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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