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:

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:

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

Socio-economic and psycho-social factors:

Nutrition and dietary habits:

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:

Absence of long-term health complaints:

9.1.5 Selected aggregated results 1998-2000 (16 cities)

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:

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.

Fig. 9.1a Personal medical history, diseases reported by respondent, 2000
Fig. 9.1b Personal medical history, diseases notified by physician, 2000
Fig. 9.1c Subjectively perceived health in last 6 months
Fig. 9.2a Risk factors of chronic noninfectious diseases, 2000
Fig. 9.2b Selected high distressing environmental factors
Fig. 9.3a Risk factors simultaneously existing at respondents, 1999 + 2000
Fig. 9.3b Selected positive factors simultaneously existing at respondents, 1999 + 2000
Fig. 9.4a Incidence rate of selected malignant neoplasms in four years intervals, men, 1979–1998
Fig. 9.4b Incidence rate of selected malignant neoplasms in four years intervals, women, 1979–1998
Fig. 9.4c Incidence ratio of malignant neoplasms in Czech Republic, 1979–1998

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