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BACKGROUND: Summary measures such as disability-adjusted life years (DALY) are becoming increasingly important for the standardized assessment of the burden of disease due to death and disability. The BURDEN 2020 pilot project was designed as an independent burden-of-disease study for Germany, which was based on nationwide data, but which also yielded regional estimates. METHODS: DALY is defined as the sum of years of life lost due to death (YLL) and years lived with disability (YLD). YLL is the difference between the age at death due to disease and the remaining life expectancy at this age, while YLD quantifies the number of years individuals have spent with health impairments. Data are derived mainly from causes of death statistics, population health surveys, and claims data from health insurers. RESULTS: In 2017, there were approximately 12 million DALY in Germany, or 14 584 DALY per 100 000 inhabitants. Conditions which caused the greatest number of DALY were coronary heart disease (2321 DALY), low back pain (1735 DALY), and lung cancer (1197 DALY). Headache and dementia accounted for a greater disease burden in women than in men, while lung cancer and alcohol use disorders accounted for a greater disease burden in men than in women. Pain disorders and alcohol use disorders were the leading causes of DALY among young adults of both sexes. The disease burden rose with age for some diseases, including cardiovascular diseases, dementia, and diabetes mellitus. For some diseases and conditions, the disease burden varied by geographical region. CONCLUSION: The results indicate a need for age- and sex-specific prevention and for differing interventions according to geographic region. Burden of disease studies yield comprehensive population health surveillance data and are a useful aid to decision-making in health policy.

Highlights • First longitudinal data analyses on sports activity patterns and health. • Long-standing sports activity engagement improves cardio-metabolic health. • Starting regular sports activity reduces cardio-metabolic risk factor occurrence. • Relapse from regular sports activity increases cardio-metabolic disease incidence., Background Physical activity is favorable for health, and vigorous sports activity is particularly beneficial. This study investigates the association between changes in sports participation patterns over time and cardio-metabolic and self-perceived health outcomes. Methods Data from 3752 adults (18–79 years of age) who participated in 2 national health interview and examination surveys in 1997–1999 and 2008–2011 were included, with a mean follow-up time of about 12 years. A change in self-reported sports activity was analyzed with respect to the incidence of type 2 diabetes, coronary heart disease (CHD), hypertension, obesity, dyslipidemia, metabolic syndrome, and poor self-perceived health. Participants with pre-existing disease or risk factor of interest at baseline were excluded from the analysis. Being sufficiently active in sports was specified as doing sports for at least 1–2 h per week, and 4 activity categories were defined: 1) inactive at both time points (inactive–inactive), 2) inactive at baseline and active at follow-up (inactive–active), 3) active at baseline and inactive at follow-up (active–inactive), and 4) active at both time points (active–active). Associations between sports activity engagement and health outcomes were estimated by logistic regression models with different stages of adjustments. Results Not engaging in any regular sports activity at both time points (inactive–inactive) was associated with higher rates of type 2 diabetes (odds ratio (OR) = 1.82, 95% confidence interval (95%CI): 1.08–3.08), CHD (OR = 1.82, 95%CI: 1.16–2.84), hypertension (OR = 1.36, 95%CI: 1.03–1.81), metabolic syndrome (OR = 1.58, 95%CI: 1.08–2.32), and poor self-perceived health (OR = 2.54, 95%CI: 1.83–3.53) compared to doing regular sports for a minimum of 1–2 h per week over time (active–active). In case of change from inactivity to any regular sports activity (inactive–active), the rate of risk factor occurrence was not statistically different from the active–active reference group except for poor self-perceived health, but it was higher for type 2 diabetes (OR = 2.15, 95%CI: 1.12–4.14) and CHD (OR = 1.77, 95%CI: 1.03–3.03). Being active at baseline but inactive at follow-up (active–inactive) was not associated with higher disease incidence of type 2 diabetes (OR = 0.70, 95%CI: 0.25–1.97) or CHD (OR = 1.20, 95%CI: 0.49–2.99), but was associated with higher rates of hypertension (OR = 1.61, 95%CI: 1.11–2.34), obesity (OR = 2.34, 95%CI: 1.53–3.57), metabolic syndrome (OR = 1.70, 95%CI: 1.11–2.63), and poor self-perceived health (OR = 2.16, 95%CI: 1.53–3.07) at follow-up. Conclusion Even a low weekly quantity (1–2 h) of regular sports activity is partly associated with health benefits. Being formerly but not currently active was not associated with an increased disease incidence, but was associated with a higher risk-factor development compared to the reference group (active–active). Becoming active was preventive for risk-factor development but was not preventive for disease incidence, which probably means that the health benefits from sports activity are not sustainable and disease incidence is only shifted to a later period in life. For this reason, the promotion of and commitment to regular sports activity should be addressed as early as possible over the lifespan to achieve the best health benefits., Graphical Abstract Image, graphical abstract

Trends of frequent chronic diseases and health problems, e.g. allergic diseases, have already been published based on the KiGGS Wave 2 study as part of the health monitoring of children and adolescents in Germany. The present work complements these findings with results on less frequent noncommunicable diseases and the trend of communicable, vaccine-preventable diseases.Information from parents about diagnoses and diseases of their 0‑ to 17-year-old children from the representative cross-sectional survey KiGGS Wave 2 (2014-2017) are compared with those from the KiGGS baseline survey (2003-2006) and KiGGS Wave 1 (2009-2012).The current KiGGS results show almost unchanged prevalences for the noncommunicable diseases epilepsy, migraine, and heart disease. However, the data from KiGGS Wave 2 are supportive of an increased prevalence of diabetes mellitus, which nevertheless continues to be relatively rare and predominantly type 1 diabetes in children and adolescents.The decline in measles, chicken pox, and whooping cough diseases related to changes in vaccination recommendations shows that preventive measures can effectively benefit children and adolescents.However, the data on vaccine-preventable diseases indicate regionally varying immunity gaps in certain age groups, so the prevention potential of the vaccination recommendations of the Standing Vaccination Commission (STIKO) at the Robert Koch Institute does not seem to have been sufficiently exploited.

Der Nutzen medikamentoser Sekundarpravention bei koronarer Herzkrankheit (KHK) ist fur Frauen und Manner belegt. In der Verordnung dieser Arzneimittel werden aber geschlechtsspezifische Unterschiede beobachtet. Was fehlt, sind Ergebnisse zur zeitlichen Entwicklung der Anwendungspravalenzen in bevolkerungsbezogenen Studien fur Frauen und Manner im Vergleich. Genutzt wurden Daten von Personen mit KHK aus dem Bundes-Gesundheitssurvey (BGS98 1997–1999, n = 411) und aus der Studie zur Gesundheit Erwachsener in Deutschland (DEGS1 2008–2011, n = 440) im Alter von 40–79 Jahren. Die zeitliche Entwicklung medikamentoser Sekundarpravention mit Thrombozytenaggregationshemmern (TAH), Statinen, Betarezeptorenblockern, Mitteln mit Wirkung auf das Renin-Angiotensin-System (RAS-Blocker), Calciumantagonisten und Nitraten zwischen BGS98 und DEGS1 wurde in Trendanalysen mit multivariablen Regressionsmodellen fur Frauen und Manner ermittelt. In einer Dekade stieg die Anwendungspravalenz fur TAH (24,0 % vs. 59,6 %), Statine (18,5 % vs. 56,2 %), Betarezeptorenblocker (24,7 % vs. 65,5 %) und RAS-Blocker (31,6 % vs. 69,0 %) an. Sie nahm fur Calciumantagonisten (33,3 % vs. 20,5 %) und Nitrate (40,6 % vs. 10,1 %) ab. In BGS98 wiesen Manner hohere Anwendungspravalenzen von RAS-Blockern auf als Frauen. Signifikante geschlechtsspezifische Unterschiede waren in DEGS1 nur fur „Angiotensin-Converting-Enzyme“(ACE)-Hemmer festzustellen. Die Ergebnisse reflektieren eine Verbesserung medikamentoser Sekundarpravention bei KHK fur beide Geschlechter.

IntroductionWe investigated whether the presence of depressive symptoms among adults with diagnosed diabetes is associated with adverse quality of diabetes care.Research design and methodsThe study population was drawn from the German national health survey ‘German Health Update’ 2014/2015-European Health Interview Survey and included 1712 participants aged ≥18 years with self-reported diabetes during the past 12 months. Depressive symptoms in the past 2 weeks were assessed by the eight-item depression module of the Patient Health Questionnaire (PHQ-8), with PHQ-8 sum score values ≥10 indicating current depressive symptoms. We selected 12 care indicators in diabetes based on self-reported information on care processes and outcomes. Associations of depressive symptoms with those indicators were examined in multivariable logistic regression models with stepwise adjustments.ResultsOverall, 15.6% of adults with diagnosed diabetes reported depressive symptoms, which were higher in women than in men (18.7% vs 12.9%). Adjusted for age, sex, education, social support, health-related behaviors, and diabetes duration, adults with depressive symptoms were more likely to report acute hypoglycemia (OR 1.81, 95% CI 1.13 to 2.88) or hyperglycemia (OR 2.10, 95% CI 1.30 to 3.37) in the past 12 months, long-term diabetes complications (OR 2.30, 95% CI 1.55 to 3.39) as well as currently having a diet plan (OR 2.14, 95% CI 1.39 to 3.29) than adults without depressive symptoms. Significant associations between depressive symptoms and other care indicators were not observed.ConclusionsThe present population-based study of adults with diagnosed diabetes indicates an association between depressive symptoms and adverse diabetes-specific care with respect to outcome but largely not to process indicators. Our findings underline the need for intensified care for persons with diabetes and depressive symptoms. Future research needs to identify underlying mechanisms with a focus on the inter-relationship between diabetes, depression and diabetes-related distress.

The SARS-CoV-2 coronavirus has spread rapidly across Germany. Infections are likely to be under-recorded in the notification data from local health authorities on laboratory-confirmed cases since SARS-CoV-2 infections can proceed with few symptoms and then often remain undetected. Seroepidemiological studies allow the estimation of the proportion in the population that has been infected with SARS-CoV-2 (seroprevalence) as well as the extent of undetected infections. The 'CORONA-MONITORING bundesweit' study (RKI-SOEP study) collects biospecimens and interview data in a nationwide population sample drawn from the German Socio-Economic Panel (SOEP). Participants are sent materials to self-collect a dry blood sample of capillary blood from their finger and a swab sample from their mouth and nose, as well as a questionnaire. The samples returned are tested for SARS-CoV-2 IgG antibodies and SARS-CoV-2 RNA to identify past or present infections. The methods applied enable the identification of SARS-CoV-2 infections, including those that previously went undetected. In addition, by linking the data collected with available SOEP data, the study has the potential to investigate social and health-related differences in infection status. Thus, the study contributes to an improved understanding of the extent of the epidemic in Germany, as well as identification of target groups for infection protection.

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.

The health status of older people in Germany can be compared with the health of older people in other European Union (EU) Member States using data on the distribution of limitations in activities of daily living. This concept covers basic limitations in activities of daily living (ADL) such as eating, as well as limitations in instrumental activities of daily living (iADL) such as shopping and managing finances. The second wave of the European Health Interview Survey (EHIS 2) collected data on five ADLs and seven iADLs for people aged 65 or above. An ADL or iADL limitation was defined if a participant reported at least a lot of difficulty in at least one ADL or iADL, respectively. On average, 8.4% of the EU population reported an ADL limitation, with 25.2% reporting an iADL limitation. However, prevalences vary widely between EU Member States and are lower in Germany than the EU average (ADL limitation 6.3%, iADL limitation 14.0%). In general, women, people aged 75 or above, and lower education groups have a higher prevalence of ADL and iADL limitations.

ZusammenfassungIn allen Ländern steigt die Lebenserwartung und viele ältere Menschen verbringen mehr Zeit bei guter Gesundheit. Allerdings leiden Ältere auch unter Gebrechlichkeit (engl. frailty), die als Risikofaktor für Erkrankungen, Behinderungen oder Stürze gilt. Im Rahmen der „Studie zur Gesundheit Erwachsener in Deutschland“ (DEGS) 2008 – 2011 wurden Interviews, Untersuchungen und Tests durchgeführt. Für die Auswertungen wurden Daten von 1110 zu Hause lebenden DEGS1-Teilnehmenden im Alter von 70 bis 79 Jahren analysiert. Körperliche Gebrechlichkeit wurde definiert als das Vorliegen von drei oder mehr der folgenden Kriterien: selbst berichtete Erschöpfung, reduzierte Greifkraft, verlangsamte Gehgeschwindigkeit, geringe körperliche Aktivität und ein niedriger Body-Mass-Index; beim Vorliegen ein oder zwei der Kriterien wird von einer Vorstufe der Gebrechlichkeit (pre-frailty) ausgegangen. Bei Männern wurden 36,6% (Konfidenzintervall KI 32,2 – 41,2) als pre-frail, 2,5% (KI 1,4 – 4,4) als gebrechlich eingestuft; bei Frauen wurden 41,8% (KI 37,3 – 46,5) als pre-frail und 2,9% (KI 1,9 – 4,5) als gebrechlich eingestuft. Gebrechliche Personen geben signifikant häufiger Polypharmazie und Mehrfach-Stürze an, beziehen Leistungen aus der Pflegeversicherung, haben eine amtlich anerkannte Schwerbehinderung und geringere soziale Unterstützung. Diese bevölkerungsrepräsentativen Ergebnisse tragen zur Identifikation von gebrechlichen Menschen mit einem erhöhten Risiko für gesundheitliche Folgen bei. Entsprechende Prognosemodelle sollten in der operativen Anästhesiologie für die verschiedenen Versorgungsbereiche weiterentwickelt werden.

Background and Purpose— As stroke in young adults is assumed to have different etiologies and risk factors than in older populations, the aim of this study was to examine the contribution of established potentially modifiable cardiovascular risk factors to the burden of stroke in young adults. Methods— A German nationwide case–control study based on patients enrolled in the SIFAP1 study (Stroke In Young Fabry Patients) 2007 to 2010 and controls from the population-based GEDA study (German Health Update) 2009 to 2010 was performed. Cases were 2125 consecutive patients aged 18 to 55 years with acute first-ever stroke from 26 clinical stroke centers; controls (age- and sex-matched, n=8500, without previous stroke) were from a nationwide community sample. Adjusted population-attributable risks of 8 risk factors (hypertension, hyperlipidemia, diabetes mellitus, coronary heart disease, smoking, heavy episodic alcohol consumption, low physical activity, and obesity) and their combinations for all stroke, ischemic stroke, and primary intracerebral hemorrhage were calculated. Results— Low physical activity and hypertension were the most important risk factors, accounting for 59.7% (95% confidence interval, 56.3–63.2) and 27.1% (95% confidence interval, 23.6–30.6) of all strokes, respectively. All 8 risk factors combined explained 78.9% (95% confidence interval, 76.3–81.4) of all strokes. Population-attributable risks of all risk factors were similar for all ischemic stroke subtypes. Population-attributable risks of most risk factors were higher in older age groups and in men. Conclusions— Modifiable risk factors previously established in older populations also account for a large part of stroke in younger adults, with 4 risk factors explaining almost 80% of stroke risk. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT00414583.

OBJECTIVE To examine the association of diagnosed depression with the utilization of health care services and preventive measures among men and women in the general population in Germany. METHODS Cross-sectional analysis of data from a representative telephone survey (men N = 18,675, women N = 24,518, 18 years and older). Self-reported health professional-diagnosed depression (past 12 months) and the use of a range of health care and preventive services were assessed. RESULTS Diagnosed depression was associated with increased health care service utilization in both sexes. Diagnosed depression was associated with higher utilization of some preventive services, such as general health check-ups (odds ratio [OR] 1.2), cancer screening (OR 1.2) and flu vaccination (OR 1.3) among women and cancer screening (OR 1.4) among men. CONCLUSIONS Health professional-diagnosed depression is associated with increased health service utilization independent of somatic comorbidity and socio-demographic confounders. There was no indication for specific under-treatment with preventive measures among people with depression diagnosis.

Uber die Halfte aller kardiovaskularen Erkrankungen wird von acht zum Teil vermeidbaren Risikofaktoren verursacht. Angesichts deutlicher Pravalenz- und Mortalitatsunterschiede bei Herz-Kreislauf-Erkrankungen zwischen den deutschen Bundeslandern wird die regionale Verteilung von kardiovaskularen Risikofaktoren bevolkerungsreprasentativ und geschlechtsspezifisch untersucht. Anhand von gepoolten Daten (n = 62.606) der bundesweiten, telefonischen Gesundheitssurveys „Gesundheit in Deutschland aktuell (GEDA)“ 2009, 2010 und 2012 wurden die Pravalenz von sportlicher Inaktivitat, riskantem Alkoholkonsum, Rauchen, geringem Obst- und Gemuseverzehr, Adipositas, arztlich diagnostizierter Hypertonie, Diabetes und Fettstoffwechselstorungen sowie die zusammengefasste Anzahl von Risikofaktoren getrennt fur Manner und Frauen in den Bundeslandern bestimmt. Zusatzlich wurde der Einfluss von Alter und Sozialstatus auf Pravalenzunterschiede untersucht. Im Bundesdurchschnitt hatten 36,0 % der mannlichen und 26,6 % der weiblichen Bevolkerung drei oder mehr Risikofaktoren. Grose Unterschiede zwischen Mannern und Frauen gab es vor allem beim riskanten Alkoholkonsum (32,8 % versus 21,7 %), einem geringen Obst- und Gemuseverzehr (20,6 % versus 10,4 %) sowie beim aktuellen Rauchen (32,6 % versus 24,9 %). Bei allen acht Risikofaktoren wurden deutliche Pravalenzunterschiede zwischen den Bundeslandern gefunden. In den ostdeutschen Bundeslandern mit Ausnahme von Berlin wurden die hochsten Pravalenzen von sportlicher Inaktivitat, Adipositas, Hypertonie und Diabetes bei beiden Geschlechtern und von riskantem Alkoholkonsum bei Mannern beobachtet. Sachsen-Anhalt war das einzige Bundesland mit den hochsten Pravalenzen fur zwei Risikofaktoren. Beim Rauchen nahmen die drei Stadtstaaten Berlin, Hamburg und Bremen vordere Rangplatze ein. Der Anteil der Bevolkerung mit weniger als einer Portion Obst, Gemuse oder Saft pro Tag war geschlechtsubergreifend im Saarland am hochsten. Die regionalen Unterschiede blieben auch nach Adjustierung fur Alter und sozialen Status bestehen. Die Verteilung der Risikofaktoren zwischen den Bundeslandern zeigt ahnliche regionale Unterschiede wie die Pravalenz und Mortalitat von Herz-Kreislauf-Erkrankungen mit einer ungunstigeren Situation in den ostdeutschen Landern mit Ausnahme von Berlin. Insgesamt ist fur ganz Deutschland ein erheblicher Bedarf hinsichtlich der Pravention von grostenteils modifizierbaren Risikofaktoren fur Herz-Kreislauf-Erkrankungen bei Mannern und Frauen erkennbar.

Background The combined impact of multiple healthy behaviors on health exceeds that of single behaviors. This study aimed to estimate trends in the prevalence of a healthy lifestyle among adults in Germany. Methods A data set of 18,058 adults aged 25–69 years from three population-based national health examination surveys 1990–92, 1997–99 and 2008–11 with complete information for five healthy behavior factors was used. A ‘daily intake of both fruits and vegetables, ‘sufficient physical exercise’, ‘no current smoking’ and ‘no current risk drinking’ were assessed with self-reports and ‘normal body weight’ was calculated based on measured body weight and height. A dichotomous ‘healthy lifestyle’ indicator was defined as meeting at least four out of five healthy behaviors. Age-standardized prevalence was calculated stratified by sex, age groups (25–34, 35–44, 45–54 and 55–69 years) and education level (low, medium and high). Trends were expressed in relative change (RC) between 1990–92 and 2008–11. Results In Germany, the overall prevalence of healthy lifestyle increased from 9.3% in 1990–92 to 13.5% in 1997–99 and to 14.7% in 2008–11 (RC: +58.1%). The prevalence increased among men and women and in all age groups, with the exception of men aged 45–54 years. The RC of increasing healthy lifestyle prevalence between 1990–92 and 2008–11 was stronger albeit on a higher level among women compared to men. Therefore, the gender difference in healthy lifestyle has increased, but age-related differences have overall decreased in this period. Among high educated men the prevalence of a healthy lifestyle increased between 1990–92 and 2008–11 from 10.6% to 16.3% (p = 0.01) and among high educated women from 16.4% to 30.3% and also among medium educated women (10.9 to 16.6, p

The benefit of medicines in the secondary prevention of coronary heart disease (CHD) has been demonstrated in women and men. However, gender-specific differences have been observed in the prescription of these medicines. Information on trends in prevalence use in women and men from population-based studies are still lacking.Data of people aged 40-79 years with CHD from the national health interview and examination surveys for adults in Germany from 1997-1999 (GNHIES98, n = 411) and from 2008-2011 (DEGS1, n = 440) were analyzed. Trend analyses via multivariable regression models, taking into account relevant covariables, were used to calculate the prevalence of medicine use in secondary prevention of CHD between GNHIES98 and DEGS1. The following groups were considered: antiplatelet, statins, beta-receptor blockers, agents acting on the renin-angiotensin system (RAS blocker), calcium-channel blockers, and nitrate.In one decade, the prevalence had increased for antiplatelet (24.0% vs. 59.6%), statins (18.5% vs. 56.2%), beta-receptor blockers (24.7% vs. 65.5%), and RAS blockers (31.6% vs. 69.0%). The prevalence of calcium-channel blockers (33.3% vs. 20.5%) and nitrate (40.6% vs. 10.1%) had decreased. In GNHIES98, men were more likely to use RAS blockers. Significant gender differences were found in DEGS1 only for angiotensin-converting-enzyme (ACE) inhibitors.This study showed an improvement in the use of drugs for the secondary prevention of CHD in both sexes.

BackgroundUse of psychotropic drugs is common among older adults. Population-based studies on the associations of psychotropic drug use with mortality are sparse.ObjectivesTo investigate the associations between the use of specific psychotropic drug groups (opioids, antipsychotics, antidepressants and benzodiazepines) and all-cause mortality among community-dwelling older adults in Germany.MethodsParticipants of the German National Health Interview and Examination Survey 1998 were followed up for mortality from 1997 to 2011. Persons aged 60-79 years with complete data on psychotropic drug use at baseline and on mortality follow-up were considered as study population (N = 1,563). Associations between the use of opioids, antipsychotics, antidepressants and benzodiazepines and all-cause mortality were examined by Cox proportional hazards models adjusted for sociodemographics (sex, age, community size, region, socioeconomic status), life style (smoking, sports, risky alcohol drinking) and health conditions (obesity, disability, history of cardiovascular diseases, diabetes, hyperlipidemia, hypertension, any cancers, any mental disorders) at baseline.ResultsAfter a median follow-up of 11.4 years, 21, 18, 23 and 26 deaths were documented among those who used at baseline opioids (n = 39), antipsychotics (n = 30), antidepressants (n = 53) and benzodiazepines (n = 54) with an unadjusted mortality rate (MR) of 57.7, 59.1, 44.6 and 53.7 per 1000 person-years, respectively. Meanwhile, 400 deaths were documented among 1,406 nonusers of any of the above mentioned psychotropic drugs with a MR of 26.7 per 1000 person-years. The age and sex adjusted mortality rate ratios in comparison with nonusers were 2.20 (95% confidence intervals 1.42-3.41), 1.66(1.03-2.70), 1.56(1.06-2.28), and 1.57(1.07-2.31) for the use of opioids, antipsychotics, antidepressants and benzodiazepines, respectively. In the fully adjusted Cox models, use of opioids (hazardous ratio 2.04, 95% confidence intervals 1.07-3.89), antipsychotics (2.15, 1.11-4.15) and benzodiazepines (1.76, 1.09-2.82), but not antidepressants, were significantly associated with an increased risk of mortality.ConclusionsUse of opioids, antipsychotics, benzodiazepines is significantly associated with an increased risk of all-cause mortality among community-dwelling older adults in Germany. Clinicians should be careful in prescribing these psychotropic drugs to older adults while patients already under psychotropic therapy should well balance the risks and benefits of drug use. Further studies with a larger sample size and information on specific indications for psychotropic drug use and mental comorbidities are required to confirm the findings of the present study.

Background and Purpose— Data on recent time trends in stroke mortality by subtypes and regions are lacking for Germany. We investigated sex- and age-standardized trends in stroke mortality in Germany for different stroke subtypes from 1998 to 2015 and assessed potential regional variations between the former Eastern and former Western part of Germany. Methods— Mortality and population data from the German Federal Statistical Office were used to calculate sex- and age-standardized mortality rates for hemorrhagic stroke, ischemic stroke, and total strokes from 1998 to 2015 for all age groups. Joinpoint regression was used to examine trends and its changes. Estimations were stratified for Eastern and Western part of Germany. Results— From 1998 to 2015, age-standardized total stroke mortality decreased by >50% in men (from 78.0 to 34.1 per 100 000) and women (from 62.1 to 28.4 women per 100 000). The decrease was more pronounced for ischemic stroke mortality (rate change: men, −66%; women, −63%) than for hemorrhagic stroke mortality (men, −40%; women, −31%). Total and ischemic stroke mortality declined more in Eastern than in Western part of Germany. From 1998 to 2015, there were no differences in the decline between the regions in hemorrhagic stroke mortality. Total stroke mortality was higher in Eastern compared with Western part of Germany throughout the study period. Differences in subtype- and sex-specific mortality between the regions decreased from 1998 to 2015. Conclusions— Between 1998 and 2015, stroke mortality declined substantially in Germany with differing time trends in stroke subtypes between sexes and regions. Differences in stroke mortality rates between East and West Germany are negligible 24 years after the German reunification.

AIMS To examine the association between glycaemic status and depressive symptoms in a nationwide sample of the adult population in Germany. METHODS We conducted a cross-sectional analysis of data from 6385 participants aged 18-79 years in the nationwide German Health Interview and Examination Survey for Adults 2008-2011 (DEGS1). Glycaemic status was classified as follows: diagnosed diabetes (self-reported diagnosis or receiving antidiabetes medication); undiagnosed diabetes (HbA1c ≥48 mmol/mol [≥6.5%]); prediabetes (HbA1c 39-47 mmol/mol [5.7-6.4%]); or normoglycaemia (HbA1c

Aims To estimate the 10-year risk of fatal cardiovascular disease (CVD) in the 40 to 69 year old general population in Germany stratified by sex and to analyze differences between socio-economic status (SES), region and community size in individuals without CVD. The analysis is based on the newly recalibrated SCORE Deutschland risk charts and considered other comorbidities for the classification of the high CVD risk group according to the guidelines of the European Society of Cardiology. Methods and results In 3,498 participants (40–69 years) from the German Health Examination Survey for Adults 2008–2011 (DEGS1) without a history of CVD (myocardial infarction, coronary heart disease, heart failure, stroke) we estimated the proportion with a low (SCORE 8 mmol/l). The prevalence of low, moderate and high risk was 42.8%, 38.5% and 18.8% in men and 73.7%, 18.1% and 8.2% in women. The prevalence of high risk was significantly lower in women with a high compared to a low SES (3.3% vs. 11.2%) and in communities with ≥100.000 inhabitants compared to

To provide normative data for the Digit Symbol Substitution Test (DSST) of the Wechsler Adult Intelligence Scale, 3rd edition (WAIS-III) in a population-based sample of community-dwelling older adults in Germany according to age, sex, and level of education.The sample comprised 1385 participants aged 65-79 years from the nationwide representative 'German Health Interview and Examination Survey for Adults' (DEGS1, 2008-2011). Participants with known cognitive impairment or dementia, other medical conditions affecting cognition, or currently using psychotropic drugs were excluded. Educational level was categorized as low, medium, and high according to the Comparative Analyses of Social Mobility in Industrial Nations (CASMIN) scale. Normative values for the DSST according to age, sex, and level of education were estimated by multiple linear regression using population weights.Mean age was 71.1 years, 48.6% were men and low, medium, and high education levels were 62.8, 24.6, and 12.6%, respectively. Younger age, female sex, and higher level of education were significantly associated with higher DSST scores. Regression-based normative data for the DSST is provided according to age, sex, and level of education. In addition, a normative score calculator is provided.These are the first age-, sex-, and education-specific normative data for older individuals for the DSST of the WAIS-III in Germany. These normative data will enable future population-level analyses on impaired cognitive function according to DSST.

Background: Comparability of 25-hydroxyvitamin D (25(OH)D) measurements is hampered by method-related differences in measurement values. International standardization of laboratory assays has been suggested to solve this problem. Methods: As part of the European Commission–funded project ‘Food-based solutions for optimal vitamin D nutrition and health through the life cycle’ (ODIN), original measurements of serum 25(OH)D of three German national health surveys conducted between 1998 and 2011 have been standardized retrospectively. In these representative population-based samples including persons aged between 1 and 79 years, the original 25(OH)D values were compared with those after standardization. Mean values and prevalences of vitamin D deficiency, insufficiency, and sufficiency (25(OH)D levels =50 nmol/l, respectively) were calculated by sex and age groups based on original and standardized 25(OH)D data. Results: In comparison to the original 25(OH)D levels, the standardized levels showed higher means overall and in age- and sex-specific analyses. After standardization, the prevalence of vitamin D deficiency was lower in all surveys while the prevalence of vitamin D sufficiency was higher. Nevertheless, even after standardization ~ 15% of adults and 12.5% of children had serum 25(OH)D levels

We recently published findings in this journal on the prevalence of mental disorders from the German Health Interview and Examination Survey for Adults Mental Health Module (DEGS1-MH). The DEGS1-MH paper was also meant to be the major reference publication for this large-scale German study program, allowing future users of the data set to understand how the study was conducted and analyzed. Thus, towards this goal highest standards regarding transparency, consistency and reproducibility should be applied. After publication, unfortunately, the need for an addendum and corrigendum became apparent due to changes in the eligible reference sample, and corresponding corrections of the imputed data. As a consequence the sample description, sample size and some prevalence data needed amendments. Additionally we identified a coding error in the algorithm for major depression that had a significant effect on the prevalence estimates of depression and associated conditions. This addendum and corrigendum highlights all changes and presents the corrected prevalence tables. Copyright © 2015 John Wiley & Sons, Ltd.

We thank Dr Braillon for his comment on our study.1 It is a common problem in retrospective data analysis to be constrained to the use of data and variables previously collected for potentially other reasons than the study at hand. In our case–control study, an additional restriction was caused by the fact that data for cases and controls were derived from different data sources, which made harmonization of variables and definitions between these data sources necessary. Therefore, there was unfortunately no option of using physical activity or smoking behavior as continuous measures. However, both data sources were of high data quality; the GEDA study (German Health Update) as a nationwide representative health survey with standardized questionnaires, and the SIFAP …

The Vitamin D Standardization Program (VDSP) coordinated an interlaboratory study to assess the comparability of measurements of total 25-hydroxyvitamin D [25(OH)D] in human serum, which is the primary marker of vitamin D status. A set of 50 individual donor samples were analyzed by 15 different laboratoriesrepresenting national nutrition surveys, assay manufacturers, and clinical and/or research laboratories to provide results for total 25(OH)D using both immunoassays (IAs) and LC tandem MS (MS/MS). The resultswere evaluated relative to bias compared with the target values assigned based on a combination of measurements at Ghent University (Belgium) and the U.S. National Institute of Standards and Technology using reference measurement procedures for the determination of 25(OH)D2 and 25(OH)D3. CV and mean bias for each laboratory and assay platform were assessed and compared with previously established VDSP performance criteria, namely CV ≤ 10% and mean bias ≤ 5%. Nearly all LC-MS/MS results achieved VDSP criteria, whereas only 50% of IAs met the criterion for a ≤10% CV and only three of eight IAs achieved the ≤5% bias. These results establish a benchmark for the evaluation of 25(OH)D assay performance and standardization activities in the future.

The Vitamin D Standardization Program (VDSP) coordinated a study in 2012 to assess the commutability of reference materials and proficiency testing/external quality assurance materials for total 25-hydroxyvitamin D [25(OH)D] in human serum, the primary indicator of vitamin D status. A set of 50 single-donor serum samples as well as 17 reference and proficiency testing/external quality assessment materials wereanalyzed by participating laboratories that used either immunoassay or LC-MS methods for total 25(OH)D. The commutability test materials included National Institute of Standards and Technology Standard Reference Material 972a Vitamin D Metabolites in Human Serum as well as materials from the College of AmericanPathologists and the Vitamin D External Quality Assessment Scheme. Study protocols and data analysis procedures were in accordance with Clinical and Laboratory Standards Institute guidelines. The majority of the test materials were found to be commutable with the methods used in this commutability study. These results provide guidance for laboratories needing tochoose appropriate reference materials and select proficiency or external quality assessment programs and will serve as a foundation for additional VDSP studies.

To examine the association of diagnosed depression with the utilization of health care services and preventive measures among men and women in the general population in Germany.Cross-sectional analysis of data from a representative telephone survey (men N = 18,675, women N = 24,518, 18 years and older). Self-reported health professional-diagnosed depression (past 12 months) and the use of a range of health care and preventive services were assessed.Diagnosed depression was associated with increased health care service utilization in both sexes. Diagnosed depression was associated with higher utilization of some preventive services, such as general health check-ups (odds ratio [OR] 1.2), cancer screening (OR 1.2) and flu vaccination (OR 1.3) among women and cancer screening (OR 1.4) among men.Health professional-diagnosed depression is associated with increased health service utilization independent of somatic comorbidity and socio-demographic confounders. There was no indication for specific under-treatment with preventive measures among people with depression diagnosis.ZIEL: Untersuchung des Zusammenhangs einer Depressionsdiagnose mit der Inanspruchnahme von Gesundheitsleistungen.In einer repräsentativen Querschnittstudie Erwachsener (Männer N = 18 675, Frauen N = 24 518) wurde eine diagnostizierte Depression und medizinische Versorgungs- und Vorsorgeleistungen erhoben.Eine Depressionsdiagnose war mit einer erhöhten Inanspruchnahme aller Versorgungsleistungen und einzelner Vorsorgeleistungen assoziiert.Es gibt keinen Hinweis auf eine Unterversorgung bzgl. Vorsorgeleistungen speziell bei Personen mit einer Depressionsdiagnose.

Objectives: To examine cross-sectional and longitudinal associations between physical exercise and cognitive function across different age groups in a nationwide population-based sample of adults aged 18–79 years in Germany. Design: Cross-sectional/prospective. Methods: Cognitive function was assessed in the mental health module of the German Health Interview and Examination Survey for Adults (DEGS1-MH, 2009–2012, n = 3535), using a comprehensive neuropsychological test battery. Cognitive domain scores for executive function and memory were derived from confirmatory factor analysis. Regular physical exercise in the last three months was assessed by self-report and defined as no exercise, Results: Compared to no exercise, more weekly physical exercise was associated with better executive function in cross-sectional (Conclusions: Higher levels of physical exercise were associated with better executive function and memory in cross-sectional and longitudinal analyses with no evidence for differential effects by age.

Background Vitamin D deficiency may be a risk factor for mortality but previous meta-analyses lacked standardization of laboratory methods for 25-hydroxyvitamin D (25[OH]D) concentrations and used aggregate data instead of individual participant data (IPD). We therefore performed an IPD meta-analysis on the association between standardized serum 25(OH)D and mortality. Methods In a European consortium of eight prospective studies, including seven general population cohorts, we used the Vitamin D Standardization Program (VDSP) protocols to standardize 25(OH)D data. Meta-analyses using a one step procedure on IPD were performed to study associations of 25(OH)D with all-cause mortality as the primary outcome, and with cardiovascular and cancer mortality as secondary outcomes. This meta-analysis is registered at ClinicalTrials.gov, number NCT02438488. Findings We analysed 26916 study participants (median age 61.6 years, 58% females) with a median 25(OH)D concentration of 53.8 nmol/L. During a median follow-up time of 10.5 years, 6802 persons died. Compared to participants with 25(OH)D concentrations of 75 to 99.99 nmol/L, the adjusted hazard ratios (with 95% confidence interval) for mortality in the 25(OH)D groups with 40 to 49.99, 30 to 39.99, and, This project has received funding from the European Community’s Seventh Framework Programme (FP7/2007-2013) under Grant Agreement 613977 for the ODIN Integrated Project [Food-based solutions for optimal vitamin D nutrition and health through the life cycle http://www.odin-vitd.eu/]. Funding for the individual studies contributing data to this effort can be found in Appendix (S1 File), section 11.

Ziele Im Rahmen der Studie zur Gesundheit Erwachsener in Deutschland (DEGS) hat das Robert Koch-Institut (RKI) ein bundesweites Mortalitats-Follow-up durchgefuhrt. Da in Deutschland kein nationales Mortalitatsregister existiert, wurden Todesfalle und Todesursachen individuell und unter Berucksichtigung von landerspezifischen datenschutzrechtlichen Rahmenbedingungen recherchiert.

Ziel der Studie: Untersuchung der Komorbiditat von Diabetes und Depression. Methode: In einer bundesweiten Stichprobe Erwachsener (n = 43 312) wurden 19 diagnostizierte chronische Krankheiten und diagnostizierte Depression erfasst. Ergebnisse: 12-Monats-Pravalenzen: diagnostizierter Diabetes 7,4 %, diagnostizierte Depression 6,7 %, deren Komorbiditat 0,8 %. Eine Assoziation beider Erkrankungen lag bei Personen unter 50 und bei Frauen von 50 – 64 Jahren vor. Sie war abhangig von der Anzahl weiterer Erkrankungen. Schlussfolgerung: Trotz niedriger Pravalenz der Komorbiditat besteht Versorgungsrelevanz.

This paper provides up to date prevalence estimates of mental disorders in Germany derived from a national survey (German Health Interview and Examination Survey for Adults, Mental Health Module [DEGS1-MH]). A nationally representative sample (N = 5318) of the adult (18–79) population was examined by clinically trained interviewers with a modified version of the Composite International Diagnostic Interview (DEGS-CIDI) to assess symptoms, syndromes and diagnoses according to DSM-IV-TR (25 diagnoses covered). Of the participants 27.7% met criteria for at least one mental disorder during the past 12 months, among them 44% with more than one disorder and 22% with three or more diagnoses. Most frequent were anxiety (15.3%), mood (9.3%) and substance use disorders (5.7%). Overall rates for mental disorders were substantially higher in women (33% versus 22% in men), younger age group (18–34: 37% versus 20% in age group 65–79), when living without a partner (37% versus 26% with partnership) or with low (38%) versus high socio-economic status (22%). High degree of urbanization (> 500,000 inhabitants versus

This paper provides up-to-date data on service use for mental health problems and disorders among adults aged 18-79 years in Germany derived from the Mental Health Module of the German Health Interview and Examination Survey for Adults (DEGS1-MH; N=4483). Data are based exclusively on self-report. Respondents were examined by clinically trained interviewers with a modified version of the Composite International Diagnostic Interview DIA-X/M-CIDI to assess diagnoses according to the criteria of DSM-IV-TR. Service use, i.e. contact to mental health care services, due to mental health problems was assessed for the past 12 months and lifetime, by type of sector and type of institution. Among respondents with a 12-month diagnosis of a mental disorder, 23.5% of the women and 11.6% of the men reported any service use in the past 12 months. Service use depends on type of diagnosis, comorbidity and socio-demographic characteristics. Lowest 12-month utilization rates were found for substance use disorders (15.6%; lifetime use 37.3%), highest for psychotic disorders (40.5%; lifetime 72.1%). Further, a considerable time lap was found between disorder onset and subsequent service use among the majority of cases with anxiety and mood disorders. This paper provides self-reported epidemiological data on mental health service use in Germany, complementing administrative statistics and the predecessor mental health module of the German Health Interview and Examination Survey (GHS-MHS) from 1998. Despite considerable changes in the mental health field in Germany and the existence of a comprehensive mental health care system without major financial barriers, we find no indications of substantially higher utilization rates for mental disorders as compared to other comparable European countries. Further, no indications of major overall changes in utilization rates are apparent. To pinpoint areas with unmet needs, more detailed analyses of the data are needed taking into account type, frequency, and adequacy of service use and treatment of mental disorders. Appropriately matched comparisons with the GHS-MHS are needed to identify changes in patterns of utilization and interventions by type of disorder. Copyright © 2014 John Wiley & Sons, Ltd.

Die „Studie zur Gesundheit Erwachsener in Deutschland“ (DEGS1) und ihr Zusatzmodul „Psychische Gesundheit“ (DEGS1-MH) erlauben erstmals seit dem 15 Jahre zuruckliegenden Bundesgesundheitssurvey (BGS98) aktuelle Abschatzungen zu Morbiditat, Einschrankungsprofilen und Inanspruchnahmeverhalten der deutschen Erwachsenen. Es werden die wichtigsten Ergebnisse zu Pravalenzen psychischer Storungen, zu damit assoziierten Beeintrachtigungen sowie zu Kontaktraten mit Gesundheitsdiensten berichtet. Der Studie liegt eine bevolkerungsreprasentative Erwachsenenstichprobe (18–79 Jahre, n = 5317) zugrunde, die uberwiegend personlich mit ausfuhrlichen klinischen Interviews (Composite International Diagnostic Interview; CIDI) untersucht wurde. Die 12-Monats-Pravalenz psychischer Storungen betragt insgesamt 27,7 %, wobei grose Unterschiede in verschiedenen Gruppen (z. B. Geschlecht, Alter, sozialer Status) zu verzeichnen sind. Psychische Storungen stellten sich als besonders beeintrachtigend heraus (erhohte Zahl an Einschrankungstagen). Weniger als die Halfte der Betroffenen berichtet, aktuell wegen psychischer Probleme in Behandlung zu stehen (10–40 % in Abhangigkeit von der Anzahl der Diagnosen). Psychische Storungen sind haufig. Die im Vergleich zu Personen ohne aktuelle psychische Diagnose deutlich erhohte Rate an Beeintrachtigungstagen signalisiert neben dem individuellen Leiden der Betroffenen eine grose gesellschaftliche Krankheitslast – auch verglichen mit vielen korperlichen Erkrankungen. Trotz des in Deutschland vergleichsweise gut ausgebauten Versorgungssystems fur psychische Storungen ist Optimierungsbedarf hinsichtlich der Behandlungsrate zu vermuten.