Journal of health monitoring最新文献

Background: The World Health Organization's Framework Convention on Tobacco Control recommends tobacco control measures. The implementation of these measures in Europe is assessed using the Tobacco Control Scale. The aim of this analysis is to examine smoking behaviour in European countries in the context of national measures to curb tobacco consumption.

Methods: In addition to analysing current tobacco consumption, the relationship between the 2019 Tobacco Control Scale results, including policy areas, and smoking prevalence in 29 European countries was examined based on data from the third wave of the European Health Interview Survey (EHIS 3). This was visualised using scatter plots and analysed using Pearson's correlation coefficients.

Results: On average, 24.4 % of adults in Europe smoke, with substantial differences between countries. There are also some clear differences between the sexes, with a higher proportion of men than women smoking in all countries studied. A higher overall score on the Tobacco Control Scale is associated with a lower smoking prevalence among both women and men. Negative correlations are also evident between smoking prevalence and the policy areas of smoking cessation support and advertising bans.

Conclusions: Consistent implementation of tobacco control measures is associated with lower smoking prevalence in Europe. This highlights the importance of comprehensive tobacco control strategies to reduce tobacco consumption.

Background: In order to assess the prevention and care needs for type 2 diabetes in the coming decades from a public health perspective, forecasts on the trends in prevalence and case numbers are essential.

Methods: The data are based on age-specific estimates of diagnosed diabetes prevalence from the survey German Health Update (GEDA) 2022, and on the proportion of type 2 diabetes derived from routine health insurance data. Using routine data on the incidence and excess mortality of diabetes, various scenarios for the future trends of type 2 diabetes are modelled using an illness-death model.

Results: Based on a type 2 diabetes prevalence of 8.6 % in 2022 (women: 8.2 %, men: 9.2 %), corresponding to a total of 6.05 million cases (women: 2.92 million, men 3.13 million), the prevalence is expected to rise to 16.1 % by 2050 (women: 14.8 %, men: 17.4 %), with the number of cases increasing to 11.01 million (women: 5.19 million, men: 5.82 million). Assuming a 2.0 % annual decline in incidence, the prevalence is expected to rise to only 12.2 % (8.39 million cases); with a simultaneous 2.0 % annual decline in excess mortality, the prevalence is expected to reach 13.0 % (8.94 million cases).

Conclusions: The prognosis is mainly influenced by changes in incidence. Primary preventive approaches to reduce risk factors for type 2 diabetes are therefore crucial to counteract an increase in the number of type 2 diabetes cases.

Background: The risks of climate change for human health are becoming increasingly apparent. The prevention indicator system of the German federal states (Länder in Deutschland), developed between 2018 and 2022, was therefore reviewed in relation to its relevance to climate change.

Methods: As a first step, a working group with members from different German federal states developed a model on the relationships between climate change and health in the context of prevention. Central aspects of this model were translated into a checklist based on guiding questions, which was used to conduct a systematic, standardised, and evidence-informed assessment of the climate relevance of the prevention indicator system of the German federal states.

Results: Climate change relevance was identified for a total of 49 out of 73 prevention indicators. Most frequently, climate relevance was found for indicators relating to particularly vulnerable groups to climate change-related health impacts (27 indicators), followed by 18 indicators addressing health consequences of climate change.

Conclusions: The assessment methodology that we developed proved suitable and can be applied to assess climate relevance in other health indicator systems. This prevention indicator system requires further development of climate aspects that have not yet been included, such as 'health-relevant climate change impacts', 'health costs', and indicators on vaccine-preventable diseases as climate adaptation measures.

Background: The World Health Organization (WHO) defines maternal mortality as the death of a woman during pregnancy or up to 42 days after delivery. The maternal mortality ratio (MMR) serves as an indicator of the quality of health care. In Germany, recording is based on the death certificate (ICD-10 code), with variations in documentation leading to underreporting. Studies indicate insufficient data in Berlin and queries in Germany.

Method: 2,316 death certificates of women (aged 15 - 50) from the Berlin Central Archive (2019 - 2022) were analysed to identify maternal deaths and the quality of the information provided was assessed. In addition, the recording of pregnancy status on death certificates was examined nationwide.

Results: Fourteen maternal deaths (excluding late cases according to the WHO) were identified. Only four cases were identifiable as maternal deaths solely on the basis of ICD-10 codes. The additional information 'Is or was the woman pregnant?' which is important for identification, was available in about a quarter of the death certificates reviewed. In 73.2 % of cases, the question 'Is or was the woman pregnant?' remained unanswered. A nationwide comparison of death certificates revealed considerable differences: only Bavaria and Bremen followed the WHO definition. Saxony-Anhalt does not record pregnancy status at all.

Conclusion: The recording of maternal mortality in Germany is incomplete. Death certificates are often deficient. Many federal states record periods outside the WHO definition (3 - 12 months after birth). A standardized national system for registering maternal deaths is required to improve data collection and enable better prevention.

Background: Waterpipe (WP) use poses not only a risk of nicotine dependence but also additional health hazards. This study examined trends in WP use in Germany, focusing on prevalence by age group and differences in initiation age.

Methods: We analysed data from 76,239 respondents (≥ 14 years) from the German Study on Tobacco Use (DEBRA); a series of bi-monthly national surveys using face-to-face interviews at home (2018 - 2024). Prevalence trends were modelled using binomial logistic regression models with restricted cubic splines.

Results: The prevalence of WP use decreased over time, to an estimated 0.9 % (95 % CI = 0.6 - 1.2) by mid-2024. This prevalence is made up of 0.1 % (95 % CI = 0.0 - 0.2) 14- to 17-year-olds, 0.3 % (95 % CI = 0.2 - 0.6) 18- to 24-year-olds, 0.3 % (95 % CI = 0.2. - 0.4) 25- to 39-year-olds, and 0.2 % (95 % CI = 0.1 - 0.3) people aged 40 years and older. WP use increased until 2020 up to 2.8 % (95 % CI = 2.3 - 3.4), remained stable for two years and then decreased, especially among people between 25 and 39 years of age. The proportion of 14- to 17-year-old users and users aged at least 40 years remained stable over the years at a low level. Median initiation age was 18 years (25th percentile: 16 years; 75th percentile: 22 years). A lower initiation age was associated with male gender and lower income.

Conclusions: WP use increased from 2018 - 2020, stabilised from 2020 - 2022, and then decreased until 2024. Median initiation age was 18, with males and people with lower income starting at a younger age. Targeted public health interventions, focusing on younger males and those with lower socioeconomic status, are needed to prevent early use.

[This corrects the article DOI: 10.25646/9537.2.].

Background: During the COVID-19 pandemic, young people at risk of poverty were particularly affected by contact restrictions as well as by daycare centre and school closures. The aim here is to describe the health status of young people at risk of poverty in comparison to their peers from financially better-off families at the end of the pandemic.

Methods: The analyses are based on the data of 3- to 15-year-olds from the study German Children's Health Update (2022/2023). Prevalences stratified by income were determined for selected indicators of health, health-related behaviour and psychosocial stress and resources. A comparison was made between families at risk of poverty and families with medium and high incomes. Poisson regressions were adjusted for parents' level of education.

Results: Young people at risk of poverty are more likely to have poor health than their peers from financially better-off families. While the former are less likely to participate in organised sport in their leisure time, there are no differences in participation in voluntary sports activities at school according to family income.

Conclusions: Strategies to reduce health-related disadvantages for young people at risk of poverty must be implemented at the level of society as a whole and in local settings. Continuous monitoring of children's and adolescents' health can help to identify trends at an early stage.

Background: Coronary heart disease (CHD) is the leading cause of death in Germany. Comprehensive analyses of long-term trends in CHD mortality that also distinguish between acute myocardial infarction (AMI) and non-AMI-related chronic CHD are currently lacking.

Method: Age-specific and age-standardised CHD mortality rates for the period 1998 - 2023 were calculated based on data from the cause-of-death statistics of the Federal Statistical Office of Germany. Annual percentage changes (APC) and average annual percentage changes (AAPC) were estimated using joinpoint regression analysis.

Results: Between 1998 and 2023, the average annual change in age-standardised CHD mortality rates for women was -3.9 % ((-4.1) - (-3.7)) per year, compared with -3.2 % ((-3.3) - (-3.0)) for men. However, since the 2010s, the downward trend in CHD mortality has flattened, particularly among those aged 60 to 74 years. In the analysis by ICD subgroups, mortality rates for chronic CHD declined less sharply than for AMI over the entire period 1998 - 2023, especially among men.

Conclusions: The flattening of the CHD mortality trend, particularly among middle-aged adults over the last decade, and the smaller decline in chronic CHD mortality, especially among men, require further exploration in order to identify unmet needs at various levels of prevention for specific life stages. In addition, the influence of the COVID-19 pandemic on CHD mortality trends should be further investigated.

Background: Knowledge of the risk of cardiovascular disease (CVD) is important for its prevention.

Methods: Data from a non-clinical test for the absolute risk of having a heart attack or stroke for the first time in the next ten years is available from 3,271 35- to 69-year-old participants in the GEDA 2022 study without a diagnosis of heart attack or stroke. This risk was categorised as low (< 5 %), still low (≥ 5 % - < 7.5 %), increased (≥ 7.5 % - < 10 %) and high (≥ 10 %). In addition, the self-perceived CVD risk was asked as almost no, low, moderate and high risk.

Results: According to the CVD test, 73.5 % of adults were at low risk, 7.8 % were still at low risk, 6.0 % were at increased risk and 12.8 % were at high risk. In contrast, 28.7 % perceived themselves to be at almost no risk, 45.3 % at low risk, 20.4 % at moderate risk and 5.6 % at high risk of CVD. The higher the test-based risk, the lower the proportion of those who perceived themselves as having almost no or only a low risk. Nevertheless, half of the people with an increased to high risk according to the test result perceived themselves to be at almost no or only a low risk. The underestimation of risk was associated with lower education, better mental health and physical activity in both sexes.

Conclusions: People who underestimate their risk of CVD despite an unfavourable risk factor profile are a key target group for cardiovascular prevention.

Background: As part of the German Burden of Disease Study, population-based prevalences of important diseases are estimated. This allows regional patterns and temporal trends to be identified.

Methods: The prevalence of dementia in the population was estimated cross-sectionally for the years 2017 to 2022 at the level of the Spatial Planning Regions using routine data of persons insured in the statutory health insurance AOK, adjusted for age, sex and morbidity (administrative prevalence).

Results: In 2022, the prevalence of dementia in Germany was 2.8% of the population aged 40 and over. In women the prevalence was 3.3 %, in men 2.4 %. The prevalence of dementia rises sharply with age. For example, the prevalence among people aged 65 and over was 6.9 %. A slight downward trend was observed between 2017 and 2022. The age-standardised regional distribution shows a clear pattern of higher prevalence in eastern Germany and the eastern part of Bavaria.

Conclusions: Measured by administrative prevalence, the public health significance of dementia remains largely stable. However, demographic change is expected to increase the number of people affected by dementia. Prevention of modifiable risk factors is therefore essential, especially in middle age.