Background: The Robert Koch Institute (RKI) continuously monitors key health indicators in the general population by collecting data repeatedly. As changes in survey design can affect prevalence estimates and thus make interpreting trends difficult, the launch of the RKI Panel ‘Health in Germany’ was accompanied by a methodological study. Methods: The RKI Panel is based on a random sample drawn from population registers. The survey is self-administered in written format (online or paper). The composition of the sample, prevalence estimates and response behaviour were then compared with data collected in parallel in the GEDA 2024 telephone survey. Data from previous surveys were included in the modelling to quantify method-related differences in prevalence estimates. Results: The RKI Panel 2024 was more successful in representing young adults, the elderly and individuals with low levels of education. The prevalence estimates differ significantly from GEDA 2024 in some cases, particularly for mental health indicators and their associated factors. The RKI Panel includes more older adults with limited physical health, while in young adults more participants with poorer mental health are present. Despite method-related differences in prevalence, modelling can usually be used to assess trends. Conclusions: The RKI Panel provides a more realistic representation of the German population than previous telephone surveys. The differences in prevalence are due to effects of the survey mode, questionnaire design, and changes in sample composition.

Background: Non-communicable diseases (NCDs) are a significant public health challenge. Obesity and smoking are among the major risk factors for their development. In addition to individual behavioural changes, public health measures can help prevent NCDs by creating health-promoting conditions for the population. The aim of this paper is to analyse trends in obesity and smoking prevalence in Germany over time and place these trends in the context of existing public health measures for structural prevention. Method: The prevalence of obesity and smoking over the last 20 years was examined using data from the Robert Koch Institute Telephone Health Surveys and the German Health Update. Results: Between 2003 and 2023, the prevalence of obesity increased from 12.2 % to 19.7 % among women and men, for all age and education groups. The prevalence of smoking decreased from 32.1 % to 28.8 %, especially among younger people and in the highly educated group, but the decline has slowed in recent years. Conclusions: The continuous increase in obesity prevalence between 2003 and 2023 indicates that measures taken so far to prevent obesity have been insufficient. It is therefore imperative not only to address behavioural change at the individual level, but also to implement population-wide, settings-based prevention measures. In addition, more consistent implementation of regulatory measures is needed to further reduce tobacco consumption.

This report presents the study design and recruitment outcomes for the ‘Health in Germany’ panel, a long-term population-based health survey infrastructure developed by the Robert Koch Institute. The initial recruitment was conducted using a stratified random sample of the German population and a mixed-mode approach combining web-based and paper questionnaires. We examine participation rates across demographic subgroups, assess sample composition, and analyze potential selection effects. The panel recruitment survey for the ‘Health in Germany’ panel utilized the residents’ registration offices as the sampling frame. A two-stage stratified (cluster) sample was drawn from 359 primary sampling units across Germany. A mixed-mode approach was employed, offering both online and paper survey-mode on the basis of age groups. The sequence of survey modes was differentiated by age groups based on information from the residents’ registration offices. For respondents aged 16–69 years, a sequential mixed-mode design, offering the online mode first and only with the second reminder the paper survey-mode (also called push-to-web strategy), was applied. For respondents aged 70 years and older a simultaneous mixed-mode design was used, offering the online and paper survey-mode with the invitation. Participants completed a first panel recruitment survey in which socio-demographic and health data were collected. Selection effects and sample composition were analyzed via logistic regression models and compared with official population data. A total of 62,556 interviews were conducted, with 49,766 participants consenting to join the panel. After double opt-in registration process (for online participants), 47,863 remained. Response rates were higher among women and younger participants. Online participation predominated in the sequential design, whereas offline participation was more common in the simultaneous design. Logistic regression indicated higher participation among women and residents of smaller municipalities. Overall, the sample composition aligned broadly with population benchmarks, except for education and citizenship. The first recruitment study for the ‘Health in Germany’ panel established one of Europe’s largest population-based health panels through a mixed-mode design. Future expansions include regular health surveys, biometric measurements, complementary self-recruitment alongside the probability-based sample, and the development of a mobile survey app.

Background:As the RKI's new data collection infrastructure, the RKI Panel 'Health in Germany' offers the opportunity to regularly collect primary data on topics relevant to public health among the population in Germany (survey mode: online - CAWI and written - PAPI). This article presents the participation rates for the sub-waves and the composition of the sample. It also describes the special features of the 2024 annual survey. Methods:The 2024 annual survey followed on from the initial recruitment study of the RKI panel. For this survey wave, the registered panel participants were surveyed in three sub-waves with four different questionnaires on different topics. Results:Participation rates between 81.3 % and 75.3 % were achieved in the three sub-waves of the 2024 annual survey. In the first sub-wave, 38,212 people participated, and in the second, 36,134 interviews were conducted. The third and final sub-wave comprised 35,786 interviews. Conclusions:The 2024 annual survey provides a comprehensive data basis for various public health-related issues. The following topics are covered: physical and mental health, use of healthcare services, health-related behaviour, health literacy, social conditions, and the relationship between climate change and health. The data refer to the German resident population aged 18 and over.

Longitudinal studies are essential for understanding health trajectories and determinants over time. Successfully re-engaging and monitoring participants at key stages such as the transition from adolescence to adulthood is crucial. This stage of life is characterized by many changes and challenges and is considered critical for the manifestation of mental health problems. This study addresses challenges of contacting, re-activation and comparability of individuals in transition to adulthood with the initial population-based sample last contacted up to 9 years ago. In 2024, former participants of the “German Health Interview and Examination Survey for Children and Adolescents” (KiGGS) aged 16–25 years were invited to register in the new online panel infrastructure “Health in Germany” and participate in the “Study on Mental Health in Emerging Adulthood” (JEPSY) via a push-to-online panel approach. Logistic regression models identified predictors of registration and study participation. Weighting adjustments were applied to analyse and correct for selective participation. To assess potential selection bias, life satisfaction of JEPSY participants was benchmarked against a representative sample. Among 11,737 invitees, 4,451 (37.9

BACKGROUND:The panel `Health in Germany` has been established to gather nationwide health-related information, replacing cross-sectional surveys as primary data sources. However, panel designs involve multiple selection stages, potentially introducing additional nonresponse bias. This study aims to describe this drop-out bias and the weighting strategy used to improve representativeness. METHODS:Panelists were recruited through a recruitment study. At completion of the recruitment questionnaire, participants were invited to register for the panel. Registered panelists were subsequently invited to the first annual survey in 2024, which was divided into three sub-waves. Each included one of four questionnaires with different topics. Logistic regression models are used to estimate the probability for panel registration and participation in panel 2024 questionnaires, using sociodemographic and health-related variables from the recruitment study to illustrate drop-out bias. The weighting scheme and techniques are described. To assess the potential for drop-out bias and how it is reduced through weighting, unweighted and weighted estimates are compared to internal and external reference distributions using standardized differences. RESULTS:Drop-out analysis showed that sociodemographic characteristics (age, education, German citizenship) had a stronger association with panel registration than health-related parameters (e.g., self-rated health, smoking status, sport activity, chronic diseases) among the participants of the recruitment study. Similar patterns as for registration were found for participation in the 2024 questionnaires, except for age, which showed a reverse effect. No differences were observed across questionnaire types. Standardized differences confirmed the findings: sociodemographic characteristics-particularly education and German citizenship-showed larger deviations than health-related parameters. The largest deviations occurred in the recruitment study. The weighting procedure reduced most standardized differences to below 0.5% points. An exception is German citizenship, which showed only slight improvement. CONCLUSIONS:Drop-out within the first year of a newly established panel is mainly affected by sociodemographic variables, with minor effects due to health-related parameters. The additional recruitment steps did not lead to concerning deviations in sample composition compared to the recruitment study. Remaining differences were addressed through drop-out and calibration weighting, so the weighted panel 2024 sample does not substantially differ from what would be expected in a cross-sectional design such as the recruitment study. However, continued analyses are needed, as sample composition may change due to future panel attrition.

Background:The panel infrastructure Health in Germany, which is currently being set up, is geared towards the needs of public health research in Germany. The panel will consist of extensive probability and non-probability samples. This infrastructure will be used to collect survey data, measurement data and laboratory data to describe the health situation on an ongoing basis and make them available promptly. Methods:For the initial drawing of the probability sample, the sampling frame of the residents' registration offices (EMA) established in Germany is used. The study design follows a mixed-mode approach in which the invited persons can choose whether to participate in the survey online or in paper form. Four surveys per year are planned for the regular operation of the panel (regular annual wave). Ad-hoc studies on specific topics or acute issues are also possible. Conclusions:The panel provides a new infrastructure for continuous epidemiological studies to monitor the health of the population in Germany. This data basis strengthens the health monitoring and health reporting of the federal government, enabling a prompt and adaptable response to emerging data needs.

Im Rahmen der Mental Health Surveillance (MHS) am Robert Koch-Institut (RKI) werden für eine Auswahl an Indikatoren der psychischen Gesundheit von Erwachsenen basierend auf Surveydaten Zeitreihen bestehend aus gleitenden Drei-Monats-Schätzern und Glättungskurven berechnet. Dadurch sollen Entwicklungen in der psychischen Gesundheit der erwachsenen Bevölkerung in Deutschland mit möglichst geringem Zeitverzug beobachtet und insbesondere negative Entwicklungen frühzeitig erkannt werden. Diese hochfrequente Surveillance wurde ursprünglich vor dem Hintergrund neuer Informationsbedarfe zur Entwicklung der psychischen Gesundheit der Bevölkerung in der COVID-19-Pandemie entwickelt.

Purpose: Fear of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and lockdown measures may have an impact on health care utilization particularly for people with chronic diseases. We investigated changes in outpatient utilization behavior in pandemic phases among people with selected chronic diseases in Germany. Methods: The nationwide population-based telephone surveys German Health Update (GEDA) 2019/2020 (April 2019 to September 2020) and GEDA 2021 (July to December 2021) covered 4 out of 7 pandemic phases from the pre-pandemic to the 4th pandemic wave. Data on hypertension, diabetes and major cardiovascular diseases (CVD) in the past 12 months and visiting a general practitioner (GP) or a specialist (excluding dentist) in the past 4 weeks was collected using a standardized questionnaire. Proportions and odds ratios were derived from logistic regression models adjusted for age, sex, education and federal states. Results: Among 27,967 participants aged >= 16 years, 8,449, 2,497 and 1,136 individuals had hypertension, diabetes and major CVD. Participants with these chronic diseases visited a GP or specialist significantly more often than the overall study population, irrespective of pandemic phases. Compared to the pre-pandemic phase, a significant reduction in specialist-visiting was found in the first pandemic wave among people with hypertension (34.3% vs 24.1%), diabetes (39.5% vs 25.5%) and major CVD (41.9% vs 25.6%). GP-visiting was lower only among people with hypertension (53.0% vs 46.0%). No difference in GP or specialist visiting was found in the 4th pandemic wave compared to the pre-pandemic phase. Conclusion: The observed decrease particularly in specialist utilization among people with the selected chronic diseases at the beginning of the pandemic was not observed for the second half of 2021 despite the ongoing pandemic. Further studies are required to examine whether the temporary changes in the utilization of ambulatory health care have affected the disease management of people with chronic diseases.

Abstract Background: Fear of SARS-CoV-2 infection and lockdown measures may have an impact on health care utilization particularly for people with chronic diseases. We investigated changes in outpatient utilization behavior in pandemic phases among people with selected chronic diseases in Germany. Methods: The nationwide telephone surveys GEDA 2019/2020-EHIS (April 2019 to September 2020) and GEDA 2021 (July to December 2021) covered 4 out of 7 pandemic phases from the pre-pandemic to the 4th pandemic wave. Data on hypertension, major cardiovascular diseases (CVD) and diabetes in the past 12 months and visiting a general practitioner (GP) or a specialist (excluding dentist) in the past 4 weeks was collected using a standardized questionnaire. Proportions and odds ratios were derived from logistic regression models adjusted for age, sex, education and federal state. Results: Among 27,967 participants aged ≥16 years, 8,449, 1,136 and 2,497 individuals had hypertension, major CVD and diabetes. Participants with these chronic diseases visited a GP or specialist significantly more often than the overall study population, irrespective of pandemic phases. Compared to the pre-pandemic phase, a significant reduction in specialist-visiting was found in the 1st pandemic wave among people with hypertension (34.3% vs. 24.1%), major CVD (41.9% vs. 25.6%) and diabetes (39.5% vs. 25.5%). GP-visiting was lower only among people with hypertension (53.0% vs. 46.0%). No difference in GP or specialist visiting was found in the 4th pandemic wave compared to the pre-pandemic phase. Conclusions: The observed decrease particularly in specialist utilization among people with the selected chronic diseases at the beginning of the pandemic was not observed for the second half of 2021 despite the ongoing pandemic. Further studies are required to examine whether the temporary changes in the utilization of ambulatory health care have affected the disease management of people with chronic diseases.

The authors regret that an affiliation was omitted for Julia Charlotte Büschges. The complete list of affiliations for all authors appears above. The authors would like to apologise for any inconvenience caused. Carotid IMT and Stiffness in the KiGGS 2 National Survey: Third-Generation Measurement, Quality Algorithms and Determinants of CompletenessUltrasound in Medicine and BiologyVol. 47Issue 2PreviewCarotid intima–media thickness (cIMT) and carotid stiffness (CS) are important markers of atherosclerotic risk in the young. We assessed a novel third-generation method for its applicability in large population-based epidemiologic studies to determine strengths, limitations, completeness and predictors of unsuccessful measurement. Four thousand seven hundred ninety-eight 14- to 31-y-old participants of the German KiGGS cohort, which is based on a nationally representative sample with 11-y follow-up, underwent B-mode ultrasound examinations of the left and right common carotid artery with semi-automatic edge detection and automatic electrocardiogram-gated real-time quality control based on a sophisticated snake algorithm and subpixel interpolation. Full-Text PDF

In the course of the COVID-19 pandemic and the implementation of associated non-pharmaceutical containment measures, the need for continuous monitoring of the mental health of populations became apparent. When the pandemic hit Germany, a nationwide Mental Health Surveillance (MHS) was in conceptual development at Germany’s governmental public health institute, the Robert Koch Institute. To meet the need for high-frequency reporting on population mental health we developed a prototype that provides monthly estimates of several mental health indicators with smoothing splines. We used data from the telephone surveys German Health Update (GEDA) and COVID-19 vaccination rate monitoring in Germany (COVIMO). This paper provides a description of the highly automated data pipeline that produces time series data for graphical representations, including details on data collection, data preparation, calculation of estimates, and output creation. Furthermore, statistical methods used in the weighting algorithm, model estimations for moving three-month predictions as well as smoothing techniques are described and discussed. Generalized additive modelling with smoothing splines best meets the desired criteria with regard to identifying general time trends. We show that the prototype is suitable for a population-based high-frequency mental health surveillance that is fast, flexible, and able to identify variation in the data over time. The automated and standardized data pipeline can also easily be applied to other health topics or other surveys and survey types. It is highly suitable as a data processing tool for the efficient continuous health surveillance required in fast-moving times of crisis such as the Covid-19 pandemic.

Background Times of crisis such as the COVID-19 pandemic are expected to compromise mental health. Despite a large number of studies, evidence on the development of mental health in general populations during the pandemic is inconclusive. One reason may be that representative data spanning the whole pandemic and allowing for comparisons to pre-pandemic data are scarce. Methods We analyzed representative data from telephone surveys of Germany's adults. Three mental health indicators were observed in ~1,000 and later up to 3,000 randomly sampled participants monthly until June 2022: symptoms of depression (observed since April 2019, PHQ-2), symptoms of anxiety (GAD-2), and self-rated mental health (latter two observed since March 2021). We produced time series graphs including estimated three-month moving means and proportions of positive screens (PHQ/GAD-2 score ≥ 3) and reports of very good/excellent mental health, as well as smoothing curves. We also compared time periods between years. Analyses were stratified by sex, age, and level of education. Results While mean depressive symptom scores declined from the first wave of the pandemic to summer 2020, they increased from October 2020 and remained consistently elevated throughout 2021 with another increase between 2021 and 2022. Correspondingly, the proportion of positive screens first decreased from 11.1% in spring/summer 2019 to 9.3% in the same period in 2020 and then rose to 13.1% in 2021 and to 16.9% in 2022. While depressive symptoms increased in all subgroups at different times, developments among women (earlier increase), the youngest (notable increase in 2021) and eldest adults, as well as the high level of education group (both latter groups: early, continuous increases) stand out. However, the social gradient in symptom levels between education groups remained unchanged. Symptoms of anxiety also increased while self-rated mental health decreased between 2021 and 2022. Conclusion Elevated symptom levels and reduced self-rated mental health at the end of our observation period in June 2022 call for further continuous mental health surveillance. Mental healthcare needs of the population should be monitored closely. Findings should serve to inform policymakers and clinicians of ongoing dynamics to guide health promotion, prevention, and care.

In daycare centres, the close contact of children with other children and employees favours the transmission of infections. The majority of children <6 years attend daycare programmes in Germany, but the role of daycare centres in the SARS-CoV-2 pandemic is unclear. We investigated the transmission risk in daycare centres and the spread of SARS-CoV-2 to associated households. 30 daycare groups with at least one recent laboratory-confirmed SARS-CoV-2 case were enrolled in the study (10/2020-06/2021). Close contact persons within daycare and households were examined over a 12-day period (repeated SARS-CoV-2 PCR tests, genetic sequencing of viruses, symptom diary). Households were interviewed to gain comprehensive information on each outbreak. We determined primary cases for all daycare groups. The number of secondary cases varied considerably between daycare groups. The pooled secondary attack rate (SAR) across all 30 daycare centres was 9.6%. The SAR tended to be higher when the Alpha variant was detected (15.9% vs. 5.1% with evidence of wild type). The household SAR was 53.3%. Exposed daycare children were less likely to get infected with SARS-CoV-2 than employees (7.7% vs. 15.5%). Containment measures in daycare programmes are critical to reduce SARS-CoV-2 transmission, especially to avoid spread to associated households.

ObjectiveTo investigate SARS-COV-2 viral clearance and viral load kinetics in the course of infection in children aged 1–6 years in comparison with adults.MethodsProspective cohort study of infected daycare children and staff and their close contacts in households from 11/2020 to 06/2021. Adult participants took upper respiratory tract specimen from themselves and/or their children, for PCR tests on SARS-CoV-2. Data on symptoms and exposure were used to determine the date of probable infection for each participant. We determined (a) viral clearance, and (b) viral load dynamics over time. Samples were taken from day 4–6 to day 16–18 after diagnosis of the index case in the respective daycare group (5 samples per participant).ResultsWe included 40 children (1–6 years) and 67 adults (18–77 years) with SARS-CoV-2 infection. Samples were available at a mean of 4.3 points of time per participant. Among the participants, the 12-day study period fell in different periods within the individual course of infection, ranging from day 5–17 to day 15–26 after assumed infection.Children reached viral clearance at a median of 20 days after assumed infection (95% CI 17–21 days, Kaplan-Meier Analysis), adults at 23 days (95% CI 20–25 days, difference not significant). In both children and adults, viral load decreased over time with trajectories of the mean viral load not being statistically different between groups. Kaplan-Meier calculations show that from day 15 (95% CI 13–15), 50% of all participants had a viral load <1 million copies/ml, i.e. were no longer infectious or negative.ConclusionChildren aged 1–6 and adults infected with SARS-CoV-2 (wild type and Alpha variant) did not differ significantly in terms of viral load kinetics and time needed to clear the virus. Therefore, containment measures are important also in the daycare settings as long as the pandemic continues.

Background:Measures for containing the COVID-19 pandemic in 2020 and 2021 resulted in drastic changes in physical activity and dietary habits that also impacted body weight.Methods:The representative study German Health Update (GEDA 2021) includes self-reported information about body weight and body height for adults aged 18 years and older (n=2,985) from July to October 2021. In addition, the study asked about changes in body weight since the beginning of the COVID-19 pandemic.Results:For 59% of participants, body weight has not changed since the beginning of the COVID-19 pandemic, 26% report weight gain, and 15% report weight loss. Younger people indicate weight gain more often than older people, and individuals with obesity report weight gain more often than individuals without obesity. 1.5 years after the beginning of the COVID-19 pandemic, the average weight change within the population is approximately +0.34kg.Conclusions:The effects of restrictions in everyday life with regard to the possible negative impacts on body weight should be given greater consideration and should be monitored in the future.

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.

The spread of the coronavirus SARS-CoV-2 in 2020 and the containment measures associated therewith have changed many aspects of daily life. An impact on health even beyond infections itself is assumed as well. The health situation of the population in the first phase of the pandemic was thus analysed using data from the German Health Update (GEDA 2019/2020-EHIS). By continuing the survey, the analyses for 2020 are completed (n=26,507 participants), whereby the focus is now on the third phase of the pandemic (second wave of infection, gradual reintroduction of containment measures). The health indicators are presented on a monthly basis. As in the first phase of the pandemic, no pandemic-related changes were observed for tobacco smoking/ second-hand smoke exposure and for received/lack of/provided support. In contrast to the first phase of the pandemic, declines in utilisation of medical services and depressive symptoms are not observed in the third phase. The increase in body weight/body mass index after the first phase of the pandemic did not continue. The survey period allows for a comparison of the periods before and as of the pandemic situation. A decrease in the medical services utilisation and depressive symptoms as well as an increase in the body weight/body mass index is observed in the period from March 2020 to January 2021 compared to the pre-pandemic period from April 2019 to March 2020.

In der Studie Gesundheit in Deutschland aktuell (GEDA 2019/2020-EHIS) beantworteten 23.001 Menschen im Alter ab 15 Jahren zwischen April 2019 und September 2020 Fragen zur Gesundheit und zur Lebenssituation. Die Ergebnisse sind repräsentativ für die in Deutschland lebende Wohnbevölkerung ab 15 Jahren. Die Responserate lag bei 21,6 %. Die Fragebogeninhalte basieren auf der dritten Welle der Europäischen Gesundheitsbefragung (European Health Interview Survey, EHIS), die in allen EU-Mitgliedstaaten durchgeführt wurde. Sie umfasst die vier Module Gesundheitszustand, Gesundheitsversorgung, Gesundheitsdeterminanten und sozioökonomische Variablen. Die harmonisiert erhobenen EHISDaten besitzen ein hohes Maß an internationaler Vergleichbarkeit. Sie stellen eine wichtige Informationsgrundlage für die europäische Gesundheitspolitik und -berichterstattung dar und werden vom Statistischen Amt der Europäischen Union (Eurostat) zur Verfügung gestellt. Die Daten sind Grundlage für die Gesundheitsberichterstattung des Bundes. Der Zeitraum der Datenerhebung ab April 2019 berücksichtigte knapp ein Jahr vor der SARS-CoV-2-Pandemie und fiel dann ab März 2020 in die Anfangsphase der Pandemie. Somit stehen mit der aktuellen GEDA-Welle Daten für die Erforschung von gesundheitlichen Auswirkungen im zeitlichen Zusammenhang mit der SARS-CoV-2-Pandemie zur Verfügung. STUDIENMETHODIK · GESUNDHEITSBEFRAGUNG · TELEFONINTERVIEW · GESUNDHEITSMONITORING · EHIS · RESPONSE