methods, notes and classification Hospital days of in-patients methods, notes and classification

Health

European health statistics measure both objective and subjective aspects of population's health. They cover different kinds of health-related issues in different sides of everybody's life, including key indicators on the functioning of the health care systems.

These aspects include:

  • Public health

    • Health status: self-reported health and morbidity, functional and activity limitations, injuries
    • Health determinants: overweight and obesity, physical activity, dietary habits, risky behaviours such as tobacco and alcohol consumption
    • Health care: health care expenditure, health care resources (staff and facilities) and activities (hospital and ambulatory services)
    • Morbidity: diagnosis-specific morbidity (prevalence and incidence rates for defined diseases). This domain is under development.
    • Disability: prevalence of disability, employment of disabled persons, barriers to the social integration of disabled persons
    • Causes of death: national and regional mortality data by causes of death
  • Health and safety at work

    • Accidents at work: incidence of accidents, causes of accidents
    • Occupational diseases and other work-related health problems: incidence of work-related health problems, hazardous exposure
  • Uses of the data

Health statistics are used to monitor the EU Health strategy, the EU Strategy on health and safety at work and their contribution to the Europe 2020 strategy. They have a key role to support the elaboration of evidence-based policies both at national and European levels.

Those statistics also serve for calculating indicators of the health portfolio used for the monitoring of the social protection and social inclusion and the set of indicators known as the European Core Health Indicators (ECHI).

Health status and determinants

The section presents data on various aspects of health status of population and its non-medical determinants, life styles and health behaviour. The data enable analysing public health issues as well as demographic and socio-economic patterns and disparities in health status and its determinants and provide a tool for monitoring effects of health policies.

The data are structured as follows:

  • Health status

    • Healthy life years
    • Self-perceived health and well-being
    • Functional and activity limitations
    • Self-reported chronic morbidity
    • Injuries from accidents
  • Health determinants

    • Body mass index
    • Physical activity
    • Consumption of fruits and vegetables
    • Tobacco consumption
    • Alcohol consumption

Data

Aggregated data are presented according to several formats:

* Main tables: the data are presented according to a predefined format and allows for quick visualisation  
* Database: the data are presented in multidimensional datasets allowing visualisation and extraction in a variety of formats by the user.  

Tables on health status and health determinants indicators are expressed as percentages within (or share of) the population combining various breakdowns: sex, age (group), labour status, educational attainment level and income quintile (group).

Indicators on Healthy Life Years and other health expectancies are disseminated annually and presented in number of years and as percentages of the (total) life expectancy at different ages for men and women.

Microdata for scientific purposes are available and more information is provided at: http://epp.eurostat.ec.europa.eu/portal/page/portal/microdata/introduction.

Data sources

Most of the data on health status and indicators on health determinants come from two surveys:

* EU Statistics on Income and Living Conditions (EU-SILC) provides annually data on indicators of self-perceived health, long-standing illness or health problem and self-perceived long-standing limitations in usual activities due to health problem  
* European Health Interview Survey (EHIS) provides every five years data for most health status and health determinants indicators. The present data cover the so-called 2008 round which was conducted under a gentlemen's agreement.  

Healthy Life Years (HLY) and other health expectancies are composite indicators combining mortality and health status data. Mortality data comes from Eurostat’s demographic database, while self-perceived health data come from different sources depending on the indicator:

* Healthy Life Years (from 2004 onwards): EU Statistics on Income and Living Conditions (EU-SILC) using Global Activity Limitation Instrument (GALI)  
* Healthy Life Years (1995 - 2003): European Community Household Panel (ECHP) using activity limitation data (different form GALI)  
* Healthy life expectancy based on self-perceived health: EU-SILC using self-perceived health data.  

Health care

The section presents data on various aspects of health care systems such as health care expenditure, human and technical health care resources, health care activities in hospitals and outside hospitals (covering treatment and prevention), use of medicines and unmet needs for health care. The indicators can be used for evaluating functioning and performance of health care systems including quality and access to health care services.

The data are structured as follows:

* Health care expenditure (by provider, function and financing agent)  
* Health care resources (health care employment and education; physical and technical resources)  
* Health care activities in hospitals (hospital care and average length of stay, diagnostic exams and surgical procedures)   
* Ambulatory care (consultations of doctors, dentists and other health care professionals)  
* Preventive services (cancer-related screenings and vaccination against influenza)  
* Medicine use (use of prescribed and non-prescribed medicines)  
* Unmet needs for health (medical and dental) care  

Data

Aggregated data are presented according to several formats:

* Main tables: the data are presented according to a predefined format and allows for quick visualisation  
*Database: the data are presented in multidimensional datasets allowing visualisation and extraction in a variety of formats by the user.  

Microdata for scientific purposes are available and more information is provided at: http://epp.eurostat.ec.europa.eu/portal/page/portal/microdata/introduction.

Data on health care statistics come from administrative data and from surveys. Administrative data provide a complete and more objective picture on some topics and usually permit regional breakdown (NUTS 2). Data from surveys, which are of more subjective nature, complement administrative data for some topics and enable measuring socio-economic disparities in the use of and access to health care services.

Data sources

There are four main data collections from which data on health care come from:

* Joint OECD-Eurostat-WHO Health Accounts (SHA) Data Collection provides annually data on health care expenditure data that are compiled according to the System of Health Accounts (SHA) methodology  
* Joint OECD-Eurostat-WHO-Europe data collection on Non-Monetary Health Care Statistics provides annually data on health care resources and most of the data on health care activities (hospital discharges and length of stay, medical procedures, selected preventive services and consultations)  
* EU Statistics on Income and Living Conditions (EU-SILC) provides annually data on unmet needs for medical and dental care  
* European Health Interview Survey (EHIS) provides every five years data for some health care activities (self-reported use of hospital services, consultations, preventive services and use of medicines). The present data cover the so-called 2008 round which was conducted under a gentlemen's agreement.  

Disability

Main features of disability statistics

The United Nations Convention on the rights of persons with disabilities states that “persons with disabilities include those who have long-term physical, mental, intellectual, or sensory impairments which in interaction with various barriers may hinder their full and effective participation in society on an equal basis with others”. Disability statistics provides data on the number of disabled persons as well as on their involvement in the society, through data related to living conditions, social inclusion, labour market, health, or education.

The European Disability Strategy 2010-2020

The European Disability Strategy 2010-2020 is the EU framework for implementing the UN Convention. Disability statistics should monitor the situation of disabled people with reference to the Europe 2020 targets and the areas for action included in the Strategy.

Data

Aggregated data are presented according to several formats:

* Main tables: the data are presented according to a predefined format and allows for quick visualisation  
* Database: the data are presented in multidimensional datasets allowing visualisation and extraction in a variety of formats by the user  
* Ad-hoc module: predefined tables from the Labour Force Survey (LFS) ad-hoc module on employment of disabled people conducted in 2011  

Microdata for scientific purposes are currently available for EU-SILC, EHIS and the LFS ad hoc module on employment of disabled people. For more information see: http://epp.eurostat.ec.europa.eu/portal/page/portal/microdata/introduction.

Data sources

The following surveys provide data corresponding to different aspects of the European Disability Strategy:

* The EU Statistics on Income and Living Conditions (SILC) instrument collects annually data on long-standing activity limitation due to health problems and provides information on income, social inclusion and living conditions (from 2004 onwards)  
* The European Health Interview Survey (EHIS) collects every 5 years data on the level of functioning and activity limitations in the population and provides other information on health status, health determinants and health care use  
* The European Health and Social Integration Survey (EHSIS) collected data in 2012/2013 on the barriers to participation in different life areas for people having a health problem or a basic activity difficulty  
* The Labour Force Survey (LFS) collected in 2002 and 2011 data on the situation of disabled people on the labour market within specific ad-hoc modules.  
* The European System of Integrated Social Protection Statistics (ESSPROS) has also some data dedicated to disabled people, in particular disability benefits and disability pensions.  

Ad-hoc module

2011 Labour Force Survey ad-hoc module

* Regulation

Data on the employment of disabled people was collected in 2011 in the context of a Labour Force Survey ad-hoc module.

*Methodology

Methodological guidelines

Causes of death

Statistics on causes of death (COD) provide information on mortality patterns and form a major element of public health information.

COD data refer to the underlying cause which - according to the World Health Organisation (WHO) - is "the disease or injury which initiated the train of morbid events leading directly to death, or the circumstances of the accident or violence which produced the fatal injury".

Data are based on the International Statistical Classification of Diseases and Related Health Problems (ICD) and are available annually at national and regional level.

Data on COD are collected according to the Regulation on Causes of Death statistics which was adopted in April 2011. The first reference year to be collected following that regulation is 2011. COD statistics distinguish information on residents and non-residents; data on stillbirths allow computing perinatal mortality rates according to the EU standards fixed in the regulation.

Data

Data on causes of death are available at national and regional level (NUTS 2) for total number, crude death rates (CDRs) and standardised death rates (SDRs), broken down by sex and age groups.

From 2013 onwards, the causes of death statistics are disseminated according to different groups of causes based on the European Short List revised in 2012.

The data is based on the International Statistical Classification of Diseases and Related Health Problems (ICD). More detailed data (ICD-10 3 or 4-character level) are available for most countries on request.

From 2013 onwards a new EU standard population is in place for the calculation of standardised rates. The rates in the Eurostat data collection were re-calculated backwards and trends are shown according to that new standard.

Aggregated data are presented according to several formats:

* Main tables: the data are presented according to a predefined format and allows for quick visualisation  
* Database: the data are presented in multidimensional datasets allowing visualisation and extraction in a variety of formats by the user.  

Accidents at work & work related health problems

The need to improve working conditions is a collective concern, prompted by both humanitarian and economic considerations. Create more jobs and of better quality is one of the main objectives of the EU social policy. A safe and healthy working environment is an essential element of the quality of work.

The EU action in health and safety at work has its legal basis in Article 153 of the EU Treaty. Community action is not limited to legislation. The Commission has widened the scope of its activities, in favour of information, guidance and promotion of a healthy working environment by paying particular attention to small and medium-size enterprises.

Health and Safety at Work statistics provide data on accidents at work, work-related health problems and exposure to risk factors.

In order to develop Health and Safety at Work statistics the main partners within the European Statistical System are National Statistical Offices, Social Security Institutions (Worker's Compensation or similar) and Ministries of Labour Affairs.

Data

Aggregated data are presented according to several formats:

* Main tables: the data are presented according to a predefined format and allows for quick visualisation  
* Database: the data are presented in multidimensional datasets allowing visualisation and extraction in a variety of formats by the user.  
Data sources

Statistics on accidents at work are derived from two main sources:

* European statistics on accidents at work is the main data source and provides data on accidents at the workplace or in the course of an occupational activity from declarations to the insurance (public insurance, social security scheme, or private insurance scheme) or to another competent authority (usually the labour inspectorate). Data concern non-fatal accidents at work with more than 3 days of absence as well as fatal accidents.  
* The Labour Force Survey collected in 1999, 2007 and 2013 data on accidents at work including accidents resulting in less than 3 days of absence, work-related health problems and exposure to risk factors in specific ad-hoc modules.  

Legislation

In December 2008, the European Parliament and the Council adopted 'Regulation 1338/2008 on Community statistics on public health and health and safety at work’. The Regulation is designed to ensure that health statistics provide adequate information for all EU Member States to monitor Community actions in the field of public health and health and safety at work.

The Regulation lists five domains for which implementing regulations specifying in detail the list of variables and methodological aspects were or are to be developed:

* Health status and health determinants  
* Health care  
* Causes of death: [Regulation (EU) No 328/2011 on statistics on causes of death][14] was adopted in 2011  
* Accidents at work: [Regulation (EU) No 349/2011 on statistics on accidents at work][15] was adopted in 2011  
* Occupational diseases and other work-related health problems and illnesses  

Regulation (EU) No 141/2013 on European Health Interview Survey covers parts of the two first domains, i.e. health status, health determinants and health care.

In addition, data on selected health issues are collected via two other social surveys, namely:

Methodology

The data used to produce health statistics come from different sources, namely:

* Joint OECD-Eurostat-WHO Health Accounts (SHA) Data Collection provides annually data on [health care expenditure][24] data that are compiled according to the System of Health Accounts (SHA) methodology.  
* Joint OECD-Eurostat-WHO-Europe data collection on Non-Monetary Health Care Statistics provides annually data on [health care resources][25] and data on [health care activities][26] (hospital discharges and length of stay, medical procedures, selected preventive services and consultations).  
* European Health Interview Survey (EHIS) collects a large variety of data on health status, [health determinants and health care activities][27] on non-annual basis. The first wave was conducted around 2008 among 17 countries. The second wave will be conducted between 2013 to 2015 in all Member States, Iceland and Norway and run regularly every 5 years.  
* European Union Statistics on Income and Living Conditions (EU-SILC) is the reference source for statistics on income and poverty at EU-level. Both cross-sectional (data pertaining to a given year) and longitudinal (pertaining to changes over a four-year period) data are collected in a harmonised fashion across all EU Member States, Iceland, Norway, Switzerland and Turkey. A detailed description of the source can be found in [Income, Social Inclusion and Living Conditions][28]. The EU-SILC contains 7 annual variables on health status and health care use.  
* The Labour Force Survey (LFS) is a quarterly household sample survey carried out in the Member States of the European Union, Candidate Countries and EFTA countries (except Lichtenstein). It is the main source of information about the situation and trends on the labour market in the European Union. Further information is available in [Employment and unemployment][29]. Periodically LFS ad-hoc modules cover [employment of disabled people][30] and [accidents at work and work related health problems][31].  
* Data collection on causes of death provides annual national and regional data on selected [causes of death][32] based on the International Statistical Classification of Diseases and Related Health Problems (ICD). Data are collected according to [Regulation on Causes of Death statistics][33] which was adopted in April 2011. It replaced a prior gentlemen's agreement with Member States.  
* Data collection on accidents at work provides annual national statistics on [non-fatal accidents at work with more than 3 days of absence as well as fatal accidents at work][34]. Data are collected according the [Regulation on statistics on accidents at work][35] adopted in April 2011.  
* Data collection on diagnosis-specific morbidity was piloted in 16 Member States based on the Morbidity Statistics Development Group shortlist 2007. The goal is to develop a data collection at national level based on best estimates by linking data from different administrative sources, based on the International Statistical Classification of Diseases and Related Health Problems. No data are available for dissemination.  

Links

EU institutions and agencies
International organizations
    • Age class
      • 0 Total
      • 1 Less than 1 year
      • 2 From 1 to 4 years
      • 3 From 5 to 9 years
      • 4 From 10 to 14 years
      • 5 Less than 14 years
      • 6 From 15 to 19 years
      • 7 From 20 to 24 years
      • 8 From 25 to 29 years
      • 9 From 30 to 34 years
      • a From 35 to 39 years
      • b From 40 to 44 years
      • c From 45 to 49 years
      • d From 50 to 54 years
      • e From 55 to 59 years
      • f From 60 to 64 years
      • g From 65 to 69 years
      • h 65 years or over
      • i From 70 to 74 years
      • j From 75 to 79 years
      • k From 80 to 84 years
      • l From 85 to 89 years
      • m From 90 to 94 years
      • n 90 years or over
      • o 95 years or over
      • p Unknown
    • Health indicator
      • 0 Bed-days
    • Unit of measure
      • 0 Number
    • Sex
      • 0 Total
      • 1 Males
      • 2 Females
      • 3 Unknown
    • International Statistical Classification of Diseases and Related Health Problems (ICD-10 2007)
      • 00 All causes of diseases (A00-Z99) excluding V00-Y98
      • 01 All causes of diseases (A00-Z99) excluding V00-Y98 and Z38
      • 02 Certain infectious and parasitic diseases (A00-B99)
      • 03 Tuberculosis
      • 04 Intestinal infectious diseases except diarrhoea
      • 05 Diarrhoea and gastroenteritis of presumed infectious origin
      • 06 Septicaemia
      • 07 Human immunodeficiency virus [HIV] disease
      • 08 Other infectious and parasitic diseases (remainder of A00-B99)
      • 09 Neoplasms
      • 0a Malignant neoplasms (C00-C97)
      • 0b Malignant neoplasm of colon, rectosigmoid junction, rectum, anus and anal canal
      • 0c Malignant neoplasm of trachea, bronchus and lung
      • 0d Malignant neoplasms of skin
      • 0e Malignant neoplasm of breast
      • 0f Malignant neoplasm of uterus
      • 0g Malignant neoplasm of ovary
      • 0h Malignant neoplasm of prostate
      • 0i Malignant neoplasm of bladder
      • 0j Other malignant neoplasms (remainder of C00-C97)
      • 0k In situ neoplasms
      • 0l Benign neoplasm of colon, rectum, anus and anal canal
      • 0m Leiomyoma of uterus
      • 0n Other in situ neoplasms, benign neoplasms and neoplasms of uncertain or unknown behaviour (remainder of D00-D48)
      • 0o Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism
      • 0p Anaemias
      • 0q Other diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism
      • 0r Endocrine, nutritional and metabolic diseases (E00-E90)
      • 0s Diabetes mellitus
      • 0t Other endocrine, nutritional and metabolic diseases (remainder of E00-E90)
      • 0u Mental and behavioural disorders (F00-F99)
      • 0v Dementia
      • 0w Mental and behavioural disorders due to use of alcohol
      • 0x Mental and behavioural disorders due to psychoactive substance use
      • 0y Schizophrenia, schizotypal and delusional disorders
      • 0z Mood [affective] disorders
      • 10 Other mental and behavioural disorders (remainder of F00-F99)
      • 11 Diseases of the nervous system (G00-G99)
      • 12 Alzheimer disease
      • 13 Multiple sclerosis
      • 14 Epilepsy, status epilepticus
      • 15 Transient cerebral ischaemic attacks and related syndromes
      • 16 Other diseases of the nervous system (remainder of G00-G99)
      • 17 Diseases of the eye and adnexa
      • 18 Cataract
      • 19 Other diseases of the eye and adnexa (remainder of H00-H59)
      • 1a Diseases of the ear and mastoid process
      • 1b Diseases of the circulatory system (I00-I99)
      • 1c Hypertensive diseases
      • 1d Angina pectoris
      • 1e Acute myocardial infarction including subsequent myocardial infarction
      • 1f Other ischaemic heart disease
      • 1g Pulmonary heart disease and diseases of pulmonary circulation
      • 1h Conduction disorders and cardiac arrhythmias
      • 1i Heart failure
      • 1j Cerebrovascular diseases
      • 1k Atherosclerosis
      • 1l Varicose veins of lower extremities
      • 1m Other diseases of the circulatory system (remainder of I00-I99)
      • 1n Diseases of the respiratory system (J00-J99)
      • 1o Acute upper respiratory infections and influenza
      • 1p Pneumonia
      • 1q Other acute lower respiratory infections
      • 1r Chronic diseases of tonsils and adenoids
      • 1s Other diseases of upper respiratory tract (J30-J34, J36-J39)
      • 1t Asthma and status asthmaticus
      • 1u Other lower respiratory diseases
      • 1v Other diseases of the respiratory system
      • 1w Diseases of the digestive system (K00-K93)
      • 1x Disorders of teeth and supporting structures
      • 1y Other diseases of oral cavity, salivary glands and jaws
      • 1z Diseases of oesophagus
      • 20 Ulcer of stomach, duodenum and jejunum
      • 21 Dyspepsia and other diseases of stomach and duodenum
      • 22 Diseases of appendix
      • 23 Inguinal hernia
      • 24 Other abdominal hernia
      • 25 Crohn disease and ulcerative colitis
      • 26 Other noninfective gastroenteritis and colitis
      • 27 Paralytic ileus and intestinal obstruction without hernia
      • 28 Diverticular disease of intestine
      • 29 Diseases of anus and rectum
      • 2a Other diseases of intestine (K55,K58-K59,K63)
      • 2b Alcoholic liver disease
      • 2c Other diseases of liver
      • 2d Cholelithiasis
      • 2e Other diseases of gallbladder and biliary tract
      • 2f Diseases of pancreas
      • 2g Other diseases of the digestive system (remainder of K00-K93)
      • 2h Diseases of the skin and subcutaneous tissue (L00-L99)
      • 2i Infections of the skin and subcutaneous tissue
      • 2j Dermatitis, eczema and papulosquamous disorders
      • 2k Other diseases of the skin and subcutaneous tissue (remainder of L00-L99)
      • 2l Diseases of the musculoskeletal system and connective tissue (M00-M99)
      • 2m Coxarthrosis [arthrosis of hip]
      • 2n Gonarthrosis [arthrosis of knee]
      • 2o Internal derangement of knee
      • 2p Other arthropathies (M00-M15, M18-M22 ,M24-M25)
      • 2q Systemic connective tissue disorders
      • 2r Deforming dorsopathies and spondylopathies
      • 2s Cervical disc disorders, other intervertebral disc disorders
      • 2t Dorsalgia
      • 2u Soft tissue disorders
      • 2v Other disorders of the musculoskeletal system and connective tissue
      • 2w Diseases of the genitourinary system (N00-N99)
      • 2x Glomerular and renal tubulo-interstitial diseases
      • 2y Renal failure
      • 2z Urolithiasis
      • 30 Other diseases of the urinary system
      • 31 Hyperplasia of prostate
      • 32 Other diseases of male genital organs
      • 33 Disorders of breast
      • 34 Inflammatory diseases of female pelvic organs
      • 35 Menstrual, menopausal and other female genital conditions
      • 36 Other diseases of the genitourinary system (remainder of N00-N99)
      • 37 Pregnancy, childbirth and the puerperium (O00-O99)
      • 38 Medical abortion
      • 39 Other pregnancy with abortive outcome (O00-O03,O05-O08)
      • 3a Complications of pregnancy predominantly in the antenatal period
      • 3b Complications of labour and delivery
      • 3c Single spontaneous delivery
      • 3d Other delivery
      • 3e Complications predominantly related to the puerperium
      • 3f Other obstetric conditions
      • 3g Certain conditions originating in the perinatal period (P00-P96)
      • 3h Disorders related to short gestation and low birth weight, not elsewhere classified
      • 3i Other conditions originating in the perinatal period (remainder of P00-P96)
      • 3j Congenital malformations, deformations and chromosomal abnormalities (Q00-Q99)
      • 3k Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99)
      • 3l Pain in throat and chest
      • 3m Abdominal and pelvic pain
      • 3n Unknown and unspecified causes of morbidity
      • 3o Other symptoms, signs and abnormal clinical and laboratory findings (remainder of R00-R99)
      • 3p Injury, poisoning and certain other consequences of external causes (S00-T98)
      • 3q Other injuries (S10-S51, S53-S71, S73-S81, S83-T14, T79)
      • 3r Intracranial injury
      • 3s Other injuries to the head (S00-S05, S07-S09)
      • 3t Fracture of forearm
      • 3u Fracture of femur
      • 3v Fracture of lower leg, including ankle
      • 3w Burns and corrosions
      • 3x Poisonings by drugs, medicaments and biological substances and toxic effects
      • 3y Complications of surgical and medical care, not elsewhere classified
      • 3z Sequelae of injuries, of poisoning and of other consequences of external causes
      • 40 Other and unspecified effects of external causes (remainder of S00-T98)
      • 41 Factors influencing health status and contact with health services (Z00-Z99)
      • 42 Medical observation and evaluation for suspected diseases and conditions
      • 43 Contraceptive management
      • 44 Liveborn infants according to place of birth
      • 45 Other medical care
      • 46 Other factors influencing health status and contact with health services (remainder of Z00-Z99)
    • Geopolitical entity (reporting)
      • 0 Belgium
      • 1 Bulgaria
      • 2 Czech Republic
      • 3 Denmark
      • 4 Germany (until 1990 former territory of the FRG)
      • 5 Estonia
      • 6 Ireland
      • 7 Greece
      • 8 Spain
      • 9 France
      • a Croatia
      • b Italy
      • c Cyprus
      • d Latvia
      • e Lithuania
      • f Luxembourg
      • g Hungary
      • h Malta
      • i Netherlands
      • j Austria
      • k Poland
      • l Portugal
      • m Romania
      • n Slovenia
      • o Slovakia
      • p Finland
      • q Sweden
      • r United Kingdom
      • s Iceland
      • t Liechtenstein
      • u Norway
      • v Switzerland
      • w Montenegro
      • x Former Yugoslav Republic of Macedonia, the
      • y Serbia
      • z Turkey