title: Determinants of health check attendance in adults: findings from the cross-sectional German Health Update (GEDA) study.
abstract: BACKGROUND
  In Germany, adult health checks are carried out in the primary care setting for early detection of chronic conditions, such as cardiovascular diseases, diabetes, and kidney disease. This study aims to examine the social, behavioural, and health-related determinants of health check attendance among eligible adults in Germany.
  
  
  METHODS
  Data were derived from the cross-sectional German Health Update (GEDA) study, a national health survey among adults in Germany carried out by the Robert Koch Institute. Analyses were restricted to respondents with statutory health insurance aged 35 years or older (n = 26,555). Logistic regression models were fitted to estimate associations between health check attendance and factors selected on the basis of Andersen's Behavioral Model of Health Services Use.
  
  
  RESULTS
  After mutual adjustment, higher health check attendance was associated with a higher age, higher socioeconomic status, being married, stronger social support, physical activity, non-smoking, greater fruit and vegetable consumption, and higher use of outpatient care in both sexes. In women, higher attendance was related to alcohol consumption and having company health insurance (BKK) after multiple adjustment. In men, higher attendance was associated with better self-rated health after adjusting for all other factors.
  
  
  CONCLUSIONS
  The findings of this study suggest that people with an unfavourable risk factor profile, such as socioeconomically disadvantaged groups, smokers, physically inactive people, and persons with a low fruit and vegetable intake, are less likely to have health checks than those with a more favourable risk profile. Health checks carried out in the primary care setting should be evaluated for their effects on population health and health inequality.
authors.affiliation: Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Straße 62-66, 12101 Berlin, Germany. j.hoebel@rki.de.
authors.forename: Jens
authors.initials: J
authors.lastname: Hoebel
authors.forename: Anne
authors.initials: A
authors.lastname: Starker
authors.forename: Susanne
authors.initials: S
authors.lastname: Jordan
authors.forename: Matthias
authors.initials: M
authors.lastname: Richter
authors.forename: Thomas
authors.initials: T
authors.lastname: Lampert
mesh_terms: D000328:Adult; D017677:Age Distribution; D000367:Age Factors; D000368:Aged; D003430:Cross-Sectional Studies; D004032:Diet / Q000706:statistics & numerical data; D015444:Exercise; D005260:Female; D005858:Germany / Q000453:epidemiology; D015438:Health Behavior; D006304:Health Status; D054624:Health Status Disparities; D006306:Health Surveys / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D017533:Marital Status / Q000706:statistics & numerical data; D008875:Middle Aged; D010808:Physical Examination / Q000706:statistics & numerical data*; D012307:Risk Factors; D057185:Sedentary Behavior; D012907:Smoking / Q000453:epidemiology; D012944:Social Support; D012959:Socioeconomic Factors