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Frank LK, Schenk L, Rommel A, Thamm R, Ellert U, Lampert T. [Utilization of outpatient medical services and satisfaction with care in children and adolescents with a migration background-results of the KiGGS study]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2020; 63:103-112. [PMID: 31802152 DOI: 10.1007/s00103-019-03069-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND AND AIM Reasons for lower use of medical services by children and adolescents with migration background have not yet been investigated. The aim is therefore to identify factors that are related to the utilization of outpatient medical care and subjective patient satisfaction as well as explain differences according to migration background. METHODS On the basis of the "German Health Interview and Examination Survey for Children and Adolescents" (KiGGS, baseline study: 2003-2006), in which 17,640 children and adolescents participated, prevalences with 95% confidence intervals as well as multivariate binary logistic regression analyzes on the relationship between migration background, country of origin, the use of outpatient medical care services in the last 12 months, and satisfaction with the last medical treatment were calculated. RESULTS Children up to age 13 with two-sided migration background had lower utilization of specialist doctors compared to those without migration background (OR = 0.64 [0.56-0.74]). However, among the 14- to 17-year-olds, the utilization did not differ significantly (OR = 0.79 [0.60-1.03]). The lower use of outpatient medical care is associated with a shorter length of stay and limited German language skills. In addition, parents from Poland and the former Soviet Union are less likely to be very satisfied with the last outpatient treatment of their 0‑ to 13-year-old child, even after adjustments for German language skills and length of stay. CONCLUSION To make it easier for children with migration background to access specialist services, it is important to reduce language barriers in outpatient medical care and to promote processes of intercultural opening.
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Affiliation(s)
- Laura K Frank
- Abteilung für Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, Berlin, Deutschland
| | - Liane Schenk
- Institut für Medizinische Soziologie und Rehabilitationswissenschaft, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland.
| | - Alexander Rommel
- Abteilung für Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, Berlin, Deutschland
| | - Roma Thamm
- Abteilung für Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, Berlin, Deutschland
| | - Ute Ellert
- Abteilung für Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, Berlin, Deutschland
| | - Thomas Lampert
- Abteilung für Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, Berlin, Deutschland
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Santos-Hövener C, Kuntz B, Frank L, Koschollek C, Ellert U, Hölling H, Thamm R, Schienkiewitz A, Lampert T. The health situation of children and adolescents with migration background in Germany. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz185.251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Although more than one third of minors living in Germany have a migration background (MB), valid data on the health of this population are still lacking. The German Health Interview and Examination Survey for Children and Adolescents in Germany (KiGGS wave 2, 2014-2017) provides population-based data to make reliable statements on the health of adolescents with and without MB.
Methods
Survey data from KiGGS wave 2 are used to describe the general health status, mental health and the prevalence of allergic diseases in 3-to 17-year-old children and adolescents (n = 13,568). To determine overweight, body height and weight are measured (n = 3,463). In addition to MB (without/one-sided/two-sided), the socio-economic status (SES) and the length of stay of the parents in Germany are taken into account.
Results
Children and adolescents with two-sided MB show a physician-diagnosed atopic dermatitis (3.5%vs.6.9%) and attention deficit hyperactivity disorder (ADHD) (1.5%vs.5.1%) less frequently than their peers without MB, but more often a moderate or poor general health status (6.1%vs.3.9%). Adolescents with two-sided MB are also more often affected by overweight than those without MB (22.1%vs.12.2%). If only participants with MB are considered, their health situation is often associated with the SES and partly also with the length of stay of the parents.
Discussion
Health differences between children and adolescents with and without MB vary by the observed indicator. The heterogeneity of children and adolescents with MB, which can be partly determined by the SES or the length of stay of the parents, should be considered in target-group-specific interventions.
Main messages
The vast majority of children and adolescents in Germany grow up healthy and a MB is not per se associated with a poorer health status. Our results suggest that considering MB as the sole determinant of health to reflect the impact of migration on health is insufficient.
Key messages
Migration background is not per se associated with a poorer health status. Socioeconomic status and parents’ length of stay are derminants associated with poorer health outcomes among children and adolescents with migration background.
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Affiliation(s)
- C Santos-Hövener
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - B Kuntz
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - L Frank
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - C Koschollek
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - U Ellert
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - H Hölling
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - R Thamm
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - A Schienkiewitz
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - T Lampert
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
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Santos-Hövener C, Kuntz B, Frank L, Koschollek C, Ellert U, Hölling H, Thamm R, Schienkiewitz A, Lampert T. Zur gesundheitlichen Lage von Kindern und Jugendlichen mit Migrationshintergrund in Deutschland. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2019; 62:1253-1262. [DOI: 10.1007/s00103-019-03012-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Krist L, Keller T, Sebald L, Yesil-Jürgens R, Ellert U, Reich A, Becher H, Heuschmann PU, Willich SN, Keil T, Liman TG. The Montreal Cognitive Assessment (MoCA) in a population-based sample of Turkish migrants living in Germany. Aging Ment Health 2019; 23:30-37. [PMID: 29171956 DOI: 10.1080/13607863.2017.1396577] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Data on cognitive testing in migrants in Germany are scarce. We aimed to evaluate the Montreal Cognitive Assessment (MoCA) in Turkish migrants in Berlin and its association with demographics and health-related variables. METHOD For this cross-sectional study, a random sample of persons with Turkish names was drawn from the registration-office. Cognitive function was assessed using the MoCA; 0 = worst, 30 = best total score. Multivariable linear regression models were calculated to determine associated factors with the total MoCA-score. RESULTS In our analyses we included 282 participants (50% female), mean age 42.3 ± 11.9 years (mean ± standard deviation (SD)). The mean ± SD MoCA score was 23.3 ± 4.3. In the multivariable analysis, higher education (ß = 2.68; p < 0.001), and chosing the German version of the MoCA (ß = -1.13; p = 0.026), were associated with higher MoCA-scores, whereas higher age (ß = -0.08; p = 0.002) was associated with lower MoCA scores. CONCLUSION In our study, a higher educational level, lower age, and German as the preferred test language (as compared to Turkish) were positively associated with the cognitive performance of Berliners with Turkish roots. To examine neurocognitive health of migrants, longitudinal population-based and clinical cohort studies that specifically compare migrants and their descendants with the original population of their home countries are required.
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Affiliation(s)
- Lilian Krist
- a Institute For Social Medicine, Epidemiology and Health Economics , Charité-Universitätsmedizin Berlin , Berlin , Germany
| | - Theresa Keller
- a Institute For Social Medicine, Epidemiology and Health Economics , Charité-Universitätsmedizin Berlin , Berlin , Germany
| | - Lisa Sebald
- a Institute For Social Medicine, Epidemiology and Health Economics , Charité-Universitätsmedizin Berlin , Berlin , Germany
| | - Rahsan Yesil-Jürgens
- b Department of Epidemiology and Health Monitoring , Robert Koch-Institute Berlin , Berlin , Germany
| | - Ute Ellert
- b Department of Epidemiology and Health Monitoring , Robert Koch-Institute Berlin , Berlin , Germany
| | - Andreas Reich
- a Institute For Social Medicine, Epidemiology and Health Economics , Charité-Universitätsmedizin Berlin , Berlin , Germany
| | - Heiko Becher
- c Institute for Medical Biometry an Epidemiology , University Medical Center Hamburg-Eppendorf , Hamburg , Germany
| | - Peter U Heuschmann
- d Institute of Clinical Epidemiology and Biometry , University of Würzburg , Würzburg , Germany
| | - Stefan N Willich
- a Institute For Social Medicine, Epidemiology and Health Economics , Charité-Universitätsmedizin Berlin , Berlin , Germany
| | - Thomas Keil
- a Institute For Social Medicine, Epidemiology and Health Economics , Charité-Universitätsmedizin Berlin , Berlin , Germany
| | - Thomas G Liman
- e Center for Stroke Research Berlin , Charité-Universitätsmedizin Berlin , Berlin , Germany.,f Department of Neurology , Charité-Universitätsmedizin Berlin , Berlin , Germany
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Affiliation(s)
- Michaela Schunk
- Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Neuherberg, Germany
- German Center for Diabetes Research (DZD), Partner Site Helmholtz Zentrum München, Germany
| | - Peter Reitmeir
- Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Neuherberg, Germany
- German Center for Diabetes Research (DZD), Partner Site Helmholtz Zentrum München, Germany
| | - Ina-Maria Rückert-Eheberg
- German Center for Diabetes Research (DZD), Partner Site Helmholtz Zentrum München, Germany
- Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Epidemiology II, Neuherberg, Germany
| | - Teresa Tamayo
- Institute of Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich-Heine-University, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), Partner Site DDZ Düsseldorf, Germany
| | - Sabine Schipf
- Institute for Community Medicine, Ernst Moritz Arndt-University, Greifswald, Germany
- German Center for Diabetes Research (DZD), Project Partner Site Uni Greifswald, Greifswald, Germany
| | - Christa Meisinger
- German Center for Diabetes Research (DZD), Partner Site Helmholtz Zentrum München, Germany
- Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Epidemiology II, Neuherberg, Germany
| | - Annette Peters
- German Center for Diabetes Research (DZD), Partner Site Helmholtz Zentrum München, Germany
- Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Epidemiology II, Neuherberg, Germany
| | - Christa Scheidt-Nave
- Department of Epidemiology and Health Monitoring, Robert-Koch-Institute, Berlin, Germany
- German Center for Diabetes Research (DZD), Project Partner Site RKI, Berlin, Germany
| | - Ute Ellert
- Department of Epidemiology and Health Monitoring, Robert-Koch-Institute, Berlin, Germany
- German Center for Diabetes Research (DZD), Project Partner Site RKI, Berlin, Germany
| | - Saskia Hartwig
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
- German Center for Diabetes Research (DZD), Project Partner Site Uni Halle-Wittenberg, Halle, Germany
| | - Alexander Kluttig
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
- German Center for Diabetes Research (DZD), Project Partner Site Uni Halle-Wittenberg, Halle, Germany
| | - Henry Völzke
- Institute for Community Medicine, Ernst Moritz Arndt-University, Greifswald, Germany
- German Center for Diabetes Research (DZD), Project Partner Site Uni Greifswald, Greifswald, Germany
- German Center for Cardiovascular Research, Partner Site Greifswald, Germany
| | - Rolf Holle
- Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Neuherberg, Germany
- German Center for Diabetes Research (DZD), Partner Site Helmholtz Zentrum München, Germany
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Brettschneider AK, Schienkiewitz A, Schmidt S, Ellert U, Kurth BM. Updated prevalence rates of overweight and obesity in 4- to 10-year-old children in Germany. Results from the telephone-based KiGGS Wave 1 after correction for bias in parental reports. Eur J Pediatr 2017; 176:547-551. [PMID: 28132095 DOI: 10.1007/s00431-017-2861-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 01/15/2017] [Accepted: 01/18/2017] [Indexed: 11/27/2022]
Abstract
UNLABELLED The nationwide 'German Health Interview and Examination Survey for Children and Adolescents' (KiGGS), conducted in 2003-2006, showed an increase in the prevalence rates of overweight and obesity compared to the early 1990s, indicating the need for regular monitoring. Recently, a follow-up-KiGGS Wave 1 (2009-2012)-was carried out as a telephone-based survey, providing parent-reported height and weight from 5155 children aged 4-10 years. Since parental reports lead to a bias in prevalence rates of weight status, a correction is needed. From a subsample of KiGGS Wave 1 participants, measurements for height and weight were collected in a physical examination. In order to correct prevalence rates derived from parent reports, weight status categories based on parent-reported and measured height and weight were used to estimate a correction formula according to an established procedure. The corrected prevalence rates derived from KiGGS Wave 1 for overweight, including obesity, in children aged 4-10 years in Germany showed that stagnation is reached compared to the KiGGS baseline study (2003-2006). CONCLUSION The rates for overweight, including obesity, in Germany have levelled off. However, they still remain at a high level, indicating a need for further public health action. What is Known: • In the last decades, prevalence of overweight and obesity has risen. Now a days, the prevalence seems to be stagnating. • In Germany, prevalence estimates of overweight and obesity are only available from regional or non-representative studies. What is New: • This article gives an update for prevalence rates of overweight and obesity amongst children aged 4-10 years in Germany based on a nationwide and representative sample. • Results show that stagnation in prevalence rates for overweight in children in Germany is reached.
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Affiliation(s)
- Anna-Kristin Brettschneider
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Straße 62-66, 12101, Berlin, Germany.
| | - Anja Schienkiewitz
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Straße 62-66, 12101, Berlin, Germany
| | - Steffen Schmidt
- Department of Sports and Sports Science, Karlsruhe Institute of Technology, Engler-Bunte-Ring 15, 76131, Karlsruhe, Germany
| | - Ute Ellert
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Straße 62-66, 12101, Berlin, Germany
| | - Bärbel-Maria Kurth
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Straße 62-66, 12101, Berlin, Germany
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Wenner J, Razum O, Schenk L, Ellert U, Bozorgmehr K. [The health of children and adolescents from families with insecure residence status compared to children with permanent residence permits: analysis of KiGGS data 2003-2006]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2017; 59:627-35. [PMID: 27090244 DOI: 10.1007/s00103-016-2338-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND The health of children and adolescents from families with insecure residence status could be poorer compared to other children with permanent residence permits in Germany due to exposure before and during flight. Their insecure residence status and their comparably low social status in the destination country may contribute towards access barriers to health care. However, selection effects might also lead to better health compared to other children in the destination country. This study compares the health status of children and adolescents with insecure residence status to that of other children with and without migration background in Germany. METHODS We use data from the Health Interview and Examination Survey for Children and Adolescents (KiGGS). In multivariable logistic regression models we analyze the associations between children's residence status and their subjective and mental health, as well as their utilization of emergency services and vaccination status while adjusting for the children's social status and migration background. RESULTS AND CONCLUSION Among 17,245 children, 197 (1.1 %) had an insecure residence status. Adjusting only for age and sex, an insecure residence status is associated with poorer subjective health (OR=3.12 (2.07-4.94)), mental problems (OR=1.83 (1.16-2.87)), an incomplete vaccination status (OR=2.0 (1.33-3.0)) and the use of emergency health services (OR=2.28 (1.2-4.36)). After adjusting also for social and migration status, only the association with the use of emergency care remains significant (OR=2.53 (1.18-5.43)). This association possibly indicates barriers to the use of regular primary care services, which requires further research.
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Affiliation(s)
- Judith Wenner
- Abteilung Epidemiologie und International Public Health, Fakultät für Gesundheitswissenschaften, Universität Bielefeld, Postfach 10 01 31, 33501, Bielefeld, Deutschland.
| | - Oliver Razum
- Abteilung Epidemiologie und International Public Health, Fakultät für Gesundheitswissenschaften, Universität Bielefeld, Postfach 10 01 31, 33501, Bielefeld, Deutschland
| | - Liane Schenk
- Institut für Medizinische Soziologie und Rehabilitationswissenschaft an der Charité, Universitätsmedizin Berlin, Berlin, Deutschland
| | - Ute Ellert
- Abteilung für Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, Berlin, Deutschland
| | - Kayvan Bozorgmehr
- Abteilung für Allgemeinmedizin und Versorgungsforschung, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
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Neuhauser HK, Ellert U, Kurth BM. A comparison of Framingham and SCORE-based cardiovascular risk estimates in participants of the German National Health Interview and Examination Survey 1998. ACTA ACUST UNITED AC 2017; 12:442-50. [PMID: 16210930 DOI: 10.1097/01.hjr.0000183909.52118.9f] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Background Overestimation of risk by Framingham risk functions not only in southern but also in northern European populations including Germany, has led to the development of the SCORE risk estimation model. Design Data of the German National Health Interview and Examination Survey 1998 was used to determine whether SCORE leads to lower estimates of the 10-year absolute risk of fatal cardiovascular disease and fatal coronary heart disease than a Framingham model. Predicted numbers of events were compared with approximations based on national mortality statistics. Methods Inclusion criteria followed the recommendations for the use of SCORE: age 30 to 69 years, no previous history of cardiovascular disease and no markedly raised levels of single risk factors (leaving 1811 men and 1955 women for analysis). Results The SCORE model for high-risk regions (SCORE-HIGH, which is recommended for Germany pending calibration with national data) predicted the highest number of events, followed by the estimations with mortality statistics, the Framingham model and SCORE-LOW (87 fatal cardiovascular disease events versus 77, 62 and 47; fatal coronary heart disease events 62 versus 46, 46 and 30). Agreement on high-risk status, defined as the 10-year risk of fatal cardiovascular disease of 5% or higher now or if extrapolated to age 60, was moderate for both men and women (≤ 0.52 and 0.42 for Framingham and SCORE-HIGH). Conclusions Our results suggest that SCORE-HIGH may overestimate absolute risk of fatal coronary heart disease and cardiovascular disease in Germany and may need calibration. Furthermore, the limitations of current risk prediction tools emphasize the ongoing need for comprehensive, high-quality and timely European cohort data.
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Affiliation(s)
- Hannelore K Neuhauser
- Department of Epidemiology and Health Reporting, Robert Koch Institute, Berlin, Germany.
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9
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Saß AC, Grüne B, Brettschneider AK, Rommel A, Razum O, Ellert U. [Participation of people with migration background in health surveys of the Robert Koch Institute]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2016; 58:533-42. [PMID: 25896496 DOI: 10.1007/s00103-015-2146-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
People with migration background (PMB) make up a huge section of the population with specific health chances and risks. There are only limited data available on the health situation of PMB, since inclusion of PMB in surveys is hindered, e.g. due to language barriers. The present study has examined to what extent the population-based health surveys of the Robert Koch Institute have managed to include a representative extent of PMB, with the aim of deriving recommendations for analysis options and future recruitment strategies. The 2009 microcensus (MC) of the Federal Statistical Office was used as the basis to check whether the sample of KiGGS Wave 1 (2009-2012) and DEGS 1 (2008-2011) are representative regarding socio-demographic and migrant-specific characteristics. 1107 PMB participated in DEGS 1. In comparison to the MC, particular sub-groups are underrepresented in the sample: people who immigrated themselves (first-generation migrants), people with a low education and Turkish citizens. On the other hand, some age groups are overrepresented. In KiGGS Wave 1, 2021 children and adolescents with a migration background participated. Response was lower if parents had a low education. In total, the participation of children and adolescents with a migration background was lower in comparison to the KiGGS baseline survey. The data on PMB in DEGS 1 and KiGGS Wave 1 are appropriate for health analyses of this population group. However, analyses should be stratified according to characteristics like migrant generation, age or education level, or these characteristics should be adjusted for in statistical models. In order to achieve a representative inclusion of people with a migration background, in future surveys sub-group-specific activities to increase participation of PMB are recommended.
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Affiliation(s)
- Anke-Christine Saß
- Abteilung für Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, General-Pape-Str. 62-64, 12101, Berlin, Deutschland,
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Rommel A, Saß AC, Born S, Ellert U. [Health status of people with a migrant background and impact of socio-economic factors: First results of the German Health Interview and Examination Survey for Adults (DEGS1)]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2016; 58:543-52. [PMID: 25824135 DOI: 10.1007/s00103-015-2145-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
People with a migrant background (PMB) have specific health-related risk factors and resources compared to the non-migrant population (NMP). The analysis focuses on the relationship between migrant background and health and health-related behavior. Moreover, the study analyses whether socio-economic status (SES) contributes to the explanation of differences between PMB and the NMP. The research is based on the German Health Interview and Examination Survey for Adults (DEGS1) (2008-2012, n = 8151). The population for cross-sectional analyses contains 1107 PMB (weighted 19.8 %). The research question is addressed on the basis of nine exemplary health outcomes. All analyses are gender specific and make a distinction between first and second generation PMB. Logistic regression is calculated adjusting for age and SES. The results reveal clear gender-specific patterns: For women, differences are statistically significant mainly for first generation PMB. Compared to the NMP their self-assessed health status is lower, they are less physically active, consume less alcohol, feel less informed about cancer screening programs and make less use of preventive health services. However, daily smoking is more prevalent in second generation women. For men, differences are statistically significant for first and second generation PMB. Men with a migrant background show more symptoms of depression, consume less alcohol and feel less informed about cancer screening programs. After adjusting for SES the impact of migrant background on health status and health-related behavior largely remains stable. The study shows that the DEGS1 data offers valuable results and new insights into the health status of people with a migrant background. The use of this data for further research requires a differentiated approach to the concept of migrant background and a careful interpretation of results.
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Affiliation(s)
- Alexander Rommel
- Abteilung für Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, General-Pape-Str. 62-66, 12101, Berlin, Deutschland,
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Krause L, Neuhauser H, Hölling H, Ellert U. Kopf-, Bauch- und Rückenschmerzen bei Kindern und Jugendlichen in Deutschland – Aktuelle Prävalenzen und zeitliche Trends. Monatsschr Kinderheilkd 2016. [DOI: 10.1007/s00112-016-0128-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Brettschneidera AK, Rosario AS, Kuhnert R, Schmidt S, Wiegand S, Ellert U, Kurth BM. Erratum to: 'Updated prevalence rates of overweight and obesity in 11- to 17-year-old adolescents in Germany. Results from the telephone-based KiGGS Wave 1 after correction for bias in self-reports'. BMC Public Health 2016; 16:247. [PMID: 26961509 PMCID: PMC4784367 DOI: 10.1186/s12889-016-2855-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Affiliation(s)
- Anna-Kristin Brettschneidera
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Str. 62-66, 12101, Berlin, Germany.
| | - Angelika Schaffrath Rosario
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Str. 62-66, 12101, Berlin, Germany
| | - Ronny Kuhnert
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Str. 62-66, 12101, Berlin, Germany
| | - Steffen Schmidt
- Department of Sports and Sports Science, Karlsruhe Institute of Technology, Engler-Bunte-Ring 15, 76131, Karlsruhe, Germany
| | - Susanna Wiegand
- Department of Pediatric Endocrinology and Diabetology, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Ute Ellert
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Str. 62-66, 12101, Berlin, Germany
| | - Bärbel-Maria Kurth
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Str. 62-66, 12101, Berlin, Germany
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Brettschneider AK, Hölling H, Schlack R, Ellert U. [Mental health in adolescents in Germany: A comparison with regard to migration background and country of origin]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2016; 58:474-89. [PMID: 25691105 DOI: 10.1007/s00103-015-2129-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Many children and adolescents in Germany grow up in families with a migration background. Different cultural, religious, and linguistic backgrounds have an influence on their behavior in various ways. Health status can be affected both negatively and positively by a migration background. The aim of this study was to analyze associations between migration background and self-reported psychological problems. In addition, it was tested whether country of origin had a differential effect on the associations found. Because of its migration-specific approach, the baseline survey (2003-2006) of the nationwide German Health Interview and Examination Survey for Children and Adolescents (KiGGS) offers a solid basis for migrant-specific analyses. Self-reported mental health problems were assessed using the Strengths and Difficulties Questionnaire (SDQ), which was completed by 6,719 adolescents aged 11-17 years. Adolescents with a two-sided migration background (i.e., both parents) reported higher SDQ total difficulties scores compared with adolescents without a migration background (16.9 vs 11.5%) or those with a one-sided migration background (16.9 vs 11.3%). Adolescents with a Turkish background had higher odds (boys: OR 2.0; 95%CI 1.3-3.2; girls: OR 2.0; 95%CI 1.2-3.4) of reporting mental health problems than adolescents without a migration background. Also, girls with a migration background from Western Europe, the USA or Canada had higher odds (OR 2.2; 95%CI 1.3-3.6). In some cases, adjusting for socioeconomic status led to insignificant associations with regard to the country of origin. The findings underline the importance of migrant-specific and culture-sensitive prevention, which also takes the environment and culture-specific characteristics into account.
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Affiliation(s)
- Anna-Kristin Brettschneider
- Abteilung für Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, General-Pape-Straße 62--66, 12101, Berlin, Deutschland,
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Brettschneider AK, Brettschneidera AK, Schaffrath Rosario A, Kuhnert R, Schmidt S, Wiegand S, Ellert U, Kurth BM. Updated prevalence rates of overweight and obesity in 11- to 17-year-old adolescents in Germany. Results from the telephone-based KiGGS Wave 1 after correction for bias in self-reports. BMC Public Health 2015; 15:1101. [PMID: 26541820 PMCID: PMC4636076 DOI: 10.1186/s12889-015-2467-x] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Accepted: 10/31/2015] [Indexed: 01/11/2023] Open
Abstract
Background The nationwide “German Health Interview and Examination Survey for Children and Adolescents” (KiGGS), conducted in 2003–2006, showed an increase in the prevalence rates of overweight and obesity compared to the early 1990s, indicating the need for regularly monitoring. Recently, a follow-up—KiGGS Wave 1 (2009–2012)—was carried out as a telephone-based survey, providing self-reported height and weight. Since self-reports lead to a bias in prevalence rates of weight status, a correction is needed. The aim of the present study is to obtain updated prevalence rates for overweight and obesity for 11- to 17-year olds living in Germany after correction for bias in self-reports. Methods In KiGGS Wave 1, self-reported height and weight were collected from 4948 adolescents during a telephone interview. Participants were also asked about their body perception. From a subsample of KiGGS Wave 1 participants, measurements for height and weight were collected in a physical examination. In order to correct prevalence rates derived from self-reports, weight status categories based on self-reported and measured height and weight were used to estimate a correction formula according to an established procedure under consideration of body perception. The correction procedure was applied and corrected rates were estimated. Results The corrected prevalence of overweight, including obesity, derived from KiGGS Wave 1, showed that the rate has not further increased compared to the KiGGS baseline survey (18.9 % vs. 18.8 % based on the German reference). Conclusion The rates of overweight still remain at a high level. The results of KiGGS Wave 1 emphasise the significance of this health issue and the need for prevention of overweight and obesity in children and adolescents.
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Affiliation(s)
| | - Anna-Kristin Brettschneidera
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Str. 62-66, 12101, Berlin, Germany.
| | - Angelika Schaffrath Rosario
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Str. 62-66, 12101, Berlin, Germany.
| | - Ronny Kuhnert
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Str. 62-66, 12101, Berlin, Germany.
| | - Steffen Schmidt
- Department of Sports and Sports Science, Karlsruhe Institute of Technology, Engler-Bunte-Ring 15, 76131, Karlsruhe, Germany.
| | - Susanna Wiegand
- Department of Pediatric Endocrinology and Diabetology, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Ute Ellert
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Str. 62-66, 12101, Berlin, Germany.
| | - Bärbel-Maria Kurth
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Str. 62-66, 12101, Berlin, Germany.
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Kuntz B, Ellert U, Rommel A, Schmitz R, Gutsche J, Poethko-Müller C, Lampert T. Soziale Determinanten der Schwimmfähigkeit von Kindern und Jugendlichen in Deutschland. Gesundheitswesen 2015. [DOI: 10.1055/s-0035-1563255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Rommel A, Saß A, Born S, Ellert U. Gesundheitliche Lage und Gesundheitsverhalten von Menschen mit Migrationshintergrund. Ergebnisse der Studie zur Gesundheit Erwachsener in Deutschland (DEGS1). Gesundheitswesen 2015. [DOI: 10.1055/s-0035-1563313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Ellert U, Brettschneider AK, Ravens-Sieberer U. [Health-related quality of life in children and adolescents in Germany: results of the KiGGS study: first follow-up (KiGGS Wave 1)]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2015; 57:798-806. [PMID: 24950829 DOI: 10.1007/s00103-014-1978-4] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In recent years, there has been a change in the health and disease spectrum among children and adolescents, with an increase in mental health problems and a shift from acute to chronic illness. In this phase, the health-related quality of life (HRQoL) has increased in importance as a dimension of subjective health. The aim of this study is to describe the HRQoL of children and adolescents measured with the internationally standardized screening instrument KIDSCREEN-10. In the follow-up of the KiGGS study in 2009-2012 (KiGGS Wave 1), 2,567 parents of children aged 7-10 years and 4,878 adolescents aged 11 years or older completed the KIDSCREEN-10 questionnaire. In all, 94% of parents of 7- to 10-year-old girls and boys estimate the HRQoL of their children to be "very good" or "good." Of the 11- to 17-year-old adolescents, 96% report their HRQoL as "very good" or "good." Somatic diseases and pain as well as mental health problems and a low social status are included in the HRQoL in only a limited way. Potential differences in HRQoL by social status were not confirmed in multivariate models. The HRQoL of the examined children and adolescents is predominantly very good or good. Interventions to improve the HRQoL of children and adolescents with diseases and psychopathological problems are necessary, regardless of their social status.
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Affiliation(s)
- U Ellert
- Abteilung für Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, General-Pape-Straße 62, 12101, Berlin, Deutschland,
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Schunk M, Reitmeir P, Schipf S, Völzke H, Meisinger C, Ladwig KH, Kluttig A, Greiser KH, Berger K, Müller G, Ellert U, Neuhauser H, Tamayo T, Rathmann W, Holle R. Health-related quality of life in women and men with type 2 diabetes: a comparison across treatment groups. J Diabetes Complications 2015; 29:203-11. [PMID: 25499244 DOI: 10.1016/j.jdiacomp.2014.11.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 11/11/2014] [Accepted: 11/17/2014] [Indexed: 01/14/2023]
Abstract
AIM This study compares health-related quality of life (HRQL) in patients with type 2 diabetes (T2DM) across treatment groups and explores gender differences. METHODS Four regional surveys (KORA, CARLA, SHIP, DHS) and a national survey (GNHIES98) were pooled at individual level. HRQL was assessed with the SF-12/-36v1. Linear regression models were used to assess the effect of T2DM by treatment type (no medication; oral; oral/insulin combination; insulin) on the physical (PCS-12) and mental summary score (MCS-12) and the SF-6D, controlling for age, sex, study and covariates. We also performed an explanatory analysis of single items. RESULTS PCS-12 scores and treatment type were associated (P-value 0.006), with lowest values for insulin treatment (-4.44 vs. oral; -4.41 vs. combination). MCS-12 scores were associated with treatment type and gender (P-value <0.012), with lower scores for women undergoing oral (-4.25 vs. men) and combination treatment (-6.99 vs. men). Similar results were observed for SF-6D utilities and single items, related to mental health, social functioning, vitality and role limitation (emotional). Comorbidities were predictors of lower PCS-12 and SF-6D scores. CONCLUSIONS T2DM treatment impacts differently on physical and mental HRQL and on women and men. Further studies of gender-specific perceptions of T2DM treatment regimens are needed.
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Affiliation(s)
- M Schunk
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany
| | - P Reitmeir
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany
| | - S Schipf
- Institute for Community Medicine, Ernst Moritz Arndt-University, Greifswald, Germany
| | - H Völzke
- Institute for Community Medicine, Ernst Moritz Arndt-University, Greifswald, Germany
| | - C Meisinger
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany
| | - K-H Ladwig
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany
| | - A Kluttig
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - K H Greiser
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany; German Cancer Research Centre, Division of Cancer Epidemiology, Heidelberg, Germany
| | - K Berger
- Institute of Epidemiology and Social Medicine, University of Muenster, Muenster, Germany
| | - G Müller
- Institute of Epidemiology and Social Medicine, University of Muenster, Muenster, Germany
| | - U Ellert
- Department of Epidemiology and Health Reporting, Robert-Koch-Institute, Berlin, Germany
| | - H Neuhauser
- Department of Epidemiology and Health Reporting, Robert-Koch-Institute, Berlin, Germany
| | - T Tamayo
- Institute of Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich-Heine-University, Düsseldorf, Germany
| | - W Rathmann
- Institute of Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich-Heine-University, Düsseldorf, Germany
| | - R Holle
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany
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Schwille-Kiuntke J, Unverdorben A, Weimer K, Schlarb AA, Gulewitsch MD, Ellert U, Enck P. Bacterial infections in childhood: A risk factor for gastrointestinal and other diseases? United European Gastroenterol J 2015; 3:31-8. [PMID: 25653857 DOI: 10.1177/2050640614558346] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 10/09/2014] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND There is evidence for post-infectious irritable bowel syndrome (PI-IBS) in adults, but little is known about PI-IBS in children. The nationwide representative German Health Interview and Examination Survey for Children and Adolescents (KiGGS) assessed children's health. OBJECTIVE AND METHODS We identified 643 children (50.1% males) in the KiGGS cohort (N = 15,878, 51% males) with a history of Salmonella infection. The number was validated comparing this group with the known infection statistics from the Robert Koch-Institute registry. We compared this group to the remaining KiGGS cohort (n = 12,951) with respect to sociodemographic characteristics, pain and quality of life. To check for specificity, we repeated the comparisons with a group with a history of scarlet fever. RESULTS Infection statistics predicted 504 cases of Salmonella infection in the KiGGS cohort, indicating high validity of the data. In children between 3 and 10 years with a history of Salmonella infection, significantly more abdominal pain (31.7% versus 21.9%, p < 0.001) and headache (27.2% versus 15.1%, p < 0.001) were reported. This group showed lower quality of life (p < 0.001). Comparison to a group of scarlet fever-infected children revealed poor specificity of the data. CONCLUSION Differences found between children with and without Salmonella infection reveal the role of gastrointestinal infection in the development of post-infectious abdominal problems, but poor specificity may point toward a psychosocial ("somatization") rather than a Salmonella-specific mechanism.
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Affiliation(s)
- Juliane Schwille-Kiuntke
- University Hospital, Department of Internal Medicine VI: Psychosomatic Medicine and Psychotherapy, Tuebingen, Germany
| | - Alexandra Unverdorben
- University Hospital, Department of Internal Medicine VI: Psychosomatic Medicine and Psychotherapy, Tuebingen, Germany
| | - Katja Weimer
- University Hospital, Department of Internal Medicine VI: Psychosomatic Medicine and Psychotherapy, Tuebingen, Germany
| | - Angelika Anita Schlarb
- Faculty of Psychology and Sports Science, Department of Psychology, University of Bielefeld, Tuebingen, Germany
| | - Marco Daniel Gulewitsch
- Faculty of Science, Department of Psychology, Clinical Psychology and Psychotherapy, University of Tuebingen, Tuebingen, Germany
| | - Ute Ellert
- Robert Koch-Institute, Department of Epidemiology and Health Reporting, Berlin, Germany
| | - Paul Enck
- University Hospital, Department of Internal Medicine VI: Psychosomatic Medicine and Psychotherapy, Tuebingen, Germany
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Brettschneider AK, Schaffrath Rosario A, Wiegand S, Kollock M, Ellert U. Development and validation of correction formulas for self-reported height and weight to estimate BMI in adolescents. Results from the KiGGS study. Obes Facts 2015; 8:30-42. [PMID: 25765162 PMCID: PMC5644804 DOI: 10.1159/000375109] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Accepted: 09/15/2014] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The use of reported instead of measured height and weight induces a bias in prevalence rates for overweight and obesity. Therefore, correction formulas are necessary. METHODS Self-reported and measured height and weight were available from the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) baseline study (2003-2006) from 3,468 adolescents aged 11-17 years. With regression analyses, correction formulas for height and weight were developed. Cross-validation was conducted in order to validate and compare the formulas. Corrected BMI was calculated, and corrected prevalence rates were estimated. Sensitivity, specificity, and predictive values for overweight and obesity were calculated. RESULTS Through the correction procedure, the mean differences between reported and measured height and weight become remarkably smaller and thus the estimated prevalence rates more accurate. The corrected proportions for overweight and obesity are less under-reported, while the corrected proportions for underweight are less over-reported. Sensitivity for overweight and obesity increased after correction. Specificity remained high. CONCLUSION The validation process showed that the correction formulas are an appropriate tool to correct self-reports on an individual level in order to estimate corrected prevalence rates of overweight and obesity in adolescents for studies which have collected self-reports only.
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Affiliation(s)
| | | | - Susanna Wiegand
- Department of Pediatric Endocrinology and Diabetology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | - Ute Ellert
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
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Schlarb AA, Gulewitsch MD, Weltzer V, Ellert U, Enck P. Sleep Duration and Sleep Problems in a Representative Sample of German Children and Adolescents. Health (London) 2015. [DOI: 10.4236/health.2015.711154] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Reiss K, Dragano N, Ellert U, Fricke J, Greiser KH, Keil T, Krist L, Moebus S, Pundt N, Schlaud M, Yesil-Jürgens R, Zeeb H, Zimmermann H, Razum O, Jöckel KH, Becher H. Comparing sampling strategies to recruit migrants for an epidemiological study. Results from a German feasibility study. Eur J Public Health 2014; 24:721-6. [PMID: 24872519 DOI: 10.1093/eurpub/cku046] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In 2011, almost 20.0% of the population of Germany had a migration background. Studies on their health tend to have low participation rates. The aim of our study was to compare different sampling strategies and to test different approaches to recruit migrants for an epidemiological study. METHODS Four recruitment centres of the German National Cohort recruited persons of Turkish origin and ethnic German immigrants from former Soviet Union countries. A register-based (random samples from residents' registration offices) and a community-orientated strategy were applied. Participants underwent a medical examination and self-completed a questionnaire. RESULTS Used approaches: The community-orientated strategies comprised the acquisition of key persons from migrant networks to support the recruitment, invitation talks and distribution of study materials in migrant settings, etc. The identifying variables in the registry data were name, nationality or country of birth. All but one centres used bilingual study material and study staff. PARTICIPATION When comparing the two strategies, the register-based participation rates ranged from 10.1 to 21.0% (n = 668 participants) and the community-oriented recruitment resulted in 722 participants. CONCLUSION Register-based recruitment should use a combination of name, nationality and country of birth in order not to be limited to identifying persons with a foreign nationality. However, according to the study staff, the community-oriented approach involving key persons of the same cultural background leads to a better acceptance by the participants. Also, it covers a more heterogeneous group. Yet, it is time-consuming and needs considerably more staff. Further research should establish the effectiveness of a combination of both strategies.
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Affiliation(s)
- Katharina Reiss
- 1 Department of Epidemiology and International Public Health, Bielefeld School of Public Health (BiSPH), Bielefeld University, 33501 Bielefeld, Germany
| | - Nico Dragano
- 2 Institute for Medical Informatics, Biometry and Epidemiology (IMIBE), University Hospital Essen, 45122 Essen, Germany 3 Institute for Medical Sociology, University Hospital Duesseldorf, 40225 Duesseldorf, Germany
| | - Ute Ellert
- 4 Department of Epidemiology and Health Monitoring, Robert Koch Institute, 12101 Berlin, Germany
| | - Julia Fricke
- 5 German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | | | - Thomas Keil
- 6 Institute of Social Medicine, Epidemiology and Health Economics, Charité Universitätsmedizin, 10117 Berlin, Germany
| | - Lilian Krist
- 6 Institute of Social Medicine, Epidemiology and Health Economics, Charité Universitätsmedizin, 10117 Berlin, Germany
| | - Susanne Moebus
- 2 Institute for Medical Informatics, Biometry and Epidemiology (IMIBE), University Hospital Essen, 45122 Essen, Germany
| | - Noreen Pundt
- 2 Institute for Medical Informatics, Biometry and Epidemiology (IMIBE), University Hospital Essen, 45122 Essen, Germany
| | - Martin Schlaud
- 4 Department of Epidemiology and Health Monitoring, Robert Koch Institute, 12101 Berlin, Germany
| | - Rahsan Yesil-Jürgens
- 4 Department of Epidemiology and Health Monitoring, Robert Koch Institute, 12101 Berlin, Germany 6 Institute of Social Medicine, Epidemiology and Health Economics, Charité Universitätsmedizin, 10117 Berlin, Germany
| | - Hajo Zeeb
- 7 Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology-BIPS GmbH, 28359 Bremen, Germany
| | - Heiko Zimmermann
- 8 Institute of Public Health, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Oliver Razum
- 1 Department of Epidemiology and International Public Health, Bielefeld School of Public Health (BiSPH), Bielefeld University, 33501 Bielefeld, Germany
| | - Karl-Heinz Jöckel
- 2 Institute for Medical Informatics, Biometry and Epidemiology (IMIBE), University Hospital Essen, 45122 Essen, Germany
| | - Heiko Becher
- 8 Institute of Public Health, University Hospital Heidelberg, 69120 Heidelberg, Germany
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Ellert U, Brettschneider AK, Wiegand S, Kurth BM. Applying a correction procedure to the prevalence estimates of overweight and obesity in the German part of the HBSC study. BMC Res Notes 2014; 7:181. [PMID: 24670124 PMCID: PMC3986913 DOI: 10.1186/1756-0500-7-181] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Accepted: 03/21/2014] [Indexed: 11/10/2022] Open
Abstract
Background Prevalence rates for overweight and obesity based on self-reported height and weight are underestimated, whereas the prevalence rate for underweight is slightly overestimated. Therefore a correction is needed. Aim of this study is to apply correction procedures to the prevalence rates developed on basis of (self-reported and measured) data from the representative German National Health Interview and Examination Survey for Children and Adolescents (KiGGS) to (self-reported) data from the German Health Behaviour in School Aged Children (HBSC) study to determine whether correction leads to higher prevalence estimates of overweight and obesity as well as lower prevalence rates for underweight. Methods BMI classifications based on self-reported and measured height and weight from a subsample of the KiGGS study (2,565 adolescents aged 11–15) were used to estimate two different correction formulas. The first and the second correction function are described. Furthermore, the both formulas were applied to the prevalence rates from the HBSC study (7,274 adolescents aged 11–15) which are based on self-reports collected via self-administered questionnaires. Results After applying the first correction function to self-reported data of the HBSC study, the prevalence rates of overweight and obesity increased from 5.5% to 7.8% (compared to 10.4% in the KiGGS study) and 2.7% to 3.8% (compared to 7.8% in the KiGGS study), respectively, whereas the corrected prevalence rates of underweight and severe underweight decreased from 8.0% to 6.7% (compared to 5.7% in the KiGGS study) and from 5.5% to 3.3% (compared to 2.4% in the KiGGS study), respectively. Application of the second correction function, which additionally considers body image, led to further slight corrections with an increase of the prevalence rates for overweight to 7.9% and for obese to 3.9%. Conclusion Subjective BMI can be used to determine the prevalence of overweight and obesity among children and adolescents. Where there is evidence of bias, the prevalence estimates should be corrected using conditional probabilities that link measured and subjectively assessed BMI from a representative validation study. These corrections may be improved further by considering body image as an additional influential factor.
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Affiliation(s)
- Ute Ellert
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Str, 62-66, 12101 Berlin, Germany.
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Haftenberger M, Laußmann D, Ellert U, Kalcklösch M, Langen U, Schlaud M, Schmitz R, Thamm M. [Prevalence of sensitisation to aeraoallergens and food allergens: results of the German Health Interview and Examination Survey for Adults (DEGS1)]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2013; 56:687-97. [PMID: 23703487 DOI: 10.1007/s00103-012-1658-1] [Citation(s) in RCA: 114] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In view of the increasing prevalence of allergies, up-to-date data on the prevalence of allergic sensitisation are of major interest. In the German Health Interview and Examination Survey for Adults (DEGS1) (2008-2011) blood samples from a population-based sample of 7,025 participants aged 18 to 79 years were analysed for specific IgE antibodies against 50 common single allergens and screened for common aeroallergens (SX1) and grass pollen (GX1). In all, 48.6 % of the participants were sensitised to at least one allergen. Overall, men were more frequently sensitised to at least one allergen than women were. Sensitisations to at least one allergen were more common among younger than older participants and among participants with a higher socio-economic status. In all, 33.6 % of the participants were sensitised to common aeroallergens, 25.5 % to food allergens and 22.6 % to wasp or bee venoms. Compared with the German National Health Interview and Examination Survey 1998 (GNHIES98), the prevalence of sensitisation to common aeroallergens increased from 29.8 to 33.6 %.This increase was statistically significant only in women. The results of DEGS1 still showed a high prevalence of allergic sensitisation. An English full-text version of this article is available at SpringerLink as supplemental.
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Affiliation(s)
- M Haftenberger
- Abteilung für Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, General-Pape-Str. 62-66, 12101 Berlin, Deutschland.
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Ellert U, Kurth BM. [Health related quality of life in adults in Germany: results of the German Health Interview and Examination Survey for Adults (DEGS1)]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2013; 56:643-9. [PMID: 23703481 DOI: 10.1007/s00103-013-1700-y] [Citation(s) in RCA: 112] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The aim of this study is to describe health related quality of life (HRQL) of the German adult population and provide current representative normative data for the version 2 of the SF-36 (SF-36V2) in the German population. In the German Health Interview and Examination Survey for Adults (DEGS1) the SF-36V2 was used to measure health-related quality of life. Men report in all areas better HRQOL compared to women, a lower social status is associated with lower HRQOL-values. Having one or more chronic diseases is associated with lower values in all dimensions of health-related quality of life. Compared to 10 years ago, the General health seems to be much better in women aged 40 to 49 years and older and in men aged 50 to 59 years and older. Version 2 of the SF-36 has proved to be a robust instrument of health-related quality of life that is able to plausible map differences regarding socio-demographic and health characteristics. An English full-text version of this article is available at SpringerLink as supplemental.
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Affiliation(s)
- U Ellert
- Abteilung für Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, General-Pape-Str. 62-66, 12101 Berlin, Deutschland.
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Schmitz R, Ellert U, Kalcklösch M, Dahm S, Thamm M. Patterns of sensitization to inhalant and food allergens - findings from the German Health Interview and Examination Survey for Children and Adolescents. Int Arch Allergy Immunol 2013; 162:263-70. [PMID: 24022179 DOI: 10.1159/000353344] [Citation(s) in RCA: 95] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Accepted: 05/28/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND To assess the prevalence of allergic sensitization and to analyze patterns of sensitization to common inhalant and food allergens in a nationwide representative sample of children and adolescents in Germany. METHODS Data were collected from 2003 to 2006 within the KiGGS, the national Health Interview and Examination Survey covering a representative sample of 17,641 children and adolescents in Germany. Immunoglobulin E (IgE) antibodies to 20 specific allergens (11 inhalant and 9 food allergens) were quantitatively measured in a subsample of 12,988 KiGGS participants aged 3-17 years using the ImmunoCAP system. Serum concentrations ≥0.35 kU/l indicate sensitized participants. An exploratory factor analysis was performed in order to identify sensitization patterns. RESULTS Sensitization to at least 1 of the 20 tested allergens was detected in 40.2% [95% confidence interval (CI) 39.0-41.4] of the participants. The highest sensitization prevalences were found for pollen from Timothy grass (22.7%; 21.5-23.9) and rye (21.2%; 20.0-22.4). Sensitization was more prevalent in boys than in girls and prevalence increased generally with increasing age. We identified seven sensitization groups, namely (in descending order of magnitude) 'Timothy grass/rye', 'house-dust mites', 'food/mugwort', 'birch/apple', 'animals', 'cow's milk/egg white' and 'moulds'. CONCLUSIONS Allergic sensitization is common in German children and adolescents. The fact that sensitization potentially leads to clinically relevant allergic diseases stresses the public health relevance of this topic. Whether the grouping reflects the propensity for persons to be sensitized to multiple allergens within a group, or whether it is due to IgE cross-reactivity between different allergens of similar structure is still being discussed.
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Affiliation(s)
- Roma Schmitz
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
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Scheidt-Nave C, Fuchs J, Du Y, Ellert U, Schienkiewitz A, Busch M, Knopf H, Gaertner B, Bode L. Addressing health and ageing in the German national health monitoring system. BMC Proc 2013; 7:S12. [PMID: 24764491 PMCID: PMC3892279 DOI: 10.1186/1753-6561-7-s4-s12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Du Y, Ellert U, Lampert T, Mensink GBM, Schlaud M. Association of breastfeeding and exposure to maternal smoking during pregnancy with children's general health status later in childhood. Breastfeed Med 2012; 7:504-13. [PMID: 23003679 DOI: 10.1089/bfm.2011.0138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Maternal smoking during pregnancy is associated with a variety of risks on fetal health, whereas breastfeeding may protect infants from infections in the early postpartum period. Little has been reported regarding their associations with children's general health later in childhood. SUBJECTS AND METHODS Parent-rated children's general health status was investigated among 14,836 children and adolescents 3-17 years old who participated in the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) in 2003-2006. Data on breastfeeding and maternal smoking during pregnancy were collected by parent-administered questionnaires. SPSS complex samples logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (95% CIs). RESULTS Exclusive breastfeeding and non-exposure to maternal smoking during pregnancy were associated with better health status overall among all children in the KiGGS (both p<0.001). After adjusting for potential confounding factors including other prior and current exposures, exclusive breastfeeding over 6 months remained significant overall among all children (OR 1.21, 95% CI 1.05-1.38) and in the age groups 7-10 years (OR 1.27, 95% CI 1.01-1.60) and 11-17 years (OR 1.23, 95% CI 1.01-1.50), while non-exposure to maternal smoking during pregnancy remained significant in the age group 11-17 years only (OR 1.49, 95% CI 1.06-2.10). CONCLUSIONS Exclusive breastfeeding and non-exposure to maternal smoking during pregnancy may be associated with better children's general health status later in childhood, particularly when children reach adolescence. Further studies are required to elucidate these possible and biologically plausible associations. Health professionals should take opportunities to promote breastfeeding and cessation of smoking among (expectant) mothers for a healthy future of their children.
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Affiliation(s)
- Yong Du
- Department of Epidemiology and Health Reporting, Robert Koch Institute, Berlin, Germany
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Rückert IM, Maier W, Mielck A, Schipf S, Völzke H, Kluttig A, Greiser KH, Berger K, Müller G, Ellert U, Neuhauser H, Rathmann W, Tamayo T, Moebus S, Andrich S, Meisinger C. Personal attributes that influence the adequate management of hypertension and dyslipidemia in patients with type 2 diabetes. Results from the DIAB-CORE Cooperation. Cardiovasc Diabetol 2012; 11:120. [PMID: 23035799 PMCID: PMC3503646 DOI: 10.1186/1475-2840-11-120] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Accepted: 10/01/2012] [Indexed: 01/13/2023] Open
Abstract
Background Hypertension and dyslipidemia are often insufficiently controlled in persons with type 2 diabetes (T2D) in Germany. In the current study we evaluated individual characteristics that are assumed to influence the adequate treatment and control of hypertension and dyslipidemia and aimed to identify the patient group with the most urgent need for improved health care. Methods The analysis was based on the DIAB-CORE project in which cross-sectional data from five regional population-based studies and one nationwide German study, conducted between 1997 and 2006, were pooled. We compared the frequencies of socio-economic and lifestyle factors along with comorbidities in hypertensive participants with or without the blood pressure target of < 140/90 mmHg. Similar studies were also performed in participants with dyslipidemia with and without the target of total cholesterol/HDL cholesterol ratio < 5. Furthermore, we compared participants who received antihypertensive/lipid lowering treatment with those who were untreated. Univariable and multivariable logistic regression models were used to assess the odds of potentially influential factors. Results We included 1287 participants with T2D of whom n = 1048 had hypertension and n = 636 had dyslipidemia. Uncontrolled blood pressure was associated with male sex, low body mass index (BMI), no history of myocardial infarction (MI) and study site. Uncontrolled blood lipid levels were associated with male sex, no history of MI and study site. The odds of receiving no pharmacotherapy for hypertension were significantly greater in men, younger participants, those with BMI < 30 kg/m2 and those without previous MI or stroke. Participants with dyslipidemia received lipid lowering medication less frequently if they were male and had not previously had an MI. The more recent studies HNR and CARLA had the greatest numbers of well controlled and treated participants. Conclusion In the DIAB-CORE study, the patient group with the greatest odds of uncontrolled co-morbidities and no pharmacotherapy was more likely comprised of younger men with low BMI and no history of cardiovascular disease.
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Affiliation(s)
- Ina-Maria Rückert
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH) and German Center for Diabetes Research (DZD e,V,), Ingolstädter Landstrasse 1, D-85764, München/Neuherberg, Germany.
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Scheidt-Nave C, Kamtsiuris P, Gößwald A, Hölling H, Lange M, Busch MA, Dahm S, Dölle R, Ellert U, Fuchs J, Hapke U, Heidemann C, Knopf H, Laussmann D, Mensink GBM, Neuhauser H, Richter A, Sass AC, Rosario AS, Stolzenberg H, Thamm M, Kurth BM. German health interview and examination survey for adults (DEGS) - design, objectives and implementation of the first data collection wave. BMC Public Health 2012; 12:730. [PMID: 22938722 PMCID: PMC3490742 DOI: 10.1186/1471-2458-12-730] [Citation(s) in RCA: 287] [Impact Index Per Article: 23.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2012] [Accepted: 08/28/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The 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/DESIGN The 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. DISCUSSION DEGS 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.
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Affiliation(s)
- Christa Scheidt-Nave
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Strasse 62-66, 12101 Berlin, Germany
| | - Panagiotis Kamtsiuris
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Strasse 62-66, 12101 Berlin, Germany
| | - Antje Gößwald
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Strasse 62-66, 12101 Berlin, Germany
| | - Heike Hölling
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Strasse 62-66, 12101 Berlin, Germany
| | - Michael Lange
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Strasse 62-66, 12101 Berlin, Germany
| | - Markus A Busch
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Strasse 62-66, 12101 Berlin, Germany
| | - Stefan Dahm
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Strasse 62-66, 12101 Berlin, Germany
| | - Rüdiger Dölle
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Strasse 62-66, 12101 Berlin, Germany
| | - Ute Ellert
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Strasse 62-66, 12101 Berlin, Germany
| | - Judith Fuchs
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Strasse 62-66, 12101 Berlin, Germany
| | - Ulfert Hapke
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Strasse 62-66, 12101 Berlin, Germany
| | - Christin Heidemann
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Strasse 62-66, 12101 Berlin, Germany
| | - Hildtraud Knopf
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Strasse 62-66, 12101 Berlin, Germany
| | - Detlef Laussmann
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Strasse 62-66, 12101 Berlin, Germany
| | - Gert BM Mensink
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Strasse 62-66, 12101 Berlin, Germany
| | - Hannelore Neuhauser
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Strasse 62-66, 12101 Berlin, Germany
| | - Almut Richter
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Strasse 62-66, 12101 Berlin, Germany
| | - Anke-Christine Sass
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Strasse 62-66, 12101 Berlin, Germany
| | - Angelika Schaffrath Rosario
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Strasse 62-66, 12101 Berlin, Germany
| | - Heribert Stolzenberg
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Strasse 62-66, 12101 Berlin, Germany
| | - Michael Thamm
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Strasse 62-66, 12101 Berlin, Germany
| | - Bärbel-Maria Kurth
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Strasse 62-66, 12101 Berlin, Germany
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Yesil R, Ellert U, Schlaud M, Heuschmann P, Willich S, Krist L, Keil T. Entwicklung und Erprobung von Zugangswegen zum Aufbau einer Migrantenkohorte als Teil der Nationalen Kohorte. Gesundheitswesen 2012. [DOI: 10.1055/s-0032-1322120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Krist L, Keil T, Heuschmann P, Willich S, Ellert U, Yesil R, Schlaud M. Studie zur Gesundheit türkeistämmiger Erwachsener im Rahmen der Pretests der Nationalen Kohorte - Erfahrungen aus dem Studienzentrum Berlin-Mitte. Gesundheitswesen 2012. [DOI: 10.1055/s-0032-1322047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Schipf S, Werner A, Tamayo T, Holle R, Schunk M, Maier W, Meisinger C, Thorand B, Berger K, Mueller G, Moebus S, Bokhof B, Kluttig A, Greiser KH, Neuhauser H, Ellert U, Icks A, Rathmann W, Völzke H. Regional differences in the prevalence of known Type 2 diabetes mellitus in 45-74 years old individuals: results from six population-based studies in Germany (DIAB-CORE Consortium). Diabet Med 2012; 29:e88-95. [PMID: 22248078 DOI: 10.1111/j.1464-5491.2012.03578.x] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM In Germany, regional data on the prevalence of Type 2 diabetes mellitus are lacking for health-care planning and detection of risk factors associated with this disease. We analysed regional variations in the prevalence of Type 2 diabetes and treatment with antidiabetic agents. METHODS Data of subjects aged 45-74 years from five regional population-based studies and one nationwide study conducted between 1997 and 2006 were analysed. Information on self-reported diabetes, treatment, and diagnosis of diabetes were compared. Type 2 diabetes prevalence estimates (95% confidence interval) from regional studies were directly standardized to the German population (31 December 2007). RESULTS Of the 11,688 participants of the regional studies, 1008 had known Type 2 diabetes, corresponding to a prevalence of 8.6% (8.1-9.1%). For the nationwide study, a prevalence of 8.2% (7.3-9.2%) was estimated. Prevalence was higher in men (9.7%; 8.9-10.4%) than in women (7.6%; 6.9-8.3%). The regional standardized prevalence was highest in the east with 12.0% (10.3-13.7%) and lowest in the south with 5.8% (4.9-6.7%). Among persons with Type 2 diabetes, treatment with oral antidiabetic agents was more frequently reported in the south (56.9%) and less in the northeast (46.0%), whereas treatment with insulin alone was more frequently reported in the northeast (21.6%) than in the south (16.4%). CONCLUSION The prevalence of known Type 2 diabetes showed a southwest-to-northeast gradient within Germany, which is in accord with regional differences in the distribution of risk factors for Type 2 diabetes. Furthermore, the treatment with antidiabetic agents showed regional differences.
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Affiliation(s)
- S Schipf
- Institute for Community Medicine, Ernst Moritz Arndt-University, Greifswald, Germany.
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Schunk M, Reitmeir P, Schipf S, Völzke H, Meisinger C, Thorand B, Kluttig A, Greiser KH, Berger K, Müller G, Ellert U, Neuhauser H, Tamayo T, Rathmann W, Holle R. Health-related quality of life in subjects with and without Type 2 diabetes: pooled analysis of five population-based surveys in Germany. Diabet Med 2012; 29:646-53. [PMID: 21978176 DOI: 10.1111/j.1464-5491.2011.03465.x] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS To estimate population values of health-related quality of life (HRQL) in subjects with and without Type 2 diabetes mellitus across several large population-based survey studies in Germany. Systematic differences in relation to age and sex were of particular interest. METHODS Individual data from four population-based studies from different regions throughout Germany and the nationwide German National Health Interview and Examination Survey (GNHIES98) were included in a pooled analysis of primary data (N = 9579). HRQL was assessed using the generic index instrument SF-36 (36-item Short Form Health Survey) or its shorter version, the SF-12 (12 items). Regression analysis was carried out to examine the association between Type 2 diabetes and the two component scores derived from the SF-36/SF-12, the physical component summary score (PCS-12) and the mental component summary score (MCS-12), as well as interaction effects with age and sex. RESULTS The PCS-12 differed significantly by -4.1 points in subjects with Type 2 diabetes in comparison with subjects without Type 2 diabetes. Type 2 diabetes was associated with significantly lower MCS-12 in women only. Higher age was associated with lower PCS-12, but with an increase in MCS-12, for subjects with and without Type 2 diabetes. CONCLUSIONS Pooled analysis of population-based primary data offers HRQL values for subjects with Type 2 diabetes in Germany, stratified by age and sex. Type 2 diabetes has negative consequences for HRQL, particularly for women. This underlines the burden of disease and the importance of diabetes prevention. Factors that disadvantage women with Type 2 diabetes need to be researched more thoroughly.
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Affiliation(s)
- M Schunk
- Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Health Economics and Health Care Management, Neuherberg, Germany.
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Brettschneider AK, Ellert U, Schaffrath Rosario A. Comparison of BMI derived from parent-reported height and weight with measured values: results from the German KiGGS study. Int J Environ Res Public Health 2012; 9:632-47. [PMID: 22470314 PMCID: PMC3315268 DOI: 10.3390/ijerph9020632] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2011] [Revised: 02/06/2012] [Accepted: 02/09/2012] [Indexed: 11/16/2022]
Abstract
The use of parent-reported height and weight is a cost-efficient instrument to assess the prevalence of children's weight status in large-scale surveys. This study aimed to examine the accuracy of BMI derived from parent-reported height and weight and to identify potential predictors of the validity of BMI derived from parent-reported data. A subsample of children aged 2-17 years (n = 9,187) was taken from the 2003-2006 cross-sectional German KiGGS study. Parent-reported and measured height and weight were collected and BMI was calculated. Besides descriptive analysis, linear regression models with BMI difference and logistic regression models with weight status misclassification as dependent variables were calculated. Height differences varied by gender and were generally small. Weight and BMI were under-reported in all age groups, the under-reporting getting stronger with increasing age. Overall, the proportion for overweight and obesity based on parental and measured reports differed slightly. In the youngest age group, the proportion of overweight children was overestimated, while it was underestimated for older children and adolescents. Main predictors of the difference between parent reported and measured values were age, gender, weight status and parents' perception of the child's weight. In summary, the exclusive use of uncorrected parental reports for assessment of prevalence rates of weight status is not recommended.
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Dul Y, Knopf H, Zhuang W, Ellert U. Pain perceived in a national community sample of German children and adolescents. Eur J Pain 2012; 15:649-57. [DOI: 10.1016/j.ejpain.2010.11.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2010] [Revised: 10/19/2010] [Accepted: 11/24/2010] [Indexed: 12/18/2022]
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Affiliation(s)
- Y. Du
- Department of Epidemiology and Health Reporting, Division of Non-Communicable Disease Epidemiology; Robert Koch Institute; Berlin; Germany
| | - U. Ellert
- Department of Epidemiology and Health Reporting, Division of Non-Communicable Disease Epidemiology; Robert Koch Institute; Berlin; Germany
| | - W. Zhuang
- Department of Epidemiology and Health Reporting, Division of Non-Communicable Disease Epidemiology; Robert Koch Institute; Berlin; Germany
| | - H. Knopf
- Department of Epidemiology and Health Reporting, Division of Non-Communicable Disease Epidemiology; Robert Koch Institute; Berlin; Germany
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Ellert U, Ravens-Sieberer U, Erhart M, Kurth BM. Determinants of agreement between self-reported and parent-assessed quality of life for children in Germany-results of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS). Health Qual Life Outcomes 2011; 9:102. [PMID: 22111939 PMCID: PMC3286376 DOI: 10.1186/1477-7525-9-102] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2011] [Accepted: 11/23/2011] [Indexed: 11/20/2022] Open
Abstract
Background The aim of this study is to quantify the level of agreement between self-reporting and proxy-assessment of children's health-related quality of life using KINDL-R in a large population based study in Germany and to identify factors which are associated with agreement. Methods The German Health Interview and Examination Survey for Children and Adolescents included the KINDL-R questionnaire on health-related quality of life. 6388 children and adolescents filled in the questionnaire while their parents answered the proxy version. Means and standard deviation for the self- and proxy ratings, and also the Pearson und Intra-Class correlation coefficients for the absolute agreement were calculated. The relationship between other variables and parent-child agreement were determined by means of logistic regression. Results In the 'Physical', 'Self-esteem' and 'School' dimension and for the 'Total' score, the parents significantly overestimated the quality of life of their child. In contrast, the quality of life of the children in the dimensions 'Psychological well-being' and 'Family' were considerably underestimated by the parents. The proportion of parent-child ratings in agreement (difference < 0.5 standard deviations) ranges from 34.9% for the 'Self-esteem' scale to 51.9% in the 'Psychological' scale. The most important factor explaining parents rating was the level of the child's self-assessment followed by the parent's assessment of the subjective health, or reported emotional abnormalities. Conclusions Our study shows that parental reports cannot adequately replace self-assessment for 11-17 year olds. In view of the different underlying perspectives, the parental assessments should where possible only be regarded as providing supplementary information.
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Affiliation(s)
- Ute Ellert
- Department of Health Reporting, Robert Koch Institute, Seestr, 10, 13353 Berlin, Germany.
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Brettschneider AK, Rosario AS, Ellert U. Validity and predictors of BMI derived from self-reported height and weight among 11- to 17-year-old German adolescents from the KiGGS study. BMC Res Notes 2011; 4:414. [PMID: 22005143 PMCID: PMC3216908 DOI: 10.1186/1756-0500-4-414] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2010] [Accepted: 10/17/2011] [Indexed: 11/15/2022] Open
Abstract
Background For practical and financial reasons, self-reported instead of measured height and weight are often used. The aim of this study is to evaluate the validity of self-reports and to identify potential predictors of the validity of body mass index (BMI) derived from self-reported height and weight. Findings Self-reported and measured data were collected from a sub-sample (3,468 adolescents aged 11-17) from the German Health Interview and Examination Survey for Children and Adolescents (KiGGS). BMI was calculated from both reported and measured values, and these were compared in descriptive analyses. Linear regression models with BMI difference (self-reported minus measured) and logistic regression models with weight status misclassifications as dependent variables were calculated. Height was overestimated by 14- to 17-year-olds. Overall, boys and girls under-reported their weight. On average, BMI values calculated from self-reports were lower than those calculated from measured values. This underestimation of BMI led to a bias in the prevalence rates of under- and overweight which was stronger in girls than in boys. Based on self-reports, the prevalence was 9.7% for underweight and 15.1% for overweight. However, according to measured data the corresponding rates were 7.5% and 17.7%, respectively. Linear regression for BMI difference showed significant differences according to measured weight status: BMI was overestimated by underweight adolescents and underestimated by overweight adolescents. When weight status was excluded from the model, body perception was statistically significant: Adolescents who regarded themselves as 'too fat' underestimated their BMI to a greater extent. Symptoms of a potential eating disorder, sexual maturation, socio-economic status (SES), school type, migration background and parental overweight showed no association with the BMI difference, but parental overweight was a consistent predictor of the misclassification of weight status defined by self-reports. Conclusions The present findings demonstrate that the observed discrepancy between self-reported and measured height and weight leads to inaccurate estimates of the prevalence of under- and overweight when based on self-reports. The collection of body perception data and parents' height and weight is therefore recommended in addition to self-reports. Use of a correction formula seems reasonable in order to correct for differences between self-reported and measured data.
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Affiliation(s)
- Anna-Kristin Brettschneider
- Department of Epidemiology and Health Reporting, Robert Koch Institute, General-Pape-Str, 62-66, 12101 Berlin, Germany.
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Schipf S, Werner A, Holle R, Schunk M, Meisinger C, Thorand B, Berger K, Muller G, Moebus S, Kluttig A, Greiser KH, Neuhauser H, Ellert U, Icks A, Tamayo T, Rathmann W, Volzke H. P2-269 Regional differences in the prevalence of type 2 diabetes mellitus: results from five population-based cohort studies in Germany (DIAB-CORE consortium). Br J Soc Med 2011. [DOI: 10.1136/jech.2011.142976k.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Gutsche J, Ellert U, Poethko-Müller C, Schlaud M. Häufigkeit und Versorgung der Mittelohrentzündung bei Kindern in Deutschland – Ergebnisse aus dem Kinder- und Jugendgesundheitssurvey (KiGGS). Gesundheitswesen 2011. [DOI: 10.1055/s-0031-1283471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Schienkiewitz A, Schaffrath Rosario A, Dortschy R, Ellert U, Neuhauser H. German head circumference references for infants, children and adolescents in comparison with currently used national and international references. Acta Paediatr 2011; 100:e28-33. [PMID: 21272065 DOI: 10.1111/j.1651-2227.2011.02173.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM To present valid head circumference (HC) percentiles from early infancy to 18 years and to compare them with percentiles currently used in Germany by Prader, as well as to international WHO and CDC references. METHODS Nationally representative sample of 17,158 children and adolescents aged 0.25-17.98 years (KiGGS study 2003-2006) with standardized HC measurement. HC references were created using Cole's LMS method. RESULTS The median growth of HC is largest in the first year of life. Adult HC is reached at age 16 years in girls, while in boys, HC growth continues through age 17 years and adult HC have to be derived from future KiGGS follow-up examinations. KiGGS percentiles are quite similar from early infancy to early school age compared to older Prader references, but higher thereafter (maximum difference of median HC: girls 1.4 cm, boys 0.9 cm). KiGGS percentiles are also higher than WHO and CDC percentiles over most of the compared age range, but differences are less pronounced compared to Prader. CONCLUSION The KiGGS HC references presented here for boys and girls aged 4 months through 17 years are more valid than currently used German references. Because of the similarity of KiGGS and the currently used reference by Prader in early infancy, the currently used Prader reference for 0-4 months could complement KiGGS to cover the entire age range from birth to the end of adolescence.
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Affiliation(s)
- Anja Schienkiewitz
- Department of Epidemiology and Health Reporting, Robert Koch-Institute, Berlin, Germany.
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Schipf S, Werner A, Tamayo T, Holle R, Schunk M, Maier W, Meisinger C, Thorand B, Berger K, Müller G, Moebus S, Bokhof B, Kluttig A, Greiser KH, Neuhauser H, Ellert U, Icks A, Rathmann W, Völzke H. Neue Ergebnisse zur Epidemiologie des Typ 2 Diabetes – Süd-Nord-Gradient in der Prävalenz des bekannten Typ 2 Diabetes in Deutschland (DIAB-CORE Verbund). DIABETOL STOFFWECHS 2011. [DOI: 10.1055/s-0031-1277263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Schunk M, Reitmeir P, Schipf S, Völzke H, Meisinger C, Thorand B, Kluttig A, Greiser KH, Berger K, Müller G, Ellert U, Neuhauser H, Tamayo T, Rathmann W, Holle R. Gesundheitsbezogene Lebensqualität von Personen mit und ohne Typ 2 Diabetes: gepoolte Analyse von fünf bevölkerungsbasierten Studien aus Deutschland (DIAB-CORE Verbund). DIABETOL STOFFWECHS 2011. [DOI: 10.1055/s-0031-1277326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Neuhauser HK, Thamm M, Ellert U, Hense HW, Rosario AS. Blood pressure percentiles by age and height from nonoverweight children and adolescents in Germany. Pediatrics 2011; 127:e978-88. [PMID: 21382947 DOI: 10.1542/peds.2010-1290] [Citation(s) in RCA: 185] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To present oscillometric blood pressure (BP) references from German nonoverweight children and compare them with US references. METHODS From children and adolescents, aged 3 to 17 years, from the German Health Interview and Examination Survey for Children and Adolescents (KiGGS 2003-2006), we obtained standardized BP measurements by using an oscillometric device validated in children. Gender-specific systolic (SBP) and diastolic (DBP) BP percentiles, which simultaneously accounted for age and height by use of advanced statistical methods, were derived from nonoverweight children to avoid overweight prevalence in the reference population influencing BP references. RESULTS The age- and gender-specific 95th percentiles from nonoverweight children (n = 12 199) were lower by up to 3 mm Hg for SBP and up to 2 mm Hg for DBP compared with the total sample (N = 14 349). KiGGS percentiles from nonoverweight children accounting simultaneously for age and height were mostly lower than in the US reference sample but higher for SBP in boys aged 14 years or older. At median height, the age-specific differences in 95th percentiles of SBP ranged from -4 to 4 mm Hg in boys and -2 to 1 mm Hg in girls and, for DBP, from -6 to 2 mm Hg in boys and -5 to 2 mm Hg in girls. CONCLUSIONS Compared with current US references, the proposed German BP reference values are not influenced by the prevalence of overweight children in the reference population, they are based on a validated oscillometric device, and they take advantage of improved statistical methods.
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Affiliation(s)
- Hannelore K Neuhauser
- Robert Koch Institute, Department of Epidemiology and Health Reporting, General-Pape-Strasse 62-66, 12101 Berlin, Germany.
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Neuhauser H, Thamm M, Ellert U, Schaffrath Rosario A. Blood pressure references for children and adolescents in Germany and international comparisons. Gesundheitswesen 2010. [DOI: 10.1055/s-0030-1266419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Du Y, Ellert U, Schlaud M. Association of breast-feeding and maternal smoking during pregnancy with children's general health status later in life. Gesundheitswesen 2010. [DOI: 10.1055/s-0030-1266424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Atzpodien K, Ellert U, Neuhauser H, Lampert T. Womit ist eine gute Gesundheit bei 11- bis 17-Jährigen assoziiert? – Ergebnisse des Kinder- und Jugendgesundheitssurveys (KiGGS). Gesundheitswesen 2010. [DOI: 10.1055/s-0030-1266711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Kurth B, Ellert U. Gefühlter, geschätzter, gemessener BMI bei 11- bis 15-jährigen Jugendlichen in Deutschland – Wie kann KiGGS helfen, die geschätzten Prävalenzen für Übergewicht und Adipositas der HBSC-Studie zu korrigieren? Gesundheitswesen 2010. [DOI: 10.1055/s-0030-1266390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Knopf H, Du Y, Zhuang W, Ellert U. Schmerzmittel bei Kindern mit Schmerzen – Ergebnisse des Kinder- und Jugendgesundheitssurveys (KiGGS). Gesundheitswesen 2010. [DOI: 10.1055/s-0030-1266568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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