Background
Methods
Aim, design and setting of the study
-
H1: More diseases are detected in the intervention group (IG) than in the control group (CG).
-
H2: Diseases are detected earlier in the IG than CG.
-
H3: Early detection of disease in the IG leads to more therapies than in the CG.
-
H4: Early detection of disease in the IG leads to earlier therapy than in the CG.
Participants and material
-
Sex (male/female).
-
Age (U10: 7/8 years; U11: 9/10 years; J2: 16/17 years).
-
Federal State (Berlin/Brandenburg/Mecklenburg-Western Pomerania).
-
Presence of a chronic disease (yes/no).
Definition of outcomes
Diagnoses | ICD-Codes | |
---|---|---|
U10
| Disorders of psychological development | F80-F89 |
Behavioural and emotional disorders | F90-F98 | |
U11
| Mental and behavioural disorders due to multiple drug use and use of other psychoactive substances | F19.0-F19.2 |
Eating disorders and obesity | F50; E66 | |
Disorders of psychological development | F80-F89 | |
Behavioural and emotional disorders | F90-F98 | |
Reaction to severe stress and possible consequences (somatoform disorders and problems related to life-management difficulty) | F43.2; F45.3-F45.4; F45.8; Z73 | |
Diseases of oral cavity, salivary glands and jaws | K00-K14 | |
J2
| Disorders of thyroid gland | E00-E07 |
Diabetes mellitus | E11-E14 | |
Disorders of puberty | E30 | |
Sexual dysfunction, gender identity disorders, disorders of sexual preference | F52; F64; F65 | |
Kyphosis and lordosis, scoliosis, other deforming dorsopathies | M40; M41; M43 |
Definition of determinants
Statistical analysis
Results
Sample characteristics
U10 | U11 | J2 | |||||||
---|---|---|---|---|---|---|---|---|---|
IG n = 5,160 | CG n = 5,160 | p | IG n = 5,861 | CG n = 5,861 | p | IG n = 1,808 | CG n = 1,808 | p | |
Age (Ø) | 7.7 | 7.7 | - | 10.0 | 10.0 | - | 16.6 | 16.6 | - |
Sex (female) | 55.0% | 55.0% | - | 54.2% | 54.2% | - | 49.7% | 49.7% | - |
Federal State
| - | - | - | ||||||
B | 65.2% | 65.2% | 62.0% | 62.0% | 61.2% | 61.2% | |||
BRB | 20.5% | 20.5% | 22.2% | 22.2% | 21.8% | 21.8% | |||
MV | 14.4% | 14.4% | 15.8% | 15.8% | 17.0% | 17.0% | |||
Chronic disease (yes) | 26.0% | 26.0 | - | 29.8% | 29.8 | - | 47.2% | 47.2% | - |
School leaving
qualification*
| 0.036 | ≤ 0.001 | 0.846 | ||||||
None or low | 34.5% | 36.1% | 33.3% | 37.1% | 34.8% | 36.1% | |||
Medium | 45.9% | 47.1% | 48.5% | 49.3% | 51.7% | 51.2% | |||
High | 19.5% | 16.8% | 18.2% | 13.6% | 13.5% | 12.7% | |||
Missing
|
2,412
|
2,621
|
2,847
|
2,980
|
1,133
|
1,085
| |||
Vocational
qualification*
| 0.046 | 0.004 | 0.403 | ||||||
None | 22.9% | 24.8% | 21.7% | 23.6% | 20.2% | 20.8% | |||
Completed vocational training | 64.1% | 64.1% | 66.1% | 66.7% | 69.0% | 70.4% | |||
Higher degrees** | 13.0% | 11.1% | 12.2% | 9.7% | 10.8% | 8.7% | |||
Missing
|
2,384
|
2,600
|
2,784
|
2,915
|
1,094
|
1,050
| |||
Insurance and
occupational status*
| ≤ 0.001 | ≤ 0.001 | 0.180 | ||||||
Compulsorily insured | 58.6% | 52.9% | 58.8% | 54.3% | 58.3% | 56.5% | |||
Voluntarily insured | 4.8% | 4.5% | 5.8% | 4.5% | 6.8% | 5.4% | |||
Unemployed | 35.3% | 41.1% | 33.7% | 38.8% | 29.9% | 33.1% | |||
Other | 1.3% | 1.4% | 1.7% | 2.4% | 5.1% | 5.0% | |||
Missing
|
39
|
55
|
64
|
100
|
392
|
335
| |||
Income*
| 0.166 | 0.065 | 0.028 | ||||||
Low | 59.0% | 61.1% | 56.8% | 58.7% | 53.5% | 49.9% | |||
Medium | 32.1% | 31.1% | 33.7% | 33.2% | 35.9% | 41.6% | |||
High | 8.9% | 7.8% | 9.5% | 8.1% | 10.6% | 8.5% | |||
Missing
|
1,920
|
2,211
|
2,104
|
2,444
|
864
|
867
| |||
Nationality
| ≤ 0.001 | 0.520 | 0.300 | ||||||
German | 84.5% | 81.1% | 79.3% | 78.8% | 73.1% | 74.6% | |||
Other | 15.5% | 18.9% | 20.7% | 21.2% | 26.9% | 25.4% | |||
Missing
|
30
|
38
|
42
|
48
|
19
|
18
| |||
Region
| ≤ 0.001 | ≤ 0.001 | ≤ 0.001 | ||||||
Rural | 11.3% | 14.4% | 11.4% | 15.1% | 9.6% | 14.7% | |||
Semi-urban | 16.1% | 14.7% | 18.3% | 16.7% | 18.3% | 16.9% | |||
Urban | 72.6% | 70.9% | 70.3% | 68.2% | 72.1% | 68.3% | |||
Missing
|
0
|
0
|
0
|
2
|
1
|
2
|
Establishments and technical colleges; p = pearson-chi-quadrat
IG (n = 5,160) | CG (n = 5,160) | p-value | |||
---|---|---|---|---|---|
n | Mean/Percent | n | Mean/Percent | ||
Proportion with diagnosis
| |||||
Overall | 1,292 | 25.0% | 642 | 12.4% | ≤ 0.0011 |
F80-F89
|
411
|
8.0%
|
174
|
3.4%
| |
F90-F98
|
562
|
10.9%
|
336
|
6.5%
| |
Both
|
319
|
6.2%
|
132
|
2.6%
| |
Average age at diagnosis
| 1,292 | 8.3 | 642 | 8.9 | ≤ 0.0012 |
Proportion with therapy
| |||||
Overall | 470/5,160 | 9.1% | 278/5,160 | 5.4% | ≤ 0.0011 |
Of diagnosed | 470/1,292 | 36.4% | 278/642 | 43.3% | 0.0031 |
Average age at therapy start
| 470 | 8.5 | 278 | 8.9 | ≤ 0.0012 |
IG (n = 5,861) | CG (n = 5,861) | p-value | |||
---|---|---|---|---|---|
n | Mean/Percent | n | Mean/Percent | ||
Proportion with diagnosis
| |||||
Overall | 1,739 | 29.7% | 1,038 | 17.7% | ≤ 0.0011 |
F19.0-F19.2
|
2
|
0.0%
|
1
|
0.0%
| |
F50; E66
|
30
|
0.5%
|
9
|
0.2%
| |
F80-F89; F90-F98
|
882
|
15.0%
|
504
|
8.6%
| |
F43.2; F45.3-F45.4
|
91
|
1.6%
|
92
|
1.6%
| |
F45.8; Z73
| 449 |
7.7%
| 259 |
4.4%
| |
K00-K14
| 285 | 4.9% | 173 | 3.0% | |
More than one diagnosis
| |||||
Average age at diagnosis
| 1,739 | 10.2 | 1,038 | 10.8 | ≤ 0.0012 |
Proportion with therapy
| |||||
Of all | 395/5,861 | 6.7% | 329/5,861 | 5.6% | 0.0131 |
Of diagnosed | 395/1,739 | 22.7% | 329/1,038 | `31.7% | ≤ 0.0011 |
Average age at therapy start
| 395 | 10.4 | 329 | 10.9 | ≤ 0.0012 |
IG (n = 1,808) | CG (n = 1,808) | p-value | |||
---|---|---|---|---|---|
n | Mean/Percent | n | Mean/Percent | ||
Proportion with diagnosis
| |||||
E00-E07
| 302 | 16.7% | 198 | 11.0% | ≤ 0.0011 |
E11-E14
|
83
|
4.6%
|
67
|
3.7%
| |
E30
|
8
|
0.4%
|
2
|
0.1%
| |
F52; F64; F65
|
1
|
0.1%
|
0
|
0.0%
| |
M40; M41; M43
|
14
|
0.8%
|
12
|
0.7%
| |
More than one diagnosis
|
172
24
|
9.5%
1.3%
|
104
13
|
5.8%
0.7%
| |
Average age at diagnosis
| 302 | 16.9 | 198 | 17.3 | ≤ 0.0012 |
Proportion with therapy
| |||||
Of all | 163/1,808 | 9.1% | 118/1,808 | 6.5% | 0.0061 |
Of diagnosed | 163/302 | 53.9% | 118/198 | 60.0% | 0.2321 |
Average age at therapy start
| 163 | 17.4 | 118 | 17.8 | ≤ 0.0012 |
Subgroup-specific analyses
U10 | U11 | J2 | |||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
School leaving qualification*
| IG (n = 2,748) | CG (n = 2,539) | p | IG (n = 3,014) | CG (n = 2,881) | p | IG (n = 675) | CG (n = 723) | p | ||||||
None or low | 248 | 26.1% | 104 | 11.4% | ≤ 0.001 | 307 | 30.6% | 183 | 17.1% | ≤ 0.001 | 37 | 15.7% | 33 | 12.6% | 0.366 |
Medium | 319 | 25.3% | 157 | 13.1% | ≤ 0.001 | 461 | 31.6% | 227 | 16.0% | ≤ 0.001 | 58 | 16.6% | 43 | 11.6% | 0.068 |
High | 110 | 20.5% | 43 | 10.1% | ≤ 0.001 | 143 | 26.0% | 62 | 15.8% | ≤ 0.001 | 11 | 12.1% | 9 | 9.8% | 0.644 |
Vocational qualification*
| IG (n = 2,776) | CG (n = 2,560) | p | IG (n = 3,077) | CG (n = 2,946) | p | IG (n = 714) | CG (n = 758) | p | ||||||
None | 161 | 25.4% | 70 | 11.0% | ≤ 0.001 | 201 | 30.1% | 122 | 17.6% | ≤ 0.001 | 26 | 18.1% | 21 | 13.3% | 0.270 |
Completed vocational training | 458 | 25.7% | 198 | 12.1% | ≤ 0.001 | 628 | 30.9% | 311 | 15.8% | ≤ 0.001 | 75 | 15.2% | 61 | 11.4% | 0.080 |
Higher degrees** | 80 | 22.1% | 36 | 12.7% | 0.002 | 97 | 25.8% | 49 | 17.1% | 0.008 | 16 | 20.8% | 6 | 9.1% | 0.065 |
Insurance and occupational status*
| IG (n = 5,121) | CG (n = 5,105) | p | IG (n = 5,797) | CG (n = 5,761) | p | IG (n = 1,416) | CG (n = 1,473) | p | ||||||
Compulsorily insured | 710 | 23.7% | 329 | 12.2% | ≤ 0.001 | 992 | 29.1% | 491 | 15.7% | ≤ 0.001 | 144 | 17.5% | 94 | 11.3% | ≤ 0.001 |
Voluntarily insured | 62 | 25.3% | 23 | 10.0% | ≤ 0.001 | 99 | 29.4% | 38 | 14.8% | ≤ 0.001 | 12 | 12.5% | 6 | 7.5% | 0.325 |
Unemployed | 495 | 27.4% | 261 | 12.4% | ≤ 0.001 | 588 | 30.1% | 460 | 20.6% | ≤ 0.001 | 71 | 16.8% | 51 | 10.5% | 0.006 |
Other | 20 | 30.3% | 9 | 12.3% | 0.012 | 35 | 35.7% | 28 | 20.3% | 0.011 | 11 | 15.3% | 12 | 16.2% | 1.000 |
Income*
| IG (n = 3,240) | CG (n = 2,949) | p | IG (n = 3,757) | CG (n = 3,417) | p | IG (n = 944) | CG (n = 941) | p | ||||||
Low | 467 | 24.4% | 233 | 12.9% | ≤ 0.001 | 622 | 29.1% | 324 | 16.2% | ≤ 0.001 | 85 | 16.8% | 52 | 11.1% | 0.010 |
Medium | 234 | 22.5% | 100 | 10.9% | ≤ 0.001 | 380 | 30.0% | 182 | 16.0% | ≤ 0.001 | 61 | 18.0% | 42 | 10.7% | 0.006 |
High | 68 | 23.7% | 21 | 9.1% | ≤ 0.001 | 101 | 28.2% | 34 | 12.3% | ≤ 0.001 | 20 | 20.0% | 9 | 11.3% | 0.153 |
Nationality
| IG (n = 5,130) | CG (n = 5,122) | p | IG (n = 5,819) | CG (n = 5,813) | p | IG (n = 1,789) | CG (n = 1,790) | p | ||||||
German | 1,122 | 25.9% | 527 | 12.7% | ≤ 0.001 | 1410 | 30.6% | 813 | 17.7% | ≤ 0.001 | 221 | 16.9% | 140 | 10.5% | ≤ 0.001 |
Other | 159 | 20.0% | 112 | 11.6% | ≤ 0.001 | 316 | 26.2% | 215 | 17.5% | ≤ 0.001 | 76 | 15.8% | 57 | 12.6% | 0.161 |
Region
| IG (n = 5,160) | CG (n = 5,160) | p | IG (n = 5,861) | CG (n = 5,859) | p | IG (n = 1,807) | CG (n = 1,806) | p | ||||||
Rural | 139 | 23.9% | 84 | 11.3% | ≤ 0.001 | 198 | 29.6% | 137 | 15.5% | ≤ 0.001 | 30 | 17.3% | 30 | 11.3% | 0.088 |
Semi-urban | 244 | 29.3% | 101 | 13.3% | ≤ 0.001 | 366 | 34.2% | 182 | 18.6% | ≤ 0.001 | 55 | 16.7% | 30 | 9.8% | 0.014 |
Urban | 909 | 24.3% | 457 | 12.5% | ≤ 0.001 | 1175 | 28.5% | 718 | 18.0% | ≤ 0.001 | 217 | 16.6% | 137 | 11.1% | ≤ 0.001 |
Regression analyses
U10(n = 10,158; missing: 162; HL-Test χ² (8) = 14.230, p > 0,05; Nagelkerke’s R2 = 0.088) | |||||||||
RegB
|
SD
|
Wald
|
df
|
Sig.
|
Exp(B)
|
95%-CI
| |||
AOK-Junior | Yes vs. no (Ref.) | 0.899 | 0.055 | 269.332 | 1 | < 0.001 | 2.458 | 2.208 | 2.737 |
Sex | Male vs. female (Ref.) | 0.381 | 0.053 | 52.521 | 1 | < 0.001 | 1.464 | 1.320 | 1.622 |
Chronic disease | Yes vs. no (Ref.) | 0.782 | 0.055 | 200.638 | 1 | < 0.001 | 2.186 | 1.962 | 2.436 |
Nationality | German vs. other nationality (Ref.) | 0.250 | 0.076 | 10.880 | 1 | 0.001 | 1.284 | 1.107 | 1.489 |
Unem-ployment | Yes vs. no (Ref.) | 0.156 | 0.054 | 8.196 | 1 | 0.004 | 1.169 | 1.050 | 1.301 |
Region | Urban (Ref.) | 6.520 | 2 | 0.038 | |||||
Semi-urban | 0.134 | 0.072 | 3.475 | 1 | 0.062 | 1.144 | 0.993 | 1.317 | |
Rural | -0.113 | 0.084 | 1.789 | 1 | 0.181 | 0.894 | 0.758 | 1.054 | |
Constant | -2.577 | 0.083 | 969.362 | 1 | < 0.001 | 0.076 | |||
U11(n = 11,470; missing: 252; HL-Test χ² (8) = 8.916, p > 0,05; Nagelkerke’s R2 = 0.046) | |||||||||
RegB
|
SD
|
Wald
|
df
|
Sig.
|
Exp(B)
|
95%-CI
| |||
AOK-Junior | Yes vs. no (Ref.) | 0.685 | 0.046 | 225.644 | 1 | < 0.001 | 1.984 | 1.814 | 2.170 |
Sex | Male vs. female (Ref.) | 0.189 | 0.045 | 17.780 | 1 | < 0.001 | 1.208 | 1.106 | 1.318 |
Chronic disease | Yes vs. no (Ref.) | 0.414 | 0.047 | 76.835 | 1 | < 0.001 | 1.512 | 1.379 | 1.659 |
Nationality | German vs. other nationality (Ref.) | 0.134 | 0.058 | 5.218 | 1 | 0.022 | 1.143 | 1.019 | 1.282 |
Unem-ployment | Yes vs. no (Ref.) | 0.631 | 0.314 | 4.043 | 1 | 0.044 | 1.879 | 1.016 | 3.476 |
Region | Urban (Ref.) | 8.894 | 2 | 0.012 | |||||
Semi-urban | 0.149 | 0.060 | 6.213 | 1 | 0.013 | 1.161 | 1.032 | 1.305 | |
Rural | -0.072 | 0.071 | 1.017 | 1 | 0.313 | 0.931 | 0.809 | 1.070 | |
Constant | -1.969 | 0.068 | 830.715 | 1 | < 0.001 | 0.140 | |||
J2(n = 3,616; missing: 0; HL-Test χ² (6) = 7.352, p > 0,05; Nagelkerke’s R2 = 0.036) | |||||||||
RegB
|
SD
|
Wald
|
df
|
Sig.
|
Exp(B)
|
95%-CI
| |||
AOK-Junior | Yes vs. no (Ref.) | 0.495 | 0.099 | 25.11 | 1 | < 0.001 | 1.641 | 1.352 | 1.992 |
Sex | Male vs. female (Ref.) | -0.497 | 0.099 | 25.238 | 1 | < 0.001 | 0.609 | 0.501 | 0.739 |
Chronic disease | Yes vs. no (Ref.) | 0.442 | 0.098 | 20.407 | 1 | < 0.001 | 1.556 | 1.284 | 1.885 |
Constant | -2.099 | 0.102 | 423.735 | 1 | < 0.001 | 0.123 |
U10(n = 10,252; missing: 68; HL-Test χ² (7) = 7.668, p > 0,05; Nagelkerke’s R2 = 0.038) | |||||||||
RegB
|
SD
|
Wald
|
df
|
Sig.
|
Exp(B)
|
95%-CI
| |||
AOK-Junior | Yes vs. no (Ref.) | 0.564 | 0.079 | 50.958 | 1 | < 0.001 | 1.758 | 1.506 | 2.053 |
Sex | Male vs. female (Ref.) | 0.405 | 0.077 | 27.615 | 1 | < 0.001 | 1.500 | 1.289 | 1.745 |
Chronic disease | Yes vs. no (Ref.) | 0.688 | 0.079 | 75.889 | 1 | < 0.001 | 1.989 | 1.704 | 2.322 |
Nationality | German vs. other nationality (Ref.) | -0.124 | 0.107 | 1.362 | 1 | 0.243 | 0.883 | 0.717 | 1.088 |
Constant | -3.266 | 0.082 | 1568.237 | 1 | < 0.001 | 0.038 | |||
U11(n = 11,470; missing: 252; HL-Test χ² (8) = 7.745, p > 0,05; Nagelkerke’s R2 = 0.018) | |||||||||
RegB
|
SD
|
Wald
|
df
|
Sig.
|
Exp(B)
|
95%-CI
| |||
AOK-Junior | Yes vs. no (Ref.) | 0.222 | 0.078 | 8.011 | 1 | 0.005 | 1.249 | 1.071 | 1.456 |
Sex | Male vs. female (Ref.) | 0.220 | 0.078 | 7.968 | 1 | 0.005 | 1.246 | 1.070 | 1.452 |
Chronic disease | Yes vs. no (Ref.) | 0.529 | 0.080 | 44.300 | 1 | < 0.001 | 1.698 | 1.453 | 1.984 |
Nationality | German vs. other nationality (Ref.) | 0.309 | 0.104 | 8.856 | 1 | 0.003 | 1.362 | 1.111 | 1.670 |
Unem-ployment | Yes vs. no (Ref.) | 0.263 | 0.080 | 10.871 | 1 | 0.001 | 1.301 | 1.112 | 1.521 |
Constant | -3.483 | 0.123 | 806.205 | 1 | < 0.001 | 0.031 | |||
J2(n = 3,616; missing: 0; HL-Test χ² (6) = 6.399, p > 0,05; Nagelkerke’s R2 = 0.035) | |||||||||
RegB
|
SD
|
Wald
|
df
|
Sig.
|
Exp(B)
|
95%-CI
| |||
AOK-Junior | Yes vs. no (Ref.) | 0.373 | 0.127 | 8.614 | 1 | 0.003 | 1.452 | 1.132 | 1.863 |
Sex | Male vs. female (Ref.) | -0.649 | 0.130 | 24.813 | 1 | < 0.001 | 0.523 | 0.405 | 0.675 |
Chronic disease | Yes vs. no (Ref.) | 0.544 | 0.128 | 18.156 | 1 | < 0.001 | 1.722 | 1.341 | 2.212 |
Constant | -2.689 | 0.132 | 417.248 | 1 | < 0.001 | 0.068 |