Alcohol-related morbidity in a rural area in Germany

The federal state of Mecklenburg Western Pomerania is located in the north-eastern part of Germany encompassing an area of 23.213 km2 (Figure 1). Mecklenburg Western Pomerania is considered as rural area with 1.599.138 inhabitants (31.12.2014) corresponding to 69 inhabitants per km2 1). In 2014, the unemployment rate was 11.2% (in comparison: In 2014, the unemployment rate in Germany was 6.7%)1). Besides social problems, providing comprehensive medical care is challenging due to a low number of family practitioners in this area, long distances between patients and health care providers, but also due to the demographic change and an increase in chronic diseases. After the German reunification in 1990, data showed that life expectancy was substantially lower in the east than in the west, in particular in the northeast2). Furthermore, the burden of disease in the German population showed considerable regional variation, e.g. regarding hypertension and diabetes mellitus3, 4). One hypothesis was that people in the north-eastern part of Germany show more health-related risk factors as unhealthy eating habits, smoking and alcohol consumption. However, scientific data on these questions were lacking and a research network was founded to investigate to what extent the high mortality can be explained by risk factors. The Study of Health in Pomerania (SHIP), a population-based cohort study covering the region of Western Pomerania, was established. Study details are described in detail elsewhere2). The first aim of SHIP is to investigate the prevalence and incidence of common risk factors, subclinical disorders and clinical diseases. For example, the study is focusing on thyroid disorders, diabetes, hypertension and behavioral risk factors as smoking, physical inactivity, unhealthy eating habits and alcohol consumption. The second aim of SHIP is to investigate the complex interactions between risk factors and subclinical and clinical diseases. To achieve these aims, a comprehensive examination program was established including among others a medical interview, laboratory testing, sonographic examinations, and dermatological and dental examinations. The sample comprised of 4308 individuals aged 20 to 79 years.