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To promote long-term care policies for older adults, accurate mapping of the often invisible and insufficiently recognized role of their informal caregivers is needed. This paper measures the prevalence of informal caregivers in the European population, illustrates current difficulties in gathering unequivocal information on this topic and deals with the scientific and policy implications of the problem. Using the European Health Interview Survey (EHIS), the European Quality of Life Survey (EQLS) and the Study on Health and Ageing in Europe (SHARE), the current difficulties in gathering unequivocal information on this topic are illustrated. In most countries, the share of informal caregivers varies, sometimes markedly, among the three surveys. As for the sex of caregivers, while confirming the well-known higher prevalence of caregivers among women than among men, large variations emerge across the three surveys in most countries in respect of the two sexes. The takeaway message of the paper is that it is urgent to promote international concerted action in gathering comprehensive informal caregiving information and/or exploring in greater depth the different intercultural understandings of informal care itself.

BackgroundThe aim of this study is to describe the social characteristics, the health and living situation and the prevalence of behavioral risk factors of adult informal caregivers compared to non-caregivers in Germany.MethodsWe used data from the German Health Update (GEDA 2019/2020-EHIS survey) which is a cross-sectional population-based health interview survey conducted between 04/2019 and 09/2020. The sample comprised 22,646 adults living in private households. Three mutually exclusive groups of providing informal care or assistance were differentiated: intense caregivers (informal care ≥10 h/week), less-intense caregivers (informal careResultsOverall, 6.5% were intense caregivers, 15.2% less-intense caregivers and 78.3% non-caregivers. Women provided care more often (23.9%) than men (19.3%). Informal care was most frequently provided in the age group of 45 to 64 years. Intense caregivers reported worse health status, were more often current smokers, physical inactive, obese and lived less often alone than non-caregivers. However, in age-group adjusted regression analyses only few significant differences were seen: Female and male intense caregivers had more often a low back disorder and lived less often alone compared to non-caregivers. In addition, male intense care-givers reported more often worse self-perceived health, health-related activity limitation, and the presence of chronic diseases. In contrast, less-intense caregivers and non-caregivers differed in favor of the less-intense caregivers.DiscussionA substantial proportion of the adult German population provides informal care regularly, especially women. Intense caregivers are a vulnerable group for negative health outcomes, especially men. In particular measures to prevent low back disorder should be provided. As the necessity of providing informal care will probably increase in the future, this will be important for the society and public health.

Background Daily vegetable intake is considered an important behavioural health resource associated with improved immune function and lower incidence of non-communicable disease. Analyses of population-based data show that being female and having a high educational status is most strongly associated with increased vegetable intake. In contrast, men and individuals with a low educational status seem to be most affected by non-daily vegetable intake (non-DVI). From an intersectionality perspective, health inequalities are seen as a consequence of an unequal balance of power such as persisting gender inequality. Unravelling intersections of socially driven aspects underlying inequalities might be achieved by not relying exclusively on the male/female binary, but by considering different facets of gender roles as well. This study aims to analyse possible interactions of sex/gender or sex/gender related aspects with a variety of different socio-cultural, socio-demographic and socio-economic variables with regard to non-DVI as the health-related outcome. Method Comparative classification tree analyses with classification and regression tree (CART) and conditional inference tree (CIT) as quantitative, non-parametric, exploratory methods for the detection of subgroups with high prevalence of non-DVI were performed. Complete-case analyses (n = 19,512) were based on cross-sectional data from a National Health Telephone Interview Survey conducted in Germany. Results The CART-algorithm constructed overall smaller trees when compared to CIT, but the subgroups detected by CART were also detected by CIT. The most strongly differentiating factor for non-DVI, when not considering any further sex/gender related aspects, was the male/female binary with a non-DVI prevalence of 61.7% in men and 42.7% in women. However, the inclusion of further sex/gender related aspects revealed a more heterogenous distribution of non-DVI across the sample, bringing gendered differences in main earner status and being a blue-collar worker to the foreground. In blue-collar workers who do not live with a partner on whom they can rely on financially, the non-DVI prevalence was 69.6% in men and 57.4% in women respectively. Conclusions Public health monitoring and reporting with an intersectionality-informed and gender-equitable perspective might benefit from an integration of further sex/gender related aspects into quantitative analyses in order to detect population subgroups most affected by non-DVI.

In public health research and reporting, there is an increasing interest in eco-social theory and intersectional approaches to understand health inequity. Both approaches focus on the macrosocial c...

ZusammenfassungGesundheitsberichterstattung (GBE) als integrales Element von Public Health spielt eine wichtige Rolle bei der Entwicklung von Strategien und Konzepten, die das Ziel haben, die Gesundheit jeder Alters- und Bevölkerungsgruppe zu verbessern. Der Artikel gibt eine Übersicht zu Definition und Aufgaben der Gesundheitsberichterstattung des Bundes und beschreibt wichtige GBE-Komponenten in ihrer aktuellen Form. So wird das Publikationsformat des Journal of Health Monitoring vorgestellt, das als vielseitiges Format für die unterschiedlichen Nutzergruppen der Gesundheitsberichterstattung entwickelt wurde. Weiter werden Beispiele für die Nutzung und Wirkungen der Gesundheitsberichterstattung exemplarisch dargestellt. Gesundheitsberichterstattung ist dabei als flexibles System angelegt: So werden Veränderungen bei Datengrundlagen und Kommunikationsformen bei der Weiterentwicklung der Gesundheitsberichterstattung berücksichtigt.Die Weiterentwicklung der Gesundheitsberichterstattung setzt eine enge interdisziplinäre Zusammenarbeit unterschiedlicher Akteure voraus, um sowohl aktuelle Forschungsergebnisse verschiedener Wissenschaftsdisziplinen in die Prozesse der Gesundheitsberichterstattung zu integrieren als auch die Reichweite sowie den Impact der Gesundheitsberichterstattung weiter auszubauen. Neben der Weiterentwicklung der Gesundheitsberichterstattung auf der wissenschaftlichen Ebene stellen auch der Ausbau von partizipativen Elementen sowie eine stärkere Internationalisierung wichtige künftige Aufgaben dar.

Background Injury remains a major concern to public health in the European region. Previous iterations of the Global Burden of Disease (GBD) study showed wide variation in injury death and disability adjusted life year (DALY) rates across Europe, indicating injury inequality gaps between sub-regions and countries. The objectives of this study were to: 1) compare GBD 2019 estimates on injury mortality and DALYs across European sub-regions and countries by cause-of-injury category and sex; 2) examine changes in injury DALY rates over a 20 year-period by cause-of-injury category, sub-region and country; and 3) assess inequalities in injury mortality and DALY rates across the countries. Methods We performed a secondary database descriptive study using the GBD 2019 results on injuries in 44 European countries from 2000 to 2019. Inequality in DALY rates between these countries was assessed by calculating the DALY rate ratio between the highest-ranking country and lowest-ranking country in each year. Results In 2019, in Eastern Europe 80 [95% uncertainty interval (UI): 71 to 89] people per 100,000 died from injuries; twice as high compared to Central Europe (38 injury deaths per 100,000; 95% UI 34 to 42) and three times as high compared to Western Europe (27 injury deaths per 100,000; 95%UI 25 to 28). The injury DALY rates showed less pronounced differences between Eastern (5129 DALYs per 100,000; 95% UI: 4547 to 5864), Central (2940 DALYs per 100,000; 95% UI: 2452 to 3546) and Western Europe (1782 DALYs per 100,000; 95% UI: 1523 to 2115). Injury DALY rate was lowest in Italy (1489 DALYs per 100,000) and highest in Ukraine (5553 DALYs per 100,000). The difference in injury DALY rates by country was larger for males compared to females. The DALY rate ratio was highest in 2005, with DALY rate in the lowest-ranking country (Russian Federation) 6.0 times higher compared to the highest-ranking country (Malta). After 2005, the DALY rate ratio between the lowest- and the highest-ranking country gradually decreased to 3.7 in 2019. Conclusions Injury mortality and DALY rates were highest in Eastern Europe and lowest in Western Europe, although differences in injury DALY rates declined rapidly, particularly in the past decade. The injury DALY rate ratio of highest- and lowest-ranking country declined from 2005 onwards, indicating declining inequalities in injuries between European countries.

Germany is a country of immigration; 27% of the population are people with a migration background (PMB). As other countries, Germany faces difficulties in adequately including hard-to-survey populations like PMB into national public health monitoring. The IMIRA project was initiated to develop strategies to adequately include PMB into public health monitoring and to represent diversity in public health reporting. Here, we aim to synthesize the lessons learned for diversity-oriented public health monitoring and reporting in Germany. We also aim to derive recommendations for further research on migration and health. We conducted two feasibility studies (interview and examination surveys) to improve the inclusion of PMB. Study materials were developed in focus groups with PMB. A systematic review investigated the usability of the concept of acculturation. A scoping review was conducted on discrimination as a health determinant. Furthermore, core indicators were defined for public health reporting on PMB. The translated questionnaires were well accepted among the different migrant groups. Home visits increased the participation of hard-to-survey populations. In examination surveys, multilingual explanation videos and video-interpretation services were effective. Instead of using the concept of acculturation, we derived several dimensions to capture the effects of migration status on health, which were more differentiated. We also developed an instrument to measure subjectively perceived discrimination. For future public health reporting, a set of 25 core indicators was defined to report on the health of PMB. A diversity-oriented public health monitoring should include the following: (1) multilingual, diversity-sensitive materials, and tools; (2) different modes of administration; (3) diversity-sensitive concepts; (4) increase the participation of PMB; and (5) continuous public health reporting, including constant reflection and development of concepts and methods.

The aim of the BURDEN 2020 project is to calculate the Burden of Disease for Germany at the national and regional level. Based on the methods of the Global Burden of Disease study, the results will assess the impact of diseases on population health thus providing a freely accessible information basis for policy making and health care planning. How can the transfer from science to society take place on a low-threshold basis? We will talk about our strategy reaching out to decision-makers within health care planning in Germany and Europe. In addition, it will be examined how we wanted our results to be accessible, which possibilities of publication we choose beyond scientific articles and what options we had when talking about research marketing. We will also have a closer look on our demands for data visualization and transparency. In an ongoing process, two things were at stake: how do we define our target groups and how we address them. It has been proven to be a good strategy to continuously build up (international) networks, to share our knowledge and implement feedback. When publishing scientific results, it has turned out to be helpful for the project to approach a well-known bi-lingual journal with a wide range of coverage. We aimed to present the pilot project online with an appealing data visualization and graphic formats. This type of presentation made it easier to approach members of the press. Also, the inclusion of current topics such as COVID-19 helped to increase the media response. There are plans to include the use of the data in media formats such as webinars. Burden of Disease assessments can be challenging in implementation and communication. Before the start, the use of the metrics for Germany had to be thoroughly explained to national stakeholders. Within the project, we had to discuss how our data should be communicated to the public, to explain strength and weaknesses, and to produce publication formats that suit different target groups.

Zusammenfassung Die Gesundheitsberichterstattung (GBE) informiert über die gesundheitliche Lage von Frauen und Männern. Geschlechtergruppen werden derzeit eher homogen dargestellt. Unterschiede innerhalb der Gruppen und auch das Thema der geschlechtlichen und sexuellen Vielfalt finden bislang wenig Beachtung. Die GBE steht daher vor der Frage, wie sozial und geschlechterbezogen angemessen differenziert werden kann. Das Potenzial des Ansatzes der Intersektionalität soll künftig auf seine Nutzbarkeit in der GBE geprüft werden.

Background In Germany, different health checks for adults are offered for primary and secondary prevention. Previous findings indicate that preventive care utilization varies according to social determinants, especially migration background. This study examined the extent to which migration background is associated with preventive care utilization, independent of factors like age and socioeconomic status and whether length of stay in Germany has a positive effect on the use of preventive care. Methods The first wave of the ‘German Health Interview and Examination Survey for Adults’ (DEGS1) is a comprehensive data collection facilitating the description of the utilization of general health checks, dental check-ups, skin cancer screening, and cervical cancer screening among people aged 18–79 years with and without migration background. Migration background was differentiated in first-generation migrants having immigrated to Germany themselves or second-generation migrants born in Germany. First-generation migrants were further differentiated by length of stay in Germany, and second-generation migrants as having one or two parents who were born abroad. Multivariate binary logistic regression models with average marginal effects were calculated to analyse the associations between preventive care utilization and migration background. Results The sample comprised 7987 participants, 1091 of whom had a migration background. Compared with non-migrants, women and men with migration background— particularly first-generation migrants with length of stay Conclusions Our findings suggest inequalities in realized access to preventive care for first-generation migrants particularly for those who have lived in Germany for 20 years or less. Barriers to the utilization of preventive care may be addressed by informing migrant communities about preventive health care services at an early stage after immigration using migrant-sensitive information strategies.

Background The InfAct (Information for Action) project is a European Commission Joint Action on Health Information which has promoted the potential role of burden of disease (BoD) approaches to improve the current European Union-Health Information System (EU-HIS). It has done so by raising awareness of the concept, the methods used to calculate estimates and their potential implications and uses in policymaking. The BoD approach is a systematic and scientific effort to quantify and compare the magnitude of health loss due to different diseases, injuries, and risk factors with estimates produced by demographic characteristics and geographies for specific points in time. Not all countries have the resources to undertake such work, and may therefore start with a more restricted objective, e.g., a limited number of diseases, or the use of simple measures of population health such as disease prevalence or life expectancy. The main objective to develop these recommendations was to facilitate those countries planning to start a national burden of disease study. Results These recommendations could be considered as minimum requirements for those countries planning to start a BoD study and includes following elements: (1) Define the objectives of a burden of disease study within the context of your country, (2) Identify, communicate and secure the benefits of performing national burden of disease studies, (3) Secure access to the minimum required data sources, (4) Ensure the minimum required capacity and capability is available to carry out burden of disease study, (5) Establish a clear governance structure for the burden of disease study and stakeholder engagement/involvement, (6) Choose the appropriate methodological approaches and (7) Knowledge translation. These were guided by the results from our survey performed to identify the needs of European countries for BoD studies, a narrative overview from four European countries (Belgium, Germany, The Netherlands and Scotland) and the summary of a comparative study of country health profiles with national health statistics. Conclusions These recommendations as minimum requirements would facilitate efforts by those European countries who intend to perform national BoD studies.

Introduction The aim of this study was to estimate excess costs of depression in Germany and to examine the influence of sociodemographic and socioeconomic determinants. Methods Annual excess costs of depression per patient were estimated for the year 2019 by comparing survey data of individuals with and without self-reported medically diagnosed depression, representative for the German population aged 18–79 years. Differences between individuals with depression (n = 223) and without depression (n = 4540) were adjusted using entropy balancing. Excess costs were estimated using generalized linear model regression with a gamma distribution and log-link function. We estimated direct (inpatient, outpatient, medication) and indirect (sick leave, early retirement) excess costs. Subgroup analyses by social determinants were conducted for sex, age, socioeconomic status, first-generation or second-generation migrants, partnership, and social support. Results Total annual excess costs of depression amounted to €5047 (95% confidence interval [CI] 3214–6880) per patient. Indirect excess costs amounted to €2835 (1566–4103) and were higher than direct excess costs (€2212 [1083–3341]). Outpatient (€498), inpatient (€1345), early retirement (€1686), and sick leave (€1149) excess costs were statistically significant, while medication (€370) excess costs were not. Regarding social determinants, total excess costs were highest in the younger age groups (€7955 for 18–29-year-olds, €9560 for 30–44-year-olds), whereas total excess costs were lowest for the oldest age group (€2168 for 65+) and first-generation or second-generation migrants (€1820). Conclusions Depression was associated with high excess costs that varied by social determinants. Considerable differences between the socioeconomic and sociodemographic subgroups need further clarification as they point to specific treatment barriers as well as varying treatment needs. Supplementary Information The online version contains supplementary material available at 10.1007/s40273-021-01000-1.

Background Health reports summarize the evidence basis on disease burden and its causes and are intended to inform decisions of policy makers. By focusing on health needs of social groupings according to sex/gender or race/ethnicity, PHMR crucially contributes to achieving health equity. In order to realise its aims, PHMR relies on the availability of high-quality data, appropriate analysis methods and intuitive presentation of results. Methods The joint project AdvanceGender used mixed methods to translate principles of intersectionality into new methods for recruitment, data analysis and health reporting. A review of descriptions of representativeness in epidemiological studies was conducted to investigate how an intersectional perspective can inform recruitment. To evaluate intersectional and gender-sensitive data analysis, we reviewed and applied recently developed methods such as classification and regression tree analysis (CART) and multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA). Findings An intersectional perspective on representativeness unravelled that study participation of women and men might be differential according to further social categories such as civil status or educational level. CART analysis might help to identify intersectional groupings differing in health behaviours or outcomes by exploring a multitude of social dimensions without facing the risk of stereotyping with predefined categories. MAIHDA depicts an alternative method that is suited for descriptive analyses of health-related outcomes among intersectional strata. In contrast to analysing supposedly static features such as sex, a focus on solution-linked variables like social support might be a fertile ground to identify areas for public health action. Discussion Principles of intersectionality open up new perspectives for recruitment and data analysis that might be fruitful for population health research and ultimately for PHMR. Greta Bauer Schulich School of Medicine & Dentistry, Western University, London, Canada Contact: gbauer@uwo.ca Olena Hankivsky University of Melbourne, Centre for Health Equity, Melbourne, Australia Institute for Intersectionality Research, School of Public Policy, Simon Fraser University, Burnaby, Canada Contact: o.hankivsky@unimelb.edu.au Nicole Rosenkötter NRW Centre for Health, Division of Health Reporting, Bielefeld, Germany Contact: Nicole.Rosenkoetter@lzg.nrw.de

Background A key focus of both epidemiology and PHMR is the identification of health inequity between population groups and its determinants. However, scholars in the social sciences have criticised prevalent approaches of describing health differences according to single social categories like sex/gender or race/ethnicity, glossing over significant heterogeneity within and relations between presumed population groups. Applying these critiques to the field of PHMR, we would argue that intersectionality scholarship offers vital impulses for the study of health inequity by focusing on several, interrelated social categories and emphasising the structural determinants affecting unique population subgroups differently. Methods We mapped existing approaches to describing population differences in health. We also conducted a literature review on intersectionality scholarship in public health and then synthesised results to develop a conceptual framework for deploying intersectionality to epidemiology and PHMR. Findings We identified four key principles through which the reporting on subgroup differences could be strengthened: addressing the internal heterogeneity of population groups; contextualising inequities and focusing on societal power relations rather than individual characteristics; deploying novel multivariable modelling approaches in data analysis; and aiming towards the empowerment of population groups rather than deploying deficit-oriented and paternalistic models. Discussion To be discussed are the unique contributions of intersectionality to PHMR compared to other approaches, for example from social epidemiology or medical anthropology.

Sturzpravention ist eine wichtige Aufgabe von Public Health. Jahrlich ereignen sich weltweit etwa 37 Mio. Sturzunfalle, die eine medizinische Behandlung erfordern. Schatzungsweise 646.000 Menschen sterben jedes Jahr bei Sturzunfallen. Detaillierte Kenntnisse uber das Sturzunfallgeschehen liegen bisher nur fur wenige Lander und oft nur fur einzelne Lebensbereiche vor. Das Ziel dieser Analyse ist es, die Verbreitung und die Folgen von Sturzunfallen in der erwachsenen Bevolkerung in Deutschland zu beschreiben. Datenbasis ist der telefonische Befragungssurvey „Gesundheit in Deutschland aktuell 2010“ (GEDA 2010) mit 20.050 Teilnehmenden. Darin wurden auch Informationen uber Unfalle erfasst, die sich in den 12 Monaten vor der Befragung ereigneten und auf die eine arztliche Versorgung folgte. Jahrlich erleiden in Deutschland etwa 1,8 Mio. Erwachsene eine Verletzung durch einen Sturzunfall, die arztlich versorgt wird. Die meisten Sturzunfalle ereignen sich im Verkehr (35,5 %) und zu Hause (30,9 %). Manner erleiden Sturzunfalle haufiger auf der Arbeit als Frauen (22,5 % vs. 6,1 %). Bei alteren Menschen ereignen sich Sturzunfalle haufiger zu Hause als bei jungeren Menschen (18–29 Jahre: 13,8 %; 65+ Jahre: 54,3 %). Sturze in der Freizeit kommen besonders haufig bei jungeren Menschen vor (18–29 Jahre: 30,8 %). 26,8 % der Sturzunfalle fuhren zu einer stationaren Krankenhausbehandlung und 40,2 % zur Inanspruchnahme physiotherapeutischer oder rehabilitativer Masnahmen. Bei Erwerbstatigen kommt es bei 71,4 % der Sturzunfalle zu einer Krankschreibung. Die Analyse des Sturzunfallgeschehens in Deutschland verdeutlicht die weite Verbreitung – auch im jungen und mittleren Erwachsenenalter – und die schweren Folgen (insbesondere bei alteren Menschen) von Sturzen. Die WHO geht davon aus, dass Unfallverletzungen weitgehend vermeidbar sind. Der vorliegende Beitrag liefert Daten fur Taten.

Geoinformationssysteme (GIS) sind computergestutzte Systeme, mit welchen geografische Daten erfasst, gespeichert, verwaltet, analysiert, visualisiert und bereitgestellt werden konnen. In den letzten Jahren sind sie fester Bestandteil der Public-Health-Forschung geworden. Durch vielfaltige Analysewerkzeuge bieten sie die Moglichkeit, gesundheitsrelevante Fragestellungen innovativ zu beantworten. Die Untersuchung nationaler Studien, die Geoinformationssysteme in ihre Analysen einbezogen haben, unterstreicht das Potenzial fur das Gesundheitsmonitoring in Deutschland. Neben modernen Kartierungs- und Visualisierungsoptionen eroffnet die Nutzung von Geoinformationssystemen fur das bundesweite Gesundheitsmonitoring am Robert Koch-Institut (RKI) die Moglichkeit, die Wohnumgebung objektiv als Einflussfaktor auf die Gesundheit und das Gesundheitsverhalten der Bevolkerung zu erfassen und mit den eigenen Surveydaten auf verschiedenen geografischen Ebenen zu verknupfen. Neben physischen Faktoren wie Klima, Vegetation oder Landnutzung sowie Faktoren der bebauten Umwelt konnen zusatzlich soziookonomische und soziodemografische Daten, Versorgungsaspekte und Umweltbelastungen an Erhebungsdaten angedockt und in Auswertekonzepte integriert werden. Somit bieten Geoinformationssysteme fur das Gesundheitsmonitoring am Robert Koch-Institut ein erweitertes Potenzial, bundesweite, reprasentative und aussagekraftige Ergebnisse prasentieren zu konnen. Dabei mussen datenschutzrechtliche Vorgaben stets eingehalten werden. Durch den Aufbau einer nationalen Geodateninfrastruktur und das Erschliesen wichtiger Datenquellen konnte der Zugang zu qualitativ hochwertigen Datensatzen, die fur das Gesundheitsmonitoring relevant sind, zukunftig verbessert werden.

Informal caregivers are people providing some type of unpaid, ongoing assistance to a person with a chronic illness or disability. Long-term care measures and policies cannot take place without taking into account the quantitatively crucial role played by informal caregivers. We use the European Health Interview Survey (EHIS), the European Quality of Life Survey (EQLS), and the Study on Health and Ageing in Europe (SHARE) to measure the prevalence of informal caregivers in the European population, and analyze associated socio-demographic factors. This rate ranges between about 13 percent in Portugal and Spain, and more than 22 percent in Luxembourg, Belgium, and Denmark. It declines in older age groups and, on average, is lower in men than in women in all countries studied, and lower among the poorly educated compared to those with higher levels of education. However, large variance was observed in the average share of informal caregivers for most countries between the three surveys. Our findings, estimated through the three surveys, reveal common trends, but also a series of disparities. Additional research will be needed to enable policy makers to access a richer and more harmonized body of data, allowing them to adopt truly evidence-based and targeted policies and interventions in this field.

Hintergrund und Ziel: Gründe für eine geringere Inanspruchnahme medizinischer Leistungen durch Kinder und Jugendliche mit Migrationshintergrund (MH) sind bislang nicht untersucht. Ziel ist es daher, Faktoren zu identifizieren, die mit der Inanspruchnahme der ambulanten ärztlichen Versorgung und der subjektiven Patientenzufriedenheit im Zusammenhang stehen und Unterschiede im Inanspruchnahmeverhalten von Kindern und Jugendlichen mit und ohne MH erklären. Methodik: Auf Basis der „Studie zur Gesundheit von Kindern und Jugendlichen in Deutschland“ (KiGGS, Basiserhebung: 2003–2006), an der 17.640 Kinder und Jugendliche teilnahmen, wurden Prävalenzen mit 95 %-Konfidenzintervallen sowie multivariate binärlogistische Regressionsanalysen zum Zusammenhang zwischen MH, Herkunftsland und Inanspruchnahme von ambulanten Versorgungsleistungen in den letzten 12 Monaten sowie der Zufriedenheit mit der letzten ambulanten Behandlung berechnet. Ergebnisse: Null- bis 13-Jährige mit beidseitigem MH hatten im Vergleich zu jenen ohne MH eine geringere Inanspruchnahme spezialisierter Fachärztinnen und Fachärzte (OR = 0,64 [0,56–0,74]). Bei den 14- bis 17-Jährigen hingegen unterschied sich die Inanspruchnahme nicht signifikant (OR = 0,79 [0,60–1,03]). Die geringere Inanspruchnahme steht in Zusammenhang mit einer kürzeren Aufenthaltsdauer der Eltern und eingeschränkten Deutschkenntnissen. Zudem sind aus Polen und der früheren Sowjetunion stammende Eltern, unabhängig von Deutschkenntnissen und Aufenthaltsdauer, seltener sehr zufrieden mit der letzten ambulanten Behandlung ihres 0‑ bis 13-jährigen Kindes. Diskussion: Um Kindern mit MH den Zugang zu fachärztlichen Leistungen zu erleichtern, ist es wichtig, Sprachbarrieren in der ambulanten ärztlichen Versorgung abzubauen und Prozesse der interkulturellen Öffnung voranzutreiben., 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.

Hintergrund: Prävalenz und Inzidenz des dokumentierten Diabetes sind wesentliche Kennzahlen, für die im Rahmen der Nationalen Diabetes-Surveillance eine wiederkehrende Ermittlung geplant ist. Methodik: Es wurden Daten nach der Datentransparenzverordnung ausgewertet, die ambulante und stationäre Versorgungsinformationen zu allen rund 70 Mio. gesetzlich Krankenversicherten enthalten. Die Falldefinition für die Prävalenz des dokumentierten Diabetes umfasst eine in mindestens zwei Quartalen eines Jahres vorliegende gesicherte ambulante Diagnose oder eine in mindestens einem Quartal eines Jahres vorliegende stationäre Diagnose gemäß ICD-10-Codes E10.- bis E14.-. Die Inzidenz wurde auf Grundlage derselben Definition und mit einem Jahr diagnosefreier Vorlaufzeit berechnet. Ergebnisse: Im Jahr 2011 ist für gesetzlich Versicherte eine Prävalenz von 9,7 % (Frauen: 9,4 %, Männer: 10,1 %) beobachtbar. Es existieren Prävalenzunterschiede zwischen den Bundesländern, wobei der maximale Unterschied 7,1 %-Punkte (altersstandardisiert: 4,0 %-Punkte) beträgt. Typ-2- und Typ-1-Diabetes zeigen eine Prävalenz von 7,5 % bzw. 0,28 %. Ein unspezifischer Diabetes wird mit 1,9 % relativ häufig dokumentiert. Bei 0,21 % der Personen wird der Diabetes ausschließlich über eine stationäre Nebendiagnose dokumentiert. Zusätzlich weisen 0,17 % der Personen ohne dokumentierten Diabetes mindestens eine Verordnung eines Antidiabetikums auf. Im Jahr 2012 sind 565.040 Versicherte neu an Diabetes erkrankt, dies entspricht 1,0 % der Versicherten (Frauen: 1,0 %, Männer: 1,1 %). Diskussion: Die erarbeitete Referenzauswertung ist für die Berichterstattung von Prävalenz und Inzidenz des dokumentierten Diabetes im Rahmen der Diabetes-Surveillance geeignet. Die Unterscheidung der Diabetestypen ist aufgrund der Codierungspraxis schwierig., Background: The prevalence and incidence of documented diabetes are two essential indicators intended to be reported on a periodic basis within the framework of diabetes surveillance in Germany. Methodology: Data provided based on the Data Transparency Act were analyzed. The data contain information on outpatient and inpatient care for all approximately 70 million persons with statutory health insurance. The case definition for the prevalence of documented diabetes comprises a confirmed outpatient diagnosis in at least two quarters of a year or an inpatient diagnosis in at least one quarter of a year in accordance with ICD-10 codes E10.- to E14.-. The incidence was calculated based on the same definition and with one year of diagnosis-free lead time. Results: In 2011, a prevalence of 9.7% (women: 9.4%, men: 10.1%) was observed for persons with statutory health insurance. There are considerable differences in prevalence between the federal states and the maximum gap is 7.1 percentage points (age standardized: 4.0 percentage points). Type 2 and type 1 diabetes show a documented prevalence of 7.5% and 0.28%, respectively. Unspecified diabetes is documented relatively frequently with 1.9%. In 0.21% of persons, the diagnosis diabetes is documented via one inpatient secondary diagnosis. In addition, 0.17% of people without documented diabetes have at least one prescription of an antidiabetic drug. In 2012, 565,040 insured persons were newly diagnosed with diabetes; this corresponds to 1.0% of the insured persons (women: 1.0%, men: 1.1%). Discussion: The developed reference analysis is suitable for reporting the prevalence and incidence of documented diabetes within the framework of diabetes surveillance. The differentiation of diabetes types is difficult due to coding practice.

Im Projekt BURDEN 2020 – Die Krankheitslast in Deutschland und seinen Regionen – werden anhand der amtlichen Todesursachenstatistik die durch vorzeitige Sterblichkeit verlorenen Lebensjahre (Years of Life Lost, YLL) berechnet. Dafür müssen „ungültige ICD-Codes“ identifiziert und umverteilt werden. „Ungültig“ bedeutet, dass ein ICD-Code die Todesursache nur ungenügend wiedergibt, sodass er für die Berechnung der Krankheitslast nicht informativ ist. In diesem Artikel werden die ersten Schritte zur Berechnung der todesursachenspezifischen YLL dargestellt. Klassifizierungen ungültiger Codes werden verglichen. Es wird untersucht, wie viele Todesfälle mit ungültigen Codes in der Todesursachenstatistik in Deutschland absolut und relativ vorliegen und wie sich diese nach Alter, Geschlecht und Regionen verteilen. Auf Grundlage der Klassifikation der Weltgesundheitsorganisation (WHO) können für das Jahr 2015 in Deutschland bei den insgesamt 925.200 Todesfällen 15,6 % ungültige Codes identifiziert werden. Nach der Klassifikation der Global Burden of Disease-Studie (GBD-Studie) des Institute for Health Metrics and Evaluation (IHME) liegt der Anteil bei 26,6 %. Die ICD-bezogenen Verteilungsmuster unterscheiden sich bei WHO- und IHME-Klassifikation kaum. Große Unterschiede gibt es zwischen den Bundesländern: Der Anteil ungültiger Codes beträgt 16–35 % (nach IHME-Klassifikation). Die Todesursachenstatistik in Deutschland enthält einen erheblichen Anteil an Todesfällen mit ungültigen Codes. Die Unterschiede zwischen den Bundesländern können nur teilweise mit der unterschiedlichen Verarbeitung der Daten erklärt werden. Zukünftig ist aufgrund der weiteren Verbreitung und Verbesserung der elektronischen Datenerfassung eine höhere Qualität der Todesursachenstatistik zu erwarten.

Background In Germany, patients are consulting general practitioners increasingly frequently, resulting in a high burden on the healthcare system. This study aimed to identify factors associated with frequent primary care attendance in the German healthcare system. Methods The German Health Interview and Examination Survey for Adults (DEGS) is part of Germany’s national health monitoring, and includes a large representative sample of the German population aged 18-79 years. We defined the 10% of participants with the highest number of physician contacts in the preceding 12 months as frequent attenders. Binary logistic regression models with average marginal effects were used to identify determinants for the frequent use of primary care services. Results The sample comprised 7,956 participants. Significant effects on frequent use of primary care were observed for low socioeconomic status, stressful life events, and factors related to objective need for medical care and subjective health status. In the full model, the number of non-communicable diseases and subjective health status had the strongest effect on frequent primary care use. We found an interaction effect between subjective health status and number of non-communicable diseases, indicating the association of disease with frequent use was highly moderated by subjective perception of health. Conclusions We observed strong associations between frequent primary care attendance and objective and subjective health-related factors. These findings suggest that better coordination of care may be a preferred method to manage health services utilization behaviour and avoid redundant examinations and uncoordinated clinical pathways. Further research is needed to clarify moderating and mediating factors contributing to high utilization of primary care services. Key messages The number of NCDs diseases and subjective health had the strongest effect on frequent primary care use. The findings suggest that better coordination of care may be the preferred method to manage health services utilization.

Background Although 36.5% of minors in Germany had a migration background (MB) in 2017, data on their health situation is scarce. The project ‘Improving Health Monitoring in Migrant Populations’ (IMIRA) initiated in 2016 aims to expand health reporting on the health situation of people with MB, for which a core indicator set was developed. We are describing the health situation of adolescents based on selected core indicators. Methods Data from the German Health Interview and Examination Survey for Children and Adolescents (KiGGS wave 2) (2014-2017) are used; adolescents from 11 to 17 years are considered. Prevalences and 95% confidence intervals are calculated for the following indicators: General health status, overweight, hazardous alcohol consumption and use of pediatric or general practitioner’s services. These indicators are stratified along socio-demographic (gender, age, socio-economic status (SES)) and migration-related characteristics (MB, parents’ duration of stay, language spoken at home). Results There are hardly any migration-related differences in the general health status and the use of general medical services. While adolescents with MB are more often affected by overweight (without MB: 11.2%, one-sided: 18.9%, both-sided: 19.8%), they show less often risky alcohol consumption (without MB: 14.5%, one-sided: 7.8%, both-sided: 4.4%). There are differences in health behavior according to SES, parents’ duration of stay in Germany and language spoken at home. Conclusions Overall, the health of adolescents is good, regardless of their MB, and general medical services are used equally. Differences in health behavior cannot be reduced solely to the (non-)existence of a MB, but need a deeper consideration of more specific migration-related characteristics and the SES. Key messages The general health status and health care utilization do not differ between adolescents with and without MB. In contrast, the results on indicators of health behavior vary.

Im Dezember 2014 erschien der „Bericht zur gesundheitlichen Lage der Manner in Deutschland“ im Rahmen der Gesundheitsberichterstattung des Bundes (GBE). Er deckt ein breites Themenspektrum ab, von Erkrankungen und Todesursachen uber das Gesundheitsverhalten bis zu mannerspezifischer Pravention. Fokuskapitel widmen sich dem Einfluss von Arbeit und Lebensformen auf die Gesundheit. Auf der Grundlage methodischer Vorarbeiten zu geschlechtersensibler GBE wurde fur die Berichterstellung ein mehrstufiges Verfahren angestrebt: Uber eine geschlechtervergleichende Perspektive hinaus sollten innerhalb der Gruppe der Manner Unterschiede hinsichtlich Belastungen, Risiken und Ressourcen thematisiert werden und die Ergebnisse vor dem Hintergrund politischer und gesellschaftlicher Rahmenbedingungen eingeordnet sowie theoriegeleitet interpretiert werden. Das Projektteam des Mannergesundheitsberichtes wirft im vorliegenden Artikel einen kritischen Blick auf seine Arbeit: Welche Schritte auf dem Weg zu einer geschlechtersensiblen GBE konnten im Bericht realisiert werden? Und wo besteht weiterhin Handlungsbedarf? Denn geschlechtersensible GBE kann dazu beitragen, die gesundheitliche Situation von Mannern und Frauen besser zu beschreiben und damit eine solide empirische Grundlage fur die Umsetzung einer geschlechtergerechten Gesundheitsversorgung liefern.

Ziel der Studie: Der populationsbezogene Einsatz von Physiotherapie bei Kindern und Jugendlichen wurde bisher ausschlieslich anhand von Krankenkassendaten analysiert, die weder anamnestische noch soziale Faktoren berucksichtigen konnen. Mithilfe der KiGGS-Basiserhebung ist es moglich die Inanspruchnahme von Physiotherapie auf Grund von elternberichteten gesundheitlichen Einschrankungen und sozialen Faktoren zu untersuchen. Methodik: In der KiGGS-Basiserhebung identifizierbare Determinanten fur die Inanspruchnahme von Physiotherapie in den letzten 12 Monaten wurden bivariat untersucht und multivariat in logistischen Regressionsmodellen uberpruft. Folgende Determinanten wurden berucksichtigt: soziale Faktoren, gesundheitliche Einschrankungen und psychische Auffalligkeiten. Der Anteil an der Inanspruchnahme von Physiotherapie, welcher durch diese Determinanten erklart werden kann, wurde mittels populationsattributabler Risikofraktion geschatzt. Ergebnisse: Die Haufigkeit der Inanspruchnahme von Physiotherapie in den letzten 12 Monaten bei den 0 bis 17-Jahrigen in der KiGGS-Basiserhebung betrug 6,4%. Der soziookonomische Status der Eltern war nicht mit der Inanspruchnahme von Physiotherapie assoziiert. Ein Migrationshintergrund verringerte die Wahrscheinlichkeit der Inanspruchnahme von Physiotherapie z. B. bei Kindern im Alter von 0 bis 2 Jahre (ORadjustiert: 0,5 [95% KI: 0,2–1,0]). Der Anteil der Kinder und Jugendlichen mit Skoliose, bei welchen die Inanspruchnahme von Physiotherapie berichtete wurde, war im Sauglingsalter fast doppelt so hoch wie bei Jugendlichen (58,4 vs. 34,4%). Maximal 15% der Kinder und Jugendlichen mit Ruckenschmerzen berichteten eine Inanspruchnahme von Physiotherapie. Bei diagnostiziertem ADHS im Vorschulalter (ORadjustiert: 5,1 [95% KI: 1,4–18,6]) war die Wahrscheinlichkeit der Inanspruchnahme von Physiotherapie erhoht. Bei den 0 bis 2-Jahrigen konnten die in der KiGGS-Basiserhebung erfassten gesundheitlichen Einschrankungen die Inanspruchnahme zu 37% erklaren, in den anderen Altersgruppen zu 59 bis 62%. Schlussfolgerung: Der Vergleich der KIGGS-Basiserhebung und Krankenkassendaten zeigt ahnliche Inanspruchnahmehaufigkeiten und – muster fur Physiotherapie und kann deshalb fur die Analyse von Versorgungsfragestellungen zur Inanspruchnahme von Physiotherapie genutzt werden. Hierbei zeigen sich Hinweise auf mogliche Defizite in der Versorgung. Eine Uberprufung dieser Hypothesen anhand vertiefter Analysen von Krankenkassendaten ist sinnvoll.

Erratum to: Bundesgesundheitsbl (2018) https://doi.org/10.1007/s00103-018-2793-0 The original publication of this article contained an error in the list of the authors, in which the contributing author Christian Schmidt was missing. The full list of authors has now been updated. The original article …

Background Evidence-based policy measures need non-interest-guided information about the health status of a population and the diseases that affect the population the most. In such cases, a national burden of disease study can provide reliable insights at the regional level. Aim This article presents the potential of the BURDEN 2020 project and its expected outcome for Germany at the national and regional level. Methods The BURDEN 2020 project uses several indicators including years of life lost (YLL) to cover the impact of mortality and years lived with disability (YLD) to cover morbidity. The sum of both is the measure of population health called disability adjusted life years (DALY). Results The study ranks individual diseases and risk factors based on their impact on population health. The burden of disease approach is assumed to be sensitive to subnational differences and may generate immediate benefits for regional planning. The BURDEN 2020 study will pilot a national burden of disease study for Germany that will later be transformed into a continuous data processing and visualization tool. This is done by using, modifying and supplementing the methodology employed by the Global Burden of Disease (GBD) study to better fit the needs of health policy in Germany. This study is aimed at calculating the disease burden for up to 17 preselected diseases. Furthermore, the estimates of burden of disease are attributed to a selected set of risk factors. Conclusion The Burden 2020 study will provide the results of a new, health-related data processing system to the public. This includes a noninterest-guided presentation of the burden of disease (DALY) in Germany at the national and regional level.

Menschen mit Migrationshintergrund (MMH) weisen spezifische gesundheitliche Risiken und Ressourcen im Vergleich zu Menschen ohne Migrationshintergrund (MoMH) auf. Analysiert wird hier der Zusammenhang zwischen dem Migrationshintergrund und der gesundheitlichen Lage. Zudem wird untersucht, ob der soziookonomische Status (SES) zur Erklarung der Unterschiede zwischen MMH und MoMH beitragt. Datenbasis bildet die „Studie zur Gesundheit Erwachsener in Deutschland" (DEGS1) des Robert Koch-Instituts (2008–2012, n = 8151). Die Auswertepopulation enthalt 1107 MMH (gewichtet: 19,8 %). Der Fragestellung wird anhand von neun ausgewahlten Gesundheitsoutcomes nachgegangen. Alle Auswertungen erfolgen nach Geschlecht und unterscheiden nach MMH der 1. und 2. Generation. Logistische Regressionsmodelle werden nach Alter und SES adjustiert. Die Ergebnisse zeigen klare geschlechtsspezifische Muster. Bei Frauen sind Unterschiede vor allem bei MMH der 1. Generation signifikant. Verglichen mit MoMH weisen sie einen schlechteren allgemeinen Gesundheitszustand auf, sind korperlich inaktiver, trinken weniger Alkohol, sind schlechter uber Programme der Krebsfruherkennung informiert und nehmen praventive Leistungen seltener in Anspruch. Tagliche Raucherinnen sind nur bei Frauen der zweiten Generation haufiger vertreten als bei MoMH. Bei Mannern finden sich alle signifikanten Unterschiede in der ersten sowie der zweiten Generation. Manner mit Migrationshintergrund weisen haufiger depressive Symptome auf, konsumieren seltener Alkohol und sind uber Programme der Krebsfruherkennung schlechter informiert. Der Effekt des Migrationshintergrundes auf die gesundheitliche Lage bleibt auch nach Kontrolle des SES weitgehend erhalten. Die DEGS1-Ergebnisse sind vor dem Hintergrund der bestehenden Evidenz plausibel und liefern weiterfuhrende Erkenntnisse. Die Nutzung dieser Daten fur die Migrationsforschung erfordert eine differenzierte Betrachtung der Population der MMH und eine sorgfaltige Einordnung der Befunde.

Research into health inequalities in the elderly population of Germany is relatively scarce. This study examines socioeconomic inequalities in health and perceived unmet needs for healthcare and explores the dynamics of health inequalities with age among elderly people in Germany. Data were derived from the Robert Koch Institute’s cross-sectional German Health Update study. The sample was restricted to participants aged 50–85 years (n = 11,811). Socioeconomic status (SES) was measured based on education, (former) occupation, and income. Odds ratios and prevalence differences were estimated using logistic regression and linear probability models, respectively. Our results show that self-reported health problems were more prevalent among men and women with lower SES. The extent of SES-related health inequalities decreased at older ages, predominantly among men. Although the prevalence of perceived unmet needs for healthcare was low overall, low SES was associated with higher perceptions of unmet needs in both sexes and for several kinds of health services. In conclusion, socioeconomic inequalities in health exist in a late working age and early retirement but may narrow at older ages, particularly among men. Socially disadvantaged elderly people perceive greater barriers to accessing healthcare services than those who are better off.

Kinder und Jugendliche haben im Vergleich zu Erwachsenen ein besonders hohes Risiko, Unfallverletzungen zu erleiden. Um Unfallverletzungen vorzubeugen, sind detaillierte Kenntnisse uber das gesamte Unfallgeschehen und uber die Determinanten von Unfallverletzungen notwendig. Dieser Artikel gibt einen Uberblick uber Daten zu Unfallen bei Kindern und Jugendlichen in Deutschland. Laut dem Kinder- und Jugendgesundheitssurvey (KiGGS-Basiserhebung) des Robert Koch-Instituts (RKI) erleiden in Deutschland etwa 15,3 % der Kinder und Jugendlichen (1 bis 17 Jahre) pro Jahr mindestens eine Unfallverletzung. Die meisten Unfalle (60,7 %) ereignen sich zu Hause oder bei Freizeitbeschaftigungen. In Bildungs- und Betreuungseinrichtungen registrierte die Deutsche Gesetzliche Unfallversicherung (DGUV) im Jahr 2011 uber 1,4 Mio. Unfalle. Die amtliche Verkehrsunfallstatistik zahlte im gleichen Jahr mehr als 50.000 minderjahrige Verkehrsunfallopfer. Die Krankenhausdiagnosestatistik erfasste im Jahr 2011 insgesamt 260.534 stationare Behandlungsfalle aufgrund von Verletzungen und Vergiftungen bei Kindern und Jugendlichen. Alters- und geschlechtsspezifische Unterschiede zeigen sich in allen Datenquellen. Jungen sind haufiger von Unfallverletzungen betroffen als Madchen. Im Jugendalter erleiden sie mehr Unfalle als im Kleinkind- und Grundschulalter. Bei jungen Kindern ereignen sich Unfalle hauptsachlich zu Hause, bei Jugendlichen zunehmend im Verkehr oder bei Freizeitbeschaftigungen. Es gibt zahlreiche Initiativen in Deutschland, die sich der Pravention von Unfallen bei Kindern und Jugendlichen widmen. Die Ableitung zielgruppenspezifischer Praventionsmasnahmen wird durch die unterschiedlichen methodischen Zugange der verfugbaren Datenquellen erschwert.

BACKGROUND: In Germany, a nationwide systematic collection of data regarding fall incidents within health-care facilities is lacking. The objective of the study was to provide valid and robust data on fall rates, the severity of the fall and its resulting injuries, fall risk assessment, and preventive measures offered by professional caregivers in German hospitals and nursing homes. MATERIALS AND METHODS: Each spring from 2006 to 2013, cross-sectional studies were conducted in 124 hospitals (n = 22,493 patients) and 332 nursing homes (25,384 residents) throughout Germany. Fully trained nurses obtained information on the recent history (RESULTS: The total fall rate was 3.9 % (95 % CI 3.6-4.2) in the hospitals and 4.6 % (95 % CI 4.3-4.9) in the nursing homes. Of the fall victims, 6.4 % of the nursing home residents and 8.8 % of the hospital patients were badly injured (i.e., fracture). The fall risk was considered high for residents, with two thirds of all residents being affected, while it was lower for the patients, at one third. The following factors were associated with fall risk: limited mobility, cognitive impairment, recent history of falls for nursing home residents, and additionally urinary incontinence and higher age in hospital patients. The most common preventive measure was counseling of the individual in both settings. CONCLUSION: Although most falls have no severe consequences, the study shows that every 20-25th individual has a falling event in hospitals and nursing homes within 14 days. Despite the slight variance, the trend of the rates remains largely stable. Because specific fall risks were determined, preventive measures can be applied in a more personalized manner and care can be improved. Finally, the study provides valid and durable figures for national and international comparisons. Language: de

In Deutschland gab es im Jahr 2011 uber 20.000 Unfalltote und schatzungsweise 8,7 Mio. Unfallverletzte. Der folgende Artikel liefert einen Uberblick uber das nicht-todliche Unfallgeschehen bei Erwachsenen in Deutschland. In der telefonischen Gesundheitsbefragung „Gesundheit in Deutschland aktuell“ 2010 (n = 22.050) wurden reprasentative Daten uber das nicht-todliche Unfallgeschehen bei Erwachsenen erhoben. Personen mit arztlich versorgten Unfallverletzungen in den letzten 12 Monaten wurden anhand von 19 Items uber Unfallorte, Unfallmechanismen, Verletzungen und Unfallfolgen von bis zu 3 Unfallen innerhalb eines Jahres befragt. Insgesamt wurden 2117 Unfalle detailliert erfasst. Etwa 7,9 % der Erwachsenen in Deutschland erleiden innerhalb eines Jahres eine arztlich versorgte Unfallverletzung. Manner verunfallen haufiger als Frauen und jungere Menschen ofter als Altere. Mehr als die Halfte der Unfalle ereignet sich zu Hause oder bei Freizeitbeschaftigungen. Etwa jeder funfte Unfall geschieht auf offentlichen Wegen, Platzen oder Strasen. Fast jeder dritte Unfall ist ein Sturz, und etwa jeder funfte Unfall endet mit einem Knochenbruch. Ungefahr zwei Drittel aller Unfallverletzungen werden im Krankenhaus behandelt. Zwei von 3 Unfallen fuhren zur Arbeitsunfahigkeit von durchschnittlich 29,7 Tagen. Sturze sind die folgenreichsten Unfalle in der hauslichen Umgebung und der Freizeit und spielen eine wichtige Rolle bei Fahrrad- und Fusgangerunfallen. Unfallverletzungen betreffen grose Teile der erwachsenen Bevolkerung in Deutschland. Das Unfallgeschehen unterscheidet sich zwischen Frauen und Mannern sowie zwischen Lebensbereichen und Lebensphasen. Praventionsmasnahmen sollten folglich zielgruppenspezifische Bedarfe und settingspezifische Charakteristika des Unfallgeschehens berucksichtigen.

Demographic change, advances in medicine, and innovative health care services are leading to changes in the professional qualification requirements for nursing and care staff. Detecting future trends in relation to these requirements was the focus of a Delphi study developed as part of the BMBF FreQueNz initiative. After qualitative expert interviews, data collection was organized in three consecutive steps, with 243 interviews realized in the second wave. It was found that home care will further diversify in the fields of supporting and counseling services as well as in palliative care, resulting in the necessary expansion of specific qualifications (e.g., intensive care). Moreover, there will be an increased need for interprofessional, intersectoral, and intercultural coordination and communication skills. As a consequence of the delegation of medical tasks, new duties for nonmedical professions in inpatient and outpatient care will also arise. For instance, qualifications need to be tailored to the new demands of assessment, diagnostics, therapy, and patient education and they should take into account evidence-based knowledge as well as clinical practice guidelines. Consequently, the system of care professionals will further diversify through advanced training programs and the continued academization of nursing.

The aim of this special issue is therefore to combine the different perspectives and to bring together the available data sources and research results on the accident and its consequences. Experts from the fields of public health, medicine, nursing, sports, psychology, prevention, come from the insurance sector and from research to speak. Equally varied are the target groups for which should provide a good introduction to the subject, or new insights for their own area of ​​interest . Language: de

Mit dem Gesundheitsmonitoring der Migrationsbevolkerung in der Schweiz (GMM) wurde ein Datensatz uber die Gesundheitssituation, das Gesundheitsverhalten sowie die Inanspruchnahme der Gesundheitseinrichtungen von Migranten1 geschaffen. Dieser ermoglicht erstmals reprasentative Aussagen uber die Gesundheitssituation der Eingewanderten im Vergleich zur einheimischen Bevolkerung. In Anlehnung an die schweizerische Gesundheitsbefragung wurde ein Fragebogen entwickelt und in verschiedene Sprachen ubersetzt. Es wurden telefonische Interviews mit Migranten aus der standigen Wohnbevolkerung sowie mit Asylsuchenden wahlweise in der Muttersprache oder einer schweizerischen Landessprache durchgefuhrt. Erste deskriptive Analysen des Datensatzes liegen vor. Die Ergebnisse zeigen, dass Migranten aus westeuropaischen Landern vergleichbare gesundheitliche und soziale Werte wie die einheimische Bevolkerung aufweisen. Alle anderen Eingewanderten zeigen hinsichtlich vieler gesundheitlicher und auch sozialer Indikatoren ungunstigere Ergebnisse. Sie beurteilen beispielsweise ihren selbst wahrgenommenen Gesundheitszustand haufiger als mittelmasig oder schlecht, fuhlen sich psychisch weniger ausgeglichen oder besuchen haufiger einen Arzt als Autochthone. Die Daten verdeutlichen das Bestehen erheblicher Unterschiede im Gesundheitszustand innerhalb der befragten Migrationsbevolkerung, der je nach Geschlecht, Alter, dem Aufenthaltsstatus oder der Nationalitat variiert.

Health and social monitoring are important foundations of political decision making. In order to make statements about populations and subgroups different sources of information are generally used. The potential contribution which aggregated official health data of service providers can make is discussed in the exemplary context of the utilisation of medical rehabilitation of mental diseases. Age specific rates and age standardised ratios show a significantly increased utilisation of services for depression and somatoform disorders amongst women in general and the migrant population in particular. It is demonstrated that the interpretation of such results raises new research questions rather than providing explanations that could prove to be conducive for practical measures. In a methodological discussion it is stated that the reason for this has to be seen in the fact that important structures of action within the care system are concealed by the specific method of collecting and processing official health data. Nevertheless, conceivable interpretations are given regarding the psycho-social living conditions of large parts of the migrant population as well as their difficulties in the interaction with the medical system. This enables the formulation of a hypothetical framework for further research which could help to clarify statistical phenomena found in the official data of service providers.

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.

Vor dem Hintergrund der Frage, inwieweit in Deutschland noch eine Gesundheitsversorgung fur alle auf hochstem Niveau gewahrleistet werden kann, wird das deutsche Gesundheitswesen auf seine allokativen Grundprinzipien hin untersucht. Die Art und Weise, wie die Rationierungsdebatte insbesondere auch in Bezug auf ihre ethischen Aspekte offentlich ausgetragen wird, macht es notwendig, zunachst sowohl egalitaristische als auch utilitaristische Denkansatze unter Berucksichtigung der Verteilung von Gesundheitsgutern zu unterscheiden. Mit Hilfe der so herausgearbeiteten Begrifflichkeiten wird es vor dem Hintergrund des Neokorporatismus im deutschen Gesundheitswesen moglich, einerseits die Rationierung von Gesundheitsgutern und andererseits die entsprechende Debatte analytisch zu fassen. Wahrend sich Rationierung auch fur Deutschland nachweisen lasst, wird Leistungsausgrenzung in der Diskussion zumeist noch als etwas Zukunftiges behandelt. Diese Diskrepanz von Realitat und Debatte findet ihren Ausdruck nicht zuletzt in einer Rationierungspraxis, die den Prinzipien einer pluralistisch verfassten Gesellschaft entgegensteht. Abschlieβend wird besonders unter demokratisch legitimatorischen Gesichtspunkten der Rahmen des Vertretbaren abgesteckt.

Background Unintentional injuries (UIs) caused by falls are an important public health issue in ageing populations. This paper describes the incidence and consequences of falls in the adult population in Germany; the focus is on age and gender differences. Methods The representative phone survey “German Health Update 2010” (n = 22,050) provides information on up to three medically treated UIs within twelve months. Analyses focus on the characteristics of falls compared to other types of UIs. Frequencies and 95% confidence intervals (CI: 95) were calculated and logistic regression was applied to control for confounders. Results Like UIs in general, falls are more frequent in younger than in older age, particularly in men. The prevalence decreases from 5.3% (CI95: 4.2–6.7) in men aged 18–29 to 1.8% (CI95: 1.0–3.3) in men aged 70 and over. However, at the same time, the proportion of falls among all UIs rises with age: from 22.7% (CI95: 18.4–27.7) to 52.6% (CI95: 32.7–71.7) in men and from 20.1% (CI95:15.2–26.0) to 63.9% (CI95: 47.7–77.5) in women. The proportion of falls that occur at home also increases significantly with age: from 14% to over 50%. Still, among the elderly, about one third of falls occurs in public places (among pedestrians). The consequences of UIs caused by falls are often serious: 34.4% (CI95:29.8–39.4) of all falls cause bone fractures (all UIs: 20.4%; CI95: 18.3–22.6). One-quarter (26.8%; CI95: 22.4–31.7) result in hospitalisation (all UIs: 18.3%; CI95: 16.2–20.5). Moreover, the need for physical therapy and rehabilitation is higher after falling compared to all other UIs. Conclusions The data demonstrate the severity of UIs caused by falls and reveal important age and gender specific patterns. Older people are no more at risk than younger people, but the consequences for them are more serious than for the younger. Consequently, fall-related UIs are of importance in all ages and require age and gender specific approaches to prevention.