Herman Van Oyen

Death toll exceeded 70,000 in Europe during the summer of 2003

Daily numbers of deaths at a regional level were collected in 16 European countries. Summer mortality was analyzed for the reference period 1998-2002 and for 2003. More than 70,000 additional deaths occurred in Europe during the summer 2003. Major distortions occurred in the age distribution of the deaths, but no harvesting effect was observed in the months following August 2003. Global warming constitutes a new health threat in an aged Europe that may be difficult to detect at the country level, depending on its size. Centralizing the count of daily deaths on an operational geographical scale constitutes a priority for Public Health in Europe.

Inequalities in healthy life years in the 25 countries of the European Union in 2005: a cross-national meta-regression analysis

BACKGROUND Although life expectancy in the European Union (EU) is increasing, whether most of these extra years are spent in good health is unclear. This information would be crucial to both contain health-care costs and increase labour-force participation for older people. We investigated inequalities in life expectancies and healthy life years (HLYs) at 50 years of age for the 25 countries in the EU in 2005 and the potential for increasing the proportion of older people in the labour force. METHODS We calculated life expectancies and HLYs at 50 years of age by sex and country by the Sullivan method, which was applied to Eurostat life tables and age-specific prevalence of activity limitation from the 2005 statistics of living and income conditions survey. We investigated differences between countries through meta-regression techniques, with structural and sustainable indicators for every country. FINDINGS In 2005, an average 50-year-old man in the 25 EU countries could expect to live until 67.3 years free of activity limitation, and a woman to 68.1 years. HLYs at 50 years for both men and women varied more between countries than did life expectancy (HLY range for men: from 9.1 years in Estonia to 23.6 years in Denmark; for women: from 10.4 years in Estonia to 24.1 years in Denmark). Gross domestic product and expenditure on elderly care were both positively associated with HLYs at 50 years in men and women (p<0.039 for both indicators and sexes); however, in men alone, long-term unemployment was negatively associated (p=0.023) and life-long learning positively associated (p=0.021) with HLYs at 50 years of age. INTERPRETATION Substantial inequalities in HLYs at 50 years exist within EU countries. Our findings suggest that, without major improvements in population health, the target of increasing participation of older people into the labour force will be difficult to meet in all 25 EU countries. FUNDING EU Public Health Programme.

Comparative appraisal of educational inequalities in overweight and obesity among adults in 19 European countries

BACKGROUND In Western societies, a lower educational level is often associated with a higher prevalence of overweight and obesity. However, there may be important international differences in the strength and direction of this relationship, perhaps in respect of differing levels of socio-economic development. We aimed to describe educational inequalities in overweight and obesity across Europe, and to explore the contribution of level of socio-economic development to cross-national differences in educational inequalities in overweight and obese adults in Europe. METHODS Cross-sectional data, based on self-reports, were derived from national health interview surveys from 19 European countries (N = 127 018; age range = 25-44 years). Height and weight data were used to calculate the body mass index (BMI). Multivariate regression analysis was employed to measure educational inequalities in overweight and obesity, based on BMI. Gross domestic product (GDP) per capita was used as a measure of level of socio-economic development. RESULTS Inverse educational gradients in overweight and obesity (i.e. higher education, less overweight and obesity) are a generalized phenomenon among European men and even more so among women. Baltic and eastern European men were the exceptions, with weak positive associations between education and overweight and obesity. Educational inequalities in overweight and obesity were largest in Mediterranean women. A 10 000-euro increase in GDP was related to a 3% increase in overweight and obesity for low-educated men, but a 4% decrease for high-educated men. No associations with GDP were observed for women. CONCLUSION In most European countries, people of lower educational attainment are now most likely to be overweight or obese. An increasing level of socio-economic development was associated with an emergence of inequalities among men, and a persistence of these inequalities among women.

Assessing the validity of the Global Activity Limitation Indicator in fourteen European countries

BackgroundThe Global Activity Limitation Indicator (GALI), the measure underlying the European indicator Healthy Life Years (HLY), is widely used to compare population health across countries. However, the comparability of the item has been questioned. This study aims to further validate the GALI in the adult European population.MethodsData from the European Health Interview Survey (EHIS), covering 14 European countries and 152,787 individuals, were used to explore how the GALI was associated with other measures of disability and whether the GALI was consistent or reflected different disability situations in different countries.ResultsWhen considering each country separately or all combined, we found that the GALI was significantly associated with measures of activities of daily living, instrumental activity of daily living, and functional limitations (P < 0.001 in all cases). Associations were largest for activity of daily living and lowest though still high for functional limitations. For each measure, the magnitude of the association was similar across most countries. Overall, however, the GALI differed significantly between countries in terms of how it reflected each of the three disability measures (P < 0.001 in all cases). We suspect cross-country differences in the results may be due to variations in: the implementation of the EHIS, the perception of functioning and limitations, and the understanding of the GALI question.ConclusionThe study both confirms the relevance of this indicator to measure general activity limitations in the European population and the need for caution when comparing the level of the GALI from one country to another.

Eating out of home in Belgium: current situation and policy implications

The aim of the study was to characterise substantial out-of-home (SOH) eaters, describe the nutritional quality of their diet, compare SOH eaters and non-SOH eaters for a set of nutritional indicators and evaluate the quality of meals consumed at home and at different places outside the home. Information on food intake was collected with two 24 h recalls. Habitual food intake was estimated by the Nusser method. Non-dietary variables were obtained using a face-to-face questionnaire. SOH eaters were defined as individuals who consume at least 25% of their daily energy out of home. A representative sample (n 3245) of the Belgian population aged 15 years and older was randomly selected from the National Register using a multi-stage stratified procedure. Of the Belgian population, 35.2% were defined as SOH eaters. Energy intake, energy density of the total diet and daily consumption of most food groups, except for fruits and vegetables, were substantially higher among SOH eaters compared with non-SOH eaters. Out-of-home eating was more common among men than women and decreased with increasing age. There were considerable differences in portion sizes, consumption frequency of different foods and diversity of meals according to different places of consumption. Out-of-home eating is a significant nutritional issue in Belgium and is associated with a more adverse dietary profile. Out-of-home eating, places of consumption, and specific population groups, eating substantially out of home, should consequently be taken into account when designing and evaluating nutrition policies.

Reproducibility and validity of a diet quality index for children assessed using a FFQ

The diet quality index (DQI) for preschool children is a new index developed to reflect compliance with four main food-based dietary guidelines for preschool children in Flanders. The present study investigates: (1) the validity of this index by comparing DQI scores for preschool children with nutrient intakes, both of which were derived from 3 d estimated diet records; (2) the reproducibility of the DQI for preschoolers based on a parentally reported forty-seven-item FFQ DQI, which was repeated after 5 weeks; (3) the relative validity of the FFQ DQI with 3 d record DQI scores as reference. The study sample included 510 and 58 preschoolers (2.5-6.5 years) for validity and reproducibility analyses, respectively. Increasing 3 d record DQI scores were associated with decreasing consumption of added sugars, and increasing intakes of fibre, water, Ca and many micronutrients. Mean FFQ DQI test-retest scores were not significantly different: 72 (sd 11) v. 71 (sd 10) (P = 0.218) out of a maximum of 100. Mean 3 d record DQI score (66 (sd 10)) was significantly lower than mean FFQ DQI (71 (sd 10); P < 0.001). The reproducibility correlation was 0.88. Pearsons correlation (adjusted for within-person variability) between FFQ and 3 d record DQI scores was 0.82. Cross-classification analysis of the FFQ and 3 d record DQI classified 60 % of the subjects in the same category and 3 % in extreme tertiles. Cross-classification of repeated administrations classified 62 % of the subjects in the same category and 3 % in extreme categories. The FFQ-based DQI approach compared well with the 3 d record approach, and it can be used to determine diet quality among preschoolers.

Food Intakes by Preschool Children in Flanders Compared with Dietary Guidelines

The objective of this study was to compare food group intakes among preschool children with food-based dietary guidelines (FBDG) and to determine the proportion of children meeting these guidelines. Food consumption of preschool children (2.5–6.5 years) living in Flanders (Belgium) were assessed in a cross-sectional study, using proxy reported 3d estimated dietary records (EDR) (n 696). Statistical modelling was used to account for within-individual variation in the 3d EDR. Mean daily intakes of most food groups (beverages, vegetables, fruit and milk) were below the minimum recommendations. Only ‘grains and potatoes’ and ‘meat products’ were in line with the recommendations and ‘bread and cereals’ showed borderline intakes. Mean intakes of energy-dense and low-nutritious foods, which are discouraged within a healthy diet (like snacks and sugared drinks), were high. Furthermore, the percentage of children complying with the different food-based dietary guidelines was for most food groups extremely low (ranging from approximately 4% for fluid and vegetable intakes up to 99% for potato intakes). Boys had in general higher mean intakes of the recommended food groups. In conclusion, preschool children in Flanders follow eating patterns that do not meet Flemish FBDG. Although the impact of these eating habits on preschooler’s current and future health should be further investigated, it is clear that nutrition education and intervention are needed among preschool children and their parents in Flanders.

Calculating disability-adjusted life years to quantify burden of disease

The disability-adjusted life year or DALY is a summary measure of public health widely used to quantify burden of disease. In the DALY philosophy, every person is born with a certain number of life years potentially lived in optimal health. People may lose these healthy life years through living with illness and/or through dying before a reference life expectancy. These losses in healthy life years are exactly what is measured by the DALY metric. Ten DALYs, for instance, correspond to ten lost years of healthy life, attributable to morbidity, mortality, or both. On a population level, diseases with a higher public health impact will thus account for more DALYs than those with a lesser impact. DALYs have been the key measure in the four Global Burden of Disease (GBD) studies, each presenting a comprehensive assessment of the worldwide health impact of disease, injury and risk factors (Murray and Lopez 1996; Lopez et al. 2006; World Health Organization 2008; Murray et al. 2013a; Lopez 2013). Table 1 shows the most important diseases according to the different GBD studies. Furthermore, various national and regional DALY calculations have been performed to assess and monitor local health and to set priorities within the local health sector (e.g., Melse et al. 2000; Mathers et al. 2001; Devleesschauwer et al. 2013; Shield et al. 2013). In this Hints and Kinks paper, we summarize the DALY’s basic features and present a description of its calculation. An ‘‘Appendix’’ includes R code to calculate DALYs. The

The reliability of the Minimum European Health Module.

Objectives:The Minimum European Health Module (MEHM) consists of 3 global questions concerning 3 health domains: self-perceived health, chronic conditions and long-term activity limitation. The objective of this paper is to evaluate the reliability of the MEHM.Methods:Participants of the Belgian Food Consumption Survey were interviewed twice: 170 individuals were selected for the MEHM reliability evaluation. For each of the 3 questions Pearson and Kappa coefficients were estimated. Analyses were stratified by gender, age, education, language and time between the interviews.Results:The Pearson correlations are between 0.73 and 0.81. The Kappa estimates are good or excellent: 0.74 (self-perceived health), 0.77 (chronic conditions) and 0.68 (activity limitation). Also stratified analyses indicated in general an acceptable reliability.Conclusion:The MEHM has an acceptable reliability.

The Global Activity Limitation Index measured function and disability similarly across European countries

OBJECTIVE This work aims to validate and increase understanding of the Global Activity Limitation Index (GALI), an activity limitation measure from which the new structural indicator Healthy Life Years is generated. STUDY DESIGN AND SETTING Data from the Survey of Health and Retirement in Europe, covering 11 European countries and 27,340 individuals older than 50 years, was used to investigate how the GALI was associated with other existing measures of function and disability and whether the GALI was consistent or reflected different levels of health in different countries. RESULTS The GALI was significantly associated with the two subjective measures of activities of daily living score and instrumental activities of daily living (IADL) score, and the two objective measures of maximum grip strength and walking speed (P<0.001 in all cases). The GALI did not differ significantly between countries in terms of how it reflected three of the health measures, with the exception being IADL. CONCLUSION The GALI appears to satisfactorily reflect levels of function and disability as assessed by long-standing objective and subjective measures, both across Europe and in a similar way between countries.