Physical activity of older children and adolescents in Germany - Results of the HBSC study 2022 and trends since 2009/10

Background

Physical activity is central to health, beginning in childhood and adolescence, and regular monitoring provides important information for strategic decisions on promoting physical activity in Germany.

Methods

The current survey cycle of the Health Behaviour in School-aged Children (HBSC) study gives an insight into the prevalence of the indicators daily recommended physical activity, high and low physical activity, and sporting activity among students aged between 11 and 15 for 2022. In addition, the data is compared to the survey cycles of the 2009/10, 2013/14, and 2017/18 school years and analysed over time.

Results

The results of the current survey cycle show that 10.8 % of girls, 20.9 % of boys, and 12.4 % of gender diverse adolescents fulfil the daily physical activity recommendation. There are also major gender-specific differences for the other indicators. The group of gender diverse adolescents needs to be analysed further. The changes over time between 2009/10 and 2022 are relatively small. While girls' physical activity habits decreased slightly for the various indicators between 2009/10 and 2022, boys' prevalence remained relatively stable over the same period.

Conclusions

Overall, in part due to the effects of the various COVID-19 lockdowns, the need for effective and population-based measures to promote physical activity in childhood and adolescence remains high.

Traditional bullying and cyberbullying at schools in Germany: Results of the HBSC study 2022 and trends from 2009/10 to 2022

Background

Bullying is a form of violence that is carried out repeatedly, with the intention of causing harm and with an imbalance of power between those involved. Bullying has serious negative effects on the mental health of adolescents and thus represents a significant health risk in childhood and adolescence.

Methods

Based on data from the Health Behaviour in School-aged Children (HBSC) study from the survey year 2022 in Germany (N = 6,475), the prevalence of school bullying and cyberbullying among 11-, 13- and 15-year-olds in Germany was analysed. In addition, the prevalence of school bullying and cyberbullying was analysed as a trend from 2009/10 to 2022 (bullying) and from 2017/18 to 2022 (cyberbullying).

Results

Around 14 % of the learners surveyed reported direct experience of bullying at school, and around 7 % reported cyberbullying experiences as bullied and/or bullying victims. Adolescents who identified as gender diverse were particularly likely to report bullying experiences. School bullying decreased over time, but remained stable between 2017/18 and 2022. Cyberbullying, on the other hand, increased in 2022 compared to 2017/18.

Conclusions

Experiencing bullying at school and online is an everyday experience for many children and young people, so there is still a need for the broad implementation of effective anti-bullying measures in schools.

Trends in health inequalities in childhood and adolescence in Germany: Results of the HBSC study 2009/10 - 2022

Background

Many studies have identified health inequalities in childhood and adolescence. However, it is unclear how these have developed in recent years, particularly since the COVID-19 pandemic.

Methods

Analyses are based on the German data from the international Health Behaviour in School-aged Children (HBSC) study from 2009/10 (n = 5,005), 2013/14 (n = 5,961), 2017/18 (n = 4,347), and 2022 (n = 6,475). A total of 21,788 students aged approximately between 11 and 15 years were included. Socioeconomic status (SES) was assessed using the Family Affluence Scale (FAS). Several health indicators were analysed stratified by gender using bivariate and multivariate analysis methods.

Results

In 2022, there are clear socioeconomic inequalities in life satisfaction, self-rated health, fruit and vegetable consumption, and physical activity. These inequalities remained largely constant or increased between 2009/10 and 2022. Between 2017/18 and 2022, no significant changes in inequalities were found.

Conclusions

Health inequalities are persistent and reduce the chances of growing up healthy. There is no evidence that inequalities in the analysed outcomes have changed during the pandemic period (between 2017/18 and 2022). Rather, the changes in the health indicators seem to affect all adolescents in a similar way.

Subjective health and psychosomatic complaints of children and adolescents in Germany: Results of the HBSC study 2009/10 - 2022

Background

Subjective health and well-being are important health indicators in childhood and adolescence. This article shows current results and trends over time between 2009/10 and 2022.

Methods

The Health Behaviour in School-aged Children (HBSC) study examined subjective health, life satisfaction and psychosomatic complaints of N = 21,788 students aged 11 to 15 years in the school years 2009/10, 2013/14, 2017/18 and in the calendar year 2022. Multivariate regression analyses show the associations between sociodemographic characteristics and well-being in 2022, as well as trends since 2009/10.

Results

The majority of children and adolescents indicate a good subjective health and high life satisfaction. About half of the girls and one third of the boys report multiple psychosomatic health complaints, with a clear increase over time. Older adolescents, girls and gender diverse adolescents are at an increased risk of poor well-being. Subjective health and life satisfaction varied between 2009/10 and 2022, with a significant deterioration between 2017/18 and 2022.

Conclusions

The high proportion of children and adolescents with psychosomatic complaints, as well as the observed gender and age differences, underline the need for target group-specific prevention, health promotion and continuous health monitoring.

Concept and methodology of the Health Behaviour in School-aged Children (HBSC) study - Insights into the current 2022 survey and trends in Germany

Background

Health Behaviour in School-aged Children (HBSC) is one of the largest international studies on child and adolescent health and cooperates with the World Health Organization (WHO). In Germany, adolescents aged 11, 13 and 15 are surveyed every four years about their health, health behaviour and social conditions. This article describes the HBSC study and in particular the methodology of the current 2022 survey and prior surveys conducted between 2009/10 and 2017/18.

Method

174 schools with a total of 6,475 students participated in the 2022 survey. The survey was conducted using questionnaires and covered a wide range of topics (including mental health, physical activity, bullying experiences, social determinants of health and experiences related to COVID-19). The 2022 survey was complemented by a school principal survey (N = 160). In addition to the current sample, the samples of the three previous surveys with representative data for Germany are presented: 2009/10 (N = 5,005), 2013/14 (N = 5,961) and 2017/18 (N = 4,347).

Discussion

The health of children and adolescents is of great public health importance. The HBSC study makes a substantial contribution by providing internationally comparable results, analysing trends, and providing stakeholders with comprehensive and representative health monitoring data.

Health literacy of students in Germany - Results of the HBSC study 2022

Background

Health literacy (HL) encompasses knowledge and skills for dealing critically and confidently with health information in individual and social contexts. Current studies show that a high proportion of children and adolescents have limited health literacy, depending on aspects of their social background. Health literacy is considered an important factor influencing health. Little is known about the development of health literacy over time and its connection with psychosomatic complaints in young people.

Methods

Based on the results of the Health Behaviour in School-aged Children (HBSC) study, this article focusses on the level of HL in 11-, 13-, and 15-year-old students (N = 6,475) over time and taking social differences into account. Finally, the relationship between HL and psychosomatic complaints is analysed. Univariate, bivariate, and multivariate analyses were carried out for this purpose.

Results

At 24.4 %, slightly more students have low HL in 2022 than in 2017/18 (21.4 %). There are differences in HL according to gender, age, type of school, and family affluence. Low HL is associated with a high psychosomatic burden.

Conclusions

The results highlight the need for target group-specific measures to promote young people's HL, which address individual and organisational aspects of HL.

Rare diseases in Germany - Developments in the status of medical care

Background

Rare diseases are a heterogeneous group of complex clinical patterns, which more often than not run a chronic course. The fact that they are rare complicates the provision of medical care for the specific diseases.

Results

In the field of action titled 'Care, Centres, Networks' of its National Action Plan, the National Action League for People with Rare Diseases recommends the formation of a three-level, interconnected centre model. This form of care was investigated in two large research projects. It was shown that the time to diagnosis was markedly reduced. Commissioned by the Federal Ministry of Health, the expert report on the health status of people with rare diseases in Germany issued in 2023 concludes that the medical care provided to this group of people has improved markedly since the National Action Plan was introduced. The establishment of the Centres for Rare Diseases (ZSE, Zentren für Seltene Erkrankungen) is seen as the most important development. However, it is noted that there is still a lack of coordinated care provision pathways for referring patients to the appropriate facilities.

Conclusion

The provision of care to people with rare diseases has improved upon the implementation of the measures from the National Action Plan. In a next step, care provision pathways must be established across sector boundaries. Challenges remain in the area of psychosocial care and the long-term securing of funding for these structures.

Prevalence of loneliness among older adults in Germany

Background

Loneliness refers to the subjective perception of a mismatch between a person's social needs and their actual personal relationships. In this paper, the prevalence of loneliness in the older population was examined based on current data.

Methods

The German Ageing Survey is an ongoing, population-representative study. A total of 4,261 people 50 years of age and older were surveyed in 2020/2021 with regard to their experience of loneliness.

Results

Overall, 8.3 % of the population 50 years of age and older feel lonely. The findings showed no differences between different age groups over 50 years of age, nor are there gender or educational differences.

Conclusions

There was no evidence that older individuals living in private households experience loneliness more commonly than middle-aged individuals. Data from nursing home residents indicate that there may be a higher risk of loneliness.

Study on Health of Older People in Germany (Gesundheit 65+): objectives, design and implementation

Background

The longitudinal population-based study Gesundheit 65+ aimed to close data gaps on health and well-being of older adults in Germany in times of the COVID-19 pandemic.

Methods

The target population comprised persons 65 years and older permanently residing in Germany and with sufficient German language skills. Proxy interviews were possible and consent from legal representatives was obtained as necessary in order to enable participation of physically or cognitively impaired persons. A two-stage sampling process, was used to draw 128 primary sample points (PSUs) and within these PSUs sex- and age-stratified random samples were drawn from population registries. A mixed-mode design was applied to contact the study population and for data collection. Data were collected between June 2021 and April 2023. Participants were surveyed a total of four times at intervals of four months. At month 12 participants were offered a home visit including a non-invasive examination. Data on all-cause mortality and information on neighborhood social and built environment as well as health insurance data will be linked to primarily collected data at the individual level.

Discussion

Results will inform health politicians and other stakeholders in the care system on health and health care needs of older people in Germany.

Childhood and adolescent cancer in Germany - an overview

Background

Childhood and adolescent cancer constitutes only a very small fraction of the cancer cases in Germany and throughout the world, but it is the most frequent cause of disease-related death in children. The diagnostic spectrum differs markedly from that of adults. More than 90% of all cases of childhood and adolescent cancer in Germany are treated according to centralised protocols or in therapy studies.

Methods

The main epidemiological data for this group are collected by the German Childhood Cancer Registry (GCCR) since 1980. Based on this data, three typical diagnoses and their incidence and prognosis are described in exemplary manner: Lymphoid leukaemia (LL), astrocytoma and neuroblastoma.

Results

Approximately 2,250 new cancers are diagnosed in children and adolescents under the age of 18 in Germany every year. In this age group, leukaemia and lymphoma account for almost 50% of all new cancer cases, predominately acute forms. Overall, the prognosis is considerably better than in adults.

Conclusions

There is relatively little consistent evidence available on external factors as risk factors for childhood cancer, despite decades of research. For LL, the immune system and infections are assumed to play a role, as early training of the immune system appears to be protective. To an increasing degree, research is identifying genetic risk factors for many types of childhood and adolescent cancer. The therapy is sometimes very intensive and leads to a variety of late effects for at least 75% of the survivors, which may occur soon after the primary diagnosis, but also decades later.

Changes in mental health in the German child and adolescent population during the COVID-19 pandemic - Results of a rapid review

Background

This rapid review examines changes in the mental health of the German child and adolescent population during the COVID-19 pandemic.

Methods

The basis are 39 publications, which were identified by means of systematic literature search (until 19.11.2021) and manual search. The databases of the included publications were systematized with regard to their representativeness for the general population, and the indicators used were categorized with regard to the depicted constructs and their reliability.

Results

The large majority of the studies took place at the beginning of the pandemic until the summer plateau 2020. Representative studies mainly reported high levels of pandemic-related stress, increases in mental health problems, and negative impacts on the quality of life. Non-representative studies showed mixed results. Vulnerable groups could only be identified to a limited extent. Both routine and care-related data showed declines in the outpatient and inpatient service utilisation during the various waves of the pandemic followed by catch-up effects. Children and adolescents turned out to be more vulnerable during the pandemic compared to adults, but their stress levels varied with the waves of the pandemic and the related containment measures.

Conclusions

A future forward-looking crisis and pandemic management requires a close-knit and continuous surveillance of the mental health of children as well as an improved identification of risk groups.

Abortions in Germany - Current data from the statistics on terminations of pregnancy

Unwanted pregnancies and abortions are experiences shared by many women. In light of the fact that some general framework conditions are currently changing in Germany, and that the Corona pandemic represents a particular challenge for the care of women with unwanted pregnancies, current data from the statistics on terminations of pregnancy of the Federal Statistical Office are outlined. Compared to Europe, Germany has a low proportion of induced abortions. In 2021, 94,596 abortions were reported. The number of abortions as well as the abortion rate and the abortion ratio have decreased since 2001. 95.8% of abortions took place according to the so-called counselling provision. In more than half of the abortions (52.1%) vacuum aspiration was used, in 11.4% curettage, 32.3% were medical abortions using mifepristone. There are large regional differences in the method used.

Limitations in activities of daily living and support needs - Analysis of GEDA 2019/2020-EHIS

Being able to perform activities of daily living is an important component of a person's ability to function. If these activities are impaired, support is needed. Using data from GEDA 2019/2020-EHIS, we present how many people aged 55 and older living in private households in Germany experience limitations in activities of daily living. Severe limitations in basic (fundamental) activities (e.g. food intake) are reported by 5.8% of women and 3.7% of men. The proportion increases with age as 13.4% of women and 9.0% of men aged 80 and older experience limitations. Severe limitations of instrumental activities of daily living (e.g. grocery shopping) are rather rare in participants less than 80 years of age. But at age 80 and older the proportion rises to 35.9% of women and 21.0% of men. A total of 68.1% of afflicted women and 57.5% of men receive help and support related to limitations of basic activities. Women are also more likely to report a lack of support (48.8% vs. 43.2%). The situation is slightly better with regard to instrumental activities. The results of GEDA 2019/2020-EHIS show in which areas of daily life older and very old people are impaired, give an impression of who is affected particularly strongly and indicate where support services are insufficient. As such, these results provide clues as to where support can be provided to enable older people to keep living in their own homes for a long time.

Disease severity of the first COVID-19 wave in Germany using reporting data from the national notification system

As of December 31, 2019, initial reports circulated internationally of an unusual cluster of pneumonia of unknown cause in China. By the end of January 2020, the virus affected Germany with the first case confirmed on January 27, 2020. Intensive contact tracing and infection control measures contained the first two clusters in the country. However, the dynamic of the first wave gained momentum as of March, and by mid-June 2020 over 190,000 laboratory-confirmed cases had been reported to the Robert Koch Institute. This article examines these cases as part of a retrospective descriptive analysis focused on disease severity. Most cases (80%) were mild and two thirds of the cases were younger than 60 years (median age: 50 years). Severe cases were primarily reported among men aged 60 or over who had at least one risk factor (particularly cardiovascular disease, diabetes, neurological disorders and/or lung diseases). Cases between the ages of 40 and 59 years had the longest interval between symptom onset and hospitalisation (median: six days) and - if admitted to an intensive care unit (ICU) - also the longest ICU stay (median: eleven days). This analysis provides valuable information about disease severity of COVID-19 and particularly affected groups.

Care for the chronically ill in Germany - The challenges during the COVID-19 pandemic

The COVID-19 pandemic is posing major challenges to the health care sector. This scoping review compiles evidence concerning changes to health care service availability and utilisation as well as possible impacts on health for selected groups of chronically ill people in Germany. The focus is on cancer, cardiovascular diseases, diabetes mellitus and mental disorders. Most empirical data available concerned inpatient care and showed a clear decline in the utilisation of inpatient treatments in March and April 2020 in the areas of oncology and cardiology as well as in mental health. For cardiovascular emergencies such as heart attack and stroke, a decline was observed especially regarding less serious cases. Although there were indications of treatment delays, there was no evidence thus far that emergency care had been generally compromised due to adjustments to inpatient care capacities. In the outpatient setting, extensive adjustments to health care services availability were observed for all disease groups considered. Overall, very limited empirical data were available. In particular, hardly any data were available on how changes in care impacted population health. There is an urgent need for continuous surveillance and evaluation based on health care and epidemiological data.

Gynaecology and general practitioner services utilisation by women in the age group 50 years and older

There are relatively few representative data on the utilisation of physician services in Germany and its influencing. Based on data from the German Health Interview and Examination Survey for Adults (DEGS1, 2008-2011), we analyse the utilisation of gynaecology and general practitioner (GP) services, with a focus on women aged 50 years and older. We compare these findings with data from the German National Health Interview and Examination Survey 1998 (GNHIES98) and, based on this and further data, discuss possible developments. Figures for seeking GP services (over 80%) are constantly high across the entire lifespan, whereas figures for gynaecology services drop with age. Around 60% of women aged 50 years and older go to a gynaecological practice at least once a year. Socioeconomic status and place of residence are important determinants for the utilisation of services. Around half of all women aged 50 years and older sought both gynaecology and GP services at least once over a one-year period. Under 10% had only been to a gynaecologist, and around one third sought GP services only. Compared to GNHIES98, figures for GP and gynaecology services were considerably higher in DEGS1, health insurance data, however, shows no increase in the use of gynaecology services between 2008 and 2018. The results highlight the need to increase awareness among GPs of the needs of middle-aged and older women for gynaecological consultation and treatment.

Reasons for women aged 50 years and older to seek gynaecological advice and treatment

Gynaecological care is generally perceived as focused on reproductive health. However, when women enter the non-reproductive life phase, other reasons to seek gynaecological care gain in importance. This paper presents findings on the reasons for women in the 50 years and older age group to seek gynaecological consultation and treatment. Our findings are based on data from the German Health Interview and Examination Survey for Adults (DEGS1, 2008-2011), conducted by the Robert Koch Institute (RKI), as well as the 2016 claims data from the Associations of Statutory Health Insurance Physicians (KVen), provided by the Central Research Institute of Ambulatory Health Care in Germany (Zi). At this age, cancer screening and menopausal complaints can become, as DEGS1 data shows, important reasons to seek gynaecological services. Around 65.0% of 50- to 79-year-old women took advantage of breast palpation examinations during the last twelve months, and 58.0% underwent cervical cell smear tests (pap smear). 47.2% of women had their last menstrual period at age 50 or later. KV data shows that with 45.3% and 33.1% of cases respectively, menopausal symptoms (International Statistical Classification of Diseases and Related Health Problems, 10th revision, ICD-10: N95) and screening for malignant neoplasms (ICD 10: Z12) were the most frequently billed services. The data clearly shows reasons for consultation and treatment of women aged 50 years and older and these should therefore be considered in treatment planning and design.

Barriers for women aged 50 years and older to accessing health care in Germany

For older and very old women in rural areas, the long distances involved and the limited availability of services can make accessing general practitioners and specialist physicians difficult. Based on data from the recent wave of the German Health Update (GEDA 2014/2015-EHIS), we have analysed the barriers to accessing health care for women in the age group 50 years and older in Germany. 21.0% of the women reported having had difficulties getting an appointment for an examination when it was needed during the twelve-month period before the interview. Fewer than 5% of the women reported distance as the reason for delayed medical examinations. Over the course of a one-year period, women in the large cities more frequently had to wait for an appointment for an examination than women in smaller towns. However, women in smaller towns reported more often that an examination had taken place late due to distance. The results are informative for the planning of health care services.

Fast food consumption among 12- to 17-year-olds in Germany - Results of EsKiMo II

Consuming high amounts of fast food can lead to an excessive intake of energy and subsequently promote obesity. Obesity increases a person's risk for diabetes and cardiovascular diseases. The second wave of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS Wave 2, 2014-2017) included the Eating study as a KiGGS Module (EsKiMo II, 2015-2017) which assessed the self-reported dietary habits of children and adolescents in Germany. The analysis of the data permits an overview of the fast food consumption of 12- to 17-year-olds (n=1,353). Girls consume 57.5 grams and boys 86.3 grams of fast food per day on average (around 400 grams and 600 grams per week, respectively). Pizza is the most consumed fast food product, followed by filled pita and sausage/meat products such as curry sausage. Adolescent girls on average get 6.5% and boys 7.8% of total daily energy intake from fast food. 23% of 12- to 17-year-olds get at least 10% of their daily energy intake from fast food (high consumers). Significant differences between the proportion of high consumers exist regarding sex, age, socioeconomic status, community size, type of school and media consumption. Compared to EsKiMo I (2006), girls' daily energy intake from fast food has remained nearly constant, whereas that of boys has dropped substantially. From a nutrition physiology perspective, the aim should be to further reduce fast food consumption.

Educational differences in the prevalence of behavioural risk factors in Germany and the EU - Results from the European Health Interview Survey (EHIS) 2

This article examines educational differences in the prevalence of behavioural risk factors among adults and compares the results for Germany with the average from the European Union (EU). Data were derived from the second wave of the European Health Interview Survey, which took place between 2013 and 2015 (EHIS 2). Analyses were conducted using a regression-based calculation of relative and absolute educational differences in the prevalence of behavioural risk factors, based on self-reported data from women and men aged between 25 and 69 (n=217,215). Current smoking, obesity, physical activity lasting less than 150 minutes per week, heavy episodic drinking and non-daily fruit or vegetable intake are more prevalent among people with a low education level than those with a high education level. This applies to Germany as well as the EU average. Overall, the relative educational differences identified for these risk factors place Germany in the mid-range compared to the EU average. However, relative educational differences in current smoking and heavy episodic drinking are more manifest among women in Germany than the EU average, with the same applying to low physical activity among men. In contrast, relative educational differences in non-daily fruit or vegetable intake are less pronounced among women and men in Germany than the average across the EU. Increased efforts are needed in various policy fields to improve the structural conditions underlying health behaviour, particularly for socially disadvantaged groups, and increase health equity.

Good Practice in Health Reporting - Guidelines and Recommendations 2.0: The boards of the German Society for Social Medicine and Prevention and the German Society for Epidemiology have approved this second edition of Good Practice in Health Reporting.December 2018

Health reporting provides a description of the health of the population, analyses problems and demonstrates areas in which action needs to be taken in health care provision, health promotion and disease prevention. Accordingly, it offers a rational basis for participatory processes and health policy decision-making. This edition of Good Practice in Health Reporting resulted from a revision of the first edition, which was first published in March 2017. It incorporates contributions from experts, and various institutions and associations from the German federal-state and national levels. This revised edition rose out of the need for continual development in health reporting. In some cases, a number of changes were made so that certain aspects could be defined more clearly; in other cases, changes were made to methodology, for example, in order to accommodate participatory and qualitative approaches. This publication is aimed at providing people working in health reporting with professional direction and guidance. We welcome your feedback.

Adult exposure to passive smoking in Germany

Passive smoking is associated with the same consequences for health as smoking, albeit to a lesser extent. Various legislative measures have been put in place in Germany to lower exposure to passive smoking. According to data from GEDA 2014/2015-EHIS, 11.3% of non-smoking adults are regularly exposed to passive smoking in enclosed spaces, this is particularly the case with young adults. Non-smoking women who are regularly exposed to passive smoking usually come into contact with passive smoking when they are together with friends and acquaintances (51.2%). Non-smoking men most frequently face passive smoking in the work place (56.1%). People with a high level of education are much less frequently exposed to passive smoking than those with medium to lower levels of education. Action still needs to be taken to protect people against the dangers linked to passive smoking.

Utilization of physical therapy services in Germany

Physical therapy plays an important role in health care and is listed as a therapy in many clinical guidelines. Claims data gathered by statutory health insurers demonstrate that in Germany physical therapy accounts for more than 70% of the reimbursable costs of all non-medical treatments comprising physical therapy, logopaedics, occupational therapy and podiatry. In monetary terms, this equates to about EUR 4.4 billion annually. According to self-reports of the respondents of GEDA 2014/2015-EHIS on their utilization of physical therapy services 25.5% of women and 17.7% of men used physical therapy services within the 12 months that preceded the interview. This rate increases significantly with age, reaching its peak among the 50-to-59 year age group, at 30.7% among women and 20.1% among men. People with a high level of education and those with private health insurance use physical therapy services more frequently. Moreover, people living in the eastern part of Germany use physical therapy services more often than those living in the western federal states.

Early detection of breast cancer: the utilization of mammography in Germany

Breast cancer is the most common cancer in women in Germany. In addition to physical examinations (palpation) mammographies are offered every two years to women aged 50 to 69 years as part of the mammography screening programme. For this purpose women are invited in writing and recive a leaflet with information about the background, aims procedures, benefits and possible disadvantages that the screening programme might have. The invitation and the leaflet were revised in 2015 to better support the invited women in making an informed decision about whether they should participate in the programme. In the GEDA 2014/2015-EHIS study, the respondents provided the date of their last mammography and the reason for this. A mammography has been performed on 74.2% of women aged 50 to 69 years within the last two years. 80.7% of these women stated that the reason for this was an invitation sent out by the national screening programme.

Use of medicines by adults in Germany

The use of medicines is an essential aspect of treating disease. In this field, surveys that map the population's use of medicines are of particular interest. The GEDA 2014/2015-EHIS study collected data on the use of medically prescribed and self-medicated drugs during the two weeks that preceded the survey. 58.9% of women and 52.0% of men reported that they had taken medically prescribed drugs during this period. 48.5% of women and 35.4% of men stated they had taken medication during this period that had not been prescribed by a doctor. The prevalence of the use of medically prescribed drugs and self-medication was higher among women than among men. Finally, the prevalence of the use of medically prescribed drugs increased significantly with age, whereas the prevalence of self-medication decreased with age.

Utilization of outpatient medical care in Germany

Outpatient care in Germany is mainly provided in physicians' private practices. Data from health surveys enable to analyse the utilization of outpatient services from the patient's perspective, and to identify associations with social determinants and other influencing factors. As part of the GEDA 2014/2015-EHIS study, data was collected for the indicator 'utilization of outpatient medical care in the last 12 months'. The analysis found that 90.9% of women aged 18 years and over and 84.1% of men had used outpatient medical services within the last 12 months. The utilization of outpatient medical care increases with age: about 94% of people aged 65 or over were provided with outpatient medical treatment in the last 12 months. There were significant differences in utilization between younger men and women, which balance out with age. No differences were identified in relation to educational level or federal state.

Social support as a health resource in Germany

Social support is a psychosocial resource that results from social ties and networks. It has a significant impact on health and can improve mental well-being, reduce stress and mitigate the impact of unfavourable living conditions. The GEDA 2014/2015-EHIS survey undertaken by the Robert Koch Institute (RKI) is used to examine the extent and distribution of perceived social support among the adult population in Germany (n=23,617). The results show that both women and men largely feel supported by the people they are close to and their neighbours. However, perceived social support is not distributed equally across the population: the elderly, people with low levels of education and the unemployed report relatively frequently that they receive low levels of social support. As such, the sections of the population that are more frequently affected by health problems are also less likely to be able to rely on social support.

The utilization of colonoscopy in Germany

Colorectal cancer is one of the three most common cancers in German adults. There are several legally based examinations for the early detection of colorectal cancer. People aged 50 to 54 years can have a faecal blood test annually. From the age of 55, this test is offered every two years as part of cancer screening, or alternatively a preventive colonoscopy, which can be repeated after ten years if the findings are inconspicuous. However, colonoscopies are also carried out to clarify complaints or other diseases (curative colonoscopy). In the GEDA 2014/2015-EHIS study, the respondents provided the date of their last colonoscopy. No data was collected on the reason why this colonoscopy was performed. 57% of women and 61% of men aged 55 years or older reported that they had a colonoscopy within the last 10 years. New legal regulations envisage the expansion of colorectal cancer screening and its development into an organised, quality-assured early detection programme.

The utilization of psychiatric and psychotherapeutic services in Germany - individual determinants and regional differences

In Germany, the provision of health services to people with mental disorders is an issue that is subject to controversial debate. On the one hand, regional differences exist in the distribution of psychotherapists in Germany. On the other hand, patients are often willing to accept the extra effort of having to travel further in order to access treatment even in case of a low supply. Thus, in addition to issues of access, an analysis of care provision also needs to take into account the actual level of services utilization. The present paper analyses the utilization of outpatient psychiatric and psychotherapeutic services and identifies individual and regional determinants. The German Health Update (GEDA) is a nationwide survey of the adult population that is conducted by the Robert Koch Institute in the context of its population-based health monitoring. The GEDA 2014/2015-EHIS study (n=24,016) is based on a two-stage stratified random sample drawn from the population registers of 301 local authorities in Germany. The main outcome is the utilization of psychotherapeutic or psychiatric services during the last 12 months. In addition to the consideration of individual factors, the survey data was combined with information describing the regional distribution of providers of outpatient psychotherapeutic and neurological care. The data was analysed using logistic multi-level regression. In Germany, 11.3% of women and 8.1% of men report that they have used psychotherapeutic or psychiatric treatment within the last 12 months. Among respondents with current depressive symptoms, these rates are 35.0% in women and 31.0% in men. This means that approximately two thirds of people with current depressive symptoms do not seek the services of these health professionals during this period. Apart from current depressive symptoms the utilization of psychiatric and psychotherapeutic services is associated with not living with a partner and with low levels of social support. Furthermore, in regions with a high density of care providers, the proportion of people with current depressive symptoms using such services is about 15 percentage points higher than in regions with a low density. The conditions for the utilization of the respective services should not only be improved by increasing the number of care providers, but also by implementing accompanying measures. Innovations in health care aiming at rapid and low-threshold access as well as approaches for a better cooperation between primary and specialist care should therefore be evaluated regarding their contribution to an improved early treatment.

The uptake of influenza vaccination for the 2013/2014 season in Germany

Seasonal influenza (flu) is an acute viral disease that occurs every winter in Germany and is referred to as the 'flu wave'. The Standing Committee on Vaccination (STIKO) at the Robert Koch Institute recommends annual vaccination for people who are at greater risk of disease-related complications, this includes men and women aged 60 or above. In this target group, 48.1% of women and 48.7% of men who participated in the GEDA 2014/2015-EHIS study reported that they had been vaccinated against influenza during the 2013/2014 winter season. However, there were marked differences according to region. Vaccination rates decreased over time. Moreover, although the European Commission has been calling for a vaccination rate of at least 75% among the elderly from the 2014/2015 influenza season onwards, it is unclear to what extent this rate can actually be achieved. However, rates can be improved by doctors providing advice and recommending vaccination to their patients.

Perceived exposure to hazardous working conditions in Germany

Data on the prevalence of perceived exposure to hazardous working conditions were gathered for the GEDA 2014/2015-EHIS study using a simple graduated question. Approximately one-fifth of people in employment state that they face serious or very serious occupational health hazards. However, women (18.6%) are significantly less likely to have this perception than men (27.0%). The differences between women and men can be explained by the variation in working hours and by the continued gender specific division of the labour market (segregation). There are pronounced differences among men with regard to educational and vocational qualifications, with lower qualified men viewing their employment as posing a higher risk to their health than higher qualified men; no similar differences exist between women. Finally, perceived health risks are highest among women and men in the passenger and freight transport sectors. The results of this study underline the importance of occupational safety and workplace health promotion.

Utilization of inpatient medical care in Germany

Inpatient care is an important pillar of the health care system. Data from health surveys enable to analyse the utilization of inpatient treatment from the patient's perspective, and to identify associations to social determinants and other influencing factors. As part of the GEDA 2014/2015-EHIS study, data was collected for the indicator 'utilization of inpatient medical care during the last 12 months'. The data analysis shows that 16.9% of women and 15.3% of men were admitted to hospital at least once during the last 12 months. The utilization of inpatient treatment depends on age: among people aged 65 or above, 25.9% of women and 25.8% of men were admitted to hospital during the last 12 months. Almost no significant differences in utilization were identified in regard to gender, with the exception of the 18-to-29 age group, where admittance to hospital was more common among women than men. In terms of education, people with the lowest level of education have a higher utilization of inpatient care, and this is particularly the case in middle age.

Prevalence of joint pain in Germany

Joint symptoms and pain belong to the most common diseases worldwide that affect people in their usual activities and lead to loss of quality of life. 29.3% of women and 24.4% of men reported acute joint pain, which is defined as pain suffered during the past 24 hours. With age, these figures increase. Women report pain in 3.9 joints on average and men in 3.6. In both genders the joints most affected are the shoulders, knees and hips. Respondents suffering from joint pain significantly more often report medically diagnosed osteoarthritis or rheumatoid arthritis than respondents who were free of pain.

12-month prevalence of self-reported medical diagnoses of depression in Germany

Depression is a frequent mental disorder and has a growing importance in health care provision. In GEDA 2014/2015-EHIS, 9.7% of women and 6.3% of men self-reported having received a medical diagnosis of depression during the past 12 months. For both genders, the rate of self-reported diagnoses of depression is highest in the 45- to 64-year age group. Education thereby plays a significant role. Prevalence for women from low education is about double that of women from high education backgrounds (12.2% compared with 6.5%). The education gradient for men is smaller (7.5% compared with 5.1%). Prevalence rates also differ sharply between federal states (for women, between 5.4% and 13.4%; for men, between 3.3% and 9.4%). These results are discussed in the light of data currently available.

12-month prevalence of asthma among adults in Germany

Asthma is a chronic inflammatory disease of the airways affecting people of all ages. The disease is characterised by a variable narrowing of the bronchia, which may be accompanied by symptoms such as wheezing or shortness of breath. In GEDA 2014/2015-EHIS, 6.2% of respondents aged 18 years or older with complete information on the respective indicator (n=22,671) reported having had asthma during the past 12 months. The 12-month prevalence among women (7.1%) is higher than among men (5.4%). Overall, women and men with a low level of education more often reported having had asthma than those with a higher level of education. In analyses stratified by age and gender, differences in asthma prevalence with regard to educational level are evident among women under 30 years of age. In a comparison of federal states, the prevalence of asthma ranges from 3.0% to 9.7% among women and from 2.9% to 7.0% among men.

12-month prevalence of osteoarthritis in Germany

Osteoarthritis is the most common joint disease worldwide. In the advanced stage the disease is characterised by joint pain and loss of joint functionality. In the Robert Koch Institute's GEDA 2014/2015-EHIS health interview survey, 17.9% of adults over 18 reported having suffered from osteoarthritis during the past twelve months, whereby prevalence for women (21.8%) was higher than for men (13.9%). Osteoarthritis becomes more common with age. Among those aged 65 and over, around half of all women (48.1%) and nearly one third of men (31.2%) are affected. Due to population ageing, the prevalence of osteoarthritis in Germany can be expected to increase further in the future.

Depressive symptoms among adults in Germany

Depressive symptoms imply a loss of quality of life, leading to increased morbidity and mortality as well as increased costs to the healthcare system. Information on the prevalence and distribution of depressive symptoms in the population is essential in light of planning prevention and care. GEDA 2014/2015-EHIS surveyed current depressive symptoms among adults in Germany through the Patient Health Questionnaire (PHQ-8). The surveyed prevalence of 10.1% indicates the widespread occurrence of depressive symptoms, regardless of an actual clinical diagnosis of depression. Prevalence for women (11.6%) is higher than for men (8.6%). Further differences exist concerning age and education as well as regional differences. The results are discussed in the light of the data available so far.

12-month prevalence of osteoporosis in Germany

Osteoporosis is a systemic skeletal disease associated with increased bone fragility, which correspondingly leads to increased bone fractures. In the GEDA 2014/2015-EHIS survey, 7.8% of women and 2.0% of men aged 18 and over reported suffering from osteoporosis during the past 12 months. The share of people reporting osteoporosis increases considerably in the age group 65 and over. Elder women significantly more often report osteoporosis than men. As this was the first time the present indicator for the 12-month prevalence of osteoporosis was evaluated in the context of the European Health Interview Survey (EHIS) 2014/2015, there is no comparative data available.

Limitations to usual activities due to health problems in Germany

Limitations to usual activities due to health problems impact quality of life and well-being. The Global Activity Limitation Indicator (GALI) was developed to assess the trends in limitations to usual activities. The GALI question is applied in a single or routed, multi-question version. GEDA 2014/2015-EHIS for the first time applied a three-question version. Three quarters of respondents reported that they did not experience any limitations to their usual activities. 18.7% of women and 17.0% of men said they had experienced moderate limitations. 6.4% of women and 6.8% of men reported severe limitations. The share of respondents experiencing limitations increases with age and shows a clear education gradient. Changes in methodology, however, mean that current results based on the GALI question cannot be compared to the results from earlier survey waves of the same study.

12-month prevalence of known chronic obstructive pulmonary disease (COPD) in Germany

Chronic obstructive pulmonary disease (COPD) is associated with a high disease burden and is one of the leading causes of death worldwide. Smoking is the key modifiable risk factor for COPD in Germany. GEDA 2014/2015-EHIS surveyed the 12-month prevalence of known COPD using the European indicator on self-reported chronic bronchitis, chronic obstructive pulmonary disease, emphysema. Among adults aged 18 years or older with complete information on the indicator (n=22,702), the 12-month prevalence of known COPD is 5.8% (5.8% for women and 5.7% for men). In both genders, the prevalence increases strongly with age. Overall, the presence of COPD was more often reported by women and men with a low educational level than by those with a higher one. In a comparison of federal states, the 12-month prevalence of known COPD varies between 3.6% and 7.5% for women and 4.3% and 11.2% for men.

Accident injuries of adults in Germany

In 2014, according to estimates by the Federal Institute for Occupational Safety and Health (BAuA), around 9.8 million people in Germany suffered accident injuries. Over 22,000 people died. Federal statistics, however, cannot comprehensively describe accidents in Germany. Here, the Robert Koch Institute health surveys provide an important addition. In the GEDA 2014/2015-EHIS survey, 10.5% of men and 6.9% of women reported that they had suffered accident injuries requiring medical treatment during the past 12 months. Young men aged 18 to 29 have the highest accident risk (18.1%). The overall accident injury figures have hardly changed since the previous GEDA 2012 survey. Preventing accidents is a highly important topic not only for the victims of accidents and their families, but also for society as a whole. According to the World Health Organization, a largely untapped potential for accident prevention remains.

New data for action. Data collection for KiGGS Wave 2 has been completed

The fieldwork of the second follow-up to the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) was completed in August 2017. KiGGS is part of the Robert Koch Institute's Federal Health Monitoring. The study consists of the KiGGS cross-sectional component (a nationally representative, periodic cross-sectional survey of children and adolescents aged between 0 and 17) and the KiGGS cohort (the follow-up into adulthood of participants who took part in the KiGGS baseline study). KiGGS collects data on health status, health-related behaviour, psychosocial risk and protective factors, health care and the living conditions of children and adolescents in Germany. The first interview and examination survey (the KiGGS baseline study; undertaken between 2003 and 2006; n=17,641; age range: 0-17) was carried out in a total of 167 sample points in Germany. Physical examinations, laboratory analyses of blood and urine samples and various physical tests were conducted with the participants and, in addition, all parents and participants aged 11 or above were interviewed. The first follow-up was conducted via telephone-based interviews (KiGGS Wave 1 2009-2012; n=11,992; age range: 6-24) and an additional sample was included (n=4,455; age range: 0-6). KiGGS Wave 2 (2014-2017) was conducted as an interview and examination survey and consisted of a new, nationwide, representative cross-sectional sample of 0- to 17-year-old children and adolescents in Germany, and the second KiGGS cohort follow-up. The completion of the cross-sectional component of KiGGS Wave 2 means that the health of children and adolescents in Germany can now be assessed using representative data gained from three study waves. Trends can therefore be analysed over a period stretching to over ten years now. As the data collected from participants of the KiGGS cohort can be individually linked across the various surveys, in-depth analyses can be conducted for a period ranging from childhood to young adulthood and developmental processes associated with physical and mental health and the associated risk and protective factors can be explored. As such, KiGGS Wave 2 expands the resources available to health reporting, as well as policy planning and research, with regard to assessing the health of children and adolescents in Germany.

Overweight and obesity among adults in Germany

Body weight and height, as well as associated indicators like overweight and obesity, are widespread factors used to describe the health of a population. Over the past decades, the prevalence of overweight and obesity has increased worldwide and has reached significant public health relevance. According to self-reported data on body weight and body height in the GEDA 2014/2015-EHIS study, 54.0% of adults in Germany are overweight or obese (defined as having a body mass index - BMI - of 25 kg/m² or higher). Men are more often affected by overweight than women, with 43.3% of men having a BMI between 25 kg/m² and 30 kg/m², compared to women (28.8%). In Germany, the prevalence of obesity (BMI greater or equal to 30 kg/m²) is 18.1%; there is no significant difference between women and men. The prevalence of overweight, including obesity, is higher among women and men with increasing age. Although the prevalence of overweight, including obesity, has remained at a high level in recent years, the prevalence of obesity has increased compared to the GEDA 2010 study.

Vegetable consumption among adults in Germany

Vegetables are part of a healthy diet and can help prevent various chronic diseases. According to the GEDA 2014/2015-EHIS study, 40.4% of women and 23.9% of men eat vegetables on a daily basis. The proportion of women who eat vegetables every day increases with age: from 31.9% of 18- to 29-year-olds to 48.3% of women aged 65 and above. Around one fifth of men under the age of 65 eat vegetables daily; this increases to 35.9% of men aged 65 or above. Across all age groups, women with higher levels of education are more likely to eat vegetables on a daily basis; the same can only be said about men in the 45 to 64 age group. Finally, women and men living in Saxony are most likely to eat vegetables every day; however, the differences between the federal states are marginal.

Fruit consumption among adults in Germany

Eating fruit is part of a healthy diet and can help prevent various chronic diseases. According to GEDA 2014/2015-EHIS data, 54.2% of women and 38.1% of men eat fruit daily. 38.0% of women and 25.5% of men aged 18 to 29 years eat fruit daily; and in the age group of 65 and older this figure rises to 72.6% for women and 61.1% for men. In the age groups under 65, women with higher levels of education are more likely to eat fruit every day, for men this correlation applies only to those aged between 45 and 64. In Brandenburg, Mecklenburg-West Pomerania, Saxony, Saxony-Anhalt and Thuringia, the proportion of women and men who eat fruit daily is higher than the German average, and in Bavaria and Saarland the proportion of men who eat fruit daily is lower than the German average.

Health-enhancing physical activity during leisure time among adults in Germany

Self-reported data from the GEDA 2014/2015-EHIS study was used to calculate the level of compliance among adults in Germany with the World Health Organization's (WHO) recommendations on physical activity. The WHO's recommendations distinguish between 'aerobic activity' and 'muscle-strengthening activity'. In Germany, 42.6% of women and 48.0% of men reported that they conduct at least 2.5 hours of aerobic physical activity per week, and therefore meet the WHO's recommendation on this form of activity. A higher level of education among women and men of all ages is associated with a higher frequency of meeting the WHO's recommendations on aerobic activity. In addition, 27.6% of women and 31.2% of men conduct muscle-strengthening activity at least twice a week, thereby meeting the WHO's recommendations on this form of activity. About one fifth of women (20.5%) and one quarter of men in Germany (24.7%) meet both of these recommendations. In summary, the results point to the value of encouraging people to conduct more physical activity during their leisure time. In fact, inactive people who begin to follow the WHO's recommendations can significantly reduce their long-term risk of premature mortality.

Alcohol consumption among adults in Germany: heavy episodic drinking

Consuming harmful amounts of alcohol is considered a contributing factor in over 200 diseases. Heavy episodic drinking is a particularly risky drinking pattern, with possible consequences such as acute alcohol intoxication, injuries and violence. GEDA 2014/2015-EHIS defines heavy episodic drinking as the consumption of six or more alcoholic beverages on one occasion at least once per month. 24.9% of women and 42.6% of men show this drinking pattern at least once per month. Regular heavy episodic drinking is most common among 18- to 29-year-olds. The prevalence of heavy episodic drinking among highly educated women (all age groups) and men (aged over 45) is lower than it is among those with lower levels of education. The prevention of harmful levels of alcohol consumption requires measures including social and environmental interventions as well as targeting the individual behaviour which are focused on young adults as well as the diverse drinking patterns seen among groups with different levels of education.

Smoking among adults in Germany

Smoking poses a considerable health risk and is the leading cause of premature death. Germany has implemented numerous measures (such as tax increases, protection of non-smokers, and cigarette warning labels) to reduce the population's tobacco consumption. According to the GEDA 2014/15-EHIS survey, 20.8% of women and 27.0% of men aged 18 and over smoke at least occasionally. For both genders, the share of smokers is highest among the younger age groups. Among women and men with higher levels of education, smoking is far less common than among those with lower levels of education. Since 2003, the share of smokers in the adult population has decreased. Compared to other European countries, and in spite of making considerable progress in tobacco prevention policy, Germany still has great potential for improvement in many areas, such as bans on tobacco adverts and tobacco taxation.

Alcohol consumption among adults in Germany: risky drinking levels

Consuming harmful amounts of alcohol is considered a contributing factor in over 200 diseases. Women who drink over 10 g and men who drink more than 20 g of pure alcohol daily are already consuming risky amounts. According to GEDA 2014/2015-EHIS data, 13.8% of women and 18.2% of men consume risky amounts of alcohol at least weekly. The consumption of potentially dangerous levels of alcohol is most widespread in the 45-64 age group. Across all age groups, the prevalence of risky alcohol consumption patterns is higher among highly educated women compared to women with a lower level of education. For men, this pattern only appears in those aged 65 and over. Preventive measures including social and environmental interventions and responsible drinking campaigns should contribute to further reducing risky alcohol consumption among the population.

12-Month prevalence of coronary heart disease in Germany

The results of the GEDA 2014/2015-EHIS study demonstrate that during the last 12 months, 3.7% of women and 6.0% of men in Germany had coronary heart disease (CHD - defined as myocardial infarction, chronic consequences of myocardial infarction or angina pectoris). The 12-month prevalence of CHD in men and women under 45 years of age is well below 1.0%; however, the prevalence rises rapidly and disproportionately up to 16.0% among women and 24.1% among men aged 75 years and over. Women with a low level of education have a considerably higher prevalence of CHD (7.3%) compared to those with a high level of education (1.2%). Men show fewer education-related differences (6.5% versus 5.2%). As the indicators analysed here were first deployed as part of the 2014/2015 European Health Interview Survey (EHIS), no comparative data is available.