Although in the past century mortality in West Germany decreased similarly as in other Western nations, these changes were less pronounced in East Germany. 1, 2 After German reunification in 1990, there was a lack of scientifically valid data from East Germany to explain the regional differences in life expectancy and, consequently, a need for population-based research in northeast Germany.

Previous population-based studies focused mainly on specific diseases. Comparatively narrow examination programmes with time-consuming assessments may lead to a poor response. A design is needed that combines a high response with a broad and time-consuming spectrum of different health examinations. One approach might be a cohort design that includes moderately time-consuming health examinations in a first wave and, after compliance has been established, offers more time-demanding examinations in future waves. An alternative approach could be to first establish a population-based study with moderate demands on participating subjects, followed