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European Health Examination Survey

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European Health Examination Survey
"Measuring the Health of Europeans"
Type of projectMedical data gathering
LocationEurope
Key peoplePilot survey participants:
Czech Republic: National Institute of Public Health
Finland: National Institute for Health and Welfare
Germany: Robert Koch Institute
Greece: Hellenic Health Foundation
Italy: Istituto Superiore di Sanità
Malta: Department of Health Information & Research
Netherlands: National Institute of Public Health and the Environment
Norway: Norwegian Institute of Public Health
Poland: The Cardinal Stefan Wyszynski Institute of Cardiology
Portugal: Instituto Nacional de Saúde Dr. Ricardo Jorge
Slovakia: Regional Authority of Public Health
UK: University College London [1]
FundingDG Santé
Websitewww.ehes.info

The European Health Examination Survey (EHES) is an ongoing series of large-scale clinical epidemiological studies. It is a cooperative effort among multiple European nations, in concert with the European Union (EU), the European Economic Area (EEA) and the European Free Trade Area (EFTA). While actual data collection is carried out through the health ministries of each participating nation, the coordination of these efforts across borders is under the jurisdiction of the European Commission's Directorate-General for Health and Food Safety.

Overview

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A health examination survey consists of the collection of both interview data (in the form of a self-guided questionnaire, an interview with a medical professional, or both) and physical examination data such as blood testing and weight measurement.[2][3]

The EHES is officially a project of the European Commission's Directorate-General Santé et Consommateurs (Directorate-General for Health and Consumers, DG SANCO).[4] It is a goal of the EHES project to include HES participation from all EU, EEA and EFTA countries.[1]

The importance of medical examination data that can be correlated across populations, and EHES's contributions in that regard, have been noted by a number of healthcare researchers[5][6][7][8][9][10] and policymakers.[11]

EHES data have furthermore been used as the basis for more specific studies, such as examination of issues in participation rates in healthcare surveys[8] and identification of groups with risk factors for metabolic syndrome.[12]

History

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National-level Health Examination Surveys (HES) had been carried out by multiple European countries beginning in the late 1950s, with increased interest in conducting HESs by national governments beginning around the year 2000,[13] but there was no standardisation of parameters between countries prior to 2009.[1] With nearly 20 European countries planning to conduct their own HESs within a five-year window, it was decided that standardization of survey protocols was a priority.[6]

FEHES

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Blood pressure readings are an essential component of the EHES

From 2006–2008, the feasibility of creating a single standardized HES for all European Union (EU) member nations and all members of the European Free Trade Association/European Economic Area (EFTA/EEA) was evaluated by the Feasibility of the European Health Examination Survey (FEHES) Project. This project concluded that such a standardized HES was indeed feasible, and proposed a two-phase approach to the EHES project.[13] Phase one would involve establishing centralized coordination for the project, conducting pilot surveys for an initial 8–12 nations, and designing and preparing full-scale surveys for those initial HESs. Phase two would involve carrying out the full-scale surveys in the initial 8–12 nations, and coordinating the design and preparation of full-scale surveys in the other European countries.[1]

FEHES also made recommendations regarding data management; documentation and reporting; establishing and maintaining international collaboration; ethical and legal issues; measurements to be included in the pilot HESs; models for the organization of national HES infrastructure; recruitment or study participants; sampling issues; and standardization of measurement protocols.[13]

The countries expected to be part of an eventual Europe-wide Health Examination Survey as of 2008 were Austria, Belgium, Bulgaria, Croatia, Cyprus, the Czech Republic, Denmark, Estonia, France, Germany, Greece, Hungary, Iceland, Ireland, Italy, Latvia, Lithuania, Luxembourg, the former Yugoslavian Republic of Macedonia, Malta, the Netherlands, Norway, Poland, Portugal, Romania, Slovakia, Slovenia, Spain, Sweden, Turkey, and the United Kingdom.[13]

The EHES pilot program

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The pilot project for the European HES, funded by the European Commission, was carried out from 2009–2012. Coordination for the pilot project was administered by the EHES Pilot Reference Centre (EHES RC), a collaboration between Finland's National Institute for Health and Welfare (THL), Italy's Istituto Superiore di Sanità (ISS), and Norway's Statistics Norway (SSB).

Blood tests are another essential component of the European Health Examination Survey, used to measure cholesterol and glucose levels

EHES RC created a centralised system for data management and reporting of survey data, designed and produced training seminars for participating countries, provided logistical support to countries participating in the pilot studies, published standardized HES protocols in an EHES Manual, and supervised both internal and external quality control for the EHES. The EHES Manual defined protocols for health measurements, described organization of the fieldwork, discussed ethical issues, established definitions of data-reporting indicators, included information on sampling, and provided "other details relating to the planning and conducting of a national HES."[1] The final version of the EHES Manual incorporated revisions based on discoveries made during the pilot program.[1]

Pilot project preliminary surveys were carried out in 12 countries: the Czech Republic, Finland, Germany, Greece, Italy, Malta, the Netherlands, Norway, Poland, Portugal, Slovakia, and the UK. (In Germany, Italy, the Netherlands and the UK, HESs were already under way when the pilot program began, thus the primary focus of the pilot program in those countries was evaluating the feasibility of converting the existing programs to match the EHES standards.)[1] Initially, Hungary and Spain were going to be included in the pilot project as well,[3] but logistical problems prevented their participation.[citation needed] The countries included were chosen based on their either already having begun a national HES, or being in the early planning stages for such a survey.[13] These pilot studies established standardised protocols for the measurement of key risk factors for chronic disease, such as blood lipids, blood glucose, blood pressure, height, waist circumference and weight.[6] Standardised questions for the questionnaire portion of the EHES were also developed, covering such topics as current health status, smoking history, socio-economic status, and use of health care services; as much as possible, questions conformed to the European Health Interview Survey.

Plans for training of personnel were developed, as were plans for external quality assessment. The minimum sample size in each pilot project country was 200 individuals between 25 and 64 years of age. The pilot survey project succeeded at standardizing HES measurements across populations despite participant countries having differing cultural settings, economic statuses, infrastructures and levels of previous experience conducting an HES.[1]

Participation by country

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Accurate measurements of height and weight are another essential component of the EHES
21st-century European HESs by country and year
Country Prior HESs FEHES Pilot EHES Future plans
Austria none[14] —
Belgium none[14] —
Bulgaria none[14] —
Croatia 2003[15] —
Cyprus 2000[16] —
Czech Republic 2004–2005[17] 2010–2011[17] 2014–2015[18] 2019[18]
Denmark 2007–2008[16][18] —
Estonia none[14] —
Finland 2000, 2002, 2007[16][18] 2011–2012[16][18] 2017[18]
France 2006–2007[16][18] — 2014–2016[18]
Germany 2003[16] 2008–2011[16][18] 2014–2016[18] 2018–2020[18]
Greece none[19] 2011[19] 2012,[16][19]
2013–2014[18]		 2015–2017[18]
Hungary none[14] [dropped out]
Iceland none[14] —
Ireland 2002, 2007[16] —
Italy 1998–2002[20] 2008–2012[16][20]
Country Prior HESs FEHES Pilot EHES Future plans
Latvia none[14] — 2016[18]
Lithuania none[14] —
Luxembourg none[14] — 2012,[16]
2013–2015[18]
Malta none[14] 2010[16] 2013–2014[16] 2015–2016[18]
Netherlands 1999–2001[21] 2009–2010[18][21]
Norway none[14][22] 2011,[22] 2012[14] 2013[22]
Poland 2003–2005[23]
2006–2008[23]		 2011[23] 2013–2014[18]
Portugal none[24] 2010[24] 2012–2014,[16]
2015–2016[18]		 2020[18]
Slovakia 2003[16] 2011–2012[16] 2016[18]
Slovenia none[14] —
Spain 2007[16] [dropped out]
Sweden none[14] —
Turkey 2008[14] — 2015–2017[18]
UK (England) 2000[a][16] 2008–2011[2][16] 2012–present[2][16] annually to 2019[18]
UK (Scotland) 2003[16] 2008[a]–2011[2][16] 2012–present[2][16] annually to 2019[18]
Country Prior HESs FEHES Pilot EHES Future plans

Notes

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  1. ^ a b Health Examination Surveys were carried out annually beginning with this year, and will continue until at least 2019, when the desirability of continuing to conduct annual surveys will be re-assessed.[2][18]

References

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  1. ^ a b c d e f g h Tolonen, Hanna; Koponen, Päivikki; Mindell, Jennifer; Männistö, Satu; Kuulasmaa, Kari (April 2014). "European Health Examination Survey — towards a sustainable monitoring system". European Journal of Public Health. 24 (2): 338–44. doi:10.1093/eurpub/ckt107. PMID 23867563.
  2. ^ a b c d e f Bulmer, Martin; Gibbs, Julie; Hyman, Laura (2012). Social Measurement through Social Surveys: An Applied Approach. Ashgate. ISBN 978-0-7546-7488-7. Retrieved 21 September 2015.
  3. ^ a b "European Health Examination Survey 2010". health.gov.mt. Government of Malta official website. Retrieved 21 September 2015.
  4. ^ MacMaoláin, Caoimhín (2015). Food Law,: European, Domestic and International Frameworks. Hart Publishing. p. 307. ISBN 9781782256106. Retrieved 21 September 2015.
  5. ^ Gielen, Stephan; De Backer, Guy; Piepoli, Massimo F.; et al., eds. (2015). The ESC Textbook of Preventive Cardiology: Clinical Practice. Oxford University Press. p. 4. ISBN 978-0-19-965665-3. Retrieved 26 September 2015. So that in the future data can be compared across studies and countries, new attempts to secure data harmonization from the start are being attempted in Europe by the European Health Examination Survey (EHES).
  6. ^ a b c Kuulasmaa, Kari; Tolonen, Hanna; Koponen, Päivikki; Kilpeläinen, Katri; Avdicová, Mária; Broda, Grazyna; Calleja, Neville; Dias, Carlos; Gösswald, Antje; Kubinova, Ruzena; Mindell, Jennifer; Männistö, Satu; Palmieri, Luigi; Tell, Grethe S.; Trichopoulou, Antonia; Verschuren, Monique (28 August 2012). "An overview of the European Health Examination Survey Pilot Joint Action". Archives of Public Health. 70 (20): 20. doi:10.1186/0778-7367-70-20. PMC 3508610. PMID 22958511. The EHES Pilot Project has set up the structure for obtaining comparable high quality health indicators on health and important modifiable risk factors of major non-communicable diseases from the European countries. The European Union is now in a key position to make this structure sustainable. The EHES core survey can be expanded to cover other measurements.
  7. ^ Papanicolas, Irene; Smith, Peter C., eds. (2013). Health System Performance Comparison: An Agenda For Policy, Information And Research. Open University Press. pp. 319–320. ISBN 978-0-335-24727-1. Retrieved 26 September 2015. This [EHES] has the potential to provide data that are more accurate and offer greater potential for analysis on a comparable basis, and thus to set the performance of different health systems in context more accurately.
  8. ^ a b Tolonen, Hanna; Ahonen, Sanna; Jentoft, Susie; Kuulasmaa, Kari; Heldal, Johan (March 2015). "Differences in participation rates and lessons learned about recruitment of participants – The European Health Examination Survey Pilot Project". Scandinavian Journal of Public Health. 43 (2): 212–219. doi:10.1177/1403494814565692. ISSN 1651-1905. PMID 25592449. S2CID 34823385. Retrieved 26 September 2015.
  9. ^ Verschuuren, Marieke; Kramers, Pieter; Gudfinnsdottir, Gudrun; Aromaa, Arpo (2008). "Providing a solid evidence base for policy makers: ECHI initiative" (PDF). Eurohealth. 16 (3): 6. Retrieved 26 September 2015. Another important development initiated by the Commission is the European Health Examination Survey (EHES) […] this survey will be an important data source for ECHI [European Community Health Indicators].
  10. ^ Williams, Gareth; Fruhbeck, Gema, eds. (2009). Obesity: Science to Practice. Wiley. p. 25. ISBN 978-0-470-01911-5. Retrieved 26 September 2015.
  11. ^ Commission of the European Communities (22 July 2009). "Communication from the Commission to the European Parliament and the Council on a European initiative on Alzheimer's disease and other dementias". Eur-lex.Europa.eu. Brussels. Retrieved 26 September 2015. [T]he planned European Health Examination Survey (EHES) will also be able to provide valuable information through its cognitive test module, providing data with a strong predictive value on the evolution of this problem.
  12. ^ Gaio, Vânia; Nunes, Baltazar; Fernandes, Aida; Mendonça, Francisco; Correia, Filomena; Beleza, Álvaro; Gil, Ana Paula; Bourbon, Mafalda; Vicente, Astrid; Dias, Carlos Matias; Barreto da Silva, Marta (2014). "Genetic variation at the CYP2C19 gene associated with metabolic syndrome susceptibility in a South Portuguese population: results from the pilot study of the European Health Examination Survey in Portugal" (PDF). Diabetology & Metabolic Syndrome. 6 (23): 23. doi:10.1186/1758-5996-6-23. PMC 3932792. PMID 24548628. S2CID 17686529. Retrieved 26 September 2015.
  13. ^ a b c d e Tolonen, Hanna; Koponen, Päivikki; Aromaa, Arpo; Conti, Susanna; Graff-Iversen, Sidse; Grøtvedt, Liv; Heldal, Johan; Kanieff, Mark; Mindell, Jennifer; Natunen, Sanna; Primatesta, Paola; Verschuren, Monique; Viet, Lucie; Kuulasmaa, Kari (2008). Recommendations for organizing a standardized European Health Examination Survey (PDF). Helsinki: National Public Health Institute (Finland). p. 1. ISBN 978-951-740-841-7.
  14. ^ a b c d e f g h i j k l m n o Kilpeläinen, K.; Aromaa, A.; the ECHIM Project, eds. (2008). European Health Indicators: Development and Initial Implementation (PDF). Helsinki: Helsinki University Press. pp. 146–198. ISBN 978-951-740-858-5. Archived from the original (PDF) on 4 March 2016. Retrieved 21 September 2015.
  15. ^ "Croatia Program-For-Results: Improving Quality and Efficiency of Health Services" (PDF). WorldBank.org. World Bank. p. 2. Retrieved 21 September 2015.
  16. ^ a b c d e f g h i j k l m n o p q r s t u v w Kuulasmaa, Kari (23 September 2011). European Health Examination Survey (EHES) (PDF). ECHIM Core Group. pp. 8–10. Archived from the original (PDF) on 4 March 2016. Retrieved 21 September 2015.
  17. ^ a b "European Health Examination Survey Pilot Czech Republic" (PDF). EHES.info. Retrieved 25 September 2015.
  18. ^ a b c d e f g h i j k l m n o p q r s t u v w x y "National HESs conducted between 2000–2015 and known plans for 2016–2020". EHES.info. 21 September 2015. Retrieved 26 September 2015.
  19. ^ a b c "European Health Examination Survey Pilot Greece" (PDF). EHES.info. Retrieved 25 September 2015.
  20. ^ a b "European Health Examination Survey Pilot Italy" (PDF). EHES.info. Retrieved 25 September 2015.
  21. ^ a b "European Health Examination Survey Pilot Netherlands" (PDF). EHES.info. Retrieved 25 September 2015.
  22. ^ a b c "European Health Examination Survey Pilot Norway" (PDF). EHES.info. Retrieved 25 September 2015.
  23. ^ a b c "European Health Examination Survey Pilot Poland" (PDF). EHES.info. Retrieved 25 September 2015.
  24. ^ a b "European Health Examination Survey Pilot Portugal" (PDF). EHES.info. Retrieved 25 September 2015.
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Individual countries' HES sites

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