Core measurements

Hanna Tolonen

EGHI subgroup on HES, 2nd March 2011, Luxembourg

Causes of death in EU

1. Circulator diseases

2. Cancer3. Ischemic

heart disease

4. Respiratory diseases

http://epp.eurostat.ec.europa.eu/statistics_explained/index.php/Causes_of_death_statistics

EHES core measurements

• Anthropometric measurements• Weight• Height• Waist circumference

• Blood pressure• Blood samples

• Total cholesterol• HDL cholesterol• Fasting glucose

WHY THESE MEASUREMENTS?

ANTHROPOMETRIC MEASUREMENTS

Main complications of obesity

Economic implications of obesity

Cost of obesityCost of obesity

Direct costs due to

• medical costs to treat the diseases

associated with obesity

Direct costs due to

• medical costs to treat the diseases

associated with obesity

Indirect costs due to lost

productivity:• absenteeism• premature

death

Indirect costs due to lost

productivity:• absenteeism• premature

death

Intangible costs due to

• missed opportunities

• psychological problems

• poorer quality of life

Intangible costs due to

• missed opportunities

• psychological problems

• poorer quality of life

Obesity as a public health problem

• 2-8% of health costs in Europe are due to obesity or diseases stemming from obesity

• 10-13% of deaths are obesity related in different parts of Europe

Source: WHO http://www.euro.who.int/obesity

Reporting bias - obesity

Reporting bias – weight and height

• Self-reported BMI underestimates measured BMI• Varies by BMI level ,age, sex, ethnicity

• Over the years, the difference between self-reported and measured BMI has increased

Stommel M, Schoenburn CA. BMC Public Health 2009,9:421Shiely F, Perry IJ, et al. BMC Public Health 2010, 10: 560

Reporting bias – waist circumference

• Self-reported waist circumference underestimated real waist circumference• Women underestimate more than men• Underestimation increases by increased

BMI

Source: Bigaard J, Spaggaard I et al. J Nutr. 2005; 135: 2263-2270

BLOOD PRESSURE

Reporting bias - hypertension

• 10-20% of people with elevated bloodpressure are unawareof their condition

CHOLESTEROL

High cholesterol is a risk factor

• Coronary heart disease• Stroke

Reporting bias – high cholesterol

• Up to 30% of people with elevated total cholesterol are unaware of their condition

Economic implications of CVD

Total costs (2006)• €192 billion

• 10% of health care costs

Total costs (2006)• €192 billion

• 10% of health care costs

Direct costs of health care• €110 billion

Direct costs of health care• €110 billion

Indirect costs due to

productivity loss• €41 billion•2/3 due to premature

deaths• 1/3 due to

illness

Indirect costs due to

productivity loss• €41 billion•2/3 due to premature

deaths• 1/3 due to

illness

Informal care• € 42 billion

Informal care• € 42 billion

Source: http://www.heartstats.org/uploads/documents\PDF.pdf

DIABETES

Complications of diabetes

• foot infections• chronic skin infections• gum disease and tooth loss• vision problems• heart disease and blood circulation problems

Economic implications of diabetes

Cost of diabetesCost of diabetes

Direct costs due to

• medical care, drugs, insulin and supplies

• cost to health care sector (hospital

admissions)

Direct costs due to

• medical care, drugs, insulin and supplies

• cost to health care sector (hospital

admissions)

Indirect costs due to lost

productivity:• sickness, absences, disability, premature

retirement or death

Indirect costs due to lost

productivity:• sickness, absences, disability, premature

retirement or death

Intangible costs due to • decreased

quality of life• discrimination in the workplace

• difficulty or limitations in obtaining jobs

Intangible costs due to • decreased

quality of life• discrimination in the workplace

• difficulty or limitations in obtaining jobs

Economic implications of diabetes

• 3-15% of health costs in Europe are due to direct costs of diabetes related illnesses

• Indirect costs of diabetes through loss of productivity is estimated to be at least as high as direct costs

Jönsson A. Diabetologia 2002; 45: S5-S12WHO Fact Sheet no 236. Diabetes: cost of diabetes (2002)

Reporting bias - diabetes

• Up to 30% of those with diabetes do not know that they have diabetes

EHES core measurements

• Included to previous national HESs• Can be standardized in population survey• Clear interpretation of the results• Can be modified in the population• Can be administered in the survey setting• Acceptable to the participants • Ethically acceptable• Reasonable cost

STANDARDIZATION OF MEASUREMENTS

Standardization of measurements

• To obtain reliable and comparable results from EU standardization of the measurements is needed• Training• Devices• Measurement protocols• External quality control