was also no significantly increased mortality risk at high 25(OH)D levels up to 125 nmol/L. Interpretation In the first IPD meta-analysis using standardized measurements of 25(OH)D we observed an association between low 25(OH)D and increased risk of all-cause mortality. It is of public health interest to evaluate whether treatment of vitamin D deficiency prevents premature deaths.
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Buttery AK, Du Y, Busch MA, Fuchs J, Gaertner B, Knopf H, Scheidt-Nave C. Changes in physical functioning among men and women aged 50-79 years in Germany: an analysis of National Health Interview and Examination Surveys, 1997-1999 and 2008-2011. BMC Geriatr 2016; 16:205. [PMID: 27908276 PMCID: PMC5134286 DOI: 10.1186/s12877-016-0377-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 11/23/2016] [Indexed: 11/22/2022] Open
Abstract
Background This study examines changes in physical functioning among adults aged 50-79 years in Germany based on data from two German National Health Interview and Examination Surveys conducted in 1997–1999 (GNHIES98) and 2008–2011 (DEGS1). Methods Using cross-sectional data from the two surveys (GNHIES98, n = 2884 and DEGS1, n = 3732), we examined changes in self-reported physical functioning scores (Short Form-36 physical functioning subscale (SF-36 PF)) by sex and age groups (50–64 and 65–79 years). Covariables included educational level, living alone, nine chronic diseases, polypharmacy (≥5 prescribed medicines), body mass index, sports activity, smoking and alcohol consumption. Multimorbidity was defined as ≥2 chronic diseases. Multivariable models were fitted to examine consistency of changes in physical functioning among certain subgroups and to assess changes in mean SF-36 PF scores, adjusting for changes in covariables between surveys. Results Mean physical functioning increased among adults aged 50–79 years between surveys in unadjusted analyses, but this change was not as marked among men aged 65–79 years who experienced rising obesity (20.6 to 31.5%, p = 0.004) and diabetes (13.0 to 20.0%, p = 0.014). Prevalence of multimorbidity and polypharmacy use increased among men and women aged 65–79 years. In sex and age specific multivariable analyses, changes in physical functioning over time were consistent across subgroups. Gains in physical functioning were explained by improved education, lower body mass index and improved health-related behaviours (smoking, alcohol consumption, sports activity) in women, but less so among men. Conclusions Physical functioning improved in Germany among adults aged 50–79 years. Improvements in the population 65–79 years were less evident among men than women, despite increases in multimorbidity prevalence among both sexes. Changes in health behaviours over time differed between sexes and help explain variations in physical functioning. Targeted health behaviour interventions are indicated from this study. Electronic supplementary material The online version of this article (doi:10.1186/s12877-016-0377-0) contains supplementary material, which is available to authorized users.
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Truthmann J, Mensink GBM, Bosy-Westphal A, Scheidt-Nave C, Schienkiewitz A. Metabolic Health in Relation to Body Size: Changes in Prevalence over Time between 1997-99 and 2008-11 in Germany. PLoS One 2016; 11:e0167159. [PMID: 27880828 PMCID: PMC5120858 DOI: 10.1371/journal.pone.0167159] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 11/09/2016] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE The study examined potential changes in the proportion of metabolic health according to body size categories over time and across strata of sex and age, varying definitions of metabolic health. METHODS We analysed data from national health interview and examination surveys 1997-99 and 2008-11 for adults aged 18-79 years (GNHIES98: N = 6,565; DEGS1: 6,860). Metabolic health as defined by ATPIII criteria was examined across body mass index categories. The Plourde and Karelis criteria were applied in relation to abdominal obesity. RESULTS Proportions of adults with metabolic health by body size categories were largely stable over time, except for an increasing proportion of metabolically healthy persons with pre-obesity and metabolically healthy women without abdominal obesity. In both surveys proportions of adults meeting ATPIII criteria ranged from approximately 30% among men and women with obesity, to about two thirds of those with pre-obesity to about 93% among those with normal weight. According to Plourde and Karelis criteria proportions ranged from almost 30% among men and women without abdominal obesity to less than 10% among those with abdominal obesity. Proportions were consistently higher among younger than older age groups and less consistently higher among women than men. CONCLUSIONS Proportions of adults with metabolic health by body size categories were largely stable over time, except for an increasing proportion of metabolically healthy women without abdominal obesity. There is no evidence that metabolic health among adults with obesity increased in Germany over a period of ten years.
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Paprott R, Mühlenbruch K, Mensink GBM, Thiele S, Schulze MB, Scheidt-Nave C, Heidemann C. Validation of the German Diabetes Risk Score among the general adult population: findings from the German Health Interview and Examination Surveys. BMJ Open Diabetes Res Care 2016; 4:e000280. [PMID: 27933187 PMCID: PMC5128853 DOI: 10.1136/bmjdrc-2016-000280] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 08/11/2016] [Accepted: 09/03/2016] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE To evaluate the German Diabetes Risk Score (GDRS) among the general adult German population for prediction of incident type 2 diabetes and detection of prevalent undiagnosed diabetes. METHODS The longitudinal sample for prediction of incident diagnosed type 2 diabetes included 3625 persons who participated both in the examination survey in 1997-1999 and the examination survey in 2008-2011. Incident diagnosed type 2 diabetes was defined as first-time physician diagnosis or antidiabetic medication during 5 years of follow-up excluding potential incident type 1 and gestational diabetes. The cross-sectional sample for detection of prevalent undiagnosed diabetes included 6048 participants without diagnosed diabetes of the examination survey in 2008-2011. Prevalent undiagnosed diabetes was defined as glycated haemoglobin ≥6.5% (48 mmol/mol). We assessed discrimination as area under the receiver operating characteristic curve (ROC-AUC (95% CI)) and calibration through calibration plots. RESULTS In longitudinal analyses, 82 subjects with incident diagnosed type 2 diabetes were identified after 5 years of follow-up. For prediction of incident diagnosed diabetes, the GDRS yielded an ROC-AUC of 0.87 (0.83 to 0.90). Calibration plots indicated excellent prediction for low diabetes risk and overestimation for intermediate and high diabetes risk. When considering the entire follow-up period of 11.9 years (ROC-AUC: 0.84 (0.82 to 0.86)) and including incident undiagnosed diabetes (ROC-AUC: 0.81 (0.78 to 0.84)), discrimination decreased somewhat. A previously simplified paper version of the GDRS yielded a similar predictive ability (ROC-AUC: 0.86 (0.82 to 0.89)). In cross-sectional analyses, 128 subjects with undiagnosed diabetes were identified. For detection of prevalent undiagnosed diabetes, the ROC-AUC was 0.84 (0.81 to 0.86). Again, the simplified version yielded a similar result (ROC-AUC: 0.83 (0.80 to 0.86)). CONCLUSIONS The GDRS might be applied for public health monitoring of diabetes risk in the German adult population. Future research needs to evaluate whether the GDRS is useful to improve diabetes risk awareness and prevention among the general population.
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D. Finger J, A. Busch M, Du Y, Heidemann C, Knopf H, Kuhnert R, Lampert T, Mensink GBM, K. Neuhauser H, Schaffrath Rosario A, Scheidt-Nave C, Schienkiewitz A, Truthmann J, Kurth BM. Time Trends in Cardiometabolic Risk Factors in Adults. DEUTSCHES ARZTEBLATT INTERNATIONAL 2016; 113:712-719. [PMID: 27866566 PMCID: PMC5143790 DOI: 10.3238/arztebl.2016.0712] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 04/15/2016] [Accepted: 07/07/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND Data from three representative health examination surveys in Germany were analyzed to examine secular trends in the prevalence and magnitude of cardiometabolic risk factors. METHODS The target variables were the following cardiometabolic risk factors: lack of exercise, smoking, obesity, systolic blood pressure, total cholesterol, serum glucose, self-reported high blood pressure, hyperlipidemia, and diabetes, and the use of antihypertensive, cholesterol-lowering, and antidiabetic drugs. 9347 data sets from men and 10 068 from women were analyzed. The calculated means and prevalences were standardized to the age structure of the German population as of 31 December 2010 and compared across the three time periods of the surveys: 1990-1992, 1997-1999, and 2008-11. RESULTS Over the entire period of observation (1990-2011), the mean systolic blood pressure fell from 137 to 128 mmHg in men and from 132 to 120 mmHg in women; the mean serum glucose concentration fell from 5.6 to 5.3 mmol/L in men and from 5.4 to 5.0 mmol/l in women; and the mean total cholesterol level fell from 6.2 to 5.3 mmol/L in both sexes. In men, smoking and lack of exercise became less common. On the other hand, the prevalence of use of antidiabetic, cholesterol-lowering, and antihypertensive drugs rose over the same time period, as did that of self-reported diabetes. The first of the three surveys (1990-1992) revealed differences between persons residing in the former East and West Germany in most of the health variables studied; these differences became less marked over time, up to the last survey in 2008-2011. CONCLUSION The cardiometabolic risk profile of the German adult population as a whole improved over a period of 20 years. Further in-depth analyses are now planned.
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Heidemann C, Du Y, Paprott R, Haftenberger M, Rathmann W, Scheidt-Nave C. Temporal changes in the prevalence of diagnosed diabetes, undiagnosed diabetes and prediabetes: findings from the German Health Interview and Examination Surveys in 1997-1999 and 2008-2011. Diabet Med 2016; 33:1406-14. [PMID: 26498983 DOI: 10.1111/dme.13008] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/21/2015] [Indexed: 12/17/2022]
Abstract
AIMS Nationally representative data on temporal changes in the prevalence of diagnosed diabetes, as well as undiagnosed diabetes and prediabetes, have been lacking in Germany as in most other European countries. We aimed to fill this gap using data from nationwide examination surveys of German adults. METHODS The study population comprised 18-79-year-old participants from the German Health Interview and Examination Surveys in 1997-1999 (GNHIES98, n = 6655) and 2008-2011 (DEGS1, n = 7017). Participants were classified as having diagnosed diabetes based on self-reported physician-diagnosed diabetes or the use of anti-diabetes agents. Among those without diagnosed diabetes, HbA1c measures were used to define undiagnosed diabetes [≥ 48 mmol/mol (≥ 6.5%)] or prediabetes [39-47 mmol/mol (5.7-6.4%)]. RESULTS Although the age- and sex-standardized prevalence of total diabetes remained stable between 1997-1999 at 9.3% (95% CI 8.3-10.5%) and 2008-2011 at 9.2% (8.3-10.3%), the prevalence of diagnosed diabetes increased from 5.6% (4.9-6.3%) to 7.2% (6.5-8.0%), whereas the prevalence of undiagnosed diabetes decreased from 3.8% (3.1-4.6%) to 2.0% (1.5-2.7%), resulting in a decreased proportion of undiagnosed diabetes (40.9% vs. 21.7%). Over the same period, the prevalence of prediabetes decreased from 27.7% (25.6-29.8%) to 20.8% (18.2-23.7%). Observed temporal changes were not explained by changes in BMI, sport activity and educational level. CONCLUSIONS The two nationwide surveys indicate a shift from undiagnosed to diagnosed diabetes. However, the unchanged prevalence of total diabetes and the considerably high proportion of prediabetes strongly call for a continued and concerted effort in diabetes prevention among German adults.
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Scheidt-Nave C, Du Y, Paprott R, Kroll L, Lampert T, Heidemann C. Soziale Ungleichheit und Diabetes mellitus – zeitliche Entwicklung bei Erwachsenen in Deutschland. DAS GESUNDHEITSWESEN 2016. [DOI: 10.1055/s-0036-1586556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Truthmann J, Schienkiewitz A, Heidemann C, Knopf H, Scheidt-Nave C. Changes in the prevalence of the metabolic syndrome among adults in Germany – German Health Interview and Examination Surveys 1997 – 99 and 2008 – 11. DAS GESUNDHEITSWESEN 2016. [DOI: 10.1055/s-0036-1586557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Finger J, Scheidt-Nave C, Du Y, Heidemann C, Busch M, Neuhauser H, Knopf H, Schienkiewitz A, Truthmann J, Kuhnert R, Schaffrath-Rosario A, Lampert T, Mensink G, Kurth BM. Zeitliche Entwicklung kardiometaboler Risikofaktoren bei Erwachsenen in Deutschland – Ergebnisse bundesweiter Gesundheitssurveys 1990 – 2011. DAS GESUNDHEITSWESEN 2016. [DOI: 10.1055/s-0036-1586602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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