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.

The objective is to supplement data on demographic and health statistics with selected indicators of health, to estimate the prevalence of important chronic non-infectious diseases and risk factors of those diseases in the urban population, as well as to follow up lifestyle factors and attitudes of the population of the participating localities towards problems of health and the environment.

Between 1998 and 2002, in the first stage the HELEN Study was carried out in a total of 27 cities in the Czech Republic (see Tab. 3.1). In the year 2004 the second stage in all cities shall begin so as to be able to compare the dynamics of the indicators under follow-up in time.

In each city, a systematic randomized selection of 800 subjects (400 males and 400 females) 45–54 years of age has been made for the questionnaire survey. Half of the selected subjects were invited to a medical examination which included the taking of blood pressure, body height and mass, waist and hip circumferences, and the determination of total cholesterol in the blood.

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 the last year of the survey (2002) the questionnaire consisted of 68 questions and was divided into the following sections:

The questionnaires were handed out to future respondents by investigators mostly belonging to the Public Health Service. Their major task was to establish contact with the selected probands and convince him/her to participate in the survey. Afterwards the investigators collected and checked the filled-in questionnaires. The respondent filled in the questionnaire without being influenced by the investigator. The medical check-ups were conducted at the Public Health Centers and were fully organized by the staff of the Public Health Service.

9.1.1 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 (CI95 %).

9.1.2 Selected results – HELEN 1998–2002

The questionnaire was completed by a total of 14,214 respondents (47.1 % males, 52.9 % females); the questionnaire returnability was 69.7 %, ranging from 50.7 % in Brno to 90.0 % in Svitavy. A total of 3,649 individuals (43.1 % males and 56.9 % females) underwent the medical check-ups. The percentage of responsive probands was 36.5 %, ranging from 11.6 % in Plzeň to 57.7 % in Karviná.

Health status:

Incidence of risk factors for chronic non-infectious diseases

A review of the risk factors followed up in the urban population of the age group of 45–54 years is presented in Fig. 9.3a.

Socio-economic and psycho-social factors:

Nutrition and dietary habits:

Relationships between some factors and health

The relation of certain socio-economic indicators and lifestyle factors was tested with reference to a negative assessment of one’s own health and presence of long-term health complaints.

Negative assessment of one’s own health:

Long-term health problems:

9.2 Selected indicators of demographic and health statistics

Within the framework of a regular presentation of selected demographic and health indicators there are being updated data on infant, neonatal and perinatal mortality, numbers of children born with low birth weight, and the numbers of spontaneous and induced abortions. In selected indicators there is made a comparison of data for the Czech Republic with countries of the EU (15 member states as of Jan. 1, 2004) and other selected European countries (Hungary, Poland and Slovakia) that had underwent a similar political development following 1989 like the Czech Republic. Source data on selected indicators for the Czech Republic were provided by the Institute of Healthcare Information and Statistics (ÚZIS). Data for international comparison were taken from the CD-ROM “OECD Health Data 2003” database excepting abortion data that are from the WHO database “Health for All”. Temporal series for the Czech Republic are presented for the period 1980–2002, and data for European countries for the period 1980–2000, other not being available. The presentation is an extension of a thematically similar presentation in 1999.

Infant mortality (Fig. 9.8a) is expressed by the number of live-born children that have died under 1 year of age per 1,000 live-born children. Infant mortality is presented as one of the important indicators illustrating the standard of living of a given country and the social situation therein. In the years 1980–2000 the figures for infant mortality have fallen in all the European countries under follow-up, and recent trends have led to a diminishing differentiation between individual countries. Traditionally the lowest values of this indicator are being achieved in the Scandinavian countries of Finland and Sweden. Slovakia, Hungary and Poland over the past decade exceed the maximum value of the EU countries. Infant mortality in the Czech Republic over the monitoring period has shown a downward trend except in 1990 when there was a moderate increase. Infant mortality in the Czech Republic up to 1995 exceeded the EU average by about one third, afterwards there was a marked decline. That trend continued and in 1999 it was lower than the EU average. In the year 2000 that difference was still more marked: infant mortality in the Czech Republic was 4.1 ‰, the average in EU countries being 4.9 ‰.

Neonatal mortality (Fig. 9.8b) signifies the number of children that have died within the first 27 days of life per 1,000 live-born children. The neonatal mortality curve has been similar to that of infant mortality not only in the Czech Republic but also in the EU countries followed up over the whole period of 1980–2000. Since 1998 neonatal mortality rate in the Czech Republic was lower than the average in the EU countries and decreased further to 2.5 ‰ in the year 2000.

Perinatal mortality (Fig. 9.8c) is the sum of still-born children of over 1,000 grams at birth or born after the 28th week of pregnancy, and the number of children that have died up to the 7th day of life, per 1,000 of all children born. Since 1994 perinatal mortality in the Czech Republic was lower than the average in the EU countries and fell to 4.5 ‰ in the year 2000.

The numbers of interrupted pregnancies per 1,000 live-born children in the Czech Republic over the period under follow-up of 1983–2002 are presented in Fig. 9.9. In the year 2002 there were 311 induced and 117 spontaneous interruptions of pregnancy per 1,000 live-born children. Thus, spontaneous abortions represented almost 28 % of the total. Notwithstanding the very large numbers of artificial interruptions of pregnancy (per 1,000 live-borns) in the 1980s that culminated with the dissolving of Interruption Commissions in 1986, since 1990 there is a continuous decline in those numbers. International comparison of artificially induced interruptions of pregnancy is complicated namely by their differing registration in each country. Certain countries such as Belgium keep no records of abortions at all. The OECD database does not cover this problem; the WHO database includes only artificially interrupted pregnancies, no spontaneous ones. Moreover, that database for the 1980s is insufficient. At the beginning of the 1990s the Czech Republic exceeded the average in artificially induced interruptions of pregnancy in the EU countries more than four times and was in first place among all the European countries under follow-up. In the 1990s each year there followed a decrease down to 358 abortions (per 1,000 live-born children) in the year 2000, the Czech Republic being in the middle of the list of European countries.

The proportion of children born with low birth weight, i.e. under 2,500 g, in the total number of live-born children is an important indicator characterizing the quality of the newborn population. In the years 1980–2000 there occurred an increase in this indicator in all the European countries under follow-up except for Poland and Hungary. In the Czech Republic the proportion of children with low birth weight over the whole period under follow-up was closely below the 6 % limit, since 1995 that fell below the EU average.

Figure 9.10a shows in the form of a histogram, infant, neonatal and perinatal mortality in the monitored districts over the last period under follow-up of 1999–2002. The districts with very low values in all three indicators under follow-up are three in Moravia – Znojmo, Kroměříž and Olomouc, and in the Czech-Moravian Highland. In contrast, Děčín, Most and Ostrava are districts that report high values in all of the three indicators. Attention deserves the district of Havlíčkův Brod which alone has registered in comparison with the period 1995–1998 a decline in infant, neonatal as well as perinatal mortality by more than a half. Although recent trends in these indicators show a decline, there is a number of districts that have an increase in infant mortality (Liberec, Mělník, Svitavy), neonatal mortality (Klatovy, Liberec, Žďár nad Sázavou, Svitavy) and perinatal mortality (Svitavy, Jablonec nad Nisou, Liberec, Příbram, Děčín, Klatovy). Statistically significant differences in values from the average in the Czech Republic were only in perinatal mortality: lower were in the district of Prague, higher in the district of Ostrava.

The numbers of spontaneous and artificially induced interruptions of pregnancy (per 1,000 live-born children) in the districts under monitoring over the past period of follow-up of 1999–2002 are presented in Fig. 9.10b. Surprisingly the lowest number of spontaneous abortions (per 1,000 live-born children) has been reported in the district of Prague; the highest being in the districts of Most, Ústí nad Labem, Děčín and Plzeň. The highest numbers of artificially induced abortions (per 1,000 live-born children) in the period under follow-up were in the districts of Most, Sokolov, Kladno and Plzeň; the lowest in districts of the Highlands Region (Jihlava, Havlíčkův Brod, Žďár nad Sázavou) and in the district of Ústí nad Orlicí.

From the values of indicators in the districts, for the Czech Republic there have been calculated for each year variation coefficients (in %) which estimate the degree of variability within a territorial unit (calculated as the ratio of the SD and mean). According to the regional variability of the characteristics under follow-up, on the basis of their similarity there can be delimited two groups of indicators. The first includes the number of children with low birth weight and numbers of spontaneous and artificial abortions; the other group includes indicators of infant, neonatal and perinatal mortality. As is apparent from Fig. 9.11, there is a significant difference between those groups. In the case of the first group, regional variability has not changed over the whole period under follow-up and was constantly below 20 %. On the other hand, regional variability in the other group of indicators was markedly greater and, moreover, its increment almost doubled in the year 2002. Thus, it is apparent that in the indicators of infant, neonatal and perinatal mortality there has taken place a deepening in inter-district differences.

9.3 Partial conclusions

In the recruitment of selected subjects for collaboration in the Survey, personal contact with the investigators has come of its own. It has confirmed that the best investigators came from the Public Health Service. The probands agreed more often to complete the questionnaire than with participation in a medical examination.

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 age group under follow-up reported long-term complaints (whether treated or not), most frequently problems of the musculoskeletal system. Cardiovascular diseases were 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 were 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 40 % of active male smokers while female smokers were fewer by 9 %. The most frequent occurrence of risk factors of cardiovascular disease in males was also reflected in the high degree of risk of ICVD in the following 10 years. Except for the daily intake of fluids (almost a quarter of females have a lesser intake than the recommended amount), dietary habits in females were better than in males.

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 4 % of people feel no responsibility at all for their health. The factors with most important impacts on human health, as viewed by the respondents, included permanent psychical stress and the smoking habit, while environmental influences ranked fifth in importance, after the majority of lifestyle factors.

A significant relationship between health and socioeconomic indicators has been confirmed.

Infant, neonatal and perinatal mortality (per 1,000 live-born children) in the Czech Republic had a decreasing tendency over the whole period of follow-up and in the past several years has values lower than the average in the European Union. Likewise, there is on the decrease the number of artificially interrupted pregnancies per 1,000 live-born children; however, that value in the Czech Republic is almost double that of the EU average. In the indicators of infant, neonatal and perinatal mortality over the period under follow-up there occurred a deepening of differences between districts in the Czech Republic.

Fig. 9.1a Subjectively perceived health status in relation to education, urban population (age 45–54)
Fig. 9.1b Subjectively perceived bad health urban population (age 45–54)
Fig. 9.2a Personal medical history, long-time health complaints urban population (age 45–54)
Fig. 9.2b Personal medical history, diseases notified by physician urban population (age 45–54)
Fig. 9.2c Incidence of serious diseases in urban population (age 45–54)
Fig. 9.3a Risk factors of chronic non-infectious diseases urban population (age 45–54)
Fig. 9.3b Body weight and smoking habit in urban population (age 45–54)
Fig. 9.4 Approach to active reduction of own health risks
Fig. 9.5 Health risk factors perception
Fig. 9.6 Environment quality rating in neighbourhood urban population (age 45–54)
Fig. 9.7 Environmental noise in cities as disturbing factor
Fig. 9.8a Infant mortality in CZ, comparison with EU
Fig. 9.8b Neonatal mortality in CZ, comparison with EU
Fig. 9.8c Perinatal mortality in CZ, comparison with EU
Fig. 9.9 Abortions in CZ
Fig. 9.10a Mortality up to 1 year of age, districts 1999–2002
Fig. 9.10b Abortions, districts 1999–2002
Fig. 9.11 Inter-district variability in 1983–2002

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