Core measurements Hanna Tolonen EGHI subgroup on HES, 2 nd March 2011, Luxembourg

Causes of death in EU 1.Circulator diseases 2.Cancer 3.Ischemic heart disease 4.Respiratory diseases

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 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

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 2009,9:421 Shiely 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:

BLOOD PRESSURE

Reporting bias - hypertension 10-20% of people with elevated blood pressure are unaware of 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:

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 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-S12 WHO 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