Introduction
Objectives
Main outcome | |
---|---|
Coronary artery disease and myocardial infarction | |
Atrial fibrillation | |
Heart failure | |
Dementia | |
Stroke | |
Cancer such as prostate cancer and skin cancer | |
Chronic kidney diseases | |
Arterial hypertension, hypercholesteremia and valvular diseases such as bicuspide aortic valve disease | |
Migraine | |
Musculoskeletal diseases such as osteoporosis and bone metastasis | |
Ocular diseases such as glaucoma, macular degeneration, fundus hypertonicus, retinal vessel disease and neoplasm | |
Oral health including periodontal disease and caries, oropharyngeal cancer and human papillomavirus (HPV)-infection | |
Psychiatric and psychosomatic disorders such as mental disorder or late – last depression | |
Pulmonary diseases such as chronic obstructive lung disease (COPD) and asthma | |
Sexual dysfunction | |
Skin diseases such as psoriasis, chronic wounds and inflammation | |
Vascular diseases such as cerebrovascular disease, aortic aneurysm, thrombosis and peripheral arterial disease |
- the causes for the development of functional health impairments and major chronic diseases,
- the prognostic factors for surviving chronic diseases and
- identification of factors supporting life in survivorship of major chronic diseases.
Study design and methods
Feature | Category | Hamburg | Germany | p Value | ||||
---|---|---|---|---|---|---|---|---|
Overall | Men | Women | Overall | Male | Female | |||
N(%) | N(%) | N(%) | N(%) | N(%) | N(%) | |||
Age | ||||||||
45–54 | 274.4 (42.9) | 139.6 (44.3) | 134.9 (41.5) | 13,220 (39.8) | 6657 (40.5) | 6563 (39.0) | 0.2615 | |
55–64 | 208.5 (32.6) | 102.4 (32.5) | 106.1 (32.7) | 11,698 (35.2) | 5798 (35.3) | 5900 (35.1) | ||
65–74 | 156.9 (24.5) | 72.9 (23.2) | 84.0 (25.8) | 8335 (25.1) | 3966 (24.2) | 4369 (26.0) | ||
Nationality | ||||||||
German | 1528 (84.4) | 735 (82.9) | 793 (85.8) | 73,112 (88.5) | 35,929 (87.6) | 37,183 (89.4) | < 0.001 | |
Other | 282 (15.6) | 151 (17.1) | 131 (14.2) | 9526 (11.5) | 5103 (12.4) | 4423 (10.6) | ||
Marital status | ||||||||
Married | 679 (37.9) | 339 (38.7) | 340 (37.1) | 37,194 (45.0) | 18,679 (45.5) | 18,515 (44.5) | < 0.001 | |
Single | 881 (49.1) | 467 (53.2) | 414 (45.1) | 34,348 (41.6) | 18,852 (45.9) | 15,496 (37.2) | ||
Divorced | 134 (7.5) | 53 (6.0) | 81 (8.8) | 5717 (6.9) | 2415 (5.9) | 3303 (7.9) | ||
Widowed | 99 (5.5) | 18 (2.0) | 82 (8.9) | 5379 (6.5) | 1087 (2.6) | 4292 (10.3) | ||
School education** | ||||||||
Upper secondary education | 721 (51.6) | 362 (53.5) | 359 (49.9) | 22,543 (34.6) | 11,757 (36.7) | 10,786 (32.6) | < 0.001 | |
Lower secondary education | 675 (48.4) | 315 (46.5) | 360 (50.1) | 42523 (65.4) | 20271 (63.3) | 22253 (67.4) | ||
Income in € | ||||||||
500 < 899 | 75 (9.8) | 25 (5.5) | 50 (12.3) | 10,256 (17.5) | 3675 (11.9) | 6581 (23.8) | < 0.001 | |
900 < 1299 | 126 (16.4) | 49 (10.7) | 76 (18.7) | 11984 (20.5) | 4662 (15.1) | 7322 (26.5) | ||
1300 < 1499 | 79 (10.3) | 36 (7.9) | 43 (10.6) | 5834 (10.0) | 2807 (9.1) | 3027 (11.0) | ||
1500 < 1699 | 87 (11.4) | 42 (9.2) | 45 (11.1) | 5336 (9.1) | 2818 (9.1) | 2518 (9.1) | ||
1700 < 1999 | 115 (15.0) | 59 (12.9) | 57 (14.0) | 6538 (11.2) | 3783 (12.2) | 2755 (10.0) | ||
2000 < 2599 | 69 (9.0) | 95 (20.7) | 73 (18.0) | 8724 (14.9) | 5654 (18.3) | 3070 (11.1) | ||
2600 < 3199 | 86 (11.2) | 54 (11.8) | 32 (7.9) | 4146 (7.1) | 2953 (9.5) | 1193 (4.3) | ||
3200 < 4499 | 76 (9.9) | 55 (12.0) | 20 (4.9) | 3611 (6.2) | 2788 (9.0) | 822 (3.0) | ||
≥ 4500 | 53 (6.9) | 43 (9.4) | 10 (2.5) | 2170 (3.7) | 1827 (5.9) | 344 (1.2) |
Pilot study, timeline and examinations
Components of the baseline examination | Variables |
---|---|
Novelty | |
2D and 3D transthoracic echocardiography | Complete screening of aortic-, mitral- and tricuspid-valve. 4D-echocardiography of every participant of the whole left and right heart. Measurement of ventricular and atrial strain. |
Lung function | Performance of a broad/comprehensive screening by bodyplethysmography. |
Ophthalmological examination | Assessment of the objective refraction and subjective visual acuity, imaging of the macular and papillary retinal layers including intravasal flow visualization using swept source optical coherence tomography. |
Oral examination | Scaling of periodontitis severity according to the CDC-AAP criteria and whole mouth examination with assessment of caries (DMFT index) and tooth status. |
Ultrasound of the abdominal aorta | Evaluation of the infrarenal abdominal aorta by using the b-mode and continuous-wave-Doppler-mode ultrasound to measure the diameter at the maximum, the outer-to-outer-method is used. Maximum flow-velocity is measured in the infrarenal aorta. |
Ultrasounds of the peripheral arteries | B-mode and continuous-wave-Doppler-mode is used to evaluate flow-velocity and plaque burden of the common femoral, superficial femoral and popliteal arteries. |
Established clinical practice | |
2D and 3D transthoracic echocardiography | Volumes and function of all four heart chambers by 2D and 3D echocardiography; left ventricular diastolic function; left ventricular mass. |
Manually measurement (Doppler ultrasound) of systolic blood pressures at the posterior tibial, the anterior tibial, and the brachial arteries. | |
Anthropometry | Assessment of Weight, height and measurement of waist and hip circumferences. |
Blood pressure measurement | Measurement after 5 min rest and 3 determination sitting and lying. |
Cognitive function | Screening for impairment of cognitive function: Mini-Mental State Exam (MMSE), Clock Drawing Test (CDT); test of cognitive function: verbal fluency, semantic and vocabulary memory, visual attention and task switching, response inhibition, visuospatial abilities, cognitive processing speed, executive function. |
Electrocardiography | Assessment with a standard digital 12-lead ECG and 2-min rhythm strip. |
Lung function | Assessment of spirometry. |
Muscle status and coordination | Assessment of hand-grip strength, Timed-up and go Test, Chair–Rising Test, Tandem Test. |
Oral examination | Assessment of tooth status (DMFT index), pocket probing depths (periodontitis), bleeding on probing (gingivitis), dental plaque, condition of hard and soft tissues, assessment of craniomandibular dysfunctions, saliva and sulcus fluid sampling, oral hygiene behavior and oral health literacy. |
Objective measure of physical activity with Actigraph. | |
Standardized neurological examination | Assessment of the National Institutes of Health Stroke Scale. |
Ultrasound of the carotid artery | B-mode and continuous-wave-Doppler-mode is used to evaluate flow-velocity and plaque burden of the carotid artery. |
Ultrasound of the peripheral venous system | The b-mode is used for venous compression ultrasound at the femoral and popliteal vene. |
Component of questionnaire | |
---|---|
Overview of dimensions and scales of the baseline and follow-up self-reported questionnaire | |
Adverse childhood experiences | |
Alcohol use | |
Anxiety | Generalized anxiety disorder screener (GAD-7) [16] |
Chronotype (single items) | |
Daytime sleepiness | Epsworth sleepiness skala (ESS) [19] |
Depression severity | |
Dermatology quality of life index | Dermatology life quality index (DLQI) [23] |
Family history of disease | Physical & psychological diseases of parents |
General practitioners (GP) guided care | Use of general practitioner |
Health beliefs | |
General health perception | |
Health economics | Costs, EQ-5D-5L, ICER |
Informal care | |
Lifestyle medicine | |
Living—environment—work | General housing data, technical data, quality of living, housing and work |
Medical history | Allergies, gynaecology, skin diseases, cardiovascular diseases, cancer, ENT diseases, lung diseases, nephrology, neurology, orthopaedics, other diseases, dental and oral diseases |
Medication-related beliefs | |
Migraine questionnaire | The rostock headache questionnaire (RoKoKo) [30] |
Occupational exposure to fume, gases, organic or anorganic dust | Exposure assessment, specifically adapted for HCHS, based on questionnaire of the European community respiratory health survey (ECRHS), occupational module |
Optimism, pessimism | SWOP |
Oral health | |
Patient satisfaction | Zufriedenheit in der ambulanten Versorgung [Satisfaction in outpatient care] (ZAPA) [34] |
Quality of life | |
Resilience | RES-6 |
Risk factors and medical history | National cohort study (NAKO) [39] |
Sexual dysfunctions | DSM—5 criteria |
Shift and night work | |
Social support | F-SozU-K14 |
Sociodemographic characteristics | i.e. Gender, age, nationality, mother language, religion |
Somatic symptom | |
Utilization of medical services | Scales of the German Health Interview and Examination Survey for Adults (DEGS-9, DEGS-10, ÖKO-DEGS-15) [24] |
Significant life events | Social reactivity reaction scale (SRRS) |
Smoking behavior | Fagerström questionnaire, smoking anamnesis |
Overview of dimensions and scales of the MRI self-reported questionnaire | |
Anxiety | Generalized anxiety disorder (GAD-2) [44] |
Daily life | Social interaction, cognitive deficits, own psychological diseases & in the family |
Depression | |
Emotional regulation | |
Emotional well-being | Current personal condition |
Health advice | Scale of the German health interview and examination survey for adults (DEGS-11) [24] |
Health behaviour measures | Scale of the German health interview and examination survey for adults (DEGS-20) [24] |
Health care satisfaction | |
Health literacy | Patient Activation Measure (PAM-13) |
Health risks perception | |
Media consumption | Patterns of media consumption |
Medication-related beliefs | |
Personality | Eysenck personality questionnaire (EPG-RK) [47] |
Quality of life | |
Self-efficacy | Skala zur Allgemeinen Selbstwirksamkeits-erwartung [Self-efficacy scale] (SWE) |
Significant life events | Social readjustment rating scale (SRRS) |
Somatic Symptoms | Somatic symptom disorder-B criteria scale SSD-12) [48] Somatic Symptom Scale (SSS-8) [43] |
Laboratory parameters and biobanking
Biospecimen | Novelty |
---|---|
Serum | Measurement of routine biomarkers as well as innovative markers such as non-coding RNA, proteomics, metabolomics and viruses |
EDTA plasma | Measurement of routine biomarkers as well as innovative markers such as ncRNA, proteomics, metabolomics and viruses |
Citrat plasma | Measurement of routine biomarkers and innovative markers of coagulation cascade |
Genomic DNA | Measurement genomic and epigenomic markers |
Whole blood RNA | Measurement of gene expression and expression of non-coding RNA |
Erythrocytes | Measurement of innovative biomarkers and protein activity |
PBMC | Generation of iPS cells, and cell culture experiments, Gene expression and measurement of circulating tumorcells (CTC) |
Urine | Measurement of innovative markers |
Saliva | Measurement of innovative biomarkers and oral microbiome |
Tooth fluid | Measurement of oral microbiome |
Tonsils swab | Measurement of oral microbiome and viruses |
Skin Tissue | Generation of iPS cells |