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 study HELEN 98, the questionnaire investigation was implemented in four cities of the Monitoring System (Kladno, Olomouc, Plzeň and Žďár n/S). 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 study of 1998 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, information 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. This allowed representative samples of the population to be obtained. Just as in 1998, this systematic random selection was supported by the municipal registries, the age range was limited from 45 to 54 years. After mailing the first informative letter the selected person was contacted by an investigator who handed over a questionnaire, informed the proband about the importance of the survey, checked whether it was filled in completely and collected all handed out questionnaires. The investigator’s major task was to establish contact with the proband and convince him/her to participate, but was not allowed to fill in the questionnaire or to influence the respondent. The investigators were selected among the Public Health Service workers and students of professional health care schools. In all cities, the investigators were uniformly trained and familiarized with the standard procedure of questionnaire collection.

Half of the probands (200 males and 200 females) was invited for medical check-ups fully organized by each respective district Public Health Center. Blood pressure, body height, body weight, waist and hip measurement and measurement of total cholesterol levels in the blood were recorded within this check-up.

The final questionnaire respondence was 67.5 %, the responsiveness to the medical check-up was 30.9 %. 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 - 54 years) in the four 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 (OR, for definition and description, see chapter 11). In the assessment of the incidence of any given phenomenon, among the cities the one with the least occurrence was considered as the reference level. In the comparison of the genders, males always represented the reference level.

9.1.3 Selected results in the year 1999

Health status:

Incidence of risk factors of chronic non-infectious diseases (Fig. 9.2a):

Socioeconomic a psychosocial factors:

Nutrition and dietary habits:

9.1.4 Selected summary results in the years 1998 and 1999

The summary evaluation of selected results from the questionnaire survey of 1998 (Brno, České Budějovice, Hradec Králové, Karviná, Kolín and Ústí n/L) and 1999 (Kladno, Olomouc, Plzeň and Žďár n/S) was focused on two groups of factors:

9.2 Selected parameters of demographic and health statistics

Within the regular presentation of selected demographic and health parameters, the data on the infant, neonatal and perinatal mortality rates, and on the number of children born with low birth weight were updated. Data for the Czech Republic were supplied by the Institute of Health care Information and Statistics (ÚZIS). Data for international comparison were obtained from the Statistical Database “Health for All” prepared by the World Health Organization (electronic version available on www.who.dk).

Values of the infant mortality rate (Fig. 9.4a) just as those of perinatal (Fig. 4b) and neonatal (Fig. 9.4c) mortality rates decreased in the Czech Republic as well as in the EU and in recent years the Czech values are in the vicinity of EU averages. During the period under follow-up, perinatal mortality rate decreased in our country more markedly than in the EU, and at its end the Czech values are lower than the mean values in the EU. Also the proportion of live-born children with birth weight lower than 2 500 g in the Czech Republic is very close to the EU average vacillating within the range of 0.5 %.

The evaluation of data for individual districts of the Czech Republic has been processed for a period of 16 years, from 1983 through 1998 in four four-year periods. From a comparison of individual values in each district with values for the Czech republic for the period 1995 - 1998 there was found significant difference in values in some of the districts under monitoring. Perinatal mortality rate is significantly higher (almost twice the value for the whole country) in the district of Sokolov. Values of neonatal mortality rate differing to a significant degree were found in five districts (Most and Ostrava - higher values, Prague, Liberec and Klatovy - lower values). From the mean values of the infant mortality rate in the Czech Republic, six districts under monitoring (Most, Děčín, and Ostrava - higher values, Prague, Liberec, and Hodonín - lower values) significantly differ. The highest values in the proportion of children with birth weight lower than 2 500 g were recorded in the districts of Most and Kladno, the lowest in the districts of Hodonín and Žďár n/S. Detailed results are presented in the respective Special Report.

Within the framework of the Czech Republic there is also presented a temporal series of the incidence rate of interrupted pregnancies - spontaneously and artificially (Fig. 9.6). In spontaneous abortions an important piece of information is the stability of the range from 103 per 1 000 live births in 1994 to 125 in 1984 with no time correlation. Changes in the numbers of artificially induced abortions can be explained by, e.g. legislative measures for the execution of the operation. The highest incidence rate of spontaneous abortions was recorded in the districts of Ústí n/L and Karviná, the lowest in Hradec Králové and Liberec. As regards artificial abortions, the highest numbers were again in the district of Ústí n/L and then Most and Kladno. On the other hand, the lowest numbers come from the districts of Jihlava, Žďár n/S and Ústí n/O.

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, 1999
Fig. 9.1b Personal medical history, diseases notified by physician, 1999
Fig. 9.1c Subjective evaluation of health status in last 6 months, 1999
Fig. 9.2a Risk factors of chronic noninfectious diseases, 1999
Fig. 9.2b Selected environmental factors high distressing respondents, 1999
Fig. 9.3a Selected risk factors simultaneously existing at respondents, 1998 + 1999
Fig. 9.3b Selected positive factors simultaneously existing at respondents, 1998 + 1999
Fig. 9.4a Infant mortality in CZ comparison with EU
Fig. 9.4b Perinatal mortality in CZ comparison with EU
Fig. 9.4c Neonatal mortality in CZ comparison with EU
Fig. 9.5 Living born children with low birth weight (< 2 500 g) in CZ comparison with EU
Fig. 9.6 Abortions in CZ

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