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Beller J, Safieddine B, Sperlich S, Tetzlaff J, Geyer S. Time trends in limited lung function among German middle-aged and older adults. Sci Rep 2024; 14:5036. [PMID: 38424128 PMCID: PMC10904379 DOI: 10.1038/s41598-024-55624-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 02/26/2024] [Indexed: 03/02/2024] Open
Abstract
Limited lung function represents a serious health impairment. However, studies investigating changes in limited lung function over time are rare. Thus, the current study investigates time-related changes in limited lung function and potential social inequalities. Data from the 2008 and 2017 waves of the population-based German Aging Survey were used in a repeated cross-sectional study design (N = 8778), including participants aged 40 years and older. Lung function was assessed by the peak flow test. Socio-economic indicators included educational attainment, income and occupational group. Additionally, smoking history, occupational exposure to fumes and gases, and physical exercise were used as potentially explanatory variables for the observed changes. We found that the prevalence of limited lung function decreased strongly over time on a descriptive level from 9.0 to 5.4%. In line with these results, a decreasing trend emerged (OR = 0.48) when controlling for age and gender differences. When additionally controlling for changes in socio-economic indicators and explanatory variables there were still significant decreases over time, but the decline was slightly reduced (OR = 0.57). Moreover, similar significant relative decreases over time occurred for middle-aged and older participants, female and male participants, and those belonging to the different socio-economic groups. Thus, limited lung function generally decreased over time. This decrease could partially be explained by beneficial developments in socio-economic indicators, smoking, occupational exposures, and physical exercise. Future studies might investigate how changes in medicinal treatment and prevention efforts have contributed to the observed beneficial trends in lung health.
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Affiliation(s)
- Johannes Beller
- Hannover Medical School, Center for Public Health and Health Care, Medical Sociology Unit, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - Batoul Safieddine
- Hannover Medical School, Center for Public Health and Health Care, Medical Sociology Unit, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Stefanie Sperlich
- Hannover Medical School, Center for Public Health and Health Care, Medical Sociology Unit, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Juliane Tetzlaff
- Hannover Medical School, Center for Public Health and Health Care, Medical Sociology Unit, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Siegfried Geyer
- Hannover Medical School, Center for Public Health and Health Care, Medical Sociology Unit, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
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Geyer S, Tetzlaff J, Sperlich S, Safieddine B, Epping J, Eberhard S, Stahmeyer J, Beller J. Decreasing COPD-related incidences and hospital admissions in a German health insurance population. Sci Rep 2023; 13:21293. [PMID: 38042961 PMCID: PMC10693544 DOI: 10.1038/s41598-023-48554-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 11/28/2023] [Indexed: 12/04/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is associated with smoking and work-related health hazards. Most studies have reported prevalences, and the number of studies examining incidences and social inequalities is small. We analyzed the development of social inequalities of COPD-incidences in terms of income and exacerbations in terms of hospital admissions. Findings were based on claims data from a German statutory health insurance covering 2008 to 2019. Outpatient diagnoses were used for defining COPD-cases, hospital admissions were used for detecting exacerbations. Analyses were performed using Cox-regression. Individual incomes were depicted at three levels defined according to national averages for each year. Data of 3,040,137 insured men and women were available. From 2008 to 2019 COPD-incidences in men decreased by 42% and 47% in women. After stratification by income the reduction at the lowest income level was 41% and 50% in women. Respectively, at the highest income level reductions were 28% and 41%. Disease exacerbations decreased over time, and also social inequalities between income groups emerged. COPD-rates decreased over time at all income levels, but at a faster pace in the lowest income group, thus leading to a positive development of diminishing social gradients in men as well as in women.
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Affiliation(s)
- Siegfried Geyer
- Medical Sociology Unit, Medizinische Hochschule Hannover, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany.
| | - Juliane Tetzlaff
- Medical Sociology Unit, Medizinische Hochschule Hannover, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany
| | - Stefanie Sperlich
- Medical Sociology Unit, Medizinische Hochschule Hannover, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany
| | - Batoul Safieddine
- Medical Sociology Unit, Medizinische Hochschule Hannover, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany
| | - Jelena Epping
- Medical Sociology Unit, Medizinische Hochschule Hannover, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany
| | - Sveja Eberhard
- General Local Statutory Health Insurance of Lower Saxony, Hannover, Germany
| | - Jona Stahmeyer
- General Local Statutory Health Insurance of Lower Saxony, Hannover, Germany
| | - Johannes Beller
- Medical Sociology Unit, Medizinische Hochschule Hannover, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany
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Rathmann W, Seidel-Jacobs E, Hering R, Schulz M, Hoyer A, Tönnies T. Age at type 2 diabetes diagnosis among adults in Germany in 2014, 2019 and 2020. Acta Diabetol 2023; 60:1591-1593. [PMID: 37482567 PMCID: PMC10520177 DOI: 10.1007/s00592-023-02162-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 07/16/2023] [Indexed: 07/25/2023]
Affiliation(s)
- Wolfgang Rathmann
- Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Auf'm Hennekamp 65, 40225, Düsseldorf, Germany.
- German Center for Diabetes Research, Partner Düsseldorf, Munich-Neuherberg, Germany.
| | - Esther Seidel-Jacobs
- Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Auf'm Hennekamp 65, 40225, Düsseldorf, Germany
- German Center for Diabetes Research, Partner Düsseldorf, Munich-Neuherberg, Germany
| | - Ramona Hering
- Department of Data Science and Healthcare Analyses, Central Research Institute for Ambulatory Healthcare in Germany (Zi), Berlin, Germany
| | - Mandy Schulz
- Department of Data Science and Healthcare Analyses, Central Research Institute for Ambulatory Healthcare in Germany (Zi), Berlin, Germany
| | - Annika Hoyer
- Biostatistics and Medical Biometry, Medical School EWL, Bielefeld University, Bielefeld, Germany
| | - Thaddäus Tönnies
- Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Auf'm Hennekamp 65, 40225, Düsseldorf, Germany
- German Center for Diabetes Research, Partner Düsseldorf, Munich-Neuherberg, Germany
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Blotenberg I, Hoffmann W, René Thyrian J. Dementia in Germany: Epidemiology and Prevention Potential. DEUTSCHES ARZTEBLATT INTERNATIONAL 2023; 120:470-476. [PMID: 37226316 PMCID: PMC10487668 DOI: 10.3238/arztebl.m2023.0100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 09/13/2022] [Accepted: 04/05/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND The further development of public-health approaches for the prevention of dementia requires estimates of the number of people with dementia, trends in incidence and prevalence, and the potential impact of preventive measures. METHODS The projections described here are based on incidence and prevalence data for Europe and on current and projected population figures from the German Federal Statistical Office. Four scenarios were calculated on the basis of two different population projections and the assumption of either stable or declining prevalence. Data from the German Aging Survey were used to estimate the prevention potential for eleven potentially modifiable risk factors for dementia. Weighting factors were determined to adjust for correlations between risk factors. RESULTS Approximately 1.8 million people were living with dementia in Germany as of December 31, 2021; the number of new dementia cases in 2021 is estimated at 360 000 to 440 000. In 2033, depending on the scenario, 1.65 to 2 million people aged 65 and older may be affected; we consider likelihood of the lower end of this range to be very low. It is estimated that 38% of these cases are associated with 11 potentially modifiable risk factors. A 15% reduction in the prevalence of risk factors could potentially decrease the number of cases by up to 138 000 in 2033. CONCLUSION We assume that the number of people with dementia in Germany will increase, but there is considerable prevention potential. Multimodal prevention approaches to promote healthy aging should be further developed and put into practice. Better data are needed on incidence and prevalence of dementia in Germany.
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Affiliation(s)
- Iris Blotenberg
- German Center for Neurodegenerative Diseases (DZNE), Location Rostock/Greifswald
| | - Wolfgang Hoffmann
- German Center for Neurodegenerative Diseases (DZNE), Location Rostock/Greifswald
- Institute for Community Medicine, Greifswald University Medicine
| | - Jochen René Thyrian
- German Center for Neurodegenerative Diseases (DZNE), Location Rostock/Greifswald
- Institute for Community Medicine, Greifswald University Medicine
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Grigoriev P, Klüsener S, van Raalte A. Quantifying the contribution of smoking to regional mortality disparities in Germany: a cross-sectional study. BMJ Open 2022; 12:e064249. [PMID: 36180117 PMCID: PMC9528608 DOI: 10.1136/bmjopen-2022-064249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 09/08/2022] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Substantial regional variation in smoking behaviour in Germany has been well documented. However, little is known about how these regional differences in smoking affect regional mortality disparities. We aim to assess the contribution of smoking to regional mortality differentials in Germany over the last four decades. DESIGN A cross-sectional study using official cause-specific mortality data by German Federal State aggregated into five macro-regions: East, North, South, West-I and West-II. PARTICIPANTS The entire population of Germany stratified by sex, age and region during 1980-2019. MAIN OUTCOME MEASURES Smoking-attributable fraction estimated using the Preston-Glei-Wilmoth method; life expectancy at birth before and after the elimination of smoking-attributable deaths. RESULTS In all macro-regions, the burden of past smoking has been declining among men but growing rapidly among women. The hypothetical removal of smoking-attributable deaths would eliminate roughly half of the contemporary advantage in life expectancy of the vanguard region South over the other macro-regions, apart from the East. In the latter, smoking only explains around a quarter (0.5 years) of the 2-year difference in male life expectancy compared with the South observed in 2019. Among women, eliminating smoking-attributable deaths would put the East in a more disadvantageous position compared with the South as well as the other macro-regions. CONCLUSION While regional differences in smoking histories explain large parts of the regional disparities in male mortality, they are playing an increasingly important role for female mortality trends and differentials. Health policies aiming at reducing regional inequalities should account for regional differences in past smoking behaviour.
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Affiliation(s)
- Pavel Grigoriev
- Demographic Change and Longevity, Federal Institute for Population Research (BiB), Wiesbaden, Germany
| | - Sebastian Klüsener
- Demographic Change and Longevity, Federal Institute for Population Research (BiB), Wiesbaden, Germany
- Vytautas Magnus University, Kaunas, Lithuania
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Retinal Vascular Occlusion after COVID-19 Vaccination: More Coincidence than Causal Relationship? Data from a Retrospective Multicentre Study. J Clin Med 2022; 11:jcm11175101. [PMID: 36079030 PMCID: PMC9457026 DOI: 10.3390/jcm11175101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 08/23/2022] [Accepted: 08/26/2022] [Indexed: 12/02/2022] Open
Abstract
Background: To investigate whether vaccination against SARS-CoV-2 is associated with the onset of retinal vascular occlusive disease (RVOD). Methods: In this multicentre study, data from patients with central and branch retinal vein occlusion (CRVO and BRVO), central and branch retinal artery occlusion (CRAO and BRAO), and anterior ischaemic optic neuropathy (AION) were retrospectively collected during a 2-month index period (1 June–31 July 2021) according to a defined protocol. The relation to any previous vaccination was documented for the consecutive case series. Numbers of RVOD and COVID-19 vaccination were investigated in a case-by-case analysis. A case–control study using age- and sex-matched controls from the general population (study participants from the Gutenberg Health Study) and an adjusted conditional logistic regression analysis was conducted. Results: Four hundred and twenty-one subjects presenting during the index period (61 days) were enrolled: one hundred and twenty-one patients with CRVO, seventy-five with BRVO, fifty-six with CRAO, sixty-five with BRAO, and one hundred and four with AION. Three hundred and thirty-two (78.9%) patients had been vaccinated before the onset of RVOD. The vaccines given were BNT162b2/BioNTech/Pfizer (n = 221), followed by ChadOx1/AstraZeneca (n = 57), mRNA-1273/Moderna (n = 21), and Ad26.COV2.S/Johnson & Johnson (n = 11; unknown n = 22). Our case–control analysis integrating population-based data from the GHS yielded no evidence of an increased risk after COVID-19 vaccination (OR = 0.93; 95% CI: 0.60–1.45, p = 0.75) in connection with a vaccination within a 4-week window. Conclusions: To date, there has been no evidence of any association between SARS-CoV-2 vaccination and a higher RVOD risk.
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Frost N, Griesinger F, Hoffmann H, Länger F, Nestle U, Schütte W, Wolf J, Reck M. Lung Cancer in Germany. J Thorac Oncol 2022; 17:742-750. [PMID: 35623674 DOI: 10.1016/j.jtho.2022.03.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 03/08/2022] [Accepted: 03/08/2022] [Indexed: 12/25/2022]
Affiliation(s)
- Nikolaj Frost
- Department of Infectious Diseases and Pulmonary Medicine, Charité - Universitätsmedizin Berlin (Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health), Berlin, Germany
| | - Frank Griesinger
- Department of Hematology and Oncology, University Medicine Oldenburg, Pius-Hospital, Oldenburg, Germany
| | - Hans Hoffmann
- Division of Thoracic Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; German Cancer Society, Zertifizierungskommission Lungenkrebszentrum, Berlin, Germany
| | - Florian Länger
- Institute of Pathology, Hanover Medical School, Hanover, Germany
| | - Ursula Nestle
- Department of Radiation Oncology, Kliniken Maria Hilf, Moenchengladbach, Germany; Department of Radiation Oncology, Medical Center Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Wolfgang Schütte
- Klinik für Innere Medizin II, Krankenhaus Martha-Maria Halle-Dölau, Halle (Saale), Germany
| | - Jürgen Wolf
- Lung Cancer Group Cologne, Department I of Internal Medicine, Center for Integrated Oncology, University Hospital of Cologne, Cologne, Germany
| | - Martin Reck
- Department of Thoracic Oncology, Airway Research Center North, German Center for Lung Research, LungenClinic, Grosshansdorf, Germany.
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Tetzlaff J, Tetzlaff F, Geyer S, Sperlich S, Epping J. Widening or narrowing income inequalities in myocardial infarction? Time trends in life years free of myocardial infarction and after incidence. Popul Health Metr 2021; 19:47. [PMID: 34952590 PMCID: PMC8709953 DOI: 10.1186/s12963-021-00280-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 10/10/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Despite substantial improvements in prevention and therapy, myocardial infarction (MI) remains a frequent health event, causing high mortality and serious health impairments. Previous research lacks evidence on how social inequalities in incidence and mortality risks developed over time, and on how these developments affect the lifespan free of MI and after MI in different social subgroups. This study investigates income inequalities in MI-free life years and life years after MI and whether these inequalities widened or narrowed over time. METHODS The analyses are based on claims data of a large German health insurance provider insuring approximately 2.8 million individuals in the federal state Lower Saxony. Trends in income inequalities in incidence and mortality were assessed for all subjects aged 60 years and older by comparing the time periods 2006-2008 and 2015-2017 using multistate survival models. Trends in the number of life years free of MI and after MI were calculated separately for income groups by applying multistate life table analyses. RESULTS MI incidence and mortality risks decreased over time, but declines were strongest among men and women in the higher-income group. While life years free of MI increased in men and women with higher incomes, no MI-free life years were gained in the low-income group. Among men, life years after MI increased irrespective of income group. CONCLUSIONS Income inequalities in the lifespan spent free of MI and after MI widened over time. In particular, men with low incomes are disadvantaged, as life years spent after MI increased, but no life years free of MI were gained.
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Affiliation(s)
- Juliane Tetzlaff
- Medical Sociology Unit, Hannover Medical School, Hanover, Germany.
| | - Fabian Tetzlaff
- Institute for General Practice, Hannover Medical School, Hanover, Germany
| | - Siegfried Geyer
- Medical Sociology Unit, Hannover Medical School, Hanover, Germany
| | | | - Jelena Epping
- Medical Sociology Unit, Hannover Medical School, Hanover, Germany
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Rahim-Wöstefeld S, Kronsteiner D, ElSayed S, ElSayed N, Eickholz P, Pretzl B. Development of a prognostic tool: based on risk factors for tooth loss after active periodontal therapy. Clin Oral Investig 2021; 26:813-822. [PMID: 34435251 PMCID: PMC8791882 DOI: 10.1007/s00784-021-04060-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 06/27/2021] [Indexed: 11/30/2022]
Abstract
Objectives The aim of this study was to develop a prognostic tool to estimate long-term tooth retention in periodontitis patients at the beginning of active periodontal therapy (APT). Material and methods Tooth-related factors (type, location, bone loss (BL), infrabony defects, furcation involvement (FI), abutment status), and patient-related factors (age, gender, smoking, diabetes, plaque control record) were investigated in patients who had completed APT 10 years before. Descriptive analysis was performed, and a generalized linear-mixed model-tree was used to identify predictors for the main outcome variable tooth loss. To evaluate goodness-of-fit, the area under the curve (AUC) was calculated using cross-validation. A bootstrap approach was used to robustly identify risk factors while avoiding overfitting. Results Only a small percentage of teeth was lost during 10 years of supportive periodontal therapy (SPT; 0.15/year/patient). The risk factors abutment function, diabetes, and the risk indicator BL, FI, and age (≤ 61 vs. > 61) were identified to predict tooth loss. The prediction model reached an AUC of 0.77. Conclusion This quantitative prognostic model supports data-driven decision-making while establishing a treatment plan in periodontitis patients. In light of this, the presented prognostic tool may be of supporting value. Clinical relevance In daily clinical practice, a quantitative prognostic tool may support dentists with data-based decision-making. However, it should be stressed that treatment planning is strongly associated with the patient’s wishes and adherence. The tool described here may support establishment of an individual treatment plan for periodontally compromised patients.
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Affiliation(s)
- Sonja Rahim-Wöstefeld
- Section of Periodontology, Department of Conservative Dentistry, Clinic for Oral, Dental and Maxillofacial Diseases, University Hospital Heidelberg, 69120, Heidelberg, Germany.
- Private Practice, 68159, Mannheim, Germany.
| | - Dorothea Kronsteiner
- Institute of Medical Biometry and Informatics (IMBI), University Hospital Heidelberg, 69120, Heidelberg, Germany
| | - Shirin ElSayed
- Section of Periodontology, Department of Conservative Dentistry, Clinic for Oral, Dental and Maxillofacial Diseases, University Hospital Heidelberg, 69120, Heidelberg, Germany
| | - Nihad ElSayed
- Section of Periodontology, Department of Conservative Dentistry, Clinic for Oral, Dental and Maxillofacial Diseases, University Hospital Heidelberg, 69120, Heidelberg, Germany
| | - Peter Eickholz
- Department of Periodontology, Center of Dentistry and Oral Medicine (Carolinum), Johann Wolfgang Goethe-University Frankfurt/Main, 60596, Frankfurt, Germany
| | - Bernadette Pretzl
- Section of Periodontology, Department of Conservative Dentistry, Clinic for Oral, Dental and Maxillofacial Diseases, University Hospital Heidelberg, 69120, Heidelberg, Germany
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Landgraf-Rauf K, von Mutius E. Effective Ways to Prevent Allergic Diseases: Where Do We Stand? Handb Exp Pharmacol 2021; 268:437-448. [PMID: 34196812 DOI: 10.1007/164_2021_497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Since allergic diseases are of great public health relevance, effective primary prevention strategies are urgently needed. This chapter gives an overview of existing primary prevention programs on environmental exposures and dietary strategies based on epidemiological studies which have defined risk- and protective factors for the development of allergic diseases.The allergy protective effect mediated by growing up on a traditional farm environment is well studied. But the exact underlying mechanisms have still not been fully clarified and have not yet led to concrete prevention strategies. The beneficial effect of avoiding cigarette smoke exposure, indoor moisture and molds in pregnancy and childhood on the development of asthma is well documented. Whereas the avoidance of house dust mite exposure is not recommended to prevent eczema or allergy. Dietary supplementation with vitamins, pre- and probiotics in pregnant woman and their offspring is not harmful but evidence for the prevention of allergic diseases is still lacking. Fish oil consumption was shown to be asthma protective. The early introduction of peanuts and egg protein to prevent peanut and egg allergy in children with atopic dermatitis is promising. Further studies are needed to increase the overall evidence in allergy prevention. Most studies lack methodological standards such as randomization and blinding. More evidence is in demand on the potential beneficial impact of multifaceted interventional studies. The future of allergy prevention strategies might be based on individual risk assessment. Therefore, research in the immunological and molecular basis of allergic diseases needs to be promoted.
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Affiliation(s)
- Katja Landgraf-Rauf
- Department of Dermatology and Allergology, Cluster Allergy and Immunity, School of Medicine, Technical University of Munich, Munich, Germany
| | - Erika von Mutius
- Helmholtz Centre Munich - German Research Center for Environmental Health, Institute for Asthma and Allergy Prevention, Munich, Germany. .,Dr. von Hauner Children's Hospital, Ludwig Maximilian University, Institute for Asthma and Allergy Prevention, Munich, Germany. .,Member of the German Center for Lung Research, Munich, Germany.
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Knappich C, Tsantilas P, Salvermoser M, Schmid S, Kallmayer M, Trenner M, Eckstein HH, Kuehnl A. Editor's Choice - Distribution of Care and Hospital Incidence of Carotid Endarterectomy and Carotid Artery Stenting: A Secondary Analysis of German Hospital Episode Data. Eur J Vasc Endovasc Surg 2021; 62:167-176. [PMID: 33966984 DOI: 10.1016/j.ejvs.2021.03.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 03/10/2021] [Accepted: 03/21/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE This is a description of the German healthcare landscape regarding carotid artery disease, assessment of hospital incidence time courses for carotid endarterectomy (CEA) and carotid artery stenting (CAS), and simulation of potential effects of minimum hospital caseload requirements for CEA and CAS. METHODS The study is a secondary data analysis of diagnosis related group statistics data (2005-2016), provided by the German Federal Statistical Office. Cases encoded by German operation procedure codes for CEA or CAS and by International Classification of Diseases (ICD-10) codes for carotid artery disease were included. Hospitals were categorised into quartiles according to annual caseloads. Linear distances to the closest hospital fulfilling hypothetical caseload requirements were calculated. RESULTS A total of 132 411 and 33 709 patients treated with CEA and CAS from 2012 to 2016 were included. CEA patients had lower rates of myocardial infarction (1.4% vs. 1.8%) and death (1.2% vs. 4.0%), and CAS patients were more often treated after emergency admission (38.1% vs. 27.1%). Age standardised annual hospital incidences were 67.2 per 100 000 inhabitants for CEA and 16.3 per 100 000 inhabitants for CAS. The incidence for CEA declined from 2005 to 2016, with CAS rising again until 2016 after having declined from 2010 to 2013. Regarding distance from home to hospital, centres offering CEA are distributed more homogeneously across Germany, compared with those performing CAS. Hypothetical introduction of minimum annual caseloads (> 20 for CEA; > 10 for CAS) imply that 75% of the population would reach their hospital after travelling 45 km for CEA and 70 km for CAS. CONCLUSION Differences in spatial distribution mean that statutory minimum annual caseloads would have a greater impact on CAS accessibility than CEA in Germany. Presumably because of a decline in carotid artery disease and a transition towards individualised therapy for asymptomatic patients, hospital incidence for CEA has been declining.
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Affiliation(s)
- Christoph Knappich
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Pavlos Tsantilas
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Michael Salvermoser
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Sofie Schmid
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Michael Kallmayer
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Matthias Trenner
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Hans-Henning Eckstein
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Andreas Kuehnl
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
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Walsh L, Hafner L, Straube U, Ulanowski A, Fogtman A, Durante M, Weerts G, Schneider U. A bespoke health risk assessment methodology for the radiation protection of astronauts. RADIATION AND ENVIRONMENTAL BIOPHYSICS 2021; 60:213-231. [PMID: 33929575 PMCID: PMC8116305 DOI: 10.1007/s00411-021-00910-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 04/10/2021] [Indexed: 05/05/2023]
Abstract
An alternative approach that is particularly suitable for the radiation health risk assessment (HRA) of astronauts is presented. The quantity, Radiation Attributed Decrease of Survival (RADS), representing the cumulative decrease in the unknown survival curve at a certain attained age, due to the radiation exposure at an earlier age, forms the basis for this alternative approach. Results are provided for all solid cancer plus leukemia incidence RADS from estimated doses from theoretical radiation exposures accumulated during long-term missions to the Moon or Mars. For example, it is shown that a 1000-day Mars exploration mission with a hypothetical mission effective dose of 1.07 Sv at typical astronaut ages around 40 years old, will result in the probability of surviving free of all types of solid cancer and leukemia until retirement age (65 years) being reduced by 4.2% (95% CI 3.2; 5.3) for males and 5.8% (95% CI 4.8; 7.0) for females. RADS dose-responses are given, for the outcomes for incidence of all solid cancer, leukemia, lung and female breast cancer. Results showing how RADS varies with age at exposure, attained age and other factors are also presented. The advantages of this alternative approach, over currently applied methodologies for the long-term radiation protection of astronauts after mission exposures, are presented with example calculations applicable to European astronaut occupational HRA. Some tentative suggestions for new types of occupational risk limits for space missions are given while acknowledging that the setting of astronaut radiation-related risk limits will ultimately be decided by the Space Agencies. Suggestions are provided for further work which builds on and extends this new HRA approach, e.g., by eventually including non-cancer effects and detailed space dosimetry.
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Affiliation(s)
- Linda Walsh
- Department of Physics, Science Faculty, University of Zürich, Winterthurerstrasse 190, 8057 Zurich, Switzerland
| | - Luana Hafner
- Department of Physics, ETH Zurich, Otto-Stern-Weg 1, 8092 Zurich, Switzerland
| | - Ulrich Straube
- Medical Operations and Space Medicine, HRE-OM, European Space Agency, ESA, European Astronaut Centre, EAC, Cologne, Germany
| | - Alexander Ulanowski
- Present Address: Environment Laboratories, International Atomic Energy Agency, 2444 Seibersdorf, Austria
- Institute of Radiation Medicine, Helmholtz Zentrum München- German Research Center for Environmental Health, 85764 Neuherberg, Germany
| | - Anna Fogtman
- Medical Operations and Space Medicine, HRE-OM, European Space Agency, ESA, European Astronaut Centre, EAC, Cologne, Germany
| | - Marco Durante
- Biophysics Department, GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
- Technische Universität Darmstadt, Darmstadt, Germany
| | - Guillaume Weerts
- Medical Operations and Space Medicine, HRE-OM, European Space Agency, ESA, European Astronaut Centre, EAC, Cologne, Germany
| | - Uwe Schneider
- Department of Physics, Science Faculty, University of Zürich, Winterthurerstrasse 190, 8057 Zurich, Switzerland
- Radiotherapy Hirslanden, Witellikerstrasse 40, 8032 Zurich, Switzerland
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Tetzlaff F, Epping J, Tetzlaff J, Golpon H, Geyer S. Socioeconomic inequalities in lung cancer - a time trend analysis with German health insurance data. BMC Public Health 2021; 21:538. [PMID: 33740928 PMCID: PMC7977592 DOI: 10.1186/s12889-021-10576-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 03/07/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Lung Cancer (LC) is one of the most prevalent cancer diseases. Due to the lack of databases which allow the combination of information on individual socioeconomic status (SES) and cancer incidence, research on social inequalities in LC among the German population is rare. The aim of the study is to analyse time trends in social inequalities in LC in Germany. METHODS The analyses are based on data of a large statutory health insurance provider. The data contain information on diagnoses, occupation and education (working age), and income (full age range) of the insurance population. Trends were analysed for two subpopulations (retirement age and working age) and stratified by sex. The analyses are based on incidence rates and proportional hazard models spanning the periods 2006-2009, 2010-2013 and 2014-2017. RESULTS Incidence rates declined in men but increased in women. For men, inequalities were strongest in terms of income and the decline in incidence was most pronounced in middle- and higher-income men. Among women at retirement age, a reversed income gradient was found which disappeared in the second period. The educational gradient among the working-age population decreased over time due to the trend towards increasing incidence among individuals with higher education. Declining gradients were also found for occupational position. CONCLUSION The findings reveal considerable inequalities in LC and that trends vary with respect to SES, sex and age. Widening income inequalities were found in the retired population, while educational and occupational inequalities tend to narrow among the working-age population.
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Affiliation(s)
- Fabian Tetzlaff
- Institute for General Practice, Hannover Medical School, Hanover, Germany.
| | - Jelena Epping
- Medical Sociology Unit, Hannover Medical School, Hanover, Germany
- Comprehensive Cancer Center Hannover, Hannover Medical School, Hanover, Germany
| | - Juliane Tetzlaff
- Medical Sociology Unit, Hannover Medical School, Hanover, Germany
| | - Heiko Golpon
- Department of Pneumology, Hannover Medical School, Hanover, Germany
| | - Siegfried Geyer
- Medical Sociology Unit, Hannover Medical School, Hanover, Germany
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Tetzlaff J, Geyer S, Westhoff-Bleck M, Sperlich S, Epping J, Tetzlaff F. Social inequalities in mild and severe myocardial infarction: how large is the gap in health expectancies? BMC Public Health 2021; 21:259. [PMID: 33526035 PMCID: PMC7852180 DOI: 10.1186/s12889-021-10236-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 01/13/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Acute myocardial infarction (MI) remains a frequent health event and a major contributor to long-term impairments globally. So far, research on social inequalities in MI incidence and mortality with respect to MI severity is limited. Furthermore, evidence is lacking on disparities in the length of life affected by MI. This study investigates social inequalities in MI incidence and mortality as well as in life years free of MI and affected by the consequences of mild or severe MI. METHODS The study is based on data of a large German statutory health insurance provider covering the years 2008 to 2017 (N = 1,253,083). Income inequalities in MI incidence and mortality risks and in life years with mild or severe MI and without MI were analysed using multistate analyses. The assessment of MI severity is based on diagnosed heart failure causing physical limitations. RESULTS During the study period a total of 39,832 mild MI, 22,844 severe MI, 276,582 deaths without MI, 15,120 deaths after mild MI and 16,495 deaths after severe MI occurred. Clear inequalities were found in MI incidence and mortality, which were strongest among men and in severe MI incidence. Moreover, substantial inequalities were found in life years free of MI in both genders to the disadvantage of those with low incomes and increased life years after mild MI in men with higher incomes. Life years after severe MI were similar across income groups. CONCLUSIONS Social inequalities in MI incidence and mortality risks led to clear disparities in the length of life free of MI with men with low incomes being most disadvantaged. Our findings stress the importance of primary and secondary prevention focusing especially on socially disadvantaged groups.
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Affiliation(s)
- Juliane Tetzlaff
- Medical Sociology Unit, Hannover Medical School, Hanover, Germany.
| | - Siegfried Geyer
- Medical Sociology Unit, Hannover Medical School, Hanover, Germany
| | | | | | - Jelena Epping
- Medical Sociology Unit, Hannover Medical School, Hanover, Germany
| | - Fabian Tetzlaff
- Institute for General Practice, Hannover Medical School, Hanover, Germany
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Damerow S, Rommel A, Prütz F, Beyer AK, Hapke U, Schienkiewitz A, Starker A, Richter A, Baumert J, Fuchs J, Gaertner B, Müters S, Lemcke J, Allen J. Developments in the health situation in Germany during the initial stage of the COVID-19 pandemic for selected indicators of GEDA 2019/2020-EHIS. JOURNAL OF HEALTH MONITORING 2020; 5:3-20. [PMID: 35146276 PMCID: PMC8823006 DOI: 10.25646/7172.2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 11/16/2020] [Indexed: 12/19/2022]
Abstract
SARS-CoV-2, the novel coronavirus, has posed major challenges in Germany in 2020. It is unclear whether the pandemic and containment measures will have an impact on the health of the population beyond the point of infection. The German Health Update (GEDA 2019/2020-EHIS) is a nationwide survey of the population aged 15 years and older (n=23,001) that was conducted between April 2019 and September 2020. The focus of the analysis was on indicators for which pandemic-related changes could be expected. Based on regression models, adjusted proportions and mean values were estimated as trends over time. Any differences in the values found for the time period of containment measures in spring 2020 and the reference period 2019 were statistically tested. Since the implementation of containment measures, both body weight and body mass index (BMI) have increased. The utilisation of general and specialist medical services decreased temporarily. The number of tobacco smokers during the observation period also decreased, yet without revealing a clear link to the pandemic situation. No differences were found in the general population for depressive symptoms and household assistance received and provided. During the period of containment measures, changes to the health situation beyond the occurrence of infections can be observed. However, a more differentiated explanation of these findings will require further analyses.
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Affiliation(s)
- Stefan Damerow
- Robert Koch Institute, Berlin Department of Epidemiology and Health Monitoring
| | - Alexander Rommel
- Robert Koch Institute, Berlin Department of Epidemiology and Health Monitoring
| | - Franziska Prütz
- Robert Koch Institute, Berlin Department of Epidemiology and Health Monitoring
| | - Ann-Kristin Beyer
- Robert Koch Institute, Berlin Department of Epidemiology and Health Monitoring
| | - Ulfert Hapke
- Robert Koch Institute, Berlin Department of Epidemiology and Health Monitoring
| | - Anja Schienkiewitz
- Robert Koch Institute, Berlin Department of Epidemiology and Health Monitoring
| | - Anne Starker
- Robert Koch Institute, Berlin Department of Epidemiology and Health Monitoring
| | - Almut Richter
- Robert Koch Institute, Berlin Department of Epidemiology and Health Monitoring
| | - Jens Baumert
- Robert Koch Institute, Berlin Department of Epidemiology and Health Monitoring
| | - Judith Fuchs
- Robert Koch Institute, Berlin Department of Epidemiology and Health Monitoring
| | - Beate Gaertner
- Robert Koch Institute, Berlin Department of Epidemiology and Health Monitoring
| | - Stephan Müters
- Robert Koch Institute, Berlin Department of Epidemiology and Health Monitoring
| | - Johannes Lemcke
- Robert Koch Institute, Berlin Department of Epidemiology and Health Monitoring
| | - Jennifer Allen
- Robert Koch Institute, Berlin Department of Epidemiology and Health Monitoring
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Tetzlaff F, Epping J, Golpon H, Tetzlaff J. Compression, expansion, or maybe both? Growing inequalities in lung cancer in Germany. PLoS One 2020; 15:e0242433. [PMID: 33216766 PMCID: PMC7679006 DOI: 10.1371/journal.pone.0242433] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 11/02/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Lung Cancer (LC) is one of the most common malign diseases worldwide. So far, it is unclear if the development of LC incidence and mortality leads to morbidity compression or expansion and whether these developments differ by socioeconomic characteristics. This study analyses time trends in social and gender inequalities in life years with and without LC in Germany. METHODS The study is based on data of a large German statutory health insurance provider (N = 2,511,790). Incidence and mortality risks were estimated from multistate survival models. Trends in life years with and without LC were analysed using multistate life table analyses. All analyses were performed separately for gender, time period (2006-2009 and 2014-2017), and income group (<60% and ≥60% of the German average income). RESULTS Among men, declining LC incidence rates resulted in gains of life years free of LC and declining LC- affected life years and led to a relative compression, which was strongest in men with higher incomes. Among women, a clear increase in life years with LC led to an expansion of the lifespan affected by LC. This expansion was mainly driven by increasing incidence rates in women with low incomes. Overall, income inequalities in LC increased in both genders. CONCLUSIONS Our analyses reveal that developments in the length of life affected by LC differed substantially by gender and income and led to widening health inequalities over time. Public health efforts should mainly focus on vulnerable groups to reduce the persisting social inequalities in LC.
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Affiliation(s)
- Fabian Tetzlaff
- Institute for General Practice, Hannover Medical School, Hanover, Germany
| | - Jelena Epping
- Medical Sociology Unit, Hannover Medical School, Hanover, Germany
- Comprehensive Cancer Center Hannover, Hannover Medical School, Hanover, Germany
| | - Heiko Golpon
- Department of Pneumology, Hannover Medical School, Hanover, Germany
| | - Juliane Tetzlaff
- Medical Sociology Unit, Hannover Medical School, Hanover, Germany
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Schröder S, Beller J, Golpon H, Geyer S. Are there social gradients in the occurrence of lung cancer and in the survival of lung cancer patients? Findings from an observational study using German claims data of Lower Saxony. BMJ Open 2020; 10:e036506. [PMID: 32878756 PMCID: PMC7470500 DOI: 10.1136/bmjopen-2019-036506] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Only a few studies on health inequalities in terms of lung cancer are available. We examined whether social inequalities are present for the occurrence of lung cancer. Confining the analyses to patients, it was also examined whether survival over the observation period and over a standardised period of 18 months differed by occupational position and income. METHODS Our findings are based on claims data from a German statutory health insurance covering 2005-2016. The database comprised N=3 163 211 women (50.7%) and men (49.3%) aged 18 years and older. Diagnoses (International Statistical Classification of Diseases and Related Health Problems 10th Revision: C34.0 to C34.9) were hospital-based, and income and occupational position were used as indicators of socioeconomic position. Analyses on social gradients were performed for employed and retired insured, but only for employed insured information on occupation and on income were available, for retired women and men only income was available. Analyses were performed by means of proportional hazard regression. RESULTS In employed women, social gradients for the occurrence emerged for occupational position, but not for income. In men, social differences were found for both indicators. For retired insured, income gradients were found in men. Looking at overall survival, neither in women nor in men social gradients emerged. CONCLUSIONS The reported social inequalities in the occurrence of lung cancer are pointing towards social differences in smoking behaviour, exposition to hazardous occupation-related substances and differences in preventive strategies. The absence of social inequalities in survival after lung cancer suggests equality in medical treatment of the disease.
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Affiliation(s)
| | - Johannes Beller
- Medical Sociology, Hannover Medical School, Hannover, Germany
| | - Heiko Golpon
- Pneumology, Hannover Medical School, Hannover, Germany
| | - Siegfried Geyer
- Medical Sociology, Hannover Medical School, Hannover, Germany
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Abstract
INTRODUCTION A "smoke-free" society is assumed if less than 5 % of a population smoke. We predict when this goal could be reached in Germany. To reduce the proportion of smokers in the population, the World Health Organization recommends a bundle of measures (MPOWER) that should minimize both the supply of and the demand for tobacco. The current level of implementation of these recommendations in Germany is presented. METHODS A total of 21 representative cross-sectional surveys of the Drug Affinity Study and the Epidemiological Survey of Substance Abuse since 2000/2001 with adolescents and adults show the smoking behavior of the population until 2018. Per capita consumption of factory-built and self-made cigarettes during the same period is used as an objective data basis. Regression analyses are used to model the date at which less than 5 % of the German population smoke. A selective literature review is carried out to describe the implementation of the MPOWER program. RESULTS Before 2000 there was no trend in Germany towards non-smoking. After the implementation of various preventive measures such as price increases for tobacco products and the introduction of non-smoking protection laws, the spread of smoking among the population has steadily decreased since 2000. By 2018, the 5 % prevalence target among adolescents had almost been reached, as the relative proportion of adolescents who smoked fell by 20.9 percentage points to 6.6 %. The relative proportion of smoking in adult women fell by 12.1 percentage points to 18.5 %, the relative proportion of smoking in men by 14.8 percentage points to 24.2 %. Assuming a linear trend, the prevalence target of less than 5 % smoking adults can be reached by around 2043. Of the six recommended measures of the MPOWER program, Germany is currently only implementing the monitoring of tobacco consumption in society without compromises. DISCUSSION After various tobacco prevention measures were implemented, a trend towards non-smoking began in Germany. The continual price increase recommended by the World Health Organization, the further restriction of availability, the ban on all tobacco advertising and promotion, the support of smoking cessation as well as the education of the population appear to be necessary to reinforce this trend and to achieve the health policy goal of a smoke-free society in 2040.
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Affiliation(s)
- Reiner Hanewinkel
- Institut für Therapie- und Gesundheitsforschung, IFT-Nord gGmbH, Kiel
| | | | - Barbara Isensee
- Institut für Therapie- und Gesundheitsforschung, IFT-Nord gGmbH, Kiel
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Grundmann N, Meisinger C, Trepel M, Müller-Nordhorn J, Schenkirsch G, Linseisen J. Trends in cancer incidence and survival in the Augsburg study region-results from the Augsburg cancer registry. BMJ Open 2020; 10:e036176. [PMID: 32868355 PMCID: PMC7462243 DOI: 10.1136/bmjopen-2019-036176] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES Knowledge about time trends of cancer incidence and cancer survival in a defined region is an essential prerequisite for the planning of regional healthcare infrastructure. The aim of the study was to provide population-based analyses of all common tumour sites to assess the cancer burden in the Augsburg study region. SETTING Total population of the study region of Augsburg (668 522 residents), Southern Germany. PARTICIPANTS The data obtained from the Cancer Registry Augsburg comprised 37 487 incident cases of malignant tumours (19 313 men and 18 174 women) diagnosed between 2005 and 2016 in the Augsburg region's resident population. PRIMARY AND SECONDARY OUTCOME MEASURES We calculated sex-specific, age-standardised incidence rates and annual percent change to assess time trends. In men and in women, 3-year and 5-year relative survival was calculated and results were compared with the latest German estimates. Survival trends were presented for the most common cancers only. RESULTS Decreasing age-standardised incidence rates were observed for prostate cancer and for colorectal cancer in men. For oropharyngeal cancer, rates declined in men, but significantly increased in women. Incidence for female breast cancer remained stable. Five-year relative survival ranged between 6.4% (95% CI: 4.1% to 10.1%) for pancreatic cancer and 97.7% (95% CI: 96.0% to 99.4%) for prostate cancer in men and between 10.2% (95% CI: 7.1% to 14.6%) for pancreatic cancer and 96.6% (95% CI: 93.6% to 99.6%) for malignant melanoma in women. Trends in 3-year survival of the five most common tumour sites in men showed a significant increase for lung and oropharyngeal cancer. In women, continuously rising survival trends were observed for breast cancer. CONCLUSIONS Survival of cancer patients in the Augsburg study region was largely concordant with the situation in Germany as a whole, while incidence showed slight deviations in some cancer sites. Regional evaluations on cancer survival are a valuable instrument for identifying deficits and determining advances in oncological health management.
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Affiliation(s)
- Nina Grundmann
- Chair of Epidemiology, Ludwig-Maximilians-Universität München at UNIKA-T, Augsburg, Germany
- IRG Clinical Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany
| | - Christa Meisinger
- Chair of Epidemiology, Ludwig-Maximilians-Universität München at UNIKA-T, Augsburg, Germany
- IRG Clinical Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany
| | - Martin Trepel
- Department of Internal Medicine II, University Medical Center of Augsburg, Augsburg, Germany
- Interdisciplinary Cancer Center, University Medical Center of Augsburg, Augsburg, Germany
| | | | - Gerhard Schenkirsch
- Interdisciplinary Cancer Center, University Medical Center of Augsburg, Augsburg, Germany
| | - Jakob Linseisen
- Chair of Epidemiology, Ludwig-Maximilians-Universität München at UNIKA-T, Augsburg, Germany
- IRG Clinical Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany
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Rahim‐Wöstefeld S, El Sayed N, Weber D, Kaltschmitt J, Bäumer A, El‐Sayed S, Eickholz P, Pretzl B. Tooth‐related factors for tooth loss 20 years after active periodontal therapy–A partially prospective study. J Clin Periodontol 2020; 47:1227-1236. [DOI: 10.1111/jcpe.13348] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 05/28/2020] [Accepted: 06/28/2020] [Indexed: 02/01/2023]
Affiliation(s)
- Sonja Rahim‐Wöstefeld
- Section of Periodontology Department of Conservative Dentistry Clinic for Oral, Dental and Maxillofacial Diseases University Hospital Heidelberg Heidelberg Germany
| | - Nihad El Sayed
- Section of Periodontology Department of Conservative Dentistry Clinic for Oral, Dental and Maxillofacial Diseases University Hospital Heidelberg Heidelberg Germany
| | - Dorothea Weber
- Institute of Medical Biometry and Informatics (IMBI) University Hospital Heidelberg Heidelberg Germany
| | | | - Amelie Bäumer
- Section of Periodontology Department of Conservative Dentistry Clinic for Oral, Dental and Maxillofacial Diseases University Hospital Heidelberg Heidelberg Germany
- Private Practice Bielefeld Germany
| | - Shirin El‐Sayed
- Section of Periodontology Department of Conservative Dentistry Clinic for Oral, Dental and Maxillofacial Diseases University Hospital Heidelberg Heidelberg Germany
| | - Peter Eickholz
- Department of Periodontology Center of Dentistry and Oral Medicine (Carolinum) Johann Wolfgang Goethe‐University Frankfurt/Main, Frankfurt Germany
| | - Bernadette Pretzl
- Section of Periodontology Department of Conservative Dentistry Clinic for Oral, Dental and Maxillofacial Diseases University Hospital Heidelberg Heidelberg Germany
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Sonnenschein SK, Kohnen R, Ruetters M, Krisam J, Kim T. Adherence to long‐term supportive periodontal therapy in groups with different periodontal risk profiles. J Clin Periodontol 2020; 47:351-361. [DOI: 10.1111/jcpe.13252] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 11/27/2019] [Accepted: 01/04/2020] [Indexed: 12/30/2022]
Affiliation(s)
- Sarah K. Sonnenschein
- Section of Periodontology Department of Conservative Dentistry Clinic for Oral Dental and Maxillofacial Diseases University Hospital Heidelberg Heidelberg Germany
| | - Rebecca Kohnen
- Section of Periodontology Department of Conservative Dentistry Clinic for Oral Dental and Maxillofacial Diseases University Hospital Heidelberg Heidelberg Germany
| | - Maurice Ruetters
- Section of Periodontology Department of Conservative Dentistry Clinic for Oral Dental and Maxillofacial Diseases University Hospital Heidelberg Heidelberg Germany
| | - Johannes Krisam
- Institute of Medical Biometry and Informatics Ruprecht‐Karls‐University of Heidelberg Heidelberg Germany
| | - Ti‐Sun Kim
- Section of Periodontology Department of Conservative Dentistry Clinic for Oral Dental and Maxillofacial Diseases University Hospital Heidelberg Heidelberg Germany
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Tetzlaff J, Geyer S, Tetzlaff F, Epping J. Income inequalities in stroke incidence and mortality: Trends in stroke-free and stroke-affected life years based on German health insurance data. PLoS One 2020; 15:e0227541. [PMID: 31945102 PMCID: PMC6964859 DOI: 10.1371/journal.pone.0227541] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 12/20/2019] [Indexed: 12/28/2022] Open
Abstract
Background Due to substantial improvements in prevention and therapy, stroke incidence and mortality rates have decreased during the last decades, but evidence is still lacking on whether all socioeconomic groups benefited equally and how the length of life affected by stroke developed over time. Our study investigates time trends in stroke-free life years and life years affected by stroke. Special emphasis is given to the question whether trends differ between income groups, leading to decreasing or increasing social inequalities. Methods The analyses are based on claims data of a German statutory health insurance company of the two time periods 2006–2008 and 2014–2016. Income inequalities and time trends in incidence and mortality risks were estimated using multistate survival models. Trends in stroke-free life years and life years affected by stroke are analysed separately for income groups by applying multistate life table analyses. Results Stroke incidence and mortality risks decreased in men and women in all income groups. While stroke-free lifetime could be gained in men having higher incomes, improvements in mortality counterbalanced decreasing incidences, leading to increases in life years affected by stroke among men of the lower and higher income group. Among women, no significant changes in life years could be observed. Conclusions Changes in stroke-affected life years occur among men in all income groups, but are more pronounced in the higher income group. However, irrespective of the income group the proportion of stroke-affected life years remains quite stable over time, pointing towards constant inequalities. Further research is needed on whether impairments due to stroke reduced over time and whether all socioeconomic groups are affected equally.
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Affiliation(s)
- Juliane Tetzlaff
- Medical Sociology Unit, Hannover Medical School, Hanover, Germany
- * E-mail:
| | - Siegfried Geyer
- Medical Sociology Unit, Hannover Medical School, Hanover, Germany
| | - Fabian Tetzlaff
- Institute for General Practice, Hannover Medical School, Hanover, Germany
| | - Jelena Epping
- Medical Sociology Unit, Hannover Medical School, Hanover, Germany
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Seitz NN, Lochbühler K, Atzendorf J, Rauschert C, Pfeiffer-Gerschel T, Kraus L. Trends In Substance Use And Related Disorders: Analysis of the Epidemiological Survey of Substance Abuse 1995 to 2018. DEUTSCHES ARZTEBLATT INTERNATIONAL 2019; 116:585-591. [PMID: 31587706 PMCID: PMC6804271 DOI: 10.3238/arztebl.2019.0585] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 04/04/2019] [Accepted: 06/06/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND Changes in the use of psychoactive substances and medications and in the occurrence of substance-related disorders enable assessment of the magni- tude of the anticipated negative consequences for the population. METHODS Trends were analyzed in the consumption of tobacco, alcohol, cannabis and other illegal drugs, analgesics, and hypnotics/sedatives, as well as trends in substance-related disorders, as coded according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). The data were derived from nine waves of the German Epidemiological Survey of Substance Abuse (Epidemiologischer Sucht- survey, ESA) from 1995 to 2018. The data were collected in written form or by means of a combination of paper and internet-based questionnaires or telephone interviews. RESULTS The estimated prevalence rates of tobacco and alcohol consumption and the use of hypnotics/sedatives decreased over time. On the other hand, increasing prevalence rates were observed for the consumption of cannabis and other illegal drugs and the use of analgesics. The trends in substance-related disorders showed no statistically significant changes compared to the reference values for the year 2018, except for higher prevalence rates of nicotine dependence, alcohol abuse and dependence, analgesic dependence, and hypnotic/sedative dependence in the year 2012 only. CONCLUSION Trends in tobacco and alcohol consumption imply a future decline in the burden to society from the morbidity, mortality, and economic costs related to these substances. An opposite development in cannabis use cannot be excluded. No increase over time was seen in the prevalence of analgesic dependence, but the observed increase in the use of analgesics demands critical attention.
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Affiliation(s)
| | | | | | | | | | - Ludwig Kraus
- IFT Institute for Therapy Research, Munich
- Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs, Stockholm University, Stockholm, Sweden and Institute of Psychology, ELTE, Eötvös Loránd University, Budapest, Hungary
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Kuntz B, Kroll LE, Hoebel J, Schumann M, Zeiher J, Starker A, Lampert T. [Time trends of occupational differences in smoking behaviour of employed men and women in Germany : Results of the 1999-2013 microcensus]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2019; 61:1388-1398. [PMID: 30215103 DOI: 10.1007/s00103-018-2818-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Studies show that people with a low occupational status are more likely to smoke than those with a high occupational status. Against the background of a general decline in tobacco consumption, time trends of occupational differences in smoking behaviour of employed men and women in Germany were examined. METHODS The analyses were based on the last five waves of the German microcensus that included questions about smoking (1999, 2003, 2005, 2009 and 2013), taking only employed men and women aged 18-64 years into account (n = 688,746). Information on occupational position was summarised using international classifications of occupation (ISEI-08 and ISCO-08). Raw and model-based standardized prevalence estimates of current smoking were calculated. RESULTS Between 1999 and 2013, the proportion of smokers in the working population fell from 39.9 to 34.4% (men) and from 30.6 to 26.8% (women). Differences between occupational status groups increased significantly: while the prevalence of smoking among employees with high occupational status decreased, it remained largely stable in the low status group. In 2013, the occupations with the highest proportion of smokers were waste disposal workers, cleaning staff, unskilled workers, truck and bus drivers, salespeople and cashiers, and employees in the catering industry. CONCLUSION Since the beginning of the 2000s, the prevalence of smoking in the working population has declined. The strengthened tobacco control policy - e. g. the establishment of smoke-free workplace laws - might have contributed to this trend. In the context of workplace health promotion, tobacco prevention and cessation measures should be targeted at those professions in which smoking is still particularly common.
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Affiliation(s)
- Benjamin Kuntz
- FG 28 Soziale Determinanten der Gesundheit, Abteilung für Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, General-Pape-Str. 62-66, 12101, Berlin, Deutschland.
| | - Lars Eric Kroll
- FG 28 Soziale Determinanten der Gesundheit, Abteilung für Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, General-Pape-Str. 62-66, 12101, Berlin, Deutschland
| | - Jens Hoebel
- FG 28 Soziale Determinanten der Gesundheit, Abteilung für Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, General-Pape-Str. 62-66, 12101, Berlin, Deutschland
| | - Maria Schumann
- FG 28 Soziale Determinanten der Gesundheit, Abteilung für Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, General-Pape-Str. 62-66, 12101, Berlin, Deutschland
| | - Johannes Zeiher
- FG 27 Gesundheitsverhalten, Abteilung für Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, Berlin, Deutschland
| | - Anne Starker
- FG 27 Gesundheitsverhalten, Abteilung für Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, Berlin, Deutschland
| | - Thomas Lampert
- FG 28 Soziale Determinanten der Gesundheit, Abteilung für Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, General-Pape-Str. 62-66, 12101, Berlin, Deutschland
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Wienecke A, Kraywinkel K. [Tobacco-associated cancers in Germany-incidence and mortality trends since 1995]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2018; 61:1399-1406. [PMID: 30264232 DOI: 10.1007/s00103-018-2821-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND OBJECTIVES Tobacco consumption is the most important cancer risk factor. In Germany, about 15% of all new cancer cases can be attributed to smoking. The aim of this paper is to analyze the incidence and mortality trends in tobacco-associated cancer cases in Germany for the last two decades. MATERIALS AND METHODS Age standardized incidence and mortality rates were calculated for tumors of the upper aerodigestive tract and lower urinary tract for the period from 1995 to 2014/2015. In addition, average annual percentage changes were calculated with joinpoint regression analysis. Regarding lung cancer, trends in incidence and mortality rates were also stratified by different age groups and trends in mortality rates were analyzed by birth cohorts. RESULTS The incidence and mortality rates among men are declining for all tobacco-associated cancers except esophageal cancer. Lung cancer mortality rates showed the greatest decrease with -1.9% on average per year. The incidence rates among women increased for all tobacco-associated cancers except lower urinary tract cancers. The increase in lung cancer incidence was greatest with 3.3% on average per year. Among men there was a continuous decline over all birth cohorts regarding the chance of dying of lung cancer at a certain age. Among women, the chance of dying of lung cancer increased for all birth cohorts until 1960. CONCLUSIONS The present analyses regarding tobacco-associated cancers in Germany reflect the changes in smoking prevalence with a deferment of multiple decades.
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Affiliation(s)
- Antje Wienecke
- Abteilung für Epidemiologie und Gesundheitsmonitoring, Zentrum für Krebsregisterdaten, Robert Koch-Institut, General-Pape-Straße 62-66, 12101, Berlin, Deutschland.
| | - Klaus Kraywinkel
- Abteilung für Epidemiologie und Gesundheitsmonitoring, Zentrum für Krebsregisterdaten, Robert Koch-Institut, General-Pape-Straße 62-66, 12101, Berlin, Deutschland
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