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:
personal data and employment,
housing conditions,
personal medical history,
family medical history,
lifestyle information,
personal opinions; social and economic conditions,
nutrition and dietary habits.
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:
As many as 48.3 % of the respondents considered their health to be good
or very good, 40.8 % considered it to be moderate, and 10.9 % reported it
to be poor or very poor. The rating of one’s own health depends significantly
on his/her educational status (Fig. 9.1a). There was no statistically significant
difference in the subjective rating of health between females and males
(p = 0.186). The best rating of one’s own health was in respondents from Havlíčkův
Brod, Jihlava, Klatovy, and Prague 10 (namely there was a high percentage
of satisfied respondents), respondents rating their own health the worst
were from Příbram, Ústí nad Labem, Svitavy, and Karviná. The number of persons
in each city rating their health as bad is presented in Fig. 9.1b.
Health complaints lasting more than 6 months were reported by 52.9 % of
the respondents (50.7 % males and 54.9 % females, p < 0.001). Long-term
complaints were most frequently reported by the respondents in the range
from 44.3 % (Havlíčkův Brod) to 66.2 % (Karviná). Unequivocally the most frequent
cause of long-term health complaints were problems regarding the locomotor
apparatus, reported by 33.6 % of respondents, in second place were complaints
regarding the cardiovascular system (12.6 % respondents). The frequency of
long-term health problems is presented in Fig. 9.2a.
In total, 40.5 % of the population examined (34.8 % males and 45.4 % females,
p < 0.001) was under long-term medical care. Under long-term medical follow-up
were most frequently respondents in Příbram (49.3 %) and Karviná (49.8 %),
least frequently respondents in Havlíčkův Brod (30.8 %). The most frequent
cause of long-term follow-up by a physician was cardiovascular disease (15.2 %
males and 14.5 % females, p = 0.309).
As many as 48.6 % of the respondents (40.5 % of males and 55.8 % of females,
p < 0.001) took medication for more than two weeks in the past year. Long-term
use of drugs was reported most frequently in Příbram (57.4 %), Hradec Králové
(57.8 %) and Karviná (59.5 %) and least frequently by those from Havlíčkův
Brod (39.3 %) and Jihlava (39.8 %). Most often the medication was for treating
diseases of the cardiovascular system used by 24.5 % of subjects
(23.2 % males and 25.7 % females, p = 0.001). That was followed by medication of
the musculoskeletal system (9.6 % of subjects, 8.7 % males and 11.7 % females,
p < 0.001) and for the therapy of the gastrointestinal tract and metabolic
disorders (7.5 % of subjects, no statistically significant differences
between the genders being apparent in this group).
The differences between cities in all the above-mentioned parameters of
health were statistically significant (p < 0.001).
The most frequent chronic non-infectious diseases were hypertension (26.9 %
of subjects) and diseases of the locomotor apparatus (26.7 %). A summary
of life-long prevalence in selected chronic non-infectious diseases is given
in Fig. 9.2b. In Fig. 9.2c
there is presented the prevalence of diabetes mellitus,
ischemic heart disease, and tumor diseases in each city; prevalence was
determined on the basis of a query in the questionnaire on whether those
diseases had been diagnosed in them by any physician.
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.
In the series 22.5 % of the subjects were found to be obese (24.1 % males
and 21.2 % females, p = 0.035). Significant was also the prevalence of those
overweight, namely in 42.3 % of respondents (50.4 % males and 36.1 % females,
p < 0.001). The distribution of the subjects according to the Body Mass
Index (BMI) is presented in Fig. 9.3b.
Medical check-ups revealed hypertension (systolic pressure > 140 mm Hg,
or diastolic pressure > 90 mm Hg) in 41.4 % persons (52.5 % of males and
32.9 % of females, p < 0.001). Elevated blood pressure in personal history was
reported by only 26.9 % respondents (29.0 % of males and 25.0 % of females,
p < 0.001) of which a total of 62.9 % subjects (57.6 % males and 68.4 %
of females, p < 0.001) received treatment for that reason.
Medical check-ups revealed elevated cholesterol levels (over 5.2 mmol/L)
in 50.5 % of subjects (51.1 % males and 50.1 % of females, p = 0.525).
A total of 28.3 % respondents reported in the questionnaire hypercholesterolemia
revealed by their physician (29.2 % males and 27.6 % females, p = 0.006),
20.4 % of them used medicaments, 36.8 % were on a diet, and 42.8 % took no treatment.
Among the population studied, 34.8 % were regular smokers of tobacco (39.5 %
males and 30.6 % females). The distribution of occasional smokers, those
who quit the habit, and non-smokers is presented in Fig. 9.3b.
Differences between males and females were statistically significant (p < 0.001). Regular
male smokers typically smoke 20 cigarettes per day, while most female smokers
need 15 cigarettes per day. The highest and lowest percentages of current
regular smokers were found in Most (42.8 %) and Jablonec nad Nisou
(28.2 %), respectively, differences between all the cities being statistically
significant (p < 0.001).
Exposure to passive smoking (staying in a room full of tobacco smoke for
more than 1 hour daily) was reported by 26.9 % of subjects (35.7 % of males
and 20.0 % of females, p < 0.001). The highest percentage of passive smokers
was found in Ústí nad Labem (42.6 %) and Most (41.7 %), while the lowest
percentage thereof was found in Jablonec nad Nisou (17.4 %) and Šumperk
(17.3 %), differences between all the cities were statistically significant
(p < 0.001).
On average, the respondents most often spent 3.8 hours per week practicing
sports or hiking (males 4 h and females 3.7 h, p < 0.001). Targeted physical
activities for at least 3.5 hours per week (as recommended by the American
Heart Association) were reported by 46.5 % respondents (47.8 % of males
and 45.4 % of females, p = 0.006).
A positive family history of cardiovascular morbidity was present in 33.5 %
of the respondents, while it was 32.1 % for cancer and 32.5 % for diabetes
mellitus. Allergy in parents or siblings was reported by 7.9 % of the respondents.
A lesser than 5 % risk of ICHD in the next 10 years was found in 12.8 %
of females (in males in the age group under follow-up that very-low risk
category is not present at all). A low (5–10 %) risk was had by 21.8 % of
males and 65.1 % of females; a medium (10–20 %) risk was present in 60.5 % of males
and 20.9 % of females; and a high (20–40 %) risk was present in 17.6 %
of males and 1.4 % of females. Differences between males and females were
statistically significant (p < 0.001). The “Coronary Risk Table” based on
results of the Framingham Study conducted regularly since 1948 by the National
Institute of Diseases of the Heart, Lungs, and Blood at the Boston University
served as a starting point for determining the risk of ICHD. That Table
facilitates the determination of the degree of risk of ICHD appearing in
the next ten years in subjects that still have no manifest ICHD.
Socio-economic and psycho-social factors:
In the group of respondents, 10.6 % had only elementary education (including
those with unfinished elementary education), 40.8 % were trainees without
A-levels, 35.3 % had finished secondary school and 13.3 % were university
graduates. Cities with the highest educational structure of the respondents included
Prague 10 (the most university graduates – 30.8 %; and least number of
respondents with only elementary education – 3.3 %), followed by Olomouc,
Kroměříž, Havlíčkův Brod, Brno and České Budějovice. On the contrary, lower
education levels were common among by respondents from Karviná, Most, Ústí
nad Labem, Děčín and Svitavy.
A total of 78.7 % subjects (82.4 % males and 75.4 % females) were living
with a partner. Among females there was a higher percentage of divorced
(16.3 % females; 13.3 % males) and widowed 5.5 % widows; 1.2 % widowers).
In the urban population under follow-up there was a total of 88.0 % economically
active persons (90.9 % males and 85.4 % females, p < 0.001). The group of
the economically inactive (a total of 12.0 %) comprised unemployed persons
(4.2 %), disabled people (6.9 %) and housewives (0.9 %). The least number
of unemployed was found in České Budějovice (1.0 %), Benešov (1.2 %), and
in Jihlava (1.9 %), the greatest number in Most (8.2 %, where there was a high
unemployment rate among females – 11.0 %), Znojmo (6.6 %), and Olomouc (6.6 %).
As many as 66.5 % of the respondents rated their financial situation as
good. A frequent lack of money (for payments of bills, food or clothing)
was reported by 6.7 % of the respondents. The best rating of financial situation
was found among the respondents of Jihlava, Prague 10 and Benešov, while
respondents from Kladno, Olomouc and Kroměříž chose the worst rating.
Differences between cities in the highest educational status, in the present
economic activity and financial situation of respondents were statistically significant.
A total of 48.7 % respondents were essentially satisfied with their lives,
44.8 % had a neutral attitude, 6.6 % of respondents were not satisfied; the
differences between males and females were not significant statistically
(p = 0.326). Satisfaction with life was most frequently reported by residents
of Jihlava (56.1 %) and least frequently by residents of Kladno (37.6 %)
where there was also the highest percentage of unsatisfied subjects (12.1 %).
The differences between cities were statistically significant.
A total of 62.1 % respondents felt shared responsibility for their health,
while 33.5 % provided a neutral answer and 4.4 % a negative answer. In the
feeling of shared responsibility for one’s own health there were found no
statistically significant differences among respondents from different
cities (p = 0.089).
The opinion that one can contribute to the reduction of risk of myocardial
infarction was held by 67.4 % of respondents, while it was only 37.5 % respondents
for reduction of risk of cancer (Fig. 9.4).
A review of the respondents’ opinions on selected factors of lifestyle
affecting health are presented in Fig. 9.5.
The local social environment was best rated in Jihlava and Klatovy (over
54 % of the respondents felt satisfied), while it was worst rated in Karviná,
Most and Kladno (only 30 % of the respondents felt satisfied).
The local environment was best rated in Šumperk (50 % of respondents expressed
their satisfaction), followed by Žďár nad Sázavou, Havlíčkův Brod, Jindřichův
Hradec and Jablonec nad Nisou. The highest percentage of respondents dissatisfied
with their local environment was found in Karviná (23.4 %), Plzeň, Olomouc,
Kolín and Most. The subjective assessment of the quality of the environment at
the site of residence by respondents in each city is presented in Fig. 9.6.
In 21 of 27 cities, traffic was considered the most disturbing environmental
factor, disturbed felt 31.3 % of respondents. The second most frequent disturbing
factor was the pollution of public premises, disturbing a total of 25.9 %
of respondents. In five cities it was reported by the respondents to be the
most serious problem. Day-time noise levels at site of residence was considered
to be a problem by 20.5 % of respondents, night-time noise disturbed
14.7 % of them. The distribution of the population in the age group under follow-up
disturbed by noise in each city is presented in Fig. 9.7.
18.3 % of respondents complained about ambient air pollution.
In the evaluation of the social and living environment at site of residence,
differences between the cities were statistically significant.
Nutrition and dietary habits:
The mean daily intake of liquids was 2.6 L per person (3 liters in males
and 2.3 liters in females, p < 0.001). A total of 8.2 % of males and 24.0 %
of females (p < 0.001) consumed less than two liters of liquids per day.
Alcoholic beverages were consumed excessively (i.e. more than 30 g of
pure alcohol per day in males, and more than 20 g of pure alcohol per day
in females) by 18.7 % of respondents (31.5 % males and 7.4 % females,
p < 0.001). On average, males consumed 4.2 liters of beer, 0.2 L of wine and
0.07 L of spirits per person per week, while females reported 0.5 liter of beer,
0.2 L of wine and 0.03 L of spirits per person per week.
Limited consumption of animal fats (consumption not more than twice a week)
was reported by 45.8 % of respondents (42.7 % males and 48.6 % females,
p < 0.001).
Low-fat products were preferred by 54.5 % of respondents (45.1 % males
and 62.9 % females, p < 0.001).
Vitamin and/or trace element supplements are taken regularly (three and
more times a week) by 16.8 % of respondents (12.3 % males and 21.0 % females),
occasionally by 34 % of respondents (28.1 % males and 39.3 % females), and
49.2 % (59.6 % males and 39.8 % females) not at all. Females consume such
supplements significantly more often than males (p < 0.001).
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:
No significant difference was found between males and females in assessment
of his/her health; the odds of a negative rating of one’s own health increased with age.
The odds of a negative rating of one’s own health increases with decreasing
educational level; for respondents with elementary education (as compared
with university graduates) up to OR = 4.5 (p < 0.001,
CI95 % = 3.48–5.69).
Higher odds of rating one’s health as being poor or very poor were found in:
respondents who report a poor financial situation (compared to those reporting
a good one) (OR = 5.1, p < 0.001, CI95 % = 4.31–5.98);
economically inactive respondents (compared to employed respondents) with
OR = 4.4, p < 0.001, CI95 % = 3.60–5.39);
respondents with insufficient physical activity (OR = 1.4, p < 0.001,
CI95 % = 1.31–1.65);
presently active and former tobacco smokers (OR = 1.4, p < 0.001,
CI95 % 1.22–1.59);
respondents who have not cut down on animal fat consumption (OR = 1.2,
p = 0.014, CI95 % 1.03–1.29);
The probability of their occurrence increased with age; as against the
subjective perception of one’s own health, there has been demonstrated the
influence of gender, in females there was a greater probability of long-term
complaints (OR = 1.2, p < 0.001, CI95 % 1.11–1.27).
The strongest correlation with the presence of long-term health problems
was with one’s financial situation; subjects in a bad financial situation
had a greater probability of perceiving long-term health problems
(OR = 2.4, p < 0.001, CI95 % 2.02–2.70).
In all the assessed factors there has been demonstrated a statistically
significant correlation with the presence of long-term complaints, however,
the strength of that correlation was lesser than in the subjective assessment
of one’s own health.
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:
Females significantly more frequently than males have long-term problems,
were followed-up more often by their physicians on a long-term basis, and
they more frequently used long-term medication (females and males showed
no statistical difference in the subjective self-evaluation of health).
The occurrence of most of the monitored risk factors for chronic non-infectious
diseases was more frequent in males (with the exception of insufficient
total daily intake of fluids). Differences were not statistically significant
between males and females as to elevated blood levels or total cholesterol (data
from check-ups).
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.