Scientific Concept of the National Cohort (status ... - Nationale Kohorte

A.2
A.2. Scientific background and rationale for study elements
ing to further analyze how neighborhood SES and regional differences in socioeconomic
deprivation might help to explain the geographical gradient in disease and mortality beyond
individual SES.
Assessment of SES:
Examinations & questionnaires (at baseline and during reassessment)
Level 1: Questionnaire
A.2.4.6 Sleep-related characteristics
There is evidence that sleep characteristics including sleep duration at night, sleep environment,
sleep disturbances at night, daytime sleepiness, afternoon naps (siesta), perceived
sleep satisfaction, sleep apnea syndrome, and sleep quality influence the risk of atherosclerotic
diseases, especially coronary artery disease 368, 369 , stroke 370 , and other diseases. Furthermore,
chronic sleep complaints in epidemiologic studies have been associated with an
increase in overall mortality and morbidity 371 . In addition, several diseases and exposures
influence sleep characteristics (for example, depression and medical drugs). Sleep characteristics
are also considered as intermediates between certain exposures (e.g., shift work)
and diseases (e.g., cancer). Chronodisruption is a relevant disturbance of the circadian
organization of physiology and endocrine regulation and is hypothesized to be linked to the
development of various diseases. It may be caused by shift work or other “zeitgebers” outside
of the occupational setting such as physical activity at night, nightly exposure to light,
sleep disturbance, or reduced sleep duration 372 . There is increasing interest in determining
whether chronodisruption represents a risk factor for hormone-dependent cancers, e.g.,
breast or prostrate cancer 373 . Melatonin is a robust marker for the circadian phase. Physiologically,
melatonin levels are low during the day and peak at night. Biologically relevant
chronodisruption, which is associated with a circadian phase shift, can be established by
measuring the melatonin metabolite 6-sulfatoxymelatonin in morning urine 374 .
Assessment of sleep-related characteristics:
Examinations and questionnaires (at baseline and during reassessment)
Level 1 Questionnaire
Level 2 Portable device to assess sleep apnea and other sleep characteristics
A.2.4.7 Chronic infections, immune factors, and microflora
Immunization, infection status and risk of chronic diseases
Immunizations, vaccine-preventable diseases: In view of the increasing life expectancy and
the fact that immunity to “childhood diseases” is increasingly being acquired through vaccines
instead of natural infection, pathogen-specific immunity is changing, and the public health
relevance of vaccine-preventable diseases in the adult population is bound to increase.
Based on data from the statutory health insurances, the Robert Koch Institute estimates
240,000 annual cases of herpes zoster in Germany (Robert Koch Institute, unpublished).
The prevalence of carcinogenic human papillomavirus infections among women older than
20 years in Germany is estimated to be 4.3% 375 . In Germany, 10,000 to 40,000 individuals
die annually from influenza-associated complications in Germany 376 . The notification rates
of invasive pneumococcal infections are the highest in individuals ≥60 years compared to
other age groups 376 . Investigations of the Robert Koch Institute using blood donations have
shown that the prevalence for hepatitis B virus was 133 per 100,000 blood donations 377 . At
48