. 2020 Feb;35(2):169-181.

doi: 10.1007/s10654-019-00577-4. Epub 2019 Nov 8.

Rationale and Design of the Hamburg City Health Study

Annika Jagodzinski^{1

2

3}, Christoffer Johansen^{4

5

6

7}, Uwe Koch-Gromus⁸, Ghazal Aarabi⁹, Gerhard Adam¹⁰, Sven Anders¹¹, Matthias Augustin¹², Ramona B der Kellen⁴, Thomas Beikler¹³, Christian-Alexander Behrendt¹⁴, Christian S Betz¹⁵, Carsten Bokemeyer¹⁶, Katrin Borof⁴, Peer Briken¹⁷, Chia-Jung Busch¹⁵, Christian Büchel¹⁸, Stefanie Brassen¹⁸, Eike S Debus¹⁴, Larissa Eggers⁴, Jens Fiehler¹⁹, Jürgen Gallinat²⁰, Simone Gellißen¹⁹, Christian Gerloff²¹, Evaldas Girdauskas²², Martin Gosau²³, Markus Graefen²⁴, Martin Härter²⁵, Volker Harth²⁶, Christoph Heidemann⁴, Guido Heydecke⁹, Tobias B Huber²⁷, Yassin Hussein⁴, Marvin O Kampf⁴, Olaf von dem Knesebeck²⁸, Alexander Konnopka²⁹, Hans-Helmut König²⁹, Robert Kromer³⁰, Christian Kubisch³¹, Simone Kühn²⁰, Sonja Loges^{16

32}, Bernd Löwe³³, Gunnar Lund¹⁰, Christian Meyer^{34

35}, Lina Nagel⁴, Albert Nienhaus³⁶, Klaus Pantel³², Elina Petersen⁴, Klaus Püschel¹¹, Hermann Reichenspurner²², Guido Sauter³⁷, Martin Scherer³⁸, Katharina Scherschel^{34

35}, Ulrich Schiffner¹³, Renate B Schnabel^{39

34}, Holger Schulz²⁵, Ralf Smeets²³, Vladislavs Sokalskis⁴, Martin S Spitzer³⁰, Claudia Terschüren²⁶, Imke Thederan²⁴, Tom Thoma⁴, Götz Thomalla²¹, Benjamin Waschki^{39

34

40}, Karl Wegscheider⁷, Jan-Per Wenzel^{39

4}, Susanne Wiese⁴, Birgit-Christiane Zyriax^{34

41}, Tanja Zeller^{39

34

4}, Stefan Blankenberg^{39

34}

Affiliations

¹ Department of General and Interventional Cardiology, University Heart and Vascular Center, Hamburg, Germany. a.jagodzinski@uke.de.
² German Center for Cardiovascular Research (DZHK) Partner Site Hamburg/Lübeck/Kiel, Munich, Germany. a.jagodzinski@uke.de.
³ Epidemiological Study Center, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany. a.jagodzinski@uke.de.
⁴ Epidemiological Study Center, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
⁵ Oncology Clinic, Finsen Center, Copenhagen, Denmark.
⁶ Survivorship Research Unit, The Danish Cancer Society Research Center, Copenhagen, Denmark.
⁷ Institute for Medical Biometry and Epidemiology (IMBE), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
⁸ Faculty of Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
⁹ Department of Prosthetic Dentistry, Center for Dental and Oral Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
¹⁰ Department of Diagnostics and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
¹¹ Department for Forensic Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
¹² Institute for Health Services Research in Dermatology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
¹³ Department of Periodontics, Preventive and Restorative Dentistry, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
¹⁴ Department of Vascular Medicine, University Heart and Vascular Center, Hamburg, Germany.
¹⁵ Department of Otolaryngology, Head and Neck Surgery, Head and Neurocenter, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
¹⁶ Department of Oncology, Hematology, BMT with Section Pneumology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
¹⁷ Institute for Sexual Research and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
¹⁸ Institute for Systemic Neurosciences, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
¹⁹ Clinic of Neuroradiological Diagnostics and Intervention, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
²⁰ Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
²¹ Department of Neurology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
²² Department for Cardiovascular Surgery, University Heart and Vascular Center, Hamburg, Germany.
²³ Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
²⁴ Prostate Cancer Center, Martini-Clinic, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
²⁵ Department of Medical Psychology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
²⁶ Institute for Occupational and Maritime Medicine (ZfAM), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
²⁷ Medical Clinic and Polyclinic III, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
²⁸ Institute for Medical Sociology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
²⁹ Institute for Health Economics and Healthcare Research, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
³⁰ Clinic of Ophthalmology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
³¹ Institute of Human Genetics, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
³² Institute for Tumor Biology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
³³ Institute for Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
³⁴ German Center for Cardiovascular Research (DZHK) Partner Site Hamburg/Lübeck/Kiel, Munich, Germany.
³⁵ Department of Electrophysiology, Hamburg University Heart Center, University Heart and Vascular Center, Hamburg, Germany.
³⁶ Competence Center for Epidemiology and Health Services Research for Healthcare Professionals (CVcare), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
³⁷ Department of Pathology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
³⁸ Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
³⁹ Department of General and Interventional Cardiology, University Heart and Vascular Center, Hamburg, Germany.
⁴⁰ Airway Research Center North, German Center for Lung Research, Grosshansdorf, Germany.
⁴¹ Competence Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.

PMID: 31705407
PMCID: PMC7125064
DOI: 10.1007/s10654-019-00577-4

Rationale and Design of the Hamburg City Health Study

Annika Jagodzinski et al. Eur J Epidemiol. 2020 Feb.

. 2020 Feb;35(2):169-181.

doi: 10.1007/s10654-019-00577-4. Epub 2019 Nov 8.

Authors

Affiliations

¹ Department of General and Interventional Cardiology, University Heart and Vascular Center, Hamburg, Germany. a.jagodzinski@uke.de.
² German Center for Cardiovascular Research (DZHK) Partner Site Hamburg/Lübeck/Kiel, Munich, Germany. a.jagodzinski@uke.de.
³ Epidemiological Study Center, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany. a.jagodzinski@uke.de.
⁴ Epidemiological Study Center, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
⁵ Oncology Clinic, Finsen Center, Copenhagen, Denmark.
⁶ Survivorship Research Unit, The Danish Cancer Society Research Center, Copenhagen, Denmark.
⁷ Institute for Medical Biometry and Epidemiology (IMBE), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
⁸ Faculty of Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
⁹ Department of Prosthetic Dentistry, Center for Dental and Oral Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
¹⁰ Department of Diagnostics and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
¹¹ Department for Forensic Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
¹² Institute for Health Services Research in Dermatology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
¹³ Department of Periodontics, Preventive and Restorative Dentistry, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
¹⁴ Department of Vascular Medicine, University Heart and Vascular Center, Hamburg, Germany.
¹⁵ Department of Otolaryngology, Head and Neck Surgery, Head and Neurocenter, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
¹⁶ Department of Oncology, Hematology, BMT with Section Pneumology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
¹⁷ Institute for Sexual Research and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
¹⁸ Institute for Systemic Neurosciences, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
¹⁹ Clinic of Neuroradiological Diagnostics and Intervention, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
²⁰ Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
²¹ Department of Neurology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
²² Department for Cardiovascular Surgery, University Heart and Vascular Center, Hamburg, Germany.
²³ Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
²⁴ Prostate Cancer Center, Martini-Clinic, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
²⁵ Department of Medical Psychology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
²⁶ Institute for Occupational and Maritime Medicine (ZfAM), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
²⁷ Medical Clinic and Polyclinic III, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
²⁸ Institute for Medical Sociology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
²⁹ Institute for Health Economics and Healthcare Research, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
³⁰ Clinic of Ophthalmology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
³¹ Institute of Human Genetics, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
³² Institute for Tumor Biology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
³³ Institute for Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
³⁴ German Center for Cardiovascular Research (DZHK) Partner Site Hamburg/Lübeck/Kiel, Munich, Germany.
³⁵ Department of Electrophysiology, Hamburg University Heart Center, University Heart and Vascular Center, Hamburg, Germany.
³⁶ Competence Center for Epidemiology and Health Services Research for Healthcare Professionals (CVcare), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
³⁷ Department of Pathology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
³⁸ Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
³⁹ Department of General and Interventional Cardiology, University Heart and Vascular Center, Hamburg, Germany.
⁴⁰ Airway Research Center North, German Center for Lung Research, Grosshansdorf, Germany.
⁴¹ Competence Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.

PMID: 31705407
PMCID: PMC7125064
DOI: 10.1007/s10654-019-00577-4

Abstract

The Hamburg City Health Study (HCHS) is a large, prospective, long-term, population-based cohort study and a unique research platform and network to obtain substantial knowledge about several important risk and prognostic factors in major chronic diseases. A random sample of 45,000 participants between 45 and 74 years of age from the general population of Hamburg, Germany, are taking part in an extensive baseline assessment at one dedicated study center. Participants undergo 13 validated and 5 novel examinations primarily targeting major organ system function and structures including extensive imaging examinations. The protocol includes validate self-reports via questionnaires regarding lifestyle and environmental conditions, dietary habits, physical condition and activity, sexual dysfunction, professional life, psychosocial context and burden, quality of life, digital media use, occupational, medical and family history as well as healthcare utilization. The assessment is completed by genomic and proteomic characterization. Beyond the identification of classical risk factors for major chronic diseases and survivorship, the core intention is to gather valid prevalence and incidence, and to develop complex models predicting health outcomes based on a multitude of examination data, imaging, biomarker, psychosocial and behavioral assessments. Participants at risk for coronary artery disease, atrial fibrillation, heart failure, stroke and dementia are invited for a visit to conduct an additional MRI examination of either heart or brain. Endpoint assessment of the overall sample will be completed through repeated follow-up examinations and surveys as well as related individual routine data from involved health and pension insurances. The study is targeting the complex relationship between biologic and psychosocial risk and resilience factors, chronic disease, health care use, survivorship and health as well as favorable and bad prognosis within a unique, large-scale long-term assessment with the perspective of further examinations after 6 years in a representative European metropolitan population.

Keywords: Brain MRI; Cancer; Cardiac MRI; Coronary heart disease; Dementia; Epidemiology; Hamburg; Health care; Health service research; Lifestyle; MRI imaging; Nutrition; Obesity; Ocular diseases; Oral health; Prevention; Prospective cohort study; Psychiatric and psychosomatic disorders; Resilience; Respiratory diseases; Risk factors; Sexual dysfunction; Stroke; Survivorship; Vascular diseases.

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Conflict of interest statement

Ghazal Aarabi: Has received project related funding by the DFG. Gerhard Adam: Nothing to disclose. Sven Anders: received research funding from German Ministry of Science and Education (BMBF) and Rickertsen Foundation. Matthias Augustin: Nothing to disclose. Ramona Bei der Kellen: Nothing to disclose. Thomas Beikler: Nothing to disclose. Christian-Alexander Behrendt: has received research funding from the German Federal Joint Committee (Grant No. 01VSF16008 and 01VSF18035). Christian S. Betz: Nothing to disclose relating to HCHS. Carsten Bokemeyer: Nothing to disclose. Katrin Borof: Nothing to disclose. Peer Briken: Nothing to disclose. Chia-Jung Busch: Has received project related funding by the DKFZ. Christian Büchel: Nothing to disclose. Stefanie Brassen: Nothing to disclose. Sebastian Debus received institutional Grants from COOK, Vascutek and Bayer. He has also received honoraria as member of Bayer Advisory boards. Larissa Eggers: Nothing to disclose. Jens Fiehler: received research funding from German Ministry of Science and Education (BMBF), German Ministry of Economy and Innovation (BMWi), German Research Foundation (DFG), European Union (EU), Hamburgische Investitions- und Förderbank (IFB), Medtronic, Microvention, Philips, Stryker; received honoraria as consultant or speaker for Acandis, Boehringer Ingelheim, Cerenovus, Covidien, Evasc Neurovascular, MD Clinicals, Medtronic, Medina, Microvention, Penumbra, Route92, Stryker, Transverse Medical. Jürgen Gallinat: has received research funding from the German Federal Ministry of Education and Research, German Science Foundation, and speaker fees from Lundbeck, Janssen-Cilag, Lilly and Otsuka. Christian Gerloff: received funding from German Research Council (DFG), European Union, Federal Ministery of Education and Research (BMBF), German Statutory Pension Insurance Scheme (RV Nord), National Innovation Fond, Wegener Foundation, and Schilling Foundation; received honoraria as speaker or consultant from Abbott, Amgen, Bayer Vital, Bristol-Myers-Squibb, Boehringer Ingelheim, Sanofi Aventis, and Prediction Biosciences. Evaldas Girdauskas: Nothing to disclose. Martin Gosau: Nothing to disclose. Uwe Koch- Gromus: Nothing to disclose. Markus Graefen: Nothing to disclose. Martin Härter: received funding from the Federal Ministery of Education and Research (BMBF) for the project PERGOLA. Volker Harth: received funding from European Union, Federal Ministery of Education and Research (BMBF), Federal Ministery of Health (BMG), and Deutsche Gesetzliche Unfallversicherung (DGUV). Christoph Heidemann: Nothing to disclose. Guido Heydecke: Nothing to disclose. Tobias Huber: Nothing to disclose relating to HCHS. Yassin Hussein: Nothing to disclose. Annika Jagodzinski: Has received project related funding by Amgen and an unrestricted Grant by Bayer. Christoffer Johansen: Nothing to disclose. Marvin O. Kampf: Nothing to disclose. Olaf von dem Knesebeck: Nothing to disclose. Alexander Konnopka: Nothing to disclose. Hans-Helmut König: Nothing to disclose. Robert Kromer: received funding from the Federal Ministry of Economics and Technology, European Union, Santen and StullnPharma; received honoraria as speaker from Bayer, Novartis, Santen and Topcon. Christian Kubisch: Nothing to disclose. Simone Kühn: has been funded by the German Science Foundation, the European Union (ERC-2016-StG-Self-Control-677804) and a Fellowship from the Jacobs Foundation. Sonja Loges: Nothing to disclose with regards to this publication. Bernd Löwe: Nothing to disclose. Gunnar Lund: Nothing to disclose. Christian Meyer: is supported by the German Center for Cardiovascular Research (DZHK, 81Z0710112). Lina Nagel: Nothing to disclose Albert Nienhaus: Received funds from the German Ministry of Health (BMG), the European Union Social Dialog Fund, Institution for Statutory Accident Insurance and Prevention in the Health and Welfare Services, and ZEIT-Stiftung. Klaus Pantel: Nothing to disclose. Elina Petersen: Nothing to disclose. Klaus Püschel: Nothing to disclose. Hermann Reichenspurner: received honoraria as consultant for Abiomed und Medtronic. Guido Sauter: Nothing to disclose. Martin Scherer: Nothing to disclose. Katharina Scherschel: is supported by the German Center for Cardiovascular Research (DZHK, 81Z0710112). Ulrich Schiffner: has received honoraria for lectures from 3 M, CP Gaba, and DMG. Renate Schnabel: has received funding from the European Research Council (ERC) under the European Union’s Horizon 2020 research and innovation programme (Grant Agreement No 648131), German Ministry of Research and Education (BMBF 01ZX1408A) and German Center for Cardiovascular Research (DZHK e.V.) (81Z1710103). Holger Schulz: Nothing to disclose. Ralf Smeets: Nothing to disclose. Vladislavs Sokalskis: Nothing to disclose. Martin S. Spitzer has received research funding from Novartis, Clanotech, Croma Pharma Topcon and Flouron. He received honoraria for lectures from Novartis, Bayer, Alcon, Allergan, Alimera Sciences and for consulting from Bayer, SHS and Altacor. Claudia Terschüren: received funding from Deutsche Gesetzliche Unfallversicherung (DGUV). Imke Thederan: Nothing to disclose. Götz Thomalla: received funding from the German Research Council (DFG), European Union’s Horizon 2020 research and innovation programme, German Federal Ministry for Economic Affairs and Energy (BMWi), Germany’s Federal Joint Committee (G-BA) Innovation Fund (Innovationsfonds), and has received honoraria as speaker or consultant from Acandis, Bayer Vital, Bristol-Myers-Squibb/Pfizer, Boehringer Ingelheim, Daiichi Sankyo and Stryker. Benjamin Waschki: Nothing to disclose. Karl Wegscheider: Nothing to disclose. Jan-Per Wenzel: Nothing to disclose. Susanne Wiese: Nothing to disclose. Birgit-Christiane Zyriax: has received project related funding by BASF, Unilever and DIFE. Tanja Zeller: is supported by the German Center for Cardiovascular Research (DZHK, 81Z0710102). This project has received funding from the European Union´s Horizon 2020 research and innovation programme under Grant Agreement No. 825903, the Innovative medicine initiative (IMI) under Grant No. 116074 and the Fondation Leducq under Grant Number 16 CVD 03. Stefan Blankenberg: is supported by the Innovative medicine initiative (IMI) under Grant No. 116074, the Fondation Leducq under Grant Number 16 CVD 03, Siemens, Bayer, Astra Zeneca, Deutsche Gesetzliche Unfallversicherung (DGUV) and Novartis for project related analyses.

Figures

**Fig. 1**
Summary of aims and uniqueness: the Hamburg City Health Study

See this image and copyright information in PMC

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Rationale and Design of the Hamburg City Health Study

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Rationale and Design of the Hamburg City Health Study

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