The impact of regional socioeconomic deprivation on the timing of HIV diagnosis: a cross-sectional study in Germany

Background: HIV infections which are diagnosed at advanced stages are associated with significantly poorer health outcomes. In Germany, the proportion of persons living with HIV who are diagnosed at later stages has remained continuously high. This study examined the impact of regional socioeconomic deprivation on the timing of HIV diagnosis. Methods: We used data from the national statutory notification of newly diagnosed HIV infections between 2011 and 2018 with further information on the timing of diagnosis determined by the BED-Capture-ELISA test (BED-CEIA) and diagnosing physicians. Data on regional socioeconomic deprivation were derived from the German Index of Socioeconomic Deprivation (GISD). Outcome measures were a non-recent infection based on the BED-CEIA result or an infection at the stage of AIDS. The effect of socioeconomic deprivation on the timing of diagnosis was analysed using multivariable Poisson regression models with cluster-robust error variance. Results: Overall, 67.5% (n = 10,810) of the persons were diagnosed with a non-recent infection and 15.2% (n = 2746) with AIDS. The proportions were higher among persons with heterosexual contact compared to men who have sex with men (MSM) (76.8% non-recent and 14.9% AIDS vs. 61.7% non-recent and 11.4% AIDS). MSM living in highly deprived regions in the countryside (< 100 k residents) were more likely to have a non-recent infection (aPR: 1.16, 95% CI: 1.05–1.28) as well as AIDS (aPR: 1.41, 95% CI: 1.08–1.85) at the time of diagnosis compared to MSM in less deprived regions in the countryside. No differences were observed among MSM from towns (100 k ≤ 1 million residents) or major cities (≥ 1 million residents), and no differences overall in the heterosexual transmission group. Conclusions: An effect of socioeconomic deprivation on the timing of HIV diagnosis was found only in MSM from countryside regions. We suggest that efforts in promoting HIV awareness and regular HIV testing are increased for heterosexual persons irrespective of socioeconomic background, and for MSM with a focus on those living in deprived regions in the countryside.Peer Reviewe

Determinants of health check attendance in adults: findings from the cross-sectional German Health Update (GEDA) study

Background: In Germany, adult health checks are carried out in the primary care setting for early detection of chronic conditions, such as cardiovascular diseases, diabetes, and kidney disease. This study aims to examine the social, behavioural, and health-related determinants of health check attendance among eligible adults in Germany. Methods: Data were derived from the cross-sectional German Health Update (GEDA) study, a national health survey among adults in Germany carried out by the Robert Koch Institute. Analyses were restricted to respondents with statutory health insurance aged 35 years or older (n = 26,555). Logistic regression models were fitted to estimate associations between health check attendance and factors selected on the basis of Andersen’s Behavioral Model of Health Services Use. Results: After mutual adjustment, higher health check attendance was associated with a higher age, higher socioeconomic status, being married, stronger social support, physical activity, non-smoking, greater fruit and vegetable consumption, and higher use of outpatient care in both sexes. In women, higher attendance was related to alcohol consumption and having company health insurance (BKK) after multiple adjustment. In men, higher attendance was associated with better self-rated health after adjusting for all other factors. Conclusions: The findings of this study suggest that people with an unfavourable risk factor profile, such as socioeconomically disadvantaged groups, smokers, physically inactive people, and persons with a low fruit and vegetable intake, are less likely to have health checks than those with a more favourable risk profile. Health checks carried out in the primary care setting should be evaluated for their effects on population health and health inequality

Sozialer Status und Teilnahme am Gesundheits-Check-up von Männern und Frauen in Deutschland: Ergebnisse der GEDA-Studie 2009 und 2010

Hintergrund: Auf Basis repräsentativer Daten für Deutschland wurde untersucht, inwieweit die Teilnahme am Gesundheits-Check-up zur Krankheitsfrüherkennung mit verschiedenen Merkmalen des sozialen Status zusammenhängt. Methode: Die Analysen basierten auf Daten der Studie „Gesundheit in Deutschland aktuell“ (GEDA) des Robert Koch-Instituts aus den Jahren 2009 und 2010. Es wurden Angaben zur Teilnahme am Gesundheits-Check-up von gesetzlich Krankenversicherten ab 35 Jahren ausgewertet (n = 26 555). Für die Analysen zum Zusammenhang zwischen Sozialstatus und Teilnahmeverhalten wurden sowohl ein mehrdimensionaler Statusindex als auch die statusbildenden Einzelindikatoren (Bildung, Berufsstatus, Einkommen) herangezogen. Ergebnisse: Insgesamt hatten 50,8 % der Männer ab 35 Jahren und 49,8 % der gleichaltrigen Frauen in den letzten zwei Jahren vor der Befragung am Gesundheits-Check-up teilgenommen. Dabei war ein niedriger Sozialstatus bei Männern und Frauen mit einer geringeren Teilnahme am Gesundheits-Check-up assoziiert (Männer: Odds Ratio [OR] = 0,59; 95-%-Konfidenzintervall [95-%-KI]: 0,50–0,70; p < 0,001; Frauen: OR = 0,63; 95-%-KI: 0,55–0,72; p < 0,001). Diesen Sozialstatuseffekten lagen bei Männern und Frauen eigenständige Effekte der Einkommenssituation und des Berufsstatus zugrunde, wohingegen für den Bildungsstand kein unabhängiger Effekt auf das Teilnahmeverhalten festzustellen war. Schlussfolgerung: Die Ergebnisse weisen darauf hin, dass sozial benachteiligte Bevölkerungsgruppen mit dem Gesundheits-Check-up schlechter erreicht werden als sozial besser gestellte. Bemühungen um eine Erhöhung der Teilnahme am Gesundheits-Check-up sollten unter anderem die aufgezeigten Unterschiede nach Einkommen und Berufsstatus berücksichtigen

Educational inequalities in subjective health in Germany from 1994 to 2014: a trend analysis using the German Socio-Economic Panel study (GSOEP)

Introduction As trend studies have shown, health inequalities by income and occupation have widened or remained stable. However, research on time trends in educational inequalities in health in Germany is scarce. The aim of this study is to analyse how educational inequalities in health evolved over a period of 21 years in the middle-aged population in Germany, and whether the trends differ by gender. Methods Data were obtained from the German Socio-Economic Panel covering the period from 1994 to 2014. In total, n=16 339 participants (106 221 person years) aged 30–49 years were included in the study sample. Educational level was measured based on the ‘Comparative Analysis of Social Mobility in Industrial Nations’ (CASMIN) classification. Health outcomes were self-rated health (SRH) as well as (mental and physical) health-related quality of life (HRQOL, SF-12v2). Absolute Index of Inequality (Slope Index of Inequality (SII)) and Relative Index of Inequality (RII) were calculated using linear and logarithmic regression analyses with robust SEs. Results Significant educational inequalities in SRH and physical HRQOL were found for almost every survey year from 1994 to 2014. Relative inequalities in SRH ranged from 1.50 to 2.10 in men and 1.25 to 1.87 in women (RII). Regarding physical HRQOL, the lowest educational group yielded 4.5 to 6.6 points (men) and 3.3 to 6.1 points (women) lower scores (SII). Although educational level increased over time, absolute and relative health inequalities remained largely stable over the last 21 years. For mental HRQOL, only few educational inequalities were found. Discussion This study found persistent educational inequalities in SRH and physical HRQOL among adults in Germany from 1994 to 2014. Our findings highlight the need to intensify efforts in social and health policies to tackle these persistent inequalities.Peer Reviewe

Implementation of the European health interview survey (EHIS) into the German health update (GEDA)

Background: This methodological paper describes the integration of the ‘European Health Interview Survey wave 2’ (EHIS 2) into the ‘German Health Update’ 2014/2015 (GEDA 2014/2015-EHIS). Methods: GEDA 2014/2015-EHIS is a cross-sectional health survey. A two-stage stratified cluster sampling approach was used to recruit persons aged 15 years and older with permanent residence in Germany. Two different modes of data collection were used, self-administered web questionnaire and self-administered paper questionnaire. The survey instrument implemented the EHIS 2 modules on health status, health care use, health determinants and social background variables and additional national questions. Data processing was conducted according to the quality and validation rules specified by Eurostat. Results: In total, 24,824 questionnaires were completed. The response rate was 27.6%. The two-stage cluster sample method seems to have been successful in achieving a sample with high representativeness. The final micro data file was inspected, approved and certified by Eurostat. Access to micro data of the EHIS 2 can be provided by Eurostat via research contract and to the GEDA 2014/2015-EHIS public use file by the Research Data Centre of the Robert Koch Institute. First EHIS 2 results are available at the Eurostat website. Conclusions: Integrating a multinational health survey into an existing national health monitoring system was a challenge in Germany. The national survey methodology for conducting the survey had to be further developed in order to meet the overarching goal of harmonizing the health information from national statistical offices and public health research institutes across the European Union. The harmonized EHIS 2 data source will profoundly impact international public health research in the near future. The next EHIS wave 3 will be conducted around 2019

Socioeconomic inequalities in primary-care and specialist physician visits: a systematic review

Background!#!Utilization of primary-care and specialist physicians seems to be associated differently with socioeconomic status (SES). This review aims to summarize and compare the evidence on socioeconomic inequalities in consulting primary-care or specialist physicians in the general adult population in high-income countries.!##!Methods!#!We carried out a systematic search across the most relevant databases (Web of Science, Medline) and included all studies, published since 2004, reporting associations between SES and utilization of primary-care and/or specialist physicians. In total, 57 studies fulfilled the eligibility criteria.!##!Results!#!Many studies found socioeconomic inequalities in physician utilization, but inequalities were more pronounced in visiting specialists than primary-care physicians. The results of the studies varied strongly according to the operationalization of utilization, namely whether a physician was visited (probability) or how often a physician was visited (frequency). For probabilities of visiting primary-care physicians predominantly no association with SES was found, but frequencies of visits were higher in the most disadvantaged. The most disadvantaged often had lower probabilities of visiting specialists, but in many studies no link was found between the number of visits and SES.!##!Conclusion!#!This systematic review emphasizes that inequalities to the detriment of the most deprived is primarily a problem in the probability of visiting specialist physicians. Healthcare policy should focus first off on effective access to specialist physicians in order to tackle inequalities in healthcare.!##!Prospero registration number!#!CRD42019123222

German Health Update: New data for Germany and Europe The background to and methodology applied in GEDA 2014/2015-EHIS

GEDA 2014/2015-EHIS is an up-to-date health survey of the adult population undertaken within the framework of the Robert Koch Institute’s (RKI) health monitoring system. It uses the EHIS (European Health Interview Survey) Wave 2 questionnaire and includes four modules covering health status, health care, health determinants, and socio-economic variables. Data on nationally relevant issues is also collected. The study employs a mixed-mode design, using both online and paper-based questionnaires to gather data from 24,016 people aged 18 and above: the response rate was 26.9%. The Statistical Office of the European Union (Eurostat) provides prepared data from 28 European Union (EU) member states (plus Norway and Iceland) on the Eurostat website. National analyses for Germany are published as Fact sheets on health reporting in the Journal of Health Monitoring

Surface texture measurement for additive manufacturing

The surface texture of additively manufactured metallic surfaces made by powder bed methods is affected by a number of factors, including the powder's particle size distribution, the effect of the heat source, the thickness of the printed layers, the angle of the surface relative to the horizontal build bed and the effect of any post processing/finishing. The aim of the research reported here is to understand the way these surfaces should be measured in order to characterise them. In published research to date, the surface texture is generally reported as an Ra value, measured across the lay. The appropriateness of this method for such surfaces is investigated here. A preliminary investigation was carried out on two additive manufacturing processes—selective laser melting (SLM) and electron beam melting (EBM)—focusing on the effect of build angle and post processing. The surfaces were measured using both tactile and optical methods and a range of profile and areal parameters were reported. Test coupons were manufactured at four angles relative to the horizontal plane of the powder bed using both SLM and EBM. The effect of lay—caused by the layered nature of the manufacturing process—was investigated, as was the required sample area for optical measurements. The surfaces were also measured before and after grit blasting

Marie-Claire / dir. Jean Prouvost

27 octobre 19391939/10/27 (A0,N139)-1939/10/27.Appartient à l’ensemble documentaire : UnivJeun

„Gesundheit in Deutschland aktuell“ – Neue Daten für Deutschland und Europa Hintergrund und Studienmethodik von GEDA 2014/2015-EHIS

GEDA 2014/2015-EHIS ist eine aktuelle Gesundheitsbefragung des Robert Koch-Instituts (RKI) für Erwachsene und Teil des Gesundheitsmonitorings. Sie besteht aus dem europäische Fragebogen EHIS („European Health Interview Survey“) Welle 2 mit vier Modulen: Gesundheitszustand, Gesundheitsversorgung, Gesundheitsdeterminanten und sozioökonomische Variablen. Daneben wurden national relevante Themen erhoben. Mit Web- und Papierfragebögen (Mixed-mode-Design) wurden 24.016 Personen ab 18 Jahren befragt. Die Responserate lag bei 26,9 %. Die aufbereiteten Daten aus 28 Mitgliedstaaten der Europäischen Union (sowie Norwegen und Island) werden vom Statistischen Amt der Europäischen Union (Eurostat) auf der Website angeboten. Nationale Auswertungen für Deutschland werden in Form von Fact sheets in der Gesundheitsberichterstattung (Journal of Health Monitoring) publiziert