13/03/2014 National Health Monitoring/ Tiina Laatikainen 1
Monitoring disease burden, risk
factors and behaviours at the n...
Purpose of health monitoring
- case non-communicable diseases (NCD)
Aim of health monitoring is to:
• define disease burde...
Different information needed to define
the health profile of the population
Mortality (life-expectancy)
Morbidity
Risk fac...
Different data sources on population level
• Registers:
• mortality
• morbidity
• patient registers/records
• Surveys:
– h...
Mortality and NCD registers in Finland
Administrative registers:
• Causes of Death register
• Hospital Discharge register
...
NCD monitoring in THL
Mortality:
• Permission to analyze data from administrative
registers
• Mortality data received from...
Decline in CHD mortality in men aged 35-64
North Karelia
All Finland
NCD monitoring in THL
Morbidity:
• Administrative registers
– Hospital discharge data
– Cancer register
– Drug reimburseme...
Use of administrative registers in monitoring
NCD morbidity
• Routine administrative registers
– Causes-of-Death register ...
Age-adjusted CHD incidence among
men in Finland between 1991-2011
/100000
www.thl.fi/cvdr
FINAMI
FINAMI register
Methods
• Population-based MI register aiming to record each
coronary event in the populations of m...
Age adjusted ACS mortality- (panel
A) and incidence (panel B) among
>35-year old men and women in
FINAMI –areas.
Salomaa V...
Salomaa V et al. The FINAMI Study 14
Age adjusted ACS case-fatality
trends among >35-year old men
and women in FINAMI –are...
Health2000 and 2011 Surveys
Aim and target population
• Assess health and functional capacity of Finnish adult
population ...
Survey contents
• At home
– Health interview
– Health questionnaire
• At health center
– Anthropometric measurements
– Spi...
Prevalence of back pain (%) in 2000 and 2011
Men Women
17
Difficulties (%) to crouch in population older than
55 years in 2000 and 2011
21.11.2012
18
Men Women
NCD monitoring in THL
Risk factors:
• Population health examination and health interview
surveys
– The National FINRISK St...
National FINRISK Study
 every five years since 1972
 risk factors of cardiovascular
diseases, diabetes, cancer and
astma...
Measurements, laboratory analyses
 height and weight
 waist and hip circumference
 blood pressure
(2-3 measurements)
 ...
Methodology
 WHO MONICA Project protocol
http://www.ktl.fi/monica
 European Health Risk Monitoring (EHRM)
recommendation...
13.3.2014 23
Serum cholesterol among 25-64 –year old men
Men
5,0
5,2
5,4
5,6
5,8
6,0
6,2
6,4
1982 1987 1992 1997 2002 2007...
13.3.2014 24
Systolic blood pressure among
25-64 –year old men
120
125
130
135
140
145
150
155
160
1982 1987 1992 1997 200...
13.3.201413.3.2014 25
Daily smokers (%) 1972-2012
by education, 30−59-year old men
0
10
20
30
40
50
60
1997 2002 2007 2012...
Health Behaviour among the Finnish
Adult Population, 1978-2013
• Since 1978 health behaviour of the working age
population...
Health Behaviour among the Finnish
Adult Population, 1978-2013
• The primary purpose of the monitoring is to obtain
inform...
Proportion of daily smokers in the population
aged 15–64 years in Finland, 1978–2010
Source: National Institute for Health...
Fat used for cooking at home in
Finland in 1978–2010
Source: National Institute for Health and Welfare (THL),
Health Behav...
NCD monitoring in THL
Nutrition:
• Dietary surveys
– The FINDIET Study
Oulu 1997 -
Kuopio 1982 -
Pohjois-Karjala 1982 -
Tu...
FINNISH DIETARY SURVEYS
1982, 1992, 1997, 2002, 2007, 2012
FINMONICA/FINRISK surveys
Diet subsample 3000-4000
Response rat...
Fat intake
(women 25-64 years)
0
10
20
30
40
1982 1992 1997 2002 2007 2012
Total fat (25-35
EN%)
SAFA (~10 EN%)
MUFA (10-1...
Salt intake in Finland 1977-2007
0
2
4
6
8
10
12
14
16
18
1977
1979
1981
1982
1987
1991
1992
1994
1997
1998
2002
2007
Calc...
Recent development in improving the
monitoring of different population groups
• Child health monitoring system
– aim to co...
Health and wellbeing survey of
immigrants in Finland (MAAMU –Study)
Aim of the study is to gather information on health,
w...
Daily smoking by gender and ethnic group (%).
13/03/2014 Monitoring health inequalities / Risto Kaikkonen 37
Regional Health and Wellbeing
Study, ATH
• Area level monit...
The aim in ATH is to strengthen the
national, regional and local information for
planning and evaluation
13/03/2014 Monito...
National Health Monitoring in Finland
• Covers different aspects of health and welfare from
mortality to health behavior a...
Dissemination and utilization of data
• Legislation in Finland mandates municipalities to
monitor the health of population...
Health indicators by sosioeconomic status
Source: The National FINRISK Study (2002 and 2007)
Increased serum cholesterol (...
International health monitoring
approaches
13/03/2014 Presentation name / Author 45
The European Health
Examination Survey (EHES)
is a collaboration to collect nationally
representative, high quality health...
The European Health Examination
Survey (EHES)
• Health examination survey (HES) is complementary to health
interview surve...
http://www.ehes.info/
13/03/2014 Presentation name / Author 48
STEPS
• WHO STEPwise approach to chronic disease risk
factor surveillance
• By using the same standardized questions and
p...
Thank you!
Laatikainen health monitoring nc_dseminar_2014
Laatikainen health monitoring nc_dseminar_2014
Laatikainen health monitoring nc_dseminar_2014
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Laatikainen health monitoring nc_dseminar_2014

  1. 1. 13/03/2014 National Health Monitoring/ Tiina Laatikainen 1 Monitoring disease burden, risk factors and behaviours at the national and community level Professor Tiina Laatikainen
  2. 2. Purpose of health monitoring - case non-communicable diseases (NCD) Aim of health monitoring is to: • define disease burden • identify populations at highest risk • determine the prevalence of health risks Data collected is needed to: • provide ongoing or routine prevalence estimates of NCD risk factors • track health trends over time • develope targeted programs, policy and legislation • evaluate program and policy progress and success • demonstrate progress in meeting global or national health objectives
  3. 3. Different information needed to define the health profile of the population Mortality (life-expectancy) Morbidity Risk factors Health behavior Nutrition Use of health services, uptake of interventions Environmental factors Quality of life
  4. 4. Different data sources on population level • Registers: • mortality • morbidity • patient registers/records • Surveys: – health examination surveys • health surveys (diseases) • risk factor surveys – health interview surveys • health behavior surveys (behavior, self-reported diseases) • nutrition surveys
  5. 5. Mortality and NCD registers in Finland Administrative registers: • Causes of Death register • Hospital Discharge register • Cancer register • Social insurance register: drug reimbursement data Unique social security numbers enable linkage possibilities
  6. 6. NCD monitoring in THL Mortality: • Permission to analyze data from administrative registers • Mortality data received from the national Causes of Death register (Statistics Finland)
  7. 7. Decline in CHD mortality in men aged 35-64 North Karelia All Finland
  8. 8. NCD monitoring in THL Morbidity: • Administrative registers – Hospital discharge data – Cancer register – Drug reimbursement register • Special registers to monitor disease incidence – FINAMI register • FINMONICA 1983-1992, FINAMI 1993-2013 • Population health examination surveys (prevalence data) – Mini-Finland (1978-80) and Health 2000 and Health 2011 Surveys – The National FINRISK Study • every fifth year since 1972
  9. 9. Use of administrative registers in monitoring NCD morbidity • Routine administrative registers – Causes-of-Death register (Statistics Finland) – Hospital Discharge Register (Stakes) – Drug reimbursement register (KELA) • Computerized registers, cover the whole country and all age-groups, not standardized • Can be linked together using the personal ID code: www.thl.fi/cvdr
  10. 10. Age-adjusted CHD incidence among men in Finland between 1991-2011 /100000
  11. 11. www.thl.fi/cvdr
  12. 12. FINAMI FINAMI register Methods • Population-based MI register aiming to record each coronary event in the populations of monitored areas • Specific MI and Stroke registers – FINMONICA MI and stroke registers 1983-92 – FINAMI register 1993- – FINSTROKE register 1993-1997 • Planned for research: standardized data, established QC procedures, accurate and reliable results • Expensive and laborious to maintain, cannot cover the whole country and all age groups
  13. 13. Age adjusted ACS mortality- (panel A) and incidence (panel B) among >35-year old men and women in FINAMI –areas. Salomaa V et al. The FINAMI Study 13
  14. 14. Salomaa V et al. The FINAMI Study 14 Age adjusted ACS case-fatality trends among >35-year old men and women in FINAMI –areas. A: 28-days case-fatality B: Case-fatality before entering to the hospital C: Case-fatality among those entering hospital alive
  15. 15. Health2000 and 2011 Surveys Aim and target population • Assess health and functional capacity of Finnish adult population in 2000 • Target population: population aged more than 18 years • 160 municipalities included in the sample • HES survey for population 30 years or more • HIS survey for young adults (18-29 years) • Follow-up survey in 2011
  16. 16. Survey contents • At home – Health interview – Health questionnaire • At health center – Anthropometric measurements – Spirometry, bioimpedance, bone density – Blood sampling – Oral examination – Functional capacity tests – Clinical examination – Mental Health Interview
  17. 17. Prevalence of back pain (%) in 2000 and 2011 Men Women 17
  18. 18. Difficulties (%) to crouch in population older than 55 years in 2000 and 2011 21.11.2012 18 Men Women
  19. 19. NCD monitoring in THL Risk factors: • Population health examination and health interview surveys – The National FINRISK Study (HES) • every fifth year since 1972 – Health Behavior among the Finnish Adult Population Survey (HIS) • every year since 1978 – Health Behavior among the Finnish Elderly Population (HIS) • every second year since 1993
  20. 20. National FINRISK Study  every five years since 1972  risk factors of cardiovascular diseases, diabetes, cancer and astma and allergy  stratified random samples from population register  population aged 25-64 years, later years 25-74 years  stratified by age and sex  sample size 8000 – 12 000 / survey  participation rate 65 – 88 %  questionnaire, anthropometrics and laboratory analyses
  21. 21. Measurements, laboratory analyses  height and weight  waist and hip circumference  blood pressure (2-3 measurements)  pulse  serum cholesterol  HDL, triglyserides, GGT
  22. 22. Methodology  WHO MONICA Project protocol http://www.ktl.fi/monica  European Health Risk Monitoring (EHRM) recommendations http://www.thl.fi/ehrm • European Health Examination Survey http://www.ehes.info/
  23. 23. 13.3.2014 23 Serum cholesterol among 25-64 –year old men Men 5,0 5,2 5,4 5,6 5,8 6,0 6,2 6,4 1982 1987 1992 1997 2002 2007 2012 Year mmol/l North Karelia Northern Savo Turku/Loimaa Helsinki/Vantaa Oulu province
  24. 24. 13.3.2014 24 Systolic blood pressure among 25-64 –year old men 120 125 130 135 140 145 150 155 160 1982 1987 1992 1997 2002 2007 2012 mmHg North Karelia Northern Savo Turku/Loimaa Helsinki/Vantaa Oulu province
  25. 25. 13.3.201413.3.2014 25 Daily smokers (%) 1972-2012 by education, 30−59-year old men 0 10 20 30 40 50 60 1997 2002 2007 2012 % High Middle Low
  26. 26. Health Behaviour among the Finnish Adult Population, 1978-2013 • Since 1978 health behaviour of the working age population has been monitored with a postal survey • Each year a random sample of Finnish citizens aged 15- 64 years has been drawn from the Population Register • The sample size has been 5000 • The questionnaire, consistently mailed between April and June, has remained essentially the same over the years • The average response rate has been 72%
  27. 27. Health Behaviour among the Finnish Adult Population, 1978-2013 • The primary purpose of the monitoring is to obtain information on health behaviours such as smoking and food habits and changes in them • The questionnaire also contains questions on the following topics: dental health, self-perceived health, the use of health services, the consumption of alcohol and physical exercise • In addition, there are questions related to change process and health campaigns • This monitoring system provide information for health policy decision-making, and can be used for evaluating specific health promotion campaigns and programmes
  28. 28. Proportion of daily smokers in the population aged 15–64 years in Finland, 1978–2010 Source: National Institute for Health and Welfare (THL), Health Behaviour and Health among the Finnish Adult Population -surveys 1978-2010 0 10 20 30 40 5078-79 80-81 82-83 84-85 86-87 88-89 90-91 92-93 94-95 96-97 98-99 2000-01 2002-03 2004-05 2006 2007 2008 2009 2010 year % Men Women
  29. 29. Fat used for cooking at home in Finland in 1978–2010 Source: National Institute for Health and Welfare (THL), Health Behaviour and Health among the Finnish Adult Population -surveys 1978-2010 0 10 20 30 40 50 60 70 80 90 100 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 year % no fat at all Vegetable oil Liquid vegetable oil preparation Low fat spread Soft margarine Hard margarine Mixture of butter and oil Butter
  30. 30. NCD monitoring in THL Nutrition: • Dietary surveys – The FINDIET Study Oulu 1997 - Kuopio 1982 - Pohjois-Karjala 1982 - Turku and Loimaa 1982 - Helsinki and Vantaa 1992 -
  31. 31. FINNISH DIETARY SURVEYS 1982, 1992, 1997, 2002, 2007, 2012 FINMONICA/FINRISK surveys Diet subsample 3000-4000 Response rates, 55-70% 3-day food record, 1982, -92 24 h recall, 1997 48 h recall, 2002, 2007 and 2012 www.thl.fi/nutrition, Suvi Virtanen Food composition database FINELI www.fineli.fi
  32. 32. Fat intake (women 25-64 years) 0 10 20 30 40 1982 1992 1997 2002 2007 2012 Total fat (25-35 EN%) SAFA (~10 EN%) MUFA (10-15 EN%) PUFA (5-10 EN%) EN% Recommendations Year
  33. 33. Salt intake in Finland 1977-2007 0 2 4 6 8 10 12 14 16 18 1977 1979 1981 1982 1987 1991 1992 1994 1997 1998 2002 2007 Calculated, men Calculated, women 24 hour urine, men 24 hour urine, women Linear (24 hour urine, men) Linear (24 hour urine, women) Linear (Calculated, men) Linear (Calculated, women) g/day The FINDIET Study
  34. 34. Recent development in improving the monitoring of different population groups • Child health monitoring system – aim to collect relevant health data directly from child health care and school health care for national monitoring purposes – LATE –project – www.thl.fi/lastenterveysseuranta – www.terveytemme.fi/lastenterveys – A pilot study of 6500 children aged 0,5 to 15 years, 2007-2009 – Data also used for research – Main indicators will be included in collection of primary health care data (national electronic records)
  35. 35. Health and wellbeing survey of immigrants in Finland (MAAMU –Study) Aim of the study is to gather information on health, wellbeing and use of services among main immigrant groups in Finland In future, to develope a proper surveillance system on immigrants Target groups: Russian, Somalian and Kurdish population First survey carried out in 2010-2011 Youth (13-16 years old) studied in 2011-2012
  36. 36. Daily smoking by gender and ethnic group (%).
  37. 37. 13/03/2014 Monitoring health inequalities / Risto Kaikkonen 37 Regional Health and Wellbeing Study, ATH • Area level monitoring is needed for effective national level policy making • Monitoring factors affecting the health and well-being in area level and local populations and their sub-groups, – Compare data with those of other regions or of the country as a whole, or against the goals set. • ATH will further collect monitoring information which is significant for the orienting of health promotion measures and the evaluation of their effectiveness
  38. 38. The aim in ATH is to strengthen the national, regional and local information for planning and evaluation 13/03/2014 Monitoring health inequalities / Risto Kaikkonen 38 • The law and national programs and action plans motivate to devise area-level monitoring • Many decisions in the local level can and are focused to affect the health and wellbeing of citizens • Therefore the aim is to collect – Area level monitoring with population subgroups: 3000 citizens – Area comparisons: 1000 citizens – Aged: 20-54, 55-74 and 75+ – Answers on paper or intenet –respondents choice – Languages: Finnish, Swedish, Russia and English – Altogether: in first wave: 34 000, years 2010–2011 (collected) – In the future, years 2012–2014 ~150 000 Finns • Aim is also to develop survey methods and methodology – Question bank, validated questions with meta-information – Internet, with response feedback – Phone, interviews for non-respondents
  39. 39. National Health Monitoring in Finland • Covers different aspects of health and welfare from mortality to health behavior and quality of life • Relatively good geographical coverage, regional approaches developing • Covers several population groups: youth, adults, elderly. Also child health monitoring and monitoring of immigrant groups is under development. • Possibility to monitor health also in different sosioeconomic groups • Data collected by different means – however possibility to build up national and local health profiles
  40. 40. Dissemination and utilization of data • Legislation in Finland mandates municipalities to monitor the health of population • Reliable, comparable and up-to date health information needed on local level • Development of key health indicators • Dissemination of information and data interpretation through visual tools: – www.terveytemme.fi – www.hyvinvointikompassi.fi
  41. 41. Health indicators by sosioeconomic status Source: The National FINRISK Study (2002 and 2007) Increased serum cholesterol (> 5 mmol/l) South Finland Increased serum cholesterol (> 5 mmol/l) all FINRISK areas Low High Medium Low Medium High
  42. 42. International health monitoring approaches 13/03/2014 Presentation name / Author 45
  43. 43. The European Health Examination Survey (EHES) is a collaboration to collect nationally representative, high quality health data which are comparable between countries and over time. • All countries should cover at least the age group 25-64 years. • Sample should be nationally representative probability sample of at least 4000 people. • Core measurements, which all countries should at least include, are height, weight, waist circumference, blood pressure, total and HDL- cholesterol, fasting glucose or HbA1c and questionnaire(s). Countries can include additional measurements based on national needs, interests and resources. 13/03/2014 Presentation name / Author 46
  44. 44. The European Health Examination Survey (EHES) • Health examination survey (HES) is complementary to health interview survey (HIS) and administrative registers. Together these form a good basis for the health monitoring in the countries. • EHES can provide information, not available from other data sources, on key health indicators. This will facilitate evidence-based planning and evaluation of public health policies and actions. • The EHES Manual has European level recommendations and standardized measurement protocols. It has three parts: Part A: Planning and preparation of survey Part B: Fieldwork procedures Part C: European level collaboration 13/03/2014 Presentation name / Author 47
  45. 45. http://www.ehes.info/ 13/03/2014 Presentation name / Author 48
  46. 46. STEPS • WHO STEPwise approach to chronic disease risk factor surveillance • By using the same standardized questions and protocols, all countries can use STEPS information not only for monitoring within-country trends, but also for making comparisons across countries. The approach encourages the collection of small amounts of useful information on a regular and continuing basis – Step 1: demographics and behavioral – Step 2: physical measurements – Step 3: biochemical measurements http://www.who.int/chp/steps/en/index.html 13/03/2014 Presentation name / Author 49
  47. 47. Thank you!

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