9. STATE OF HEALTH AND SELECTED PARAMETERS OF DEMOGRAPHIC AND HEALTH STATISTICS |
9.1 Monitoring the population’s health status
The monitoring of the population’s health status is based on a questionnaire investigation titled HELEN Study (Health, Life Style and Environment). Between 1998 and 2001, this investigation was carried out in a total of 22 cities in the Czech Republic. In 2002, this investigation was extended to another 5 cities covered by the Monitoring System (i.e., Benešov, Jablonec nad Nisou, Jindřichův Hradec, Prague 10, Šumperk). As in previous years, the participating cities differ both in the quality of the environment, and in socio-economic and demographic indicators.
In the year 2002, the first phase of this large investigation was completed, wherein data from a total 14,190 people living in 27 Czech cities was obtained over the course of five years. Chapter 9 focuses on the results of the last year of the investigation and the final assessment report will be published in the year 2003.
9.1.1 Structure of the questionnaire and organization of monitoring activities
The structure of the questionnaire was designed in 1998 and only partial modifications to the structure were made during the years of the investigation. In 2002, a questionnaire consisted of 68 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 persons were contacted by an investigator. The investigator distributed the questionnaire, informed the respondents 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 respondent 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 Prague 10, students from the Secondary School of Nursing took the role of investigators. The investigators received written standard operating procedures to be used in this questionnaire investigation and were uniformly trained.
As part of the Study, half of the group (200 males and 200 females in each city) was invited for a medical check-up. This examination was performed in and fully organized by the employees of the respective Public Health Centers. The check-ups included repeated measurements of blood pressure, body height, body weight, waist and hip measurement, and determination of total blood cholesterol levels.
9.1.2 Methods of questionnaire data processing
The data obtained were processed as a whole and then separately for each city and gender. The results of the investigation are described using relative frequencies. The hypothesis on the concordance of the percentage share of the investigational categories in the contingence table was tested using the Chi Square test of independence. The tests were performed at the level of significance p = 0.05. In addition, relationships between the selected indicators and the health status were analyzed. This analysis was based on logistic regression 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 – HELEN 2002
The questionnaire was filled out by a total of 2,566 respondents (47.8 % males, 52.2 % females; the questionnaire returnability was 69.4 %, ranging from 51.6 % in Prague 10 to 81.3 % in Benešov. A total of 493 individuals (43.0 % males and 57.0 % females) underwent the medical check-ups. The percentage of responsive probands was 33.4 %, ranging from 24.1 % in Benešov to 56.1 % in Šumperk.
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 and health statistics
As part of the regular presentation of selected demographic and health indicators, an update of data on standardized mortality and age structure of the Czech Republic’s population have been prepared in continuation of the Summary Report for 1998. In the selected indicators, data for the Czech Republic is compared to that of EU countries and other selected European countries, which had a similar political development like the Czech Republic after the year 1989 (e.g., Hungary, Poland, Slovakia). Data on the age structure of the population and on standardized mortality in the Czech Republic were provided by the Institute of Health Information and Statistics (ÚZIS). Data for international comparisons was taken from the database, which forms a part of the WHO’s program “Health for All by the Year 2000”. In as complete post – 1999 data are not available, developmental sequences for EU countries are presented for the period from 1982 to 2001, or up to year 1999.
9.2.1 Standardized mortality
Standardized mortality (mortality calculated per 100,000 inhabitants of the standard European population) enables a comparison of the mortality rate by causes independently of the age structure of the population. For the Czech Republic, the total standardized mortality for the period 1998–2001 was analyzed. The most frequent causes of death include cardiovascular disorders, malignant neoplasms, external causes, and diseases of the respiratory and gastrointestinal tracts. These five groups encompass approximately 95 % of all causes of death. Diseases of the cardiovascular system contribute to the total standardized mortality by 49.3 % in males and 54.9 % in females. Malignant neoplasm is the cause of 28 % of all deaths in males and 26.1 % of all deaths in females. Suicides always contribute to at least one-fifth of the total number of the third most frequently occurring cause of death, “external causes” (7.9 % of males, 4.9 % of females). The contribution of respiratory tract diseases and gastrointestinal tract diseases to the mortality rate is almost identical (at 3.8% in males and approximately 4.5 % in females) and is becoming less significant. The total standardized mortality and standardized mortality due to disorders and diseases of the cardiovascular system, external causes, and diseases of the respiratory and gastrointestinal tracts has been declining. A reduction in mortality has been newly recorded in malignant neoplasms in males during the period from 1998 through 2001, while the standardized mortality due to malignant neoplasms has stagnated in females.
Great differences were confirmed between the total standardized mortality in the Czech Republic (1,169.81 in males and 700.98 in females) and mortality in the respective individual districts being monitored (in several cases, the difference was statistically significant). During the last four-year period, the difference between the minimal and maximal value of the total standardized mortality in the respective districts achieved approximately 400 in males and approximately 223 in females. Compared to the average in the Czech Republic, the total standardized mortality was the highest in males and females in the district of Most, while it was the lowest in the district of Hradec Králové. Mortality due to malignant neoplasms is consistently lower in males from Prague in comparison with the average figures for the Czech Republic.
In EU countries, the development can be analyzed from the year 1999 (except for Belgium). In all EU countries analyzed, the total standardized mortality of both males and females decreased during the period from 1981 through 1999. In the Czech Republic, the total standardized mortality was higher than in the EU countries throughout the entire period under investigation (Figures 9.9a and 9.9b). In contrast, when compared to the selected three countries from the former Eastern Block (Hungary, Poland and Slovakia), the situation in the Czech Republic has been the best over the last four years.
9.2.2 Several parameters of the age structure of the population
The age pattern of the population was analyzed in respect of the share of people in the pre-productive age (younger than 15 years) or in the post-productive age (65 and more years) in the overall population. The decline in the share of the population under 15 years of age and an increase in the share of the population aged 65 and more, indicates the process of population aging. The trend of population aging has been apparent in the Czech Republic since about the year 1985. The age pattern of the Czech Republic’s population features, on a long-term basis, more males than females in the pre-productive age and more females in the post-productive age. During the period from 1998 through 2001 the share of the population of the Czech Republic aged 0–14 years was 17.5 % in males a 15.8 % in females and the share of the population over 65 years of age was 10.9 % in males and 16.6 % in females.
In some of the districts under follow-up in the Czech Republic, the age structure of the population shows a long-term statistically significant difference compared to the average numbers for the Czech Republic. During the period from 1998 through 2001, the shift towards higher age categories continued, particularly in the district of Prague. The greatest shift towards lower age categories was reported from the district of Sokolov.
Compared to the EU countries included in the monitoring, the share of the population under 15 years of age (16.8 %) in the Czech Republic has fallen, for the first time, below the EU average in 1999 (16.9 %). The share of the Czech Republic’s population aged 65 and more is lower, on a long-term basis, than the EU’s average (16.2 % in the year 1999), see Figs. 9.10a and 9.10b.
9.3 Partial conclusions
In the urban population of the Czech Republic, the following differences between males and females were identified in the said parameters of the health status evaluated:
Half of the population in the 45- to 54-year age group under follow-up reports long-term complaints (whether treated or not), most frequently problems of the musculoskeletal system. Cardiovascular diseases are the most frequent cause for long-term follow-up care in that age category.
Half of males and one third of females in the population under study are overweight. Approximately 20 % of the study group suffered from obesity, a severe risk factor for the development of cardiovascular diseases. Elevated blood pressure in personal medical history was reported by less than one third of respondents, of which one half of males and two thirds of females received treatment. That age group includes approximately 35 % of active male smokers while female smokers are fewer by 8 %. A significant part of females, almost one quarter of them, reported a lower daily intake of fluids than recommended.
A total of 52 % of people were in principle satisfied with their lives. Half of the study population reported good health, while ten percent of the population reported a poor health status. A total of 62 % of people feel shared responsibility for their own health, while 5 % of people feel no responsibility at all for their health. The factors with most important impacts on human health, as seen by the respondents, included permanent psychical stress and smoking, while environmental influences ranked sixth in importance, after lifestyle factors.
A significant relationship between health and socioeconomic indicators has been confirmed.
The total standardized mortality and standardized mortality due to cardiovascular diseases, external causes, and diseases of the respiratory and gastrointestinal tracts are declining. Nevertheless, the total standardized mortality during the entire said period was higher in the Czech Republic than in EU countries. The decline in the population share of people younger than 15 years of age and an increase in the population share of people aged 65 and more, suggests the process of population aging. In the Czech Republic, the trend of population aging has been apparent since 1985.