In our article (1) we reported two different response rates according to international standards (2), which referred to different baseline totals (response rate 3 according to AAPOE: all likely households; cooperation rate: all target persons who had been contacted successfully). For this reason, the suggested multiplication of the two rates is not admissible. As shown in the cited references, the achieved response rates meet the expectations for population surveys (3). However, in order to be able to generalize the results to the population, the design and adjustment weightings of the analyses are additionally crucial. Still, we did mention in the article the limitations that apply to each and every telephone health survey.

Collecting data on self-reported diseases diagnosed by a physician is the common method used in health surveys to estimate disease prevalence rates at the population level. We did not validate these self-reports—this would have been impossible in a nationwide telephone survey of this order of magnitude.

In Figure 2 we described which federal state had above-average or below-average values for both indicators. The confidence interval for Germany is 8.2% to 8.7%; this is significantly different to Baden-Württemberg (6.7% to 7.8%). It also means marginally overlapping confidence intervals for Rhineland-Palatinate (8.7% to 10.8%) and Saxony-Anhalt (8.5% to 11.2%).

Other authors have also reached the conclusion that differences in cardiovascular mortality between federal states cannot plausibly be explained with method-related biases of the cause of death statistic (4). Our summary of the most important cardiovascular disorders may have balanced the effects of coding difference at state level further. When all limitations are taken into account, using the official cause of death statistic is the only option for studying differences in regional death rates.

DOI: 10.3238/arztebl.2017.0211b

On behalf of the authors:

Christina Dornquast

Charité – Universitätsmedizin Berlin

Institut für Sozialmedizin, Epidemiologie und Gesundheitsökonomie

und Robert Koch-Institut Berlin

Abteilung für Epidemiologie und Gesundheitsmonitoring

christina.dornquast@charite.de

Dr. med. Markus Busch

Robert Koch-Institut Berlin

Abteilung für Epidemiologie und Gesundheitsmonitoring

Conflict of interest statement

The authors of both contributions declare that no conflict of interest exists.

1.
Dornquast C, Kroll LE, Neuhauser HK, Willich SN, Reinhold T, Busch MA: Regional differences in the prevalence of cardiovascular disease—results from the German Health Update (GEDA) from 2009–2012. Dtsch Arztebl Int 2016; 113: 704–11 VOLLTEXT
2.
American Association of Public Opinion Research: AAPOR standard definitions. Deerfield, Illinois 2008.
3.
Lange C, Jentsch F, Allen J, et al.: Data resource profile: German Health Update (GEDA)—the health interview survey for adults in Germany. Int J Epidemiol 2015, 44: 442–50 CrossRef MEDLINE
4.
Stang A, Stang M: An inter-state comparison of cardiovascular risk in Germany— towards an explanation of high ischemic heart disease mortality in Saxony-Anhalt. Dtsch Arztebl Int 2014; 111: 530–6. VOLLTEXT
1.Dornquast C, Kroll LE, Neuhauser HK, Willich SN, Reinhold T, Busch MA: Regional differences in the prevalence of cardiovascular disease—results from the German Health Update (GEDA) from 2009–2012. Dtsch Arztebl Int 2016; 113: 704–11 VOLLTEXT
2.American Association of Public Opinion Research: AAPOR standard definitions. Deerfield, Illinois 2008.
3.Lange C, Jentsch F, Allen J, et al.: Data resource profile: German Health Update (GEDA)—the health interview survey for adults in Germany. Int J Epidemiol 2015, 44: 442–50 CrossRef MEDLINE
4.Stang A, Stang M: An inter-state comparison of cardiovascular risk in Germany— towards an explanation of high ischemic heart disease mortality in Saxony-Anhalt. Dtsch Arztebl Int 2014; 111: 530–6. VOLLTEXT

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