Introduction
Data type | Number of participants | Details | Data acquisition period |
---|---|---|---|
Baseline assessment | Whole cohort: 205,415 | Basic physical and medical examinations, face-to-face interview, touch-screen-based self-report questionnaires, biomaterial collections (Level 1) | 2014–2019 |
Extended baseline assessment | 56,971 | Additional in-depth physical and medical examinations, additional self-administered questionnaires (touch-screen, teleform, web-based) (Level 2) | 2014–2019 |
MRI | 30,861 | Whole-body 3T magnetic resonance imaging | 2014–2019 |
Mortality follow-up | Whole cohort | Ascertainment of vital status, collection and coding of death certificates and clinical/forensic reports | 2014–ongoing |
Record linkage | Whole cohort | Statutory health insurances Private health insurances Epidemiological and clinical cancer registries Central Research Institute of Ambulatory Health Care in Germany German Statutory Pension Fund Institute for Employment Research | 2014–ongoing |
Calibration Study | 5,903 | Repeated extended examination with Level 2 examination modules between 1 and 12 months after the baseline examination to assess short-term measurement variability | 2016–2019 |
Written Health Follow-up questionnaire | Whole cohort | Self-reported incident events, with verification via medical records and questionnaires provided by treating physicians | 2017–ongoing |
First re-examination | 135,000 planned | Face-to-face interview, touch-screen-based self-report questionnaires, repeat examinations, biomaterial collections | 2018–2023 |
Supplementary COVID-19 questionnaire | 160,227 | Pandemic-related questions on general state of health, SARS-CoV-2 symptoms and tests, changes in behaviour and social contacts, psychological effects, changes in employment status, physical activity and consumption of stimulating substances | 05–07/2020 |
SoccHealth | 500 former professional soccer players (additional cohort) | Additional project assessing long-term effects of high-performance sports. Participants receive the Level 2 programme and MRI of the first re-examination | 2021–ongoing |
Methods
Study population and recruitment
Examinations and data collection
Disease group/function | Specific endpoints | Instruments (examinations in bold, technical devices used in italic) | |
---|---|---|---|
Whole cohort (Level 1) | Subgroup (Level 2) | ||
Cardiovascular Diseases | Myocardial infarction | Questionnaire | 10-s Electrocardiography (Cardio Perfect PRO, WelchAllyn, Skaneateles Falls, NY, USA) |
Heart failure Diastolic/systolic dysfunction Valvular heart disease | Questionnaire | 3-D-echocardiography (Phillips iE33—Philips Medical Systems, Hamburg, Germany) MR Imaging of the heart Submaximal ergometry [25] (Bicycle ergometer Sana Bike 350F—ergosana, Bitz, Germany; Heart rate chest strap T31—Polar Electro Oy, Finland; custom design ergometer software—Dr. Schmidt GmbH, Neunkirchen, Germany) (“1 of 3-exam”*) | |
Hypertension/elevated blood pressure | Questionnaire | - | |
Peripheral arterial disease Arterial stiffness | Questionnaire Vascular Explorer (Enverdis, Düsseldorf, Deutschland) | – | |
Atrial fibrillation | Questionnaire | 10-s Electrocardiography Long-term electrocardiography (SOMNOwatch™ plus, SOMNOmedics; Randersacker, Germany) | |
Arteriovenous ratio of the retina | – | Retinal photography (Retinal Camera CenterVue, DRS -Welch Allyn, Skaneateles Falls, NY, USA) | |
Diabetes | Impaired glucose tolerance Diabetes mellitus | Questionnaire HbA1c Oral glucose tolerance test (subgroup of Level 1) | Oral glucose tolerance test (subgroup of Level 2) Skin autofluorescence (AGE reader SU—DiagnOptics Technologies, Groningen, The Netherlands) |
Diabetic retinopathy | – | Retinal photography | |
Cancer | Questionnaire | Tumor tissue bank | |
Neurologic and psychiatric diseases | Cerebrovascular diseases | Questionnaire | MR Imaging of the brain |
Cognitive impairment and dementia Impaired fine motor skills and coordination | Questionnaire Neurocognitive test battery [27] | MR Imaging of the brain Number Series Test (touchscreen) [28] Purdue pegboard test | |
Depression Anxiety | Questionnaire | – | |
Respiratory diseases | Chronic obstructive pulmonary disease, asthma, lung function, airways inflammation | Questionnaire Spirometry [29] (Easy on-PC spirometer—ndd Medizintechnik AG, Zürich, Switzerland) | Exhaled nitric oxide (FeNO) [29] (NIOX Vero—Circassia, Oxford, UK) |
Infectious disease | Selected acute transient infections | Questionnaire | – |
Gastrointestinal infections/intestinal microbiome | Questionnaire Stool samples (subgroup) | – | |
Periodontal disease, craniomandibular disease, oral microbiome | Questionnaire Tooth count [30] Saliva sample | Oral examination (e. g., dental state, pocket depth, mandibular pain) [27] (custom design software—ParoStatus.de, Berlin, Germany) (“1 of 3-exam”)* | |
Sensory systems | Olfactory function | – | Olfactory test (Sniffing Sticks Screening 12—Burghart Messtechnik, Holm, Germany) |
Vision | – | Visual acuity test (Testmonitor HP E241i (HP, Palo Alto, CA, USA) Retinal photography | |
Hearing | |||
Musculoskeletal system | Arthrosis, rheumatoid arthritis | – | Examination of knee and hip with angle chair |
Physical fitness and activity | Questionnaire Hand grip strength [25] (Digital Dynamometer Jamar Plus+ − Sammons Preston, Rolyon, Bolingbrook, IL, USA) 7-day accelerometry [34] (GT3X/+ − ActiGraph, Pensacola, FL, USA) | Ergometry (“1 of 3-exam”)* 24 h accelerometry (SOMNOwatch™ plus, SOMNOmedics; Randersacker, Germany) | |
Anthropometry [35] | Height (SECA Stadiometer 274) Weight (SECA Medical Body Composition Analyzer mBCA 515) Waist circumference (SECA Circumference measuring tape 201) Body impedance/body fat (SECA Medical Body Composition Analyzer mBCA 515) All seca GmbH & Co. KG, Hamburg, Germany | Ultrasound of the abdominal fat (Phillips iE33—Philips Medical Systems, Hamburg, Germany) |
Questionnaires |
---|
Face to face interview |
Level 1 mandatory modules (whole cohort) |
Socio-economic status and socio-demographic factors: Nationality, ethnicity, native language, family status, housing situation, education, employment/profession/status, income, partners education, parents education, occupation |
Medical history: Cardiovascular diseases, tumour diseases, metabolic diseases, musculoskeletal diseases, pulmonary diseases, allergies, gastrointestinal and liver diseases, skin diseases, kidney diseases, neurological and psychiatric diseases, eye, infectious diseases, other diseases (rheumatoid arthritis, morbus bechterew, lupus erythematodes, Sjögren syndrome, fibromyalgia, urinary tract stones, myelitis optic, multiple sclerosis, Tinnitus), operations; filter questions of Mini International Neuropsychiatric Interview vs 5.0, part Major Depression |
Medication use (past 7 days) |
Women: Menstrual cycle, contraceptives, menopause, hormone replacement, polycystic ovary syndrome, HPV |
Level 2 modules (subgroup) |
If affirmative reply regarding depression in Mini International Neuropsychiatric Interview filter question: complete Mini questionnaire module on Major Depression |
Self-administered—touchscreen in study centre |
Level 1 mandatory modules (whole cohort) |
Health-related quality of life (modified SF-12) |
Physical activity and fitness (VSAQ, Global Physical Activity Questionnaire) |
Smoking |
Alcohol consumption |
Women: Pregnancies |
Men: Family Planning |
Infections and immune function |
Participation in screening programmes |
Pulmonary health |
Oral health: Oral Health Impact Profile questionnaire (OHIP-5) |
Cardiovascular health |
Psychosocial factors [37]: Big-5 personality, stress (PHQ-Stress) |
Level 1 elective* modules (subgroup) |
Instrumental Activities of Daily Living Lawton and Brody Questionnaire (age 60+ years) |
Family history |
Occupational reward/effort reward imbalance questionnaire (ERI) |
Occupational exposures |
Environmental exposures |
Headache types/migraine |
Drug use |
Sleeping habits |
Childhood/youth [39] |
Childhood trauma questionnaire, short version (CT-S) |
Social networks and support (adapted Berkman questionnaire) [37] |
Weight history |
Tattoos and solarium |
Accidents and fractures |
Gastrointestinal symptoms |
Use of medical services |
Level 2 mandatory modules (subgroup) |
Pain mannequin |
Seeing and hearing |
Restless Legs Syndrome |
Exposure to animals |
Work-related exposures/occupational stress (COPSOQ) |
Self-administered questionnaires at home |
Diet: Food Frequency Questionnaire (FFQ), short version 24 h recall: (sv24) |
Physical activity [34]: Questionnaire on Annual Physical Activity Pattern (QUAP), computer-based 24-h physical activity recall (cpar24) |
Central data management
Collection and storage of biosamples
Follow-up
Quality management
Data protection and ethics
Use and access
Results
Recruitment, age distribution and response rates
Study centre | Time period of recruitment | Sex | Age group | Total | |||||
---|---|---|---|---|---|---|---|---|---|
Female | Male | 20–29 | 30–39 | 40–49 | 50–59 | 60+ | |||
Augsburg | 06/2014–09/2019 | 10,172 | 10,437 | 2,034 | 2,081 | 5,453 | 5,500 | 5,541 | 20,609 |
Berlin-Mitte | 04/2014–01/2019 | 5,428 | 5,601 | 1,133 | 1,109 | 3,006 | 2,963 | 2,818 | 11,029 |
Berlin-Nord | 06/2014–04/2019 | 5,134 | 4,960 | 986 | 1,051 | 2,629 | 2,731 | 2,697 | 10,094 |
Berlin-Sued | 09/2014–04/2019 | 5,232 | 4,776 | 1,008 | 997 | 2,688 | 2,583 | 2,732 | 10,008 |
Bremen | 03/2014–11/2018 | 5,318 | 5,171 | 1,083 | 1,161 | 2,679 | 2,794 | 2,772 | 10,489 |
Duesseldorf | 06/2014–06/2019 | 4,684 | 4,450 | 978 | 958 | 2,305 | 2,471 | 2,422 | 9,134 |
Essen | 03/2014–09/2019 | 5,336 | 5,316 | 1,118 | 1,288 | 2,782 | 2,756 | 2,708 | 10,652 |
Freiburg | 06/2014–04/2019 | 5,032 | 5,049 | 995 | 1,030 | 2,668 | 2,698 | 2,690 | 10,081 |
Halle | 05/2014–03/2019 | 5,247 | 4,881 | 939 | 967 | 2,585 | 2,821 | 2,816 | 10,128 |
Hamburg | 09/2014–07/2019 | 5,160 | 4,927 | 992 | 1,071 | 2,599 | 2,738 | 2,687 | 10,087 |
Hannover | 03/2014–11/2018 | 5,162 | 4,878 | 968 | 956 | 2,543 | 2,666 | 2,907 | 10,040 |
Kiel | 04/2014–06/2019 | 4,866 | 4,628 | 925 | 1,042 | 2,422 | 2,578 | 2,527 | 9,494 |
Leipzig | 08/2014–10/2018 | 5,413 | 5,443 | 1,091 | 1,154 | 2,894 | 2,873 | 2,844 | 10,856 |
Mannheim | 05/2014–09/2019 | 5,182 | 5,108 | 1,069 | 1,102 | 2,699 | 2,720 | 2,700 | 10,290 |
Muenster | 05/2014–06/2019 | 5,027 | 4,988 | 981 | 998 | 2,661 | 2,686 | 2,689 | 10,015 |
Neubrandenburg | 03/2014–02/2019 | 10,917 | 11,079 | 1,837 | 2,577 | 5,272 | 6,086 | 6,224 | 21,996 |
Regensburg | 04/2014–05/2019 | 4,992 | 5,032 | 951 | 995 | 2,673 | 2,720 | 2,685 | 10,024 |
Saarbruecken | 06/2014–04/2019 | 5,169 | 4,858 | 899 | 1,141 | 2,574 | 2,625 | 2,788 | 10,027 |
Total | 103,471 | 101,582 | 19,987 | 21,678 | 53,132 | 55,009 | 55,247 | 205,053 | |
Proportion (%) | 50 | 50 | 10 | 11 | 26 | 27 | 27 |
Baseline examination and MRI
Modules | Number of participants | Completeness of modules (%) | |
---|---|---|---|
Level 1 | 7-day accelerometry* | 89,949 | 121 |
Anthropometry | 202,617 | 99 | |
Blood pressure | 204,162 | 100 | |
Cognitive function | 196,146 | 96 | |
Hand grip strength | 201,972 | 98 | |
Spirometry | 189,583 | 92 | |
Tooth count | 189,086 | 92 | |
Vascular Explorer | 194,589 | 95 | |
Level 2** | 3D echocardiography | 41,040 | 72 |
AGE Reader | 46,585 | 82 | |
Electrocardiography | 50,817 | 89 | |
Nitric oxide in exhaled air (FeNO) | 41,895 | 73 | |
Olfactory test | 54,827 | 96 | |
Purdue pegboard test | 57,209 | 100 | |
Retinal photography | 49,193 | 86 | |
SOMNOwatch | 17,654 | 31 | |
Visual acuity test | 51,364 | 90 | |
Ultrasound of visceral and subcutaneous abdominal fat | 47,919 | 84 | |
1 of 3 system*** | Angle chair | 22,002 | 89 |
Examination of hand | 23,306 | 94 | |
Ergometry | 11,186 | 79 | |
Oral examination | 20,814 | 98 | |
Biosamples*** | Blood | 203,193 | 99 |
Nasal swab | 192,519 | 94 | |
Saliva | 191,132 | 93 | |
Stool**** | 75,242 | 73 | |
Urine | 200,927 | 98 | |
Oral glucose tolerance test | 19,723 | 88 |