9. RESULTS OF SUBSYSTEM 6: HEALTH STATUS AND SELECTED INDICATORS OF DEMOGRAPHIC AND HEALTH STATISTICS

9.1 Questionnaire on health status

9.1.1 Structure of the questionnaire and organization of monitoring activities

To extend the pilot study HELEN 97, the questionnaire investigation was implemented in autumn 1998 in six cities of the Monitoring System (Brno, České Budějovice, Hradec Králové, Karviná, Kolín and Ústí n/L). The cities were selected to be representative of different quality levels of the environment and to reflect differences in the demographic and socioeconomic parameters.

The structure of the questionnaire used for the pilot study of 1997 was kept, the questionnaire consisted of 64 questions and was divided into the following sections: personal data and employment, housing, personal medical history, family medical history, data on lifestyle, personal opinion, social and economic conditions, nutritional status and dietary habits.

As many as 800 individuals (400 males and 400 females) were systematically selected at random in each city which allowed to obtain representative samples of population. This systematic at random selection was supported by the municipal registries, the age range was limited to 45 to 54 years. This time, the questionnaire was not mailed, but the investigator whom took care of all organizational aspects of the investigation but was not allowed filling in the questionnaire or to influence the proband contacted the proband. The investigators were selected among the Public Health Service workers (Karviná, Kolín, České Budějovice) and university students (Brno, Hradec Králové) or engaged from an agency (Ústí n/L). In all cities, the investigators were uniformly trained and familiarized with the standard procedure of questionnaire collection. A half of the probands (200 males and 200 females) was invited for medical check-ups in the Public Health Service. The workers of the district Public Health Service organized these medical check-ups. Blood pressure, body height, body weight, waist and hip measurement and measurement of total cholesterol concentration in the blood were recorded within this check-up.

The final questionnaire respondence was 63.0%, the responsiveness to the medical check-up was 40.3%. Best results in this regard were obtained in the cities where the investigators were the Public Health Service workers. The method of the investigator-respondent direct contact proved unambiguously superior, as for the medical check-up, the probands showed substantially lower acceptance.

9.1.2 Methods of questionnaire data processing

The data obtained were processed as a whole and then separately for different cities and both genders. To estimate the prevalence of the indicators monitored, the results describing the whole group and different genders were weighted against the population of the age group studied (45 to 54 years) in the six cities monitored. All these comparisons between the cities and genders are based on the results of a logistic regression. The results of the regression analysis are presented as odds ratios.

9.1.3 Selected results

Health status:

Incidence of risk factors of chronic non-infectious diseases (Fig. 9.3a):

Socioeconomic a psychosocial factors:

Nutrition and dietary habits:

9.2 Selected parameters of demographic and health statistics

Within the regular presentation of selected demographic and health parameters, the data on the total standardized mortality rate, infant mortality rate and mean life expectancy were updated and selected parameters of the population age structure were newly included. All parameters are simply compared for the Czech Republic and the EU countries and other European countries with similar political development as the Czech Republic (Lithuania, Hungary, Poland and Slovakia). The Institute of Health Information and Statistics provided the data on the population age structure and mortality rate in the Czech Republic. The data for the international comparison were taken from the database which is part of the program “Health for all by the Year 2000” (WHO). The data are compared for the range from 1981 to 1995, the development is assessed only in the countries for which the data are available for the whole period evaluated (these criteria are not met for Belgium, Italy, Germany and Slovakia).

9.2.1 Standardized mortality rate

Standardized mortality rate (according to the so-called European standard) has been updated to cover another 4-year period (1994 - 1997) and extends the data of 1994 (Summary and Special Report). Total standardized mortality rate showed a decrease in the EU for this period in males of all countries monitored and in females of almost all countries followed up except Denmark and Iceland. In the other countries that are not members of the EU, a significant decrease in total standardized mortality was found in both males and females of the Czech Republic and in females of Poland and Hungary. The Czech Republic shows higher total standardized mortality rate than EU countries during the whole period evaluated (Fig. 9.4a, 9.4b). Compared to the countries which are not members of the EU, in the Czech Republic, the male mortality rate was the lowest and the female mortality rate the third lowest in 1995.

In the Czech Republic, the highest share of total standardized mortality rate was due to cardiovascular diseases and cancer, the decrease of the total mortality rate was attributable to cardiovascular and respiratory diseases. A decrease in mortality rate was recorded for all diagnoses monitored of the cardiovascular system, urinary and genital system, for suicides and external cases of mortality rate in females. Mortality rate due to tumor affections showed stagnation. As for the cancers followed up, decreased mortality rate was reported for cancer of the stomach and cervix uteri. Lung cancer showed decreased mortality rate in males and increased mortality rate in females. Increased mortality rate was also recorded for colorectal carcinoma in males.

Marked differences were recorded between the mean mortality rate in the Czech Republic and the mortality rates in different districts under monitoring (the difference is statistically significant in some cases). In the last four-year period, the difference in total standardized mortality rate between the mean of the Czech Republic and the extreme district values (maximum and minimum) reached about 19%. For some diagnostic groups (e.g. tumor affections), there are even more marked differences between the Czech Republic and individual districts. Lastingly higher total standardized mortality rate was in the districts of Sokolov, Most, Děčín and Ústí n/L compared to the mean of the Czech Republic, while lastingly lower total standardized mortality rate was recorded in the districts of Brno and Hradec Králové. In Prague and Hradec Králové, the lower total mortality rate is attributable to lower mortality rate due to cardiovascular diseases. Mortality rate due to tumor affections is stable lower in males in Prague compared to the mean of the Czech Republic which seems to result from lower mortality rate due to cancer of the stomach and lungs, while stable higher in females, probably because of higher mortality rate due to cancer of the breast and lungs.

9.2.2 Infant mortality rate

A decrease in infant mortality rate was found in all of the EU countries and in almost all countries followed up which are not EU members, except of Lithuania showing stagnation. In the Czech Republic, infant mortality rate decreased statistically significantly within the evaluated period. Compared to the mean rates of the EU countries, infant mortality rate in the Czech Republic is lastingly higher (Fig. 9.5). In 1995, only Greece from the EU countries showed higher infant mortality than the Czech Republic. Compared to the countries that are not EU members, the Czech Republic reported the lowest infant mortality rate in 1995.

9.2.3 Mean life expectancy at birth

The trend in mean life expectancy at birth is consistent with that in standardized mortality rate in a given country. In the EU countries followed up and in the Czech Republic, an increase in mean life expectancy is evident, nevertheless, the values in the Czech Republic are permanently lower compared to any of the EU countries (Fig. 9.6a, 9.6b). Out of the countries which are not members of the EU, only the Czech Republic shows increased life expectancy in males, while increased life expectancy in females has been reported in the Czech Republic, Hungary and Poland.

9.2.4 Several parameters of age structure of population

Population age structure is evaluated according to the share of individuals of the pre-productive age (less than 15 years), post-productive age (65 and more years) and total population. The data are processed for the period 1982 - 1997. In both the EU countries and the European countries which are not members of the EU, population is aging since the share of the population aged under 15 years is decreasing while the percentage of the population aged 65 and more years is increasing. The share of children is decreasing in all countries except of Luxembourg and the Great Britain, while the share of post-productive population is increasing in all countries monitored.

In the Czech Republic, the tendency of the population to aging has been evident since 1985. Compared to the values found in the EU countries, the Czech Republic shows lastingly higher percentage of the population aged under 15 years, while the percentage of the population aged 65 years or more is lastingly lower in this country (Fig. 9.7a, 9.7b). The age distribution of the population of some of the Czech districts evaluated has been statistically significantly different from the mean of the Czech Republic. A shift to the higher age groups was recorded in the districts of Prague, Brno and Kolín, while a shift to the lower age groups in the districts of Sokolov, Děčín and Šumperk. In the districts of Znojmo and Ústí n/O, a higher share of the population aged under 15 years was found, the share of the post-productive population did not differ from the mean of the Czech Republic.

9.3 Partial conclusions

The following conclusions concerning the health status can be drawn from the results obtained:



Fig. 9.1a Personal medical history, diseases reported by respondent, 1998
Fig. 9.1b Subjective evaluation of health status in last 6 months, 1998
Fig. 9.2 Quantity of drugs used in last year during more than 14 days, 1998
Fig. 9.3a Risk factors of chronic non-infectious diseases, 1998
Fig. 9.3b Personal medical history, diseases notified by physician, 1998
Fig. 9.4a Total standardized mortality rate of males, 1998 - comparison with EU
Fig. 9.4b Total standardized mortality rate of females, 1998 - comparison with EU
Fig. 9.5 Infant mortality rate up to 1 year of age, 1998 - comparison with EU
Fig. 9.6a Average life expectancy of males at birth, 1998 - comparison with EU
Fig. 9.6b Average life expectancy of females at birth, 1998 - comparison with EU
Fig. 9.7a Share of persons in post-productive age, 1998 - comparison with EU
Fig. 9.7b Share of persons younger 15 years of age, 1998 - comparison with EU

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