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Study of Health in Pomerania (SHIP): a Health Survey in an East German Region

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Study of Health in Pomerania (SHIP): a Health Survey in an East German Region Epidemiology Study of Health in Pomerania (SHIP): A health survey in an East German region. Objectives and design of the oral health section Elke Hensel, Prof Dr Med DentVDietmar Gesch, Dr Med DentVReiner Biffar, Prof Dr Med Dent^/ Olaf Bernhardt, Dr Med Deni-TThomas Kocfier, Prof Dr Med DenfVChrisfian Splieth, PhD, Dr Med DenfV Gabriele Born, Dr Ing'/Ulrich John, Prof Dr PhiP The goai ol the Study of Health in Pomerania ¡SHIP) was to estimate the prevalence ol diseases, identify potential risk factors in a defined region in northeast Germany, and examine the particular living situation of this population after the reunification ol East and West Germany. One of the main concerns ol the SHIP design is the analysis of the relationships between dental, medical, social, and environmentally and be- haviorally determined health tactors. SHIP is a cross-seotional study (clinical findings and sociologie inter- views). The sample was drawn in two steps; Thirty-two communities in the region were selected, and within these communities, a simple random sample was drawn from residence registries, stratified by gen- der and age. The final sample included 4,310 males and females, aged 20 to 79 years.This is equivalent tc a participation rate of 68.87a. Data collection was completed in May 2001. The data collecticn and items comprised four parts: oral health examination, medical examination, health-related interview, and a health- and risk-factor-related questionnaire. The oral health examination included the teeth, periodontium, oral mueosa, morphology and function ofthe craniomandiPular system, and prosthodontics. The medical ex- amination included biood pressure measurements; electrocardiography; echocardiography; carotid, thy- roid, and liver ultrasound examinations; neurologic screening; and blood and urine sampling. The com- puter-assisted interview consisted of questions on symptoms of disease, utilization of medical and dental services, self-assessment of general and oral health, health behavior and knowledge, and socioeconomic variables. The self-administered questionnaire comprised housing conditions, social network, work condi- tions, subjective well-being, and individual consequences of the German reunification. (Quiniessence Int 2003:34:370-378) Key words: general health, Germany, health behavior, health examination and investigaticn survey, oral health, prevalence, socioeconomic factors he background of the Study of Health in 'Associate Professor, Department of Orthodontics, Denial Schooi, TPomerania (SHIP) is the need for population- University of Greifswald, Greifswald, Germany. based health surveys encompassing a broad spectrum ^Assistant Professor, Department of Orthodontics, Denial School, of health and lifestyle factors. Particularly in Germany, University of Gieifswald, Greifswald, Germany. most population studies focus on single diseases and 3p;ofesso( and iHead, Deparimeni of Prosthodontpcs, Dental Sohooi, University ot Greifswald, Greitswald, Germany. their risk markers: In medicine, this is most frequently 'Assistant Professor, Department of Operative Dentistry, Dental Schooi, cardiovascular disease, and in dentistry, most fre- University of Greifswaid, Greifswaid, Gerrnany quently coronal caries and its consequences. ^Associate Professor, Unit of Periodontoiogy, Dental Schooi, University ot The design of SHIP is complex, allowing multiple Greifswaid, Greifswald, Germany. anaiyses in terms of comorbidity and risk combina- ^Associate Professor, Department of Operative Dentistry, Dental Schooi, tions for crucial health problems, in addition to the University of Greifswald, Greifswald. Germany, prevalence estimations of diseases determining mor- 'Assistant Professor, institute ot Epidemioiogy and Social Medicine. bidity among adults in Vorpommern (West Pomer- University of Greitswald, Greifswald, Germany. ania) in northeastern Germany. In tbe future, the re- 'Professor and Head, Institute of Epidemiology and Social Medicine, sults of SHIP will be supplemented by cohort, University of Greifswald, Greitswaid, Germany. case-control, and intervention studies. The pilot pbase Reprint requests: Dr Thomas Kocher, Zentrum für Zahn-. Mund-, und Kieferheilkunde, Ernst-fulorilz-Aindt-Universität Greifswald, Rotgerber- of a SHIP follow-up study started at the beginning of siraße 8, t74e7 Greifswald, Germany, E-mail: [email protected] 2002, preparing the way for incidence estimations. 370 Volume 34, Number 5, 2003 • Hensei et al The overall design of SHIP, its general objectives, and lected communities, subjects were drawn at random medical contents have been publisbed in a previous from ofl^icial inhabitant data files-wbicb include insti- report,^ Tbis report focuses on the design and objec- tutionalized persons-proportional to the population tives of tbe oral beaitb section of SHIP, size of eacb community and stratified by age and gen- der. Since tbere was just a proportion of 1,6% nonGerman citizens in the population, only individu- RESEARCH OBJECTIVES AND STUDY DESIGN als with German citizenship and main residence in the study area were included. From the entire study popu- The oral health section pursued the foiiowing research lation of 212,157 inbabitants, 7,008 subjects were goals: sampled, with 292 persons of each gender in each of the 12 five-year age strata. This sample size was calcu- • To determine current age- and gender-related preva- lated on the basis of pre-existing prevalence data, ' lences of oral diseases in persons aged 20 to 79 years Tbe collection of personal data was supported by (crown caries, root caries, periodontal disease, dis- the residents' registration offices. The sampling proce- eases of the oral mucosa, dysgnathic conditions and dure followed strict data security protocols. The initial orofacial deformities, tooth loss, prosthetic status, sample size of 7,008 persons was reduced by 741 neu- craniomandibular dysfunctions) tral dropouts (126 had died and 615 had moved • To coEect population-based information on the self- away). Five additionai participants were also classified assessment of oral health and esthetics, satisfaction as neutral dropouts due to severe medical problems with oral health, oral care habits, locus-of-control for that did not allow for an oral examination, oral health, utilization of dental services and atten- A response rate of 70% was intended. Given this, dance patterns, satisfaction with dental care, percep- the sample was 2,15% of the 20- to 79-year-old popu- don of para- and dysfunctions, and problems and pain lation in the region, Tbe overall response rate was in tbe craniomandibular system (dental interview) 68,8% (n = 4,310), With exclusion of the oldest age • To test for correlations between clinical variables group (70-F), a mean response rate of 71,2û,'b was at- and behavioral and socioeconomic variables tained (Figs 1 and 2), • To test for correlations between dental and medical Reasons given by 1,683 nonresponders (839 men, morbidity, including a genetic examination 844 women) for declining to participate in the study • To identify potential risk indicators for caries, perio- were recorded. In tbe younger age groups, the pre- dontitis, tooth loss, and craniomandibular dysfunc- dominant reasons given by both men and women tions were "no time" and "not interested," With increasing • To modify health programs based on the results and age, the frequency of the answers "adequate medical use the data in follow-up, case-control, and inter- care," "health reasons," and "fear of the results" also vention studies. increased. The latter two reasons were most frequently given by women in the oldest age group. Sample and study area Oral health data collection procedure and criteria A sample of 7,008 women and men aged 20 to 79 years was drawn from the cities of Greifswald, Stralsund, and The criteria for the oral-bealth data collection and ex- Anklam, and from 29 communities in tbe surrounding amination procedures had been developed in collabo- region, which is part of West Pomerania (2,024 km^), ration with local, national, and international experts the most northeasterly region of Germany, on the and tested during three pilot phases, Baltic Sea at the north and the Polish border in tbe A detailed description of procedures and criteria east. West Pomerania makes up tbe northeastern part for collecting medical data has been published by of Mecklenburg-Vorpommern, one of tbe 16 federal Jobn et al,^ German states, Mecklenburg-Vorpommern is, with 79 Data collection began in October 1997 and ended inhabitants/Ion^, the state with the lowest population in May 2001, density in Germany (For comparison: Germany has an The oral beaitb examinations included the teetb, average of 229 inhabitants/km'),' periodontium, oral mucosa, morpbology (alignment Tbe sample selection was carried out in two steps. and occlusion of teeth) and function of the cran- First, of tbe tbree districts in the region, the three iomandibular system, and prostbodontics (Table 1). cities (17,076 to 65,977 inhabitants) and 12 towns Additionally, an online interview was conducted with (1,516 to 3,044 inhabitants) were selected, and of the questions about knowledge relevant for the mainte- small towns (less than 1,500 inhabitants), 17 out of 97 nance of oral health, the self-assessment of oral health, were drawn at random. Second, from each of the se- utilization of dental services, pain and dysfunctions in •fi IntprnatJonal 371 Hensel et ai recorded from all teeth except the third moiars (64 TABLE 1 Oral
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