German Adult Population Research Articles

Health situation and health care of women aged 50 years and older in rural regions in Germany

Abstract Background In many countries demographic changes and regional differences lead to inequalities in healthcare provision. In Germany, this applies especially to rural regions and could affect the healthcare situation of middle-aged and older women in particular. Our study, which is part of the project “Frauen 5.0”, explores the health and healthcare situation of women 50 years and older in Northeastern Germany, with focus on outpatient gynaecological and general medical care and reasons for healthcare utilisation. Methods Our analyses comprise the health situation of women aged 50 years and older, their utilisation of outpatient gynaecologists and general practitioners (GPs), reasons for utilisation, access barriers to outpatient care, the demographic situation and the spatial distribution of gynaecological and GP practices in Northeastern Germany. We use a variety of data sources; main data source is the German Health Interview and Examination Survey for Adults (DEGS1, 2008-2011), which was carried out by the Robert Koch Institute and is representative of the German adult population. Results There is an unequal distribution of gynaecologic and GP practices in Northeastern Germany, with the highest density in and around Berlin. About 30% of gynaecologists and GPs in the study region are aged 60 years and older. Whereas in all age groups at least 80% of women used GP services in the last 12 months, the use of gynaecologic services declines from 80% in 18- to 29 year-old to 45% in 70- to 79 year-old women. Most important reasons for seeking gynaecological treatment are menopause and early detection of cancer. Conclusions The analyses show that there is need to ensure adequate health care for women aged 50 and over in rural regions in Germany. Based on the results, within the project “Frauen 5.0” innovative solutions for this task, e.g. interprofessional cooperation, will be identified. Key messages Analyses of outpatient healthcare services show an unequal distribution of gynaecologic and GP practices in Northeastern Germany; about 30% of the gynaecologists and GPs are aged 60 years and older. Whereas in all age groups at least 80% of women used GP services in the last 12 months, the use of gynaecologic services declines from 80% in 18- to 29 year-old to 45% in 70- to 79 year-old women.

Dietary exposure to elements from the German pilot total diet study (TDS)

ABSTRACTDietary exposure of the German adult population to the elements aluminium, copper, mercury (and as methylmercury), manganese and lead were assessed using data from the first total diet study (TDS) in Germany. In this pilot TDS, performed 2014–2015, 246 food samples were purchased in the Berlin area, prepared ‘as consumed’, and subsequently analysed. Dietary exposure for the German adult population between 14 and 80 years of age was estimated by combining TDS data with individual consumption data from the German National Consumption Survey II (NVS II). Estimated mean and high-level dietary exposure values showed that none of the elements analysed exceeded toxicological reference values; neither was there an undersupply of essential elements. Assessments for methylmercury and lead in women of child-bearing age, in particular, showed no considerable elevated intake levels.

The Use of Alcohol, Tobacco, Illegal Drugs and Medicines: An Estimate of Consumption and Substance-Related Disorders in Germany.

Prevalence estimates of the use of tobacco, alcohol, illegal drugs, and psychoactive medications and of substance-related disorders enable an assessment of the effects of substance use on health and society. The data used for this study were derived from the 2018 Epidemiological Survey of Substance Abuse (Epidemiologischer Suchtsurvey, ESA). The sample of the German adult population comprised 9267 persons aged 18 to 64 (response rate, 42%). Population estimates were obtained by extrapolation to a total resident population of 51 544 494 people. In the 30 days prior to the survey, 71.6% of the respondents (correspond- ing to 36.9 million persons in the population) had consumed alcohol, and 28.0% (14.4 million) had consumed tobacco. 4.0% reported having used e-cigarettes, and 0.8% reported having used heat-not-burn products. Among illegal drugs, cannabis was the most commonly used, with a 12-month prevalence of 7.1% (3.7 million), followed by amphetamines (1.2%; 619 000). The prevalence of the use of anal- gesics without a prescription (31.4%) was markedly higher than that of the use of prescribed analgesics (17.5%, 26.0 million); however, analgesics were taken daily less commonly than other types of medication. 13.5% of the sample (7.0 million) had at least one dependence diagnosis (12-month prevalence). Substance use and the consumption of psychoactive medications are widespread in the German population. Substance-related disorders are a major burden to society, with legal substances causing greater burden than illegal substances.

Trends in socioeconomic inequalities in self-rated health in Germany: a time-trend analysis of repeated cross-sectional health surveys between 2003 and 2012

ObjectivesThis study assessed the extent of educational and income inequalities in self-rated health (SRH) in the German adult population between 2003 and 2012 and how these inequalities changed over time.DesignRepeated...

The Cultivation of Idealistic Moral Expectations: The Role of Television Exposure and Narrative Engageability

The aim of this study was to gain a better understanding of how fictional television shapes people’s expectations about the moral workings of the real world, relying on cultivation theory and models of narrative and moral effects as theoretical frameworks. Using a cross-sectional sample of the general German adult population, this study investigated the relationship between television viewing time (overall television and three genres—crime drama, medical drama, sitcoms) and narrative engageability with three idealistic moral expectations (just world beliefs, professional altruism of doctors, tolerance of otherness). Although genre viewing was not related to idealistic moral expectations, overall television viewing and narrative engageability proved to have consistent positive relationships. Results indicate that television viewing, the audience’s eagerness to engage with narratives (narrative engageability), and moral expectations about the real world are intertwined and mutually dependent.

Decreasing sunbed use in the German population between 2001 and 2015: survey in 155679 working persons.

UV radiation is a proven cause of skin cancer. Use of sunbeds has been shown to provide an attributable risk. To evaluate the proportion of regular sunbed use in Germany based on large-scale population-based surveys over 15years. Skin cancer screenings by dermatologists were conducted between 2001 and 2015 in more than 500 German companies, including a clinical examination and interviews on the risk behaviour related to sunburns and sunbeds. Among 155679 persons included regular sunbed use significantly declined from 11.0% in 2001 to 1.6% in 2015 (P<0.001). There were significantly higher rates of sunbed use in women (12.5%/2.0%) vs. men (7.3%/1.3%; P<0.001), in younger persons and in participants with darker skin (type II and III) vs. fair skin (type I). Individuals with sunburns in childhood were significantly more often sunbed users (5.1% vs. 4.6%; P=0.002). A remarkable decline of sunbed use was observed after 2009 (7.0% in 2001-2008 and 2.2% in 2009-2015). This reduction occurred in the time of a legal ban of sunbed use for minors but also with the start of the national skin cancer screening programme. Use of sunbeds in the German adult population has dropped by more than 85% in the past decade. Primary prevention, including the large public awareness following the legal ban of sunbed use for young people and the effects of the statutory skin cancer screening programme may have contributed to this.

Association of anthropometric markers with globe position: A population-based MRI study.

PurposeExophthalmometry is a common examination in ophthalmology. For example it is relevant for diagnosis or follow-up of thyroid eye disease. However, exophthalmometry is affected by several factors such as ethnicity, sex and age. The purpose of this study was to determine the globe position by magnetic resonance imaging (MRI) and to investigate its correlates among the general Northeast German adult population.MethodsA total of 3030 subjects aged between 20 and 89 from the population-based Study of Health in Pomerania (SHIP) underwent a standardised whole-body MRI. Axial length and globe position were determined in axial T1-weighted images of the orbit. The image had to include the corneal apex as well as the optic nerve head. Study participants were excluded from imaging analysis if there was no plane available that included both structures. Further exclusion criterion was a lateral deviation of the subject’s viewing direction. Images with inadequate quality due to motion artefacts or other technical reasons were excluded as well. Globe position was defined as the perpendicular distance between the interzygomatic line and the posterior surface of the cornea (exophthalmometric value). The distance between the posterior surface of the cornea and the posterior pole of the eyeball, at the boundary with orbital fat, was defined as axial length. We used posterior surface of the cornea for our measurements, because it seemed to be less vulnerable for motion artefacts than the anterior one. Moreover body measurements including body mass index (BMI), waist and hip circumferences were determined. Associations between anthropometric measurements with exophthalmometric outcomes were analysed by linear regressions adjusted for age and stratified by sex. P-values <0.05 were considered as statistically significant. To assess intra-reader variability intra-class correlation coefficients (ICC) were computed for repeated measurements of the MRI scans of 25 subjects.ResultsAfter considering the exclusion criteria 1926 evaluable subjects remained. There was no significant difference between means of right and left eyes. The mean exophthalmometric value was significantly higher in men (16.5 +/- 2.2 mm) than in women (15.3 +/- 2.1 mm). The mean MRI-axial length was 23.4 +/- 0.8 mm for men and 22.8 +/- 0.9 mm for women. BMI, waist and hip circumferences were positively correlated with exophthalmometric value (p<0.001). Difference of mean MRI-based exophthalmometric value for obese subjects (BMI ≥30 kg/m2) and non-overweight (BMI <25 kg/m2) was 2.1 mm for men and 1.6 mm for women. ICC between 0.97 and 0.99 indicate excellent repeatability of our method.ConclusionWe conclude that MRI-based exophthalmometric values are positively correlated with BMI, waist- and hip-circumference among the general Northeast German adult population. This association is independent from age and axial length. Consequently bodyweight of patients should be regarded to interpret exophthalmometric values correctly. MRI-exophthalmometry seems to be a suitable method to determine globe position. Considering the large number of study participants, exophthalmometric values of our study could be used as comparative values for exophthalmometry of people of Western European descent in future.

Socioeconomic Inequalities in the Rise of Adult Obesity: A Time-Trend Analysis of National Examination Data from Germany, 1990–2011

Objective: Despite extensive study of the obesity epidemic, research on whether obesity has risen faster in lower or in higher socioeconomic groups is inconsistent. This study examined secular trends in obesity prevalence by socioeconomic position and the resulting obesity inequalities in the German adult population. Methods: Data were drawn from three national examination surveys conducted in 1990–1992, 1997–1999 and 2008–2011 (n = 18,541; age range: 25–69 years). Obesity was defined by a body mass index ≥30 kg/m² using standardised measurements of body height and weight. Education and equivalised household disposable income were used as indicators of socioeconomic position. Time trends in socioeconomic inequalities in obesity were examined using linear probability and log-binomial regression models. Results: In each survey period, the highest socioeconomic groups had the lowest prevalence of obesity. The low and medium socioeconomic groups showed increases in obesity prevalence, whereas no such trend was observed in the high socioeconomic groups. Absolute inequalities in obesity by income increased by an average of 0.53 percentage points per year (95% confidence interval [CI] 0.01–1.05, p = 0.047) among men and 0.47 percentage points per year (95% CI 0.05–0.90, p = 0.029) among women. Absolute inequalities in obesity by education increased on average by 0.64 percentage points per year (95% CI 0.19–1.08, p = 0.005) among women but not among men (0.33 percentage points, 95% CI –0.27 to 0.92, p = 0.283). Conclusions: These findings suggest a widening obesity gap between the top and the bottom of the socioeconomic spectrum. This has the potential to have adverse consequences for population health and health inequalities in coming decades. Interventions that are effective in preventing and reducing obesity in socially disadvantaged groups are needed.

Patterns of multiple lifestyle risk factors and their link to mental health in the German adult population: a cross-sectional study

ObjectivesLifestyle risk factors, such as drinking or unhealthy diet, can expotentiate detrimental health effects. Therefore, it is important to investigate multiple lifestyle risk factors instead of single ones. The study...

The association of adverse childhood experiences and of resilience with chronic noncancer pain in the German adult population - A cross-sectional survey.

Adverse childhood experiences (ACE) might predispose to and resilience might protect against chronic noncancer pain (CNCP). We studied whether ACE are positively associated with CNCP, whether resilience was negatively associated with CNCP and whether resilience buffered a potential association of ACE with CNCP. A cross-sectional survey (N=2,425) representative for the adult German general population was conducted in 2013. The following questionnaires were used: Chronic Pain Grade Questionnaire for CNCP stages; Childhood Trauma Screener for ACE; Brief Resilient Coping Scale for resilience; Patient Health Questionnaire 4 for psychological symptom burden; Giessen Subjective Complaints List for somatic symptom burden. To test the association of ACE and resilience with CNCP stages, logistic regression analyses including sociodemographic variables and psychological and somatic symptom burden as possible confounders were calculated. No statistically significant associations between any CNCP and disabling CNCP respectively with physical, emotional, and sexual abuse; emotional and physical neglect if compared to no chronic pain were found in uni- and multivariate analyses. There was a small effect of combined ACE and a small attenuating effect of resilience on any and disabling CNCP in univariate, but not in multivariate analysis. Large associations were found between age>65years with any CNCP (OR 6.51 [95% confidence interval 3.38 to 12.51)] and disabling CNCP (OR 9.33 [95% confidence interval 2.39 to 36.41]), respectively, if compared to no pain. There was no pain-proneness by single and combined ACE for and no protection by resilience for any and for disabling CNCP in the general adult German population. There is no pain-proneness due to adverse childhood experiences for any and disabling chronic noncancer pain. Resilience does not protect against any and disabling chronic noncancer pain. Older age is the strongest predictor of any and disabling chronic noncancer pain.

Meal and habitual dietary networks identified through Semiparametric Gaussian Copula Graphical Models in a German adult population.

Gaussian graphical models (GGMs) are exploratory methods that can be applied to construct networks of food intake. Such networks were constructed for meal-structured data, elucidating how foods are consumed in relation to each other at meal level. Meal-specific networks were compared with habitual dietary networks using data from an EPIC-Potsdam sub-cohort study. Three 24-hour dietary recalls were collected cross-sectionally from 815 adults in 2010–2012. Food intake was averaged to obtain the habitual intake. GGMs were applied to four main meals and habitual intakes of 39 food groups to generate meal-specific and habitual dietary networks, respectively. Communities and centrality were detected in the dietary networks to facilitate interpretation. The breakfast network revealed five communities of food groups with other vegetables, sauces, bread, margarine, and sugar & confectionery as central food groups. The lunch and afternoon snacks networks showed higher variability in food consumption and six communities were detected in each of these meal networks. Among the central food groups detected in both of these meal networks were potatoes, red meat, other vegetables, and bread. Two dinner networks were identified with five communities and other vegetables as a central food group. Partial correlations at meals were stronger than on the habitual level. The meal-specific dietary networks were only partly reflected in the habitual dietary network with a decreasing percentage: 64.3% for dinner, 50.0% for breakfast, 36.2% for lunch, and 33.3% for afternoon snack. The method of GGM yielded dietary networks that describe combinations of foods at the respective meals. Analysing food consumption on the habitual level did not exactly reflect meal level intake. Therefore, interpretation of habitual networks should be done carefully. Meal networks can help understand dietary habits, however, GGMs warrant validation in other populations.

Construct Validity and Population-Based Norms of the German Brief Resilience Scale (BRS).

. The Brief Resilience Scale (BRS) measures the ability to recover from stress. To provide further evidence for construct validity of the German BRS and to determine population-based norms, a large sample (N = 1,128) representative of the German adult population completed a survey including the BRS and instruments measuring perceived stress and the resilience factors optimism, self-efficacy, and locus of control. Confirmatory factor analyses showed best model fit for a five-factor model differentiating the ability to recover from stress from the three resilience factors. On the basis of latent and manifest correlations, convergent and discriminant validity of the BRS were fair to good. Female sex, older age, lower weekly working time, higher perceived stress, lower optimism, and self-efficacy as well as higher external locus of control predicted lower BRS scores, that is, lower ability to recover from stress.

Hepatitis E virus seroprevalence, seroincidence and seroreversion in the German adult population.

A steep rise in Hepatitis E diagnoses is currently being observed in Germany and other European countries. The objective of this study was (i) to assess whether this trend mirrors an increase in infection pressure or is caused by increased attention and testing and (ii) estimate individual and population-based Hepatitis E Virus (HEV) seroconversion and seroreversion rates for Germany. We measured anti-HEV IgG prevalence in 10407 adults participating in two linked, population-representative serosurveys (total n=12971) conducted in 1998 and 2010. In this period, we found a moderate but statistically significant decline of overall anti-HEV IgG prevalence from 18.6% to 15.3%. At both time points, seroprevalence increased with age and peaked in persons born between 1935 and 1959 suggesting a past period of increased infection pressure. Paired samples of individuals participating in 1998 and 2010 (n=2564) revealed respective seroconversion and seroreversion rates of 6.2% and 22.6% among seronegative and seropositive individuals during 12years, or 5.2 and 2.9 per 1000 inhabitants per year. This corresponds to a total of 417242 [95%CI: 344363-495971] new seroconversions per year in the German population. While anti-HEV seroprevalence has decreased in the last decade, infection pressure and seroincidence remains high in Germany. Continuously rising numbers of Hepatitis E diagnoses in Europe are likely due to an increased awareness of clinicians and indicate that still there is a gap between incident and diagnosed cases. Studies on the true burden of the disease, specific risk factors and sources of autochthonous infections as well as targeted prevention measures are urgently needed.

Football-related patriotism in Germany and the 2016 UEFA EURO

This paper coins the term ‘football patriotism’ to describe the open, expressive handling of national symbols (e. g. flags, anthems, national colors) in the context of international football events. Based on a representative online survey of the adult German population (N = 1092), which was carried out in the course of the 2016 UEFA EURO, this paper presents, for the first time, empirical findings on three essential questions: (1) Which proportion of the German population was involved in which forms of football-related patriotic behavior? (2) To what extent does this proportion vary between different social demographic groups? (3) Which political and ideological attitudes are associated with football patriotism? The results illustrate that roughly 15% of German adults were involved in three or more different patriotic actions during the EURO. This proportion was lower among older, East German and immigrant respondents and higher in families with children. Football patriots positioned themselves less often as politically ‘left’ and endorsed patriotic and nationalistic statements more strongly.

Dietary Acid Load and Potassium Intake Associate with Blood Pressure and Hypertension Prevalence in a Representative Sample of the German Adult Population.

Diets rich in fruits and vegetables, like the Dietary Approaches to Stop Hypertension (DASH)-diet, are usually characterized by high potassium intake and reduced dietary acid load, and have been shown to reduce blood pressure (BP). However, the relevance of potential renal acid load (PRAL) for BP has not been compared with the relevance to BP of urinary biomarker (K-urine)- and dietary food frequency questionnaire (K-FFQ)-based estimates of potassium intake in a general adult population sample. For 6788 participants (aged 18–79 years) of the representative German Health-Interview and Examination Survey for Adults (DEGS1), associations of PRAL, K-urine, and K-FFQ with BP and hypertension prevalence were cross-sectionally examined in multivariable linear and logistic regression models. PRAL was significantly associated with higher systolic BP (p = 0.0002) and higher hypertension prevalence (Odds ratio [OR] high vs. low PRAL = 1.45, p = 0.0004) in models adjusted for age, sex, body mass index (BMI), estimated sodium intake, kidney function, relevant medication, and further important covariates. Higher estimates of K-FFQ and K-urine were related to lower systolic BP (p = 0.04 and p < 0.0001) and lower hypertension prevalence (OR = 0.82, p = 0.04 and OR = 0.77, p = 0.02) as well as a lower diastolic BP (p = 0.03 and p = 0.0003). Our results show, for the first time in a comparative analysis of a large representative population sample, significant relationships of BP and hypertension prevalence with questionnaire- and biomarker-based estimates of potassium intake and with an estimate of dietary acid load.

Long-lasting cough in an adult German population: incidence, symptoms, and related pathogens.

Studies of the incidence of pertussis in adults have shown that it accounts for only 5–15% cases of prolonged coughing. We assessed the burden of suffering related to prolonged coughing and tried to identify further causative agents. Based on a sentinel study with 35 general practitioners in two German cities (Krefeld, Rostock), with 3,946 patients fulfilling the inclusion criteria, we estimated the incidence of prolonged coughing in adults. In 975 of these outpatients, PCR and/or serology for adenovirus, Bordetella pertussis and B. parapertussis, human metapneumovirus, influenza virus A and rhinovirus, parainfluenza virus, Mycoplasma pneumonia, and respiratory syncytial virus (RSV) were performed. Treatment data were extracted for a subgroup of 138 patients. Descriptive statistics, including Kaplan–Maier curves were generated. Yearly incidence ranged between 1.4 and 2.1% per population in the two cities. Adult patients sought medical attention only after a median of 3 weeks of coughing. Irrespective of smoking and unrelated to the identified pathogens, the median duration of coughing was 6 weeks, with an interquartile range of 4–11 weeks. In 48.3% of patients, possible pathogens were identified, among which adenovirus (15.1%), RSV (7.5%), B. pertussis (5.6%), and influenza viruses (4.0%) were most often found. Symptoms were not indicative of a specific agent and a total of 64% of patients received antibiotics. Prolonged adult coughing requiring medical attention prompts substantial healthcare use. Apart from B. pertussis, a broad range of pathogens was associated with the symptoms. However, patients sought medical attention too late to guide efficacious therapeutic interventions using the diagnostic tests.

Dietary Potential Renal Acid Load Is Positively Associated with Serum Uric Acid and Odds of Hyperuricemia in the German Adult Population

Initial interventional data indicate that a reduction in dietary acid load (e.g., by an increased consumption of alkalizing fruit and vegetables) can increase renal uric acid excretion and decrease serum uric acid (SUA). Against this background, we examined the association between dietary potential renal acid load (PRAL) and SUA in a representative population sample. Cross-sectional analyses were performed in 6894 participants (aged 18-79 y) of the German Health Interview and Examination Survey for Adults (DEGS1). Dietary intake was assessed with a food-frequency questionnaire. Nutritive acid load and the intake of uric acid equivalents (UAEs) were characterized by assigning PRAL and UAE values to reported food consumption. In multiple linear regression models, the associations of PRAL, UAEs, and relevant food groups with SUA were analyzed. Multiple logistic regressions were used to calculate ORs for hyperuricemia comparing lower and upper tertiles of the predictors. After adjustment for relevant confounders, PRAL (P = 0.003), alcohol (P < 0.0001), and UAE (P = 0.03) intakes were positively associated with SUA, whereas the intake of dairy products and fruit and vegetables was inversely associated (both P < 0.0001). Subgroup analyses among participants without interacting medication use confirmed these results. In addition, participants with lower PRAL had lower odds for hyperuricemia (OR: 0.60; 95% CI: 0.43, 0.83). Apart from observing known dietary influences on SUA, we found in this population-based, cross-sectional study in adults that low PRAL may represent a potentially SUA-reducing dietary pattern. This highlights dietary alkalization as a possible nonpharmacologic option to influence elevated SUA concentrations.

Hepatitis E Seroprevalence and Genotyping in a Cohort of Wild Boars in Southern Germany and Eastern Alsace

In the last few years it has been realized that the hepatitis E virus (HEV) is endemic in most industrialized countries and that it is a zoonotic disease. Potential reservoirs for HEV have been identified to be wild boars and deers, but HEV has also been found in domestic pigs and other animals. Due to the probable spread of the virus via contaminated food or contact to infected animals, HEV antibodies are present in more than 16% of the German adult population and rates are increasing with age. We collected blood from 104 wild boars in southern Germany and the border region of Alsace. We found an anti-HEV seroprevalence of 11.5% in our cohort, using ELISA. Furthermore, we observed active infection in 3.85% of the animals by positive HEV PCR in the sera of the boars. In our cohort, no regional differences of seroprevalence or active infection were seen. Sequencing revealed rather close homology of some detected HEV sequences to genotypes isolated from patients in Germany. Hence wild boars are a potential source of HEV infection in Middle Europe and the rate of infectious animals is quite high.

Anti-nuclear autoantibodies in the general German population: prevalence and lack of association with selected cardiovascular and metabolic disorders\u2014findings of a multicenter population-based study

BackgroundWe determined the prevalence of anti-nuclear autoantibodies (ANAs) in the German adult population and examined the association between ANAs and cardiovascular and metabolic disorders.MethodsWe used data and blood samples from the pretest phases of the German National Cohort, obtained from six of the 18 study centers (n = 1199). All centers applied standardized instruments including face-to-face interviews, anthropometric measurements and collection of blood samples. Self-reported histories of diabetes mellitus, heart attack and elevated blood cholesterol and/or lipids were recorded. Height, weight and blood pressure were measured. ANAs were detected using a semi-automated system (AKLIDES®; Medipan GmbH, Dahlewitz, Germany). A positive ANA was defined as a titer ≥ 1:80. ANA were classified as weakly (1:80 or 1:160), moderately (1:320 or 1:640) or strongly (≥1:1280) positive. Specific autoantibodies against nuclear antigens were detected with second-step assays according to the ANA staining pattern. Associations between the assessed disorders and ANA positivity and pattern were examined using sex and age-adjusted mixed-effects logistic regression models.ResultsThirty-three percent (95% confidence interval; 31–36%) of the 1196 participants (measurements could not be obtained from three samples) were ANA positive (titer ≥ 1:80). The proportions of weakly, moderately and strongly positive ANA were 29%, 3.3% and 1.3%, respectively. ANA positivity was more common among women than men across all titers (χ2, p = 0.03). ANA positivity, even when stratified according to height of titer or immunofluorescent pattern, was not associated with diabetes, elevated blood cholesterol and/or lipids, obesity or hypertension. Second-step autoantibody assays were positive in 41 of the 83 samples (49%) tested, with anti-DFS70 (n = 13) and anti-dsDNA (n = 7) being most frequent. These subgroups were too small to test for associations with the disorders assessed.ConclusionsThe prevalence of ANA positivity in the German general population was similar to values reported from other countries. Contrary to other studies, there was no association with selected self-reported and objectively measured cardiovascular and metabolic variables.

Coming Out of the Niche? Social Banking in Germany: An Empirical Analysis of Consumer Characteristics and Market Size

The social banking market constitutes a small but rapidly growing submarket of the global banking sector. Due to an explicit commitment to sustainability, social banking is a segment of banking services which is not exclusively focused on economic performance criteria, but pursues ecological and social goal dimensions on an equal footing. Information on the number and reachability of potential social banking customers is essential for social banks to further promote sustainable consumption in finance. In scientific research, social banking is considered a relatively new field, still lacking empirical analyses regarding the market size and specific consumer behaviour. This study addresses the research gap by generating first insights into the German social banking market. Based on an online survey using an adaptive conjoint analysis, a large data set covering 3537 respondents was compiled. Sample 1 comprises 2896 respondents who are customers of three major social banks in Germany. Sample 2 covers the remaining 641 respondents who represent the German adult population and exclusively buy from conventional banks. Logistic regression modelling reveals that social banking customers differ significantly from their conventional counterparts regarding several socio-demographic, behavioural and psychographic factors. In comparison with conventional banking customers, social banking customers tend to be younger, higher educated and located in larger places of residence. Contrary to existing research on socially responsible investors, they are male to a higher proportion than female. Moreover, social banking customers demonstrate stronger sustainable buying patterns and weaker preferences for financial, but stronger preferences for social return than conventional banking customers. The results further indicate a considerable untapped growth potential for social banks by uncovering a market size ranging between 10 and 26% of the German adult population. Finally, suggestions for marketing strategies and future research are given.