9. RESULTS OF SUBSYSTEM 6: STATE OF HEALTH AND SELECTED PARAMETERS
OF DEMOGRAPHIC AND HEALTH STATISTICS
9.1 Questionnaire on health status
9.1.1 Structure of the questionnaire and organization of monitoring activities
In extension of the studies HELEN 98 and 99, in the autumn of 2000, the
questionnaire investigation was implemented in six cities under the Monitoring
System (Klatovy, Kroměříž, Liberec, Mělník, Most, and Příbram). The cities
were selected to be representative in different environment quality level
and to reflect differences in demographic and socio-economic parameters.
The structure of the questionnaire used comes from the study of 1998 and
is to be adhered to in all cities where the investigation will be conducted.
In 2000, the questionnaire consisted of 65 questions and was divided into
the following sections:
personal data and employment;
housing;
personal medical history;
family medical history;
information on lifestyle;
personal opinions; 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, allowing representative samples of the
population to be obtained. Just as in previous years, this systematic random
selection was supported by the municipal registries, and 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 issued 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 participate
in filling in the questionnaire or to influence the respondent. The majority
of investigators were selected among the Public Health Service staff. In
all of the cities, the investigators were uniformly trained and familiarized
with the standard procedure of questionnaire collection that has been worked out.
Half of the probands (200 males and 200 females in each city) were invited
for medical check-ups fully organized by each respective Public Health Centre.
The investigation included blood pressure, body height, body weight, waist
and hip measurement, and determination of total cholesterol blood levels,
as well as an orientational spirometric examination. The methodology is
presented in the Manual for the HELEN Investigation.
The final questionnaire respondence was 76.2 %, the responsiveness to the
medical check-up was 37.0 %. The method of the investigator-respondent direct
contact proved definitely 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 both gender were weighted against
the population number of the age group studied (45-54 years) in the six
cities under monitoring. All these comparisons based on the results of
a logistic regression are adjusted by gender, age, and city. The results
of the regression analysis are presented as the odds ratio, giving the
p-values and the 95% confidence interval.
In the final section, a comparison of selected results from the study HELEN
98 (Brno, České Budějovice, Hradec Králové, Karviná, Kolín and Ústí n/L),
the study HELEN 99 (Kladno, Olomouc, Plzeň, Žďár n/S), and the study HELEN
2000 (Klatovy, Kroměříž, Liberec, Mělník, Most, and Příbram) is presented.
Compared are two groups of selected results: a) occurrence and cumulation
of the five most serious risk factors of the cardiovascular diseases (hypertension,
increased cholesterol level, obesity, lack of motion and smoking) and b)
occurrence of some positive perceived factors (satisfaction with financial
situation, positive evaluation of the own health, light distress feelings
from job, satisfaction with own life).
9.1.3 Selected results in 2000
Health status:
47.0 % of the probands thought their health to be good or very good, 41.3 %
thought it to be average, and 11.6 % poor or very bad. Females rated their
health similarly to males; most subjects dissatisfied with their health
state were found in Most (13.8 %) and Příbram (13.1 %)
(Fig. 9.1c).
Health complaints lasting more than 6 months are reported in 56.6 % of
the subjects. Most frequent are long-term complaints concerning the locomotion
system. Cardiovascular, gastrointestinal and respiratory disorders follow.
The frequency of each type of long-term health problems by gender is documented
in Fig. 9.1a. Long-term health problems were reported
most often by the inhabitants of Liberec (59.7 %), least often by those
of Klatovy (47.0 %).
In all, 43.5 % of persons under follow-up were under long-term medical
care. The most frequent cause of long-term follow-up by a physician was
cardiovascular disease (16.0 %).
44.9 % of males and 59.5 % of females used drugs for more than two weeks
in the past year. In all, 52.6 % of the probands undergo long-term pharmacotherapy.
Most often drugs were used for treating diseases of the cardiovascular system
(25.2 %), followed by drugs for the therapy of metabolic disorders (9.7 %),
the musculoskeletal system (10.7 %), and the nervous system (7.5 %).
The most frequent diseases in both genders are disorders of the locomotion
system, hypertension, gall-bladder diseases, gastro-duodenal ulcers, and
chronic skin affections. A review of the prevalence of selected chronic
non-infectious diseases is presented in Fig. 9.1b.
Incidence of risk factors of chronic non-infectious diseases
(Fig. 9.2a):
In the population under follow-up, 26.7 % of males and 22.1 % of females
were found to be obese. Significant is also the overweight prevalence in
both genders - 46.7 % in males and 36.6 % in females.
During physical check-ups hypertension (systolic pressure > 140 mm Hg,
or diastolic pressure > 90 mm Hg) was found in 62.7 % of males and
in 37.8 % of females. Elevated blood pressure in one’s personal history was
reported by 30.7 % of males and by 26.3 % of females.
Elevated cholesterol levels (over 5 mmol/L) were found in 68.3 % of males
and in 66.4 % of females. Most such subjects were discovered in Most
(73.6 %) and the least in Liberec (61.6 %).
There were 38.3 % regular smokers of tobacco, more often among males (43.3 %)
than in females (33.8 %). Regular smokers - males mostly smoke 20 cigarettes
per day, female smokes most often ten. The greatest number of smokers smoking
at present was found in Most, the least in Kroměříž.
Exposure to passive (second-hand) smoking was the greatest among the inhabitants
of Most (37.0 %), the least being in Kroměříž (18.3 %) and Klatovy (19.0 %).
On the average, the respondents indulged in sports and touring 4.2 hours
per day. 41.0 % of males indulged in physical exercise at least half
an hour per day, similarly females in 39.8 % of cases.
A positive family history of cardiovascular diseases was present in 34.8 %
of the subjects, of tumour diseases in 32.3 %, and diabetes mellitus in
32.4 % of cases. An allergic affection among close relatives was reported
by 7.3 % of the respondents.
Socio-economic and psycho-social factors:
In the series, 11.3 % of subjects completed elementary education, 43.7 %
secondary school, 33.2 % sat a grammar school leaving exam, and 11.9 %
were university graduates.
82.4 % of males and 72.6 % of females were living in a partnership. The
highest numbers were found in Kroměříž (86.9 % and 79.3 %, respectively),
the lowest in Most (78.5 and 71.4 %).
In the series 87.2 % of subjects were found to be economically active.
The group of economically inactive was comprised of 36.4 % unemployed,
56.6 % disability and old-age pensioners, and 7 % housewives.
60.0 % of the respondents rated their situation as favourable, more so
males (65.4 %) than females (55.7 %). A frequent lack of money for food
or clothing was reported by 14.9 % of the respondents.
86.1 % of the respondents feel safe in their neighbourhood in the daytime,
only 49.2 % at night. In case of being in need, 64.9 % of the respondents
believe in help coming from neighbours; 40.0 % of subjects feel trust in
local people; whereas trust in people generally is felt by only 20.5 %
of the respondents.
Males and females feel similarly satisfied with their lives. The feeling
of being satisfied was in the range of 43.9 % (Most) and 43.3 % (Klatovy).
Shared responsibility for one’s own health is felt by 55.1 % of the respondents,
37.3 % gave a neutral reply and 7.6 % a negative one.
The living environment was considered to be satisfactory by 30.1 % of
the subjects, as average by 54.9 %, and unsatisfactory by 14.9 % of them.
Most respondents satisfied with the environment were found in Klatovy
(39.6 % and Kroměříž (37.2 %); most dissatisfied respondents were found in Most
(19.7 %) and Mělník (19.0 %). In Fig. 9.2b
percentages of respondents severely annoyed by the individual environmental
factors are presented.
Nutrition and dietary habits:
The mean daily intake of liquids was 3.0 litres in males and 2.2 litres
in females. Less than two litres of liquids were consumed by 9.9 % of males
and by 28.8 % of females.
Alcoholic beverages were consumed by 31.7 % of males (more than 30 g pure
alcohol per day) and by 7.0 % of females (more than 20 g pure alcohol per
day). On average males consumed 4.7 litres of beer, 200 ml of wine and
60 ml of distilled spirits per person and week; in females that is 1.5 litres
of beer, 170 ml of wine, and 20 ml of distilled spirits.
Among regular consumers of vitamin and mineral supplements there were
included 13.0 % of males and 19.9 % of females, the most frequent being
in Most and Příbram.
59.6 % of males and 75.2 % of females consumed more than 500 g of fruit
and vegetables per day (including potatoes).
9.1.4 Relationships between some factors and health
The relation of certain socio-economic indicators has been tested, namely
lifestyle and assessment of the environment to a positive assessment of
one’s own health and to the absence of long-term health complaints.
Positive assessment of one’s own health:
the most significant relationship was found in economic activity:
OR = 4.7 (p < 0.001, CI 95% = 3.61-6.03);
the chance of positively rating one’s own health increases with better
education; for university graduates: OR = 3.90 (p < 0.001, CI 95% = 2.86-5.31);
also people who are satisfied with their lives have a significantly higher
chance of rating one’s own health positively: OR = 3.33 (p < 0.001,
CI 95% = 2.89-3.85);
with increasing age the chance of rating one’s own health positively decresed,
no significant difference between males and females was found. There was
a significant difference between ratings in the cities Příbram and Mělník
(OR = 0.65 vs. 1.00, p = 0.001; CI 95% = 0.50-0.84);
the chance of positive rating of one’s own health increased with a higher
position at one’s place of employment (OR = 1.9 in comparison with persons
without any subordinates), with satisfactory rating of one’s own financial
situation (OR = 2.0), with being satisfied with the environment (OR = 1.7),
and having sufficient physical activity (OR = 1.5), respectively.
Absence of long-term health complaints:
just as in the case of positive ratings of one’s own health, analogous
statistically significant relationships with socio-economic indicators,
lifestyle and rating of the environment have been demonstrated, however,
the links are weaker.
None of the five risk factors of cardiovascular diseases (hypertension,
elevated cholesterol level, obesity, lack of physical activity, and the
smoking habit) have been demonstrated in 12.3 % (Mělník) to 37.5 % (Plzeň)
of the respondents. One risk factor was found in 29.7 % (Most) to 43.9 %
(Č. Budějovice); two risk factors were present in the range of 18.6 %
(Kolín) to 36.6 % (Most); subjects with three or more risk factors were
present in the range of from 6.8 % (Olomouc) to 20.9 % (Příbram)
(Fig. 9.3a).
The relative incidence of selected positive factors (satisfaction with
own financial situation, satisfaction with one’s own health, little or
no feeling of exhaustion from work, and satisfaction with one’s own life)
in the ten selected cities does not differ so much. The presence of none
of the positive factors presented has been demonstrated in 3.2 % (Kolín)
to 12.2 % (Most) of the respondents. The presence of one factor ranged
from 9.9 % (Č. Budějovice) to 22.8 % (Most), that of two in the range of from
21.4 % (Č. Budějovice) to 31.3 % (H. Králové), three factors were reported
by the respondents in the range between 22.4 % (Mělník) and 36.9 % (Č.
Budějovice). All four positive factors were present in Příbram (14.1 %)
and České Budějovice (27.2 %) (Fig. 9.3b).
9.2 Selected parameters of demographic statistics
Within the framework of standard processing of selected demographic parameters,
on the basis of the National Oncological Registry of the Czech Republic
in collaboration with the Institute of Healthcare Information and Statistics,
information on trends in the incidence of malignant tumours in the Czech
Republic in the period 1979 through 1998 has been provided. The data are
presented as the numbers of reported cases of neoplasm calculated per 100 000
of the population.
The incidence of selected groups of neoplasms is presented in five four-year
periods (Figs. 9.4a, 9.4b).
In values of overall incidence that includes all the malignant neoplasms under follow-up,
there is an apparent repeatedly observed continuous increase over time
with an unequivocal difference between the male and female populations
to the disadvantage of males (Fig. 9.4c).
In summary there can be stated:
a higher incidence in males in comparison with females in the case of
malignant neoplasms (ZN) of the stomach, colon and rectum, lungs, kidneys
and urether, urinary bladder, malignant neoplasms of the skin, leukaemia
and other malignant neoplasms;
an increasing incidence in males as well as females of malignant neoplasms
of the kidneys and urinary bladder, and neoplasms of the colon, skin, and
other tissues. Just in females in the case of neoplasms of the mammary
gland, lungs and ovaries; just in males in the case of the prostate;
a decreasing incidence of neoplasms of the stomach, more so in males than
in females.
More detailed information and evaluations up to the district level and
individual selected diagnostic entities are presented in the Special Report
of Subsystem 6.
9.3 Partial conclusions
Personal contact with the investigator proved helpful when recruiting individuals
for participation in the questionnaire investigation.
It was easier to recruit individuals for filling in the questionnaire than
for a medical check-up.
It can be seen from the results that the selected city population showed
statistically significant differences in the health status indicators monitored
between males and females.
The significant relationship between assessment of one’s own health and
socio-economic and psycho-social factors, namely economic activity, education,
positive financial situation and satisfaction with one’s life.
In values of overall incidence that includes all the neoplasms under follow-up,
there is an apparent repeatedly observed continuous increase over time
with an unequivocal difference between the male and female populations to
the disadvantage of males.