Smoking behaviour and passive smoke exposure of adults – Results from GEDA 2019/2020-EHIS

Background: Smoking is a significant health risk and the leading cause of premature death. Passive smoke causes the same negative effects on health as smoking, albeit to a lesser extent. The reduction of tobacco consumption and the protection against passive smoke are thus important health objectives. Methods: The study German Health Update (GEDA 2019/2020-EHIS) is a cross-sectional telephone survey (04/2019 to 09/2020) of the resident population in Germany with questions relating to the current smoking behaviour and relating to the passive smoke exposure. The analysis sample comprises 22,708 persons from 18 years of age. Results: 24.0% of women and 33.9% of men from 18 years of age smoke currently, at least occasionally. Among both sexes, adults from 65 years of age smoke significantly more rarely than adults in the younger age groups. 4.1% of adults, who do not smoke themselves, are subjected daily to passive smoke exposure indoors. This affects in particular young adults and men. There are educational differences in tobacco consumption and in passive smoke exposure to the disadvantage of adults from lower educational groups. Conclusions: In Germany, there is still a need for action for effective measures for tobacco prevention, smoking cessation and tobacco control policy, which are effective in all population groups and which take into account the concerns of socially disadvantaged groups

Depressive symptoms in the general population before and in the first year of the COVID-19 pandemic: Results of the GEDA 2019/2020 study

Background: Study results on the impact of the COVID-19 pandemic on mental health in the first year of the pandemic are contradictory. The GEDA 2019/2020 study makes it possible to examine changes in depressive symptoms in the population. Methods: A standardised telephone interview was used to survey a random sample of the population in Germany aged 15 and older. To exclude seasonal effects, 10,220 interviewees from the period April 2019 to January 2020 were compared with 11,900 from the period April 2020 to January 2021. Depressive symptoms were assessed with the internationally established 8-item Patient Health Questionnaire (PHQ-8). Results: The prevalence of depressive symptoms decreased from 9.2% to 7.6% in the first year of the pandemic. Changes differ between women and men as well as between age and education groups. The analysis of individual symptoms suggests that it is not about a reduction of mental disorders of the depressive type in the narrower sense, but rather a decrease in stress-associated individual symptoms. Conclusions: The decrease in stress-associated depressive symptoms in parts of the population can be interpreted as an indication that pandemic-related changes in everyday life and the working environment may have had a positive effect on individual areas of mental health in certain groups, at least temporarily in the first year of the pandemic. The continuing strong social inequality in depressive symptoms to the disadvantage of low education groups confirms that the need for social situation-related health promotion and prevention with regard to the living and working conditions of socially disadvantaged people must not be lost sight of in times of pandemic. For groups in the population that partly showed a worsening of symptoms in this phase of the pandemic, e.g. the diminished ability to concentrate of very old men, targeted support options should be created in the future

Social differences in COVID-19 vaccination status – Results of the GEDA 2021 study

Background: The COVID-19 vaccination is a key measure to contain the pandemic. It aims to restrict new infections and to reduce severe courses of the disease. This paper examines the influence of various social determinants on COVID-19 vaccination status. Methods: The analyses are based on data from the study German Health Update (GEDA 2021), a nationwide telephone-based survey of the adult population in Germany, which was conducted between July and December 2021. In addition to bivariate analyses, the association between the COVID-19 vaccination status and the social determinants was examined using Poisson regression. Results: A total of 86.7% of people aged 18 years and older who participated in GEDA 2021 have been received at least one dose of COVID-19 vaccine. Social differences are evident: The proportion of people vaccinated against COVID-19 increases with age, income and higher education group. Lower vaccination rates are found among people with a history of migration, people living in rural areas and people from East Germany. An age-differentiated analysis shows that the social differences in COVID-19 vaccination uptake are lower among those aged 60 years and older. Conclusions: The presented results should be considered when designing targeted interventions to overcome potential barriers to COVID-19 vaccination uptake. Further research is needed regarding the explanatory factors for the social differences in vaccination behaviour, such as structural and group-specific barriers or psychological determinants

Rauchverhalten und Passivrauchbelastung Erwachsener – Ergebnisse aus GEDA 2019/2020-EHIS

Hintergrund: Rauchen ist ein bedeutendes Gesundheitsrisiko und die führende Ursache vorzeitiger Sterblichkeit. Passivrauch verursacht dieselben negativen gesundheitlichen Folgen wie das Rauchen, wenn auch in einem geringeren Ausmaß. Die Verringerung des Tabakkonsums und der Schutz vor Passivrauch sind daher wichtige gesundheitspolitische Ziele. Methode: Die Studie Gesundheit in Deutschland aktuell (GEDA 2019/2020-EHIS) ist eine telefonische Querschnittbefragung (04/2019 bis 09/2020) der in Deutschland lebenden Wohnbevölkerung mit Fragen zum aktuellen Rauchverhalten und zur Passivrauchbelastung. Die Analysestichprobe umfasst 22.708 Personen ab 18 Jahren. Ergebnisse: 24,0 % der Frauen und 33,9 % der Männer ab 18 Jahren rauchen aktuell, zumindest gelegentlich. Bei beiden Geschlechtern rauchen Erwachsene ab 65 Jahren deutlich seltener als Erwachsene in den jüngeren Altersgruppen. 4,1 % der Erwachsenen, die selbst nicht rauchen, sind täglich Passivrauchbelastung in geschlossenen Räumen ausgesetzt. Das betrifft besonders junge Erwachsene und Männer. Es bestehen Bildungsunterschiede im Tabakkonsum und in der Passivrauchbelastung zuungunsten von Erwachsenen aus unteren Bildungsgruppen. Schlussfolgerungen: In Deutschland besteht weiterhin Handlungsbedarf für eine effektive Maßnahmen der Tabakprävention, Rauchentwöhnung und Tabakkontrollpolitik, die in allen Bevölkerungsgruppen wirken und die Belange sozial benachteiligter Gruppen berücksichtige

Widening area‑based socioeconomic inequalities in cancer mortality in Germany between 2003 and 2019

Cancer mortality has declined in recent decades, but—due to a lack of national individual-level data—it remains unclear whether this applies equally to all socioeconomic groups in Germany. Using an area-based approach, this study investigated socioeconomic inequalities in cancer mortality and their secular trends on a German nationwide scale for the first time. Official cause-of-death data from 2003 to 2019 were linked to the district-level German Index of Socioeconomic Deprivation. Age-standardised mortality rates for all cancers combined and the most common site-specific cancers were calculated according to the level of regional socioeconomic deprivation. To quantify the extent of area-based socioeconomic inequalities in cancer mortality, absolute (SII) and relative (RII) indices of inequality were estimated using multilevel Poisson models. On average, cancer mortality was 50% (women) and 80% (men) higher in Germany’s most deprived than least deprived districts (absolute difference: 84 deaths per 100,000 in women and 185 deaths per 100,000 in men). As declines in cancer mortality were larger in less deprived districts, the socioeconomic gap in cancer mortality widened over time. This trend was observed for various common cancers. Exceptions were cancers of the lung in women and of the pancreas in both sexes, for which mortality rates increased over time, especially in highly deprived districts. Our study provides first evidence on increasing socioeconomic inequalities in cancer mortality on a nationwide scale for Germany. Area-based linkage allows to examine socioeconomic inequalities in cancer mortality across Germany and identify regions with high needs for cancer prevention and control.Peer Reviewe

Association of regional socioeconomic deprivation and rurality with global developmental delay in early childhood: Data from mandatory school entry examinations in Germany

Background: From birth to young adulthood, health and development of young people are strongly linked to their living situation, including their family’s socioeconomic position (SEP) and living environment. The impact of regional characteristics on development in early childhood beyond family SEP has been rarely investigated. This study aimed to identify regional predictors of global developmental delay at school entry taking family SEP into consideration. Method: We used representative, population-based data from mandatory school entry examinations of the German federal state of Brandenburg in 2018/2019 with n=22,801 preschool children. By applying binary multilevel models, we hierarchically analyzed the effect of regional deprivation defined by the German Index of Socioeconomic Deprivation (GISD) and rurality operationalized as inverted population density of the children’s school district on global developmental delay (GDD) while adjusting for family SEP (low, medium and high). Results: Family SEP was significantly and strongly linked to GDD. Children with the highest family SEP showed a lower odds for GDD compared to a medium SEP (female: OR=4.26, male: OR=3.46) and low SEP (female: OR=16.58, male: OR=12.79). Furthermore, we discovered a smaller, but additional and independent effect of regional socioeconomic deprivation on GDD, with a higher odds for children from a more deprived school district (female: OR=1.35, male: OR=1.20). However, rurality did not show a significant link to GDD in preschool children beyond family SEP and regional deprivation. Conclusion: Family SEP and regional deprivation are risk factors for child development and of particular interest to promote health of children in early childhood and over the life course.Peer Reviewe

German Index of Socioeconomic Deprivation (GISD): Revision, update and application examples

Background: Regional deprivation indices enable researchers to analyse associations between socioeconomic disadvantages and health outcomes even if the health data of interest does not include information on the individuals’ socioeconomic position. This article introduces the recent revision of the German Index of Socioeconomic Deprivation (GISD) and presents associations with life expectancy as well as age-standardised cardiovascular mortality rates and cancer incidences as applications. Methods: The GISD measures the level of socioeconomic deprivation using administrative data of education, employment, and income situations at the district and municipality level from the INKAR database. The indicators are weighted via principal component analyses. The regional distribution is depicted cartographically, regional level associations with health outcomes are presented. Results: The principal component analysis indicates medium to high correlations of the indicators with the index subdimensions. Correlation analyses show that in districts with the lowest deprivation, the average life expectancy of men is approximately six years longer (up to three years longer for women) than for those from districts with the highest deprivation. A similar social gradient is observed for cardiovascular mortality and lung cancer incidence. Conclusions: The GISD provides a valuable tool to analyse socioeconomic inequalities in health conditions, diseases, and their determinants at the regional level

Depressive Symptomatik in der Allgemeinbevölkerung vor und im ersten Jahr der COVID-19-Pandemie: Ergebnisse der GEDA-Studie 2019/2020

Hintergrund: Studienergebnisse zu Auswirkungen der COVID-19-Pandemie auf die psychische Gesundheit im ersten Jahr der Pandemie sind widersprüchlich. Die Studie GEDA 2019/2020 ermöglicht, Veränderungen hinsichtlich der depressiven Symptomatik in der Bevölkerung zu untersuchen. Methode: Mit einem standardisierten telefonischen Interview wurde eine Zufallsstichprobe der Bevölkerung in Deutschland ab 15 Jahren befragt. Um saisonale Effekte auszuschließen, wurden 10.220 Interviewte des Zeitraums April 2019 bis Januar 2020 mit 11.900 des Zeitraums April 2020 bis Januar 2021 verglichen. Das Vorliegen einer depressiven Symptomatik wurde mit dem international etablierten 8-Item Patient Health Questionnaire (PHQ-8) erfasst. Ergebnisse: Die Prävalenz der depressiven Symptomatik reduzierte sich im hier betrachteten ersten Jahr der Pandemie von vorher 9,2 % auf 7,6 %. Veränderungen fallen bei Frauen und Männer sowie Alters- und Bildungsgruppen unterschiedlich aus. Die Analyse von Einzelsymptomen legt nahe, dass es sich nicht um eine Verringerung von psychischen Störungen des depressiven Formenkreises im engeren Sinne handelt, sondern um einen Rückgang stressassoziierter Einzelsymptome. Schlussfolgerungen: Der Rückgang von stressassoziierten depressiven Symptomen in Teilen der Bevölkerung lässt sich als Hinweis darauf werten, dass pandemiebedingte Veränderungen in Alltag und Arbeitswelt sich in bestimmten Gruppen positiv auf einzelne Bereiche psychischer Gesundheit ausgewirkt haben könnten, zumindest temporär im ersten Jahr der Pandemie. Die weiterhin stark ausgeprägte soziale Ungleichheit in der depressiven Symptomatik zuungunsten unterer Bildungsgruppen bekräftigt, dass der Bedarf an soziallagenbezogener Gesundheitsförderung und Prävention mit Blick auf die Lebens- und Arbeitsbedingungen sozial benachteiligter Menschen in Pandemiezeiten nicht aus dem Blickfeld geraten darf. Für Gruppen in der Bevölkerung, die in dieser Phase der Pandemie teilweise eine Verschlechterung der Symptomlage zeigten, z. B. die geminderte Konzentrationsfähigkeit hochaltriger Männer, sollten zukünftig gezielte Unterstützungsmöglichkeiten geschaffen werden