9. RESULTS OF SUBSYSTEM 6: STATE OF HEALTH AND SELECTED PARAMETERS OF DEMOGRAPHIC AND HEALTH STATISTICS

9.1 Monitoring the population health status

The monitoring of the population health status is based on a questionnaire investigation (HELEN Study – Health, Life Style and Environment). Between 1998 and 2000, such investigation was carried out in 16 cities of the Czech Republic. In 2001, this investigation was extended for other 6 cities covered by the Monitoring System, i.e. Děčín, Havlíčkův Brod, Jihlava, Svitavy, Ústí nad Orlicí and Znojmo. The participating cities differ in quality of the environment, socio-economic and demographic indicators.

9.1.1 Structure of the questionnaire and organization of monitoring activities

The structure of the questionnaire used comes from the study of 1998 and is to be adhered to onwards. The questionnaire consisted of 65 questions and was divided into the following sections:

As many as 800 individuals (400 males and 400 females) aged 45–54 years 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. After receiving the first informative letter, the selected person was contacted by an investigator who distributed the questionnaire; he informed the proband about the importance of the survey, checked whether the questionnaire was filled in completely and collected the questionnaires. The investigator’s major task was to establish contact with the proband and to invite him/her to participate, but the investigator was not allowed to participate in filling in the questionnaire or to influence the respondent. The majority of investigators were recruited among the Public Health Service staff. In all of the participating cities, the investigators were uniformly trained and familiarized with the standard operating procedures to be used in this questionnaire investigation.

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 check-up included blood pressure, body height, body weight, waist and hip measurement, determination of total blood cholesterol levels and spirometry. The methodology is presented in the Manual for the HELEN Study.

9.1.2 Methods of questionnaire data processing

The data obtained were processed in sum and then separately for each city and gender. To estimate the prevalence of the indicators monitored, the results describing the whole group and both genders were weighted against the population number of the age group studied (45–54 years) in the six cities under monitoring. Relationships between selected indicators and the health status were analyzed. All these comparisons based on the results of a logistic regression were adjusted for gender, age, and city. The results of the regression analysis are presented as the odds ratios (OR) with indication of p-values and 95 % confidence intervals.

9.1.3 Selected results

A total of 3348 respondents (46.8 % of males, 53.2 % of females) took part in the questionnaire investigation. The questionnaire returnability was 72.8 %, ranging from 60.4 % in Ústí n. Orlicí to 90.0 % in Svitavy. A total of 968 individuals (43.8 % of males and 56.2 % of females) underwent the medical check-up, the percentage of responsive probands was 42.2 %, ranging from 37 % in Jihlava to 45 % in Svitavy.

Health status:

Incidence of risk factors for 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 and lifestyle factors was tested with reference to a positive assessment of one’s own health and absence of long-term health complaints.

Positive assessment of one’s own health:

Absence of long-term health complaints:

9.2 Selected parameters of demographic statistics

Based on demographic and health data, life expectancy and incidence of congenital defects were assessed. Data of the Czech Statistical Office (Shortened mortality tables for the districts of the Czech Republic, 2001), those of the WHO database “Health for All” and those of the OECD database “Health Data, 2001” were used in assessment of life expectancy. The data on congenital defects were taken from the database of the Institute of Health Information and Statistics (Congenital Defects, 2001). The number of children born alive with a congenital defect is calculated per 10000 children born alive.

9.2.1 Life expectancy

In 2000, life expectancy at birth for males and females was 71.6 and 78.3, respectively. The increase in life expectancy in 2000 compared to 1981 was 4.4 years and 4.0 years, respectively. Life expectancy remains lower for males compared to females. The difference is on average: 6.7 years at birth, slightly decreasing with increasing age. Higher life expectancy was found in the following districts: Brno-city, Hradec Králové and Žďár nad Sázavou. Lower life expectancy was recorded in Most and Sokolov. Life expectancy increased for all age groups and all districts monitored between 1981 and 2001. Kladno, Hradec Králové, Plzeň-city, Sokolov, Znojmo and Prague showed the highest increase in life expectancy for at least one age group. In contrast, Děčín, Benešov, Jablonec nad Nisou, Jindřichův Hradec, Karviná, Most, Ostrava, Svitavy and Žďár nad Sázavou showed the lowest increase in life expectancy for at least one age group.

In the long run, life expectancy at birth is increasing in the Czech Republic; nevertheless, it remains lower than that in Portugal, the country with the lowest life expectancy in the EU. Life expectancy at birth in the Czech Republic is by 5–6 years lower for males and by 4–5 years lower for females compared to the most favourable European demographic data. The highest life expectancy is reported in Sweden and Switzerland for males and in the latter and France for females (Fig. 9.7b).

In 1999, mean life expectancy in Central and East European countries was 66.7 years for males and 75.1 years for females. The Czech Republic with life expectancy of 71.4 years for males and 78.1 years for females is second only to Slovenia.

9.2.2 Congenital defects

Data given in Fig. 9.8a and Fig. 9.9a, b show a continuous increase in the number of children born alive with a congenital defect. The increase between 1981 and 2000 was 170 cases per 10000 children born alive.

Among the notifiable defects, relevant groups of structural defects due to embryotoxic effect were selected. These defects were matched with the respective morphogenetic systems and are given as percentages of the congenital defects of each system related to the total number of children with congenital defects (Fig. 9.8b).

Most frequent congenital defects were as follows: cardiopathy, defects of the limbs, defects of the urogenital system and cleft palates and lips. The other congenital defects are markedly less frequent. Changes in the diagnostic groups of congenital defects made according to the International Classification of Diseases within the 10th revision in 1994 were to be taken into account. Notification of the total numbers of children born alive with a congenital defect continued the same way as before.

The increasing incidence of congenital cardiopathy is explainable not only by higher frequency of these defects but also by improved diagnosis thanks to newly implemented methods, including genetic methods based on recombinant DNA technology.

9.3 Partial conclusions

The selected age group of urban population (45 to 54 years) showed significant differences in the indicators monitored between males and females. Females report significantly more frequently long-term health complaints, are significantly more frequently under long-term medical follow-up and more frequently undergo long-term treatment with drugs. Long-term health complaints (either treated or untreated) are reported by half of the population monitored, the most frequent being problems concerning the locomotion system. The respondents are most frequently under medical follow-up for cardiovascular morbidity.

Among the population monitored, half of males and a third of females are overweight. About 20 % of population monitored are obese, i.e. at risk of developing e.g. cardiovascular morbidity. Elevated blood pressure in personal history was recorded for almost every third respondent; more than half of the males and three quarters of the females underwent treatment for this diagnosis. About 40 % of males and 30 % females of the age group monitored are smokers. A relatively high percentage (about 25 %) of the females reported a lower daily intake of liquids than recommended.

Fifty-two per cent of the respondents expressed general satisfaction with their lives. Almost half of the population monitored rated their health as good, 10 % of this population reported poor health. 55 % of the population feel responsible for their own health and 8 % of the respondents do not feel responsible in this regard. The population monitored reported permanent mental stress and smoking to be the factors with most serious impact on human health, impact of the environment came in sixth place only after the lifestyle factors.

A statistically significant relationship was found between subjective assessment of one’s own health and socio-economic indicators; odds for positive assessment of one’s own health increased with the education level, financial resources and higher position at work. Statistically significant but less pronounced relationships were found between socio-economic indicators and the incidence of long-term health complaints.

Life expectancy at birth in the Czech Republic is increasing and reached 71.6 years in males and 78.3 years in females in 2000. Life expectancy in males is always lower than in females. Even if increasing, life expectancy in the Czech Republic remains lower than that in the EU member states.

The incidence of congenital defects in children born alive increases. Congenital cardiopathy is the most frequent of the congenital malformations.

Fig. 9.1a Personal medical history, health complaints reported by respondent
Fig. 9.1b Personal medical history, diseases notified by physician
Fig. 9.2a Risk factors of chronic non-infectious diseases
Fig. 9.2b Risk factors simultaneously offering at respondents
Fig. 9.3 Subjectively perceived health status in last six months
Fig. 9.4 Approach to active reduction of own health risks
Fig. 9.5 Risk factors perception
Fig. 9.6 Highly distressing environmental factors
Fig. 9.7a Trend of life expectancy at birth in CZ, 1981–2000
Fig. 9.7b Life expectancy at birth in European countries
Fig. 9.8a Newly notified congenital malformations
Fig. 9.8b Proportion of selected malformations in children on the total score, 1981–2000
Fig. 9.9a Live births with congenital malformation per 10 000 live births, 1996
Fig. 9.9b Live births with congenital malformation per 10 000 live births, 2000

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