9. STATE OF HEALTH AND SELECTED PARAMETERS OF DEMOGRAPHIC AND HEALTH STATISTICS
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9.1 Monitoring the population’s health status
The monitoring of the population’s health status is based on a questionnaire
survey titled the HELEN Study – Health, Life Style and Environment. In the
years 1998–2002, in the first stage the HELEN Study was carried out
in a total of 27 cities in the Czech Republic. In the year 2004 began the second
stage of the survey. The same methodology has been applied in a repeated
survey in nine cities participating in the System of Monitoring (Brno, České
Budějovice, Hradec Králové, Karviná, Kladno, Most, Olomouc, Plzeň, and Žďár
nad Sázavou). In this chapter there are evaluated preliminary results from
the second stage of the survey that shall be finished in 2005.
9.1.1 Structure of the questionnaire and organization of the survey
The structure of the questionnaire was designed in 1998 (first stage of
the survey), in the second stage it has been supplemented with questions
concerning locomotor activity and questions on dietary habits have been
altered. The questionnaire consisted of 70 questions and was divided into
the following sections:
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Personal data and employment;
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Housing conditions;
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Personal medical history;
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Family medical history;
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Lifestyle information;
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Personal opinions, social and economic conditions;
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Nutrition and dietary habits.
In each city, through a systematic random selection ensuring the sample
to be representative, there have been selected 800 subjects (400 males and
400 females) aged 45–54 years. As support for the systematic random selection
there served the population register. First, the selected subjects received
an informing letter, and then an investigator contacted them. The investigator
handed them the questionnaire, informed them of the importance of the survey,
collected the questionnaires and checked that they were fully completed.
The major task of each investigator was to establish contact and convince
the selected person to participate; the investigator was neither allowed
to participate in the filling in the questionnaire nor to influence the
respondent. The investigators were from the staff of Public Health Institutes
or from Regional Public Health Authorities, as well as students of healthcare schools.
The investigators received written instructions on how to proceed, and
underwent unified training.
The survey also included a medical check-up to which half of the selected
subjects (200 males and 200 females) were invited. The examination took
place at the Public Health Institutes and was organized by their staff.
The examination included repeated taking of blood pressure, body height
and mass, waist and hip circumferences, and the determination of total blood
cholesterol.
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 c2-test
of independence. The tests were performed at the level of significance
p = 0.05. The value p < 0.001 signifies a statistically significant difference
between males and females, or between the individual cities.
9.1.3 Selected results – HELEN 2004
Respondency rate and structure of the series:
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The questionnaire was completed by a total of 3,461 respondents (46 %
males, 54 % females); the questionnaire returnability was 53.5 % (ranging
from 36.4 % in Plzeň to 66.7 % in Karviná). A total of 604 individuals underwent
medical check-ups, the respondency rate of the probands being 18 %.
Health status:
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Respondents rated their health on a 5-point scale, from very good to very
poor. Most respondents satisfied with their health (good and very good)
came from Plzeň (57 %), Hradec Králové and České Budějovice (over 54 %).
Health was rated the worst in Karviná with only 33 % of content subjects and the
greatest number of dissatisfied respondents (19 % rating their health as
being poor or very poor; the p-value for difference between cities: p < 0.001),
(Fig. 9.1a). A total of 48 % respondents rated their health as good or very
good, 39 % rated it as average, and 13 % as poor or very poor. In the subjective
rating of their health, males and females did not differ statistically to any
significant degree (p = 0.832).
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Long-term health complaints were reported by the respondents in the range
from 46 % in Olomouc, to 69 % in Karviná (p < 0.001). A total of 56 % respondents
(54 % males and 56 % females, p = 0.066) reported health complaints. Most
frequently the locomotor apparatus and the circulatory system were in question.
The frequencies of causes of long-term health complaints in males and females
are presented in Fig. 9.1b.
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On a long-term basis (for more than two weeks in the past year) medication
was taken most frequently by the population in Karviná (68 %) and Olomouc
(68 %), the least in Žďár nad Sázavou (59 %) and Plzeň (59 %; p = 0.011).
Overall, pharmaceuticals were taken on a long-term basis by 63 % of subjects
(57 % males and 69 % females, p < 0.001). The most frequent reasons for taking
medicine were pain in the back and in the joints (26 % of subjects), and
high blood pressure (20 %).
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The most frequently revealed diseases in the series under follow-up, in
both genders, were affections of the spine and joints, high blood pressure,
and allergic diseases. A review of life-long prevalence of selected non-infectious
diseases in males and females is presented in Fig. 9.1c; the occurrence
of the three most frequent affections in each city is presented in Fig. 9.1d.
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Overall, coronography had undergone 4 % of males and 2 % of females, most
often among respondents in České Budějovice (3.6 % of respondents, differences
between cities were not significant statistically). Aorto-coronary by-pass
had been performed in 0.5 % of subjects, angioplasty in 1 % of them.
Incidence of risk factors for chronic non-infectious diseases (A review
of the risk factors followed up is presented in Fig. 9.1e):
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On the basis of data given in the questionnaire there has been determined
the BMI value (kg/m2) of each respondent; BMI greater than 30.0 signifying
obesity. The greatest numbers of obese respondents were in Most (24 %) and
in Karviná (23 %), the least number in Olomouc (14 %; p = 0.004). In all,
in the series under follow-up 19 % of males and 17 % of females were found
to be obese (p = 0.275).
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Elevated blood pressure in their personal history have reported most frequently
respondents from Karviná (35 %), least frequently those from Plzeň (24 %)
(p = 0.046). Overall, hypertension has been diagnosed in 33 % of males and
in 24 % of females (p < 0.001), of whom 68 % males
and 73 % females (p < 0.001)
were under treatment. Most frequently, under treatment were respondents
from Hradec Králové (76 %); least frequently those from Plzeň (59 %; the difference
between cities not being significant statistically). From the group suffering
hypertension, high blood pressure newly diagnosed in the past 12 months
reported 38 % of males and 39 % of females (p = 0.692). Most persons with newly
diagnosed hypertension were in Kladno (47 %), the least in České Budějovice
(34 %; the difference between cities not being significant statistically).
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There was more than 40 % regular smokers in Karviná, Most and Kladno;
respondents smoking least frequently in Brno, Hradec Králové and Žďár nad
Sázavou (less than 30 % regular smokers; p < 0.001)
(Fig. 9.1f). In the population
under follow-up there was a total of 35 % regular smokers, more males –
37 %, than females – 32 % (p < 0.001). In Hradec Králové, Karviná and Plzeň
the percentages of smokers in males and females were practically the same;
in České Budějovice there were more female smokers by 3 %, in the other
cities males smoked more frequently.
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Exposure to passive smoking (staying in a room full of tobacco smoke for
more than 1 hour daily) was reported by 34 % of males and 18 % of females
(p < 0.001). The lowest percentage of passive smokers was found in Olomouc,
the highest in Kladno (p < 0.001).
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To physical education, sports and hiking the respondents devoted on the
average 3.6 hours in the course of a typical week. More than half of the respondents
reported only 2 hours and less of physical exercise per week (zero physical
exercise was reported by 30 % of all respondents). Of the respondents who
are devoted to sporting activities, 81 % rated that activity as less demanding,
19 % are devoted to intensive sporting activities. The greatest numbers of
those reporting zero sporting activity were from Karviná and Most; the greatest
numbers of respondents indulged in intensive sporting came from Brno, České
Budějovice, Olomouc and Plzeň. Low levels of physical exercise (less than
the 3.5 hrs/wk recommended by the American Heart Association) were reported
by 63 % of the respondents (59 % of males and 66 % of females; p < 0.001).
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A positive family history of cardiovascular morbidity was present in 33 %
of the respondents, while it was 31 % for cancer and 32 % for diabetes
mellitus. Allergy in parents or siblings was reported by 10 % of the respondents.
Nutrition and dietary habits:
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The mean daily intake of liquids was 2.5 L in males and 2.0 L in females
(p < 0.001). A total of 13 % males and
27 % females (p < 0.001)
consumed less than 2 L of liquids per day. The least number of respondents with insufficient
intake of liquids was in Kladno, the greatest in Olomouc (differences between
cities were not significant statistically).
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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 25 % of males and 8 % females (p < 0.001). The percentage of
subjects consuming alcohol excessively ranged in the cities from 8 % in Žďár
nad Sázavou to 22 % in Kladno (p < 0.001).
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On the basis of responses to ten questions surveying dietary habits there
has been determined a score that expresses the overall approach of the respondent
to rational nutrition. Overall, in 11 % of respondents we have found a good
keeping with the principles of rational nutrition, on the other hand 21 % of
subjects did not observe those rules (30 % males and 13 % females; p < 0.001).
Of the items in rational nutrition assessed, females consumed fruit
and vegetables, whole grain pastry and dairy products more frequently than
males, and also ate less frequently fried and deep-fried meals. Males ate fish
more often, and less frequently cakes and other sweets. In the consumption
of poultry meat, males and females did not differ significantly. From the
point of view of following the rules of rational nutrition the best rated
were those in Hradec Králové, and the worst in České Budějovice.
Psycho-social factors:
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In principle, 52 % of respondents (54 % males and 50 % females; p = 0.017)
were satisfied with their lives. Most satisfaction with their lives expressed
respondents from České Budějovice (57 %), least frequently those from Karviná
(49 %; the differences between cities were not significant statistically).
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The social environment at site of residence was rated best by respondents
from Žďár nad Sázavou (59 % respondents content), the worst by those from
Most and Karviná with roughly 32 % respondents content (p < 0.001).
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The living environment at site of residence was rated best by respondents
from Žďár nad Sázavou, with more than 50 % being satisfied. The least number
of respondents satisfied with the environment came from Most (21 %), wherefrom
also came the greatest number of dissatisfied subjects (16 %; p < 0.001),
see Fig. 9.1g.
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With the exception of Most, in all other cities under follow-up, the most
annoying factor was automobile traffic. In Most in question was foremost
the disorder and soiling of public premises, automobile traffic closely
following in second place (Fig. 9.1h).
9.2 Selected indicators of demographic and health statistics
Within the framework of a regular presentation of selected demographic
and health indicators there have been updated data on the incidence of tumor
diseases. Evaluated have been developments over the period of 1979 through
2002, the present situation and trends in the Czech Republic, as well as
a comparison with other countries of EU 25. Data on the Czech Republic1
have been supplied by the Institute of Health Information and Statistics
from the National Oncological Register of the Czech Republic2. Data from
the database GLOBOCAN 2002 have been used for comparison of tumor incidence
in Europe. Tumor diseases affect foremost the elderly, and therefore, it
is necessary to eliminate the influence of age distribution with the aid
of the method of direct standardization (ASR – age standardized rate). The
data have been standardized following the European standard; data obtained
from GLOBOCAN following the world standard.
The International Classification of Diseases (ICD-10) differentiates malignant
neoplasms (Dg. C00–C97), in situ neoplasms (Dg. D00–D09), and neoplasms of
uncertain or unknown behavior (Dg. D37–D48). The evaluation is focused on
the incidence and mortality rate due to malignant neoplasms (further only as MN),
and on neoplasms in situ. The most frequently diagnosed carcinoma in males
as well as in females is “other MN of the skin” (Dg. C44). In view of the
low fatality rate of that MN, its frequent multiple occurrence and reappearance,
it has been eliminated from the following evaluation. Moreover, the mode
of reporting that diagnosis varies in different countries. To have an idea,
in the Czech Republic in 2002 there have been reported 7,246 cases in males
and 6,664 in females.
1 Data on proportion of death due to of MN have been taken from the database
GLOBOCAN 2002.
2 Data on the occurrence of neoplasms are reported to the National Oncological
Registry that in the collection of information applies the principle of their
tracking down, verification, and multiple checking, wherefore definite
data are available only after a two-year delay.
9.2.1 Malignant neoplasms in the Czech Republic
The incidence of selected MN and in situ neoplasms in the Czech Republic
over the years 1985 through 2002 (Fig. 9.2a) has an unfavorable tendency,
i.e. a persistent increase in standardized rates. In view of improved diagnostics
and treatment, the increasing incidence rate is not being followed by increasing
intensity of MN mortality (Fig. 9.2b). Incidence rate of MN and in situ
neoplasms (ASR) over the whole period was higher in males than in females.
In the year 2002 more than 50,000 new cases of MN disease (Dg. C44 excluded)
and in situ neoplasms have been reported (25,305 cases in males;
25,310 cases in females).
Not counting Dg. C44, the most frequent MN in males are colorectal neoplasms
(Dg. C18–C21), followed by neoplasms of the trachea, bronchus and lung
(Dg. C33–C34), and MN of the prostate (Dg. C61). While the numbers of colorectal
MN and prostate MN are ever on the increase, there has been a moderate drop
in the numbers of cases of bronchial, tracheal, and pulmonary MN in recent
years. In the year 2002, there have been reported more than 4,700 new cases
of colorectal MN, more than 4,500 cases of pulmonary MN, and almost
3,400 MN of the prostate gland.
In females the most frequent are MN of the breast, the incidence of which
is steadily rising. In the year 2002 there have been reported almost
5,400 new cases. Other numerous diseases include MN of the female genital organs
(Dg. C51–C58). In the year 2002 more than 4,300 cases of such MN have been reported.
The most frequent of them are MN of the uterine corpus (38 %), ovarian
MN (29 %), and MN of the uterine cervix (25 %). Just as in males, colorectal
MN are a frequent diagnosis in females, namely around 3,300 cases in the
year 2002.
Malignant neoplasms belong to the most serious diseases, and in Czechia
they are the second most frequent cause of death. Their share in overall
mortality is increasing (Fig. 9.2b). In the year 2002, MN were the cause
of death in more than 29 % of all deaths in males and almost 24 % in females.
Males most often died of bronchial, tracheal, and pulmonary MN (Dg. C33,
C34). These diagnoses made up over 28 % of MN deaths. That was followed by
deaths due to MN of the colon and of the rectum (Dg. C18–C21) and deaths due
to MN of the prostate (Dg. C61), representing 16 % and 8 % of all MN deaths,
respectively. In females the most frequent cause of death due to MN was
MN of the breast and MN of the colon and rectum. Each of those diagnoses
made up more than 15 % of deaths in females due to MN. For details see
Fig. 9.2c and 9.2d.
Fig. 9.3a and 9.3b
depict the differentiation by districts of the occurrence
of malignant disease in 1999 through 2002. The influence of age distribution
on the incidence rate of MN was eliminated by the method of direct standardization.
In both genders the highest degree of incidence of MN was in the districts
of Plzeň Region, the Region Prague, and district Chomutov. On the other
hand, the lowest MN incidence rate, as regards females, was in the majority
of districts of the regions Hradec Králové, Zlín, Moravian-Silesian, South
Moravian, and of the Region Vysočina. In males there can be traced no such regional
trend in the lowest numbers of reported cases of MN. In the interpretation
of results it has to be kept in mind that the incidence value is not governed
only by the actual incidence of malignant neoplasms, but also by the quality
and level of reporting in each of the territorial units.
Incidence of MN of the colon and rectum (Dg. C18–C21)
Over the whole period of follow-up (1979 through 2002) there has been observed
an increase in the incidence of MN of the colon and rectum in males as well
as in females. The incidence of that MN was also the second most frequent
of the diagnostic units in both genders. Their mean values increased over
the four-year periods under follow-up in males from 47.4 (1979–1982) to
88.7 (1999–2002) and in females from 37.6 (1979–1982) to 61.3 (1999–2002),
see Figs. 9.4a and 9.4b.
The seriousness of that disease is confirmed by
the fact that these MN are up front not only in incidence but also in specific
mortality rate.
Dietetic factors play the most significant role in the appearance of colon
MN, namely food rich in meat and poor in fiber. On the other hand, a protective
effect was found in cereals, fruit, and vegetables. A positive family history
increases the risk of colorectal carcinoma. To a greater degree are threatened
people suffering chronic inflammatory affections, e.g. Crohn’s disease,
proctocolitis (the risk increases with increasing duration of the disorder).
Likewise, a higher risk of colorectal carcinoma has been observed in certain
vocations. Under higher risk are workers in cement works, in plants producing
polypropylane, halogens, organic solvents, and dyes.
Incidence of MN of the trachea, bronchus and lung (Dg. C33–C34)
In all the four-year periods of 1979 through 2002 under follow-up, in the
Czech Republic there has been registered a moderate decline in the incidence
of those MN in males, whereas there has been a moderate rise in incidence
in the case of females. Nevertheless, pulmonary and tracheal MN in males remained
the most frequent diagnostic cause, its incidence in the period 1999–2002
exceeding 3.5 times that found in females. It can be expected that as regards
this those diagnoses, their incidence and mortality rate in females shall
rise. Elderly females that are most threatened by these kinds of MN, shall be
joined by generations of females more widely addicted to the cigarette
smoking habit.
In over 90 % of pulmonary tumors the cause is tobacco smoking. Smokers
consuming more than 20 cigarettes a day for more than 20 years are under
20 times greater risk of acquiring bronchogenic carcinoma than non-smokers
(risk limit of 200,000 cigarettes). Acknowledged are also the effects of
passive smoking. This etiological factor is typical of small-cell carcinoma
(19–35 %) characterized by great proliferative activity and very early metastasizing
(at time of diagnosis two thirds of patients already have distant metastases).
In profession-linked exposure, heavy metals (arsenic, nickel), asbestos and radioactivity
appear as pulmonary carcinogens. Other carcinogenic factors include chemical compounds
(polycyclic aromatic hydrocarbons, nitrosamines, mycotoxins) and viruses
(RNA, retroviruses). Genetic predisposition also plays a certain role.
Incidence of malignant melanoma of the skin (Dg. C43)
From available data it follows that the mean incidence figure of malignant
melanoma of the skin in the Czech Republic has had a rising trend in the
course of the separate periods, and its value rose from 5.5 to 11.6 in males,
and from 5.7 to 13.8 in females.
Malignant tumors of the skin are basicellular and spinocellular carcinomas.
Basalioma, the most frequent dermal tumor in the 6th through 8th decennia
of life, oridinates foremost due to chronic sunning. Spinocellular carcinoma
(spinalioma) usually comes as a late consequence of solar radiation, effects
of tobacco, or X-rays. It sometimes appears in consequence of chronic inflammatory
alterations. Persons exposed to hydrocarbons in working with paraffin, mineral
oils, etc. are also threatened with the appearance of a malignant dermal
tumor.
Incidence of MN of the breast in females (Dg. C50)
Malignant neoplasia of the breast belongs to the most frequent and most
serious in females. Over the period under follow-up there has been observed
a steady rise in the frequency of this diagnosis in the Czech Republic.
The mean incidence of this MN has risen from the value of 54.7 to 97.1
newly reported cases per 100,000 females. That value was also the highest
found incidence out of the diagnostic units under follow-up. A positive
phenomenon is the long-term stagnation in the number of deaths due to this
disease. That is probably in consequence of preventive campaigns of early
diagnosis of this neoplasm.
A higher incidence of MN of the breast was found in females having a positive
family history regarding the mother or sister. A predisposing risk factor
are certain affections in the breast, e.g. proliferative mastopathy with
third degree of dysplasia, carcinoma of the contralateral mammary gland,
fibroadenoma. Obesity and diet containing increased amounts of animal fats
are considered to be a proven dietary risk factor for the appearing of MN
of the breast. Females with early onset of menarche (before the 12th year
of age), late menopause, infertile females, or those that give birth to their first
child after their 30th year of age have a higher risk of appearance of
breast carcinoma. At higher risk are also females suffering tumors of the
uterus, ovaries, or colon.
Incidence of MN of the prostate (Dg. C61)
The mean value of prostate MN incidence in the Czech Republic over the
given period has more than doubled from 25.7 (mean in 1979–1982) to 60.5
(mean in 1999–2002). Prostate MN is the third most frequent tumor in males,
its incidence increasing with age.
Risk factors are not known practically. Epidemiological surveys that have
studied factors of sexual behavior, excessive intake of fats, venereal diseases,
etc. have not demonstrated any correlation with the incidence of the tumor.
Hormone dependence, i.e. the stimulating effect of testosterone on growth
of the tumor cells is present in about 80 % of all carcinomas. A relatively
high incidence of prostate MN has been observed in profession-linked exposure
of males to cadmium oxide.
9.2.2 Comparison of MN incidence in the countries of EU 25
In the year 2002, in the countries of present-day EU (EU 25) there have
been estimated 1.1 million new cases of malignant neoplasia (excluding Dg. C44)
in males, and more than 0.9 million new cases in females. In that same
year, in the EU countries there have died 650 thousands of males and
500 thousands of females due to malignant neoplasm. The incidence is higher
in males in all countries of the EU.
The highest incidence of MN (Dg. C00–C97, excepting Dg. C44), standardized
by age, has been in the case of males in Hungary, and in the case of females
in Denmark. On the other hand, the lowest incidence for both genders was
in Greece, Latvia, and Cyprus. The incidence in males and in females in
Czechia exceeds the mean of the EU 25 countries (Fig. 9.5a).
Incidence of MN of the colon and rectum in males in European countries
likewise exceeds that in females. The incidence rate (ASR) of those MN is
depicted in Fig. 9.5b. Frequent is the occurance of colorectal MN in males
in central Europe in Czechia, Hungary, and Slovakia. In females, besides
in mentioned Hungary and Czechia, an above-average incidence is also in
Denmark and Germany.
The incidence of MN of the trachea, bronchus and lung in males in Czechia,
just as in the EU 25 countries, has decreased negligibly while the numbers
of new cases in females are continuously increasing. The highest incidence
rate (ASR) was in Hungary, Poland, and Belgium (in males), and in Denmark,
Great Britain and Ireland (in females) (details in Fig. 9.5c).
The high incidence rate is considered to be connected, foremost, with the consumption
of tobacco products.
The incidence rate (ASR) of malignant melanoma of the skin, in contrast
to previously named MN is not greater in males. Out of the EU 25 countries
the incidence rate of this MN was greater in males only in the case of Finland,
Italy, Hungary, Czechia, Slovakia, and Slovenia. The highest values in
the incidence rate of Dg. C43 have been reached in Sweden and Denmark (in
both genders). The lowest were in Greece, Cyprus, and Latvia; and in males
in Lithuania (details in Fig. 9.5d). The incidence rate of this diagnosis
in Czech females is around the mean in the EU 25 while in males it exceeds
the mean.
The incidence of MN of the breast represents the highest values out of
the malignant neoplasms in females analyzed in Czechia and other European
countries. Among the countries in which there has been the highest incidence
of this MN in 2002 were Belgium, France, Denmark (Fig. 9.5e).
The lowest values were found in the Baltic Republics. The incidence (ASR) of MN of the breast
in Czechia in 2002 was 58.4, being thus below the mean in the European countries
under follow-up.
Malignant neoplasia of the prostate in certain countries of the EU 25,
in 2002, represented the greatest numbers of new cases of malignant neoplasm
in males. Among the countries where the incidence of prostate MN is the
highest of MN in males, are Sweden, Finland, Austria, Germany, Great Britain,
Ireland, Cyprus, France, and Portugal. Countries with the highest value
of incidence are Sweden and Finland (details in Fig. 9.5f).
The lowest values, on the other hand, have been attained in Latvia, Poland, and Greece. Czechia
with 38.1 is below the EU 25 mean.
9.3 Partial conclusions
A half of the urban population aged 45–54 years, under follow-up rated
their health as good, almost 13 % as poor. Long-term health complaints (treated
or not) suffers more than half of the population of the age group under follow-up,
most frequently concerning the locomotor apparatus and cardiovascular diseases.
While there was no significant difference between males and females in the
occurrence of long-term health complaints, females took medicines on
a long-term basis significantly more frequently than males. The most frequently
occurring diseases were those of the spine and joints, being reported by
more than a third of the respondents, and high blood pressure that was found
in more than a quarter of them.
There were almost 20 % obese subjects, i.e. with a serious risk factor
of cardiovascular disease, in the age group 45–54 years under follow-up.
About 35 % of male respondents were active tobacco smokers; female smokers
among the respondents less by 4 %. In some cities, however, the difference
between the genders was negligible. There were found significant differences
between cities in the numbers of smokers – the most being in Karviná, Most,
and Kladno; the least being in Brno, Hradec Králové, and Žďár nad Sázavou.
A significant proportion of females, almost a quarter of them, consumes
less liquids than is the recommended daily intake; females abiding by most
of the other principles of rational nutrition more frequently than males.
There have been found significant differences between cities in the excessive
consumption of alcohol. The greatest consumption being found in Kladno, and
the lowest in Žďár nad Sázavou. In almost two thirds of the respondents
there has been found a low level of purposeful physical exercise.
In the age group of 45–54 years, 52 % of respondents were in principle
satisfied with their lives. While the respondents in individual cities did
not doffer in their overall satisfaction with their lives, they differed significantly
in the rating of the social and living environments in individual cities.
Malignant neoplasms are the second most frequent cause of death in Czechia.
The mortality rate of MN is stagnant, however, the share of MN in total deaths
is increasing. The incidence rate (ASR) of MN in Czechia is increasing continuously.
The ncidence rate in males in Czechia is higher in all the diagnoses under
follow-up than in females, including namely as regards malignant melanoma
of the skin. In males the most frequently reported are new cases of MN of
the colon and rectum, MN of the bronchus, trachea and lung, and MN of the
prostate. In females the most frequently reported are new cases of MN of
the breast, MN of the genital organs, and MN of the colon and rectum. Czechia
has attained higher values of total incidence rate of MN than the European
(EU 25) average. Out of the diagnoses under follow-up the Czechia has attained
more favorable values than other EU countries in the case of MN of the breast
and MN of the prostate; on the other hand, Czechia has attained outright
“primacy” in the case of colorectal MN.
Fig. 9.1a |
Subjectively perceived health status in the last six months
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Fig. 9.1b |
Personal medical history, long-time health complaints
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Fig. 9.1c |
Personal medical history, diseases notified by physician
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Fig. 9.1d |
Prevalence of selected diseases
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Fig. 9.1e |
Risk factors of chronic non-infectious diseases
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Fig. 9.1f |
Prevalence of regular smoking
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Fig. 9.1g |
Environment quality evaluation in neighbourhood
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Fig. 9.1h |
Annoying environmental factors in neighbourhood
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Fig. 9.2a |
Incidence of neoplasms in CZ, 1985–2002
(ICD-10, Dg. C00–C97 and D00–D09, Dg. C44 excluded)
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Fig. 9.2b |
Mortality due to malignant neoplasms in CZ, 1985–2002
(ICD-10, Dg. C00–C97)
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Fig. 9.2c |
Proportion of deaths due to malignant neoplasms in CZ, males, 2002
(ICD-10, C00–C97, Dg. C44 excluded)
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Fig. 9.2d |
Proportion of deaths due to malignant neoplasms in CZ, females, 2002
(ICD-10, C00–C97, Dg. C44 excluded)
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Fig. 9.3a |
Incidence rate (ASR) of neoplasms in districts of CZ, males
(average over years 1999–2002)
(ICD-10, Dg. C00–C97 and D00–D09, Dg. C44 excluded)
|
Fig. 9.3b |
Incidence rate (ASR) of neoplasms in districts of CZ, females
(average over years 1999–2002)
(ICD-10, Dg. C00–C97 and D00–D09, Dg. C44 excluded)
|
Fig. 9.4a |
Incidence of selected malignant neoplasms in CZ (1979–2002), males
|
Fig. 9.4b |
Incidence of selected malignant neoplasms in CZ (1979–2002), females
|
Fig. 9.5a |
Age standardized incidence rate of malignant neoplasms in EU states, 2002
(ICD-10, Dg. C00–C97, Dg. C44 excluded)
|
Fig. 9.5b |
Age standardized incidence rate of malignant neoplasm of colon and rectum
in EU states, 2002
(ICD-10, Dg. C18–C20)
|
Fig. 9.5c |
Age standardized incidence rate of malignant neoplasm of trachea,
bronchus and lung in EU states, 2002
(ICD-10, Dg. C33–C34)
|
Fig. 9.5d |
Age standardized incidence rate of malignant neoplasm of skin
in EU states, 2002
(ICD-10, Dg. C43)
|
Fig. 9.5e |
Age standardized incidence rate of malignant neoplasm of breast
in EU states, 2002
(ICD-10, Dg. C50)
|
Fig. 9.5f |
Age standardized incidence rate of malignant neoplasm of the prostate
in EU states, 2002
(ICD-10, Dg. C61)
|