EURO GBD SEDATA COLLECTION

Gwenn MenvielleInserm, France

Consortium meetingRotterdam, March 25-26 2010

Plan

Mortality datasets Cross-sectionnal unlinked (CSU) datasets Longitudinal datasets

Risk factors datasets National datasets (NHS: National Health Survey) International datasets

Milestones for the coming months

General objective of the project Data on socioeconomic inequalities in mortality (total and by

cause of death), self-reported morbidity (self-assessed health, functional impairment), selected diseases (incidence of ischemic heart disease, cancers) and risk factors (smoking, alcohol, physical inactivity, overweight/obesity, high blood pressure, cholesterol, high blood glucose) in 2000-2005 will be collected from national and international data sources.

Data sources include national and regional longitudinal census-linked mortality studies, national and international health interview and health examination surveys, and regional and national disease incidence registries.

An effort will be made to cover as many countries of the European Union (including neighboring countries like Norway, Switzerland, Russia, …) as possible. Based on the experiences of a previous project (Eurothine, which covered the 1990s) we expect to be able to include more than 20 countries in the database.

Mortality data

Data on socioeconomic inequalities in mortality (total and by cause of death), self-reported morbidity (self-assessed health, functional impairment), selected diseases (incidence of ischemic heart disease, cancers) and risk factors (smoking, alcohol, physical inactivity, overweight/obesity, high blood pressure, cholesterol, high blood glucose) in 2000-2005 will be collected from national and international data sources.

Data sources include national and regional longitudinal census-linked mortality studies, national and international health interview and health examination surveys, and regional and national disease incidence registries.

An effort will be made to cover as many countries of the European Union (including neighboring countries like Norway, Switzerland, Russia, …) as possible. Based on the experiences of a previous project (Eurothine, which covered the 1990s) we expect to be able to include more than 20 countries in the database.

Mortality data

Objective To build a database on socioeconomic inequalities in

mortality in Europe in 2000-2005 To cover Europe, to include more than 20 countries

Format of the dataset Census around 2000

Demographic characteristics Mortality during the early 2000s

Information by causes of death

Countries included

Green: Cross-sectional unliked datasets

Red: Longitudinal datasets

22 countries or populations

New countries/populations

« Holes » remain

Cross-sectional unlinked datasets Already collected for Eurothine

Country Census Mortality

Hungary 2001 1999-2002

Czech Republik

2001 1999-2003

Poland 2002 2001-2003

Estonia 2000 1998-2002

(Lithuania) 2001 2000-2002

Longitudinal linked datasets

Region Country Census MortalityNorthern Europe

Norway 2001 Nov 2001-Nov 2006

Sweden 2001?Finland 2000Denmark 2001 2001-2005

Baltic countries Lithuania 2001 2001-2004UK England&Wales 2001 PROBLEM

Scotland 2001 PROBLEMWestern Europe Netherlands 2000

Belgium (Brussels)

2001 2001-2004

Austria 2001 May 2001-May 2002Switzerland 2000 Jan 2001-Dec 2005France 1999 Mar 1999-Dec 2007

Longitudinal datasets

Region Country Census

Mortality

Southern Europe

Italy Turin 2001 Nov 2001-Oct 2006

Tuscany (Florence, Leghorn, Prato)

2001 Oct 2001-Dec 2005

Spain Madrid 2001 Nov 2001-June 2003

Barcelona 2000 2000-2006

Basque country 2001

Central Europe Slovenia 2002 PROBLEM

Bulgaria 1992 1992-1998

Data collection update

Green: received

Yellow: coming

Violet: no access to the data

Red: Problem

New countries

More than 20 populations

More complex analysis process (not all will be run in Rotterdam)

Data collection update

Country Euro-GBD-SE

Follow-up Nb deaths Nb person years

Norway 2002-2006 205,702 13,286,050

Brussels 2001-2004 32,347 1,845,940

Austria 2001-2002 62,209 5,183,680

Switzerland 2001-2005 267,653 18,557,583

Turin 2001-2005 41,278 2,824,679

Madrid 2001-2003 68,916 5,593,910

Barcelona 2001-2006 107,078 8,077,659

Data collection update

Country Euro-GBD-SE Eurothine (age 30-74)

Follow-up Nb deaths Nb person years

Follow-up Nb deaths

Nb person years

Norway 2002-2006 205,702 13,286,050 1990-2000 213,022 19,956,767

Brussels 2001-2004 32,347 1,845,940 1991-1995 283,349 24,861,015

Austria 2001-2002 62,209 5,183,680 -- -- --

Switzerland 2001-2005 267,653 18,557,583 1990-2000 255,251 27,910,587

Turin 2001-2005 41,278 2,824,679 1991-2001 50,621 4,873,109

Madrid 2001-2003 68,916 5,593,910 1996-1997 22,585 3,663,333

Barcelona 2001-2006 107,078 8,077,659 1992-2001 77,101 8,151,810

Variables collected

Age Sex Place of residence (rural/urban) Marital status Housing tenure (tenant/owner)

Education (as detailed as possible) Occupational class

Causes of death

GBD methodology

Objective To adapt metrics like the Population Attributable

Fraction (PAF) and other methods developed in the Global Burden of Disease study to the needs of EURO-GBD-SE.

Format of the data Cross-sectional Causes of death causally associated with risk factors

This implies A new structure for the file A new list of causes of death

New structure of the file

Solution to get cross-sectional data Ask information (nb person years, nb subjects and nb

of deaths) year by year CSU datasets already in the good format

With this new structure Study socioeconomic inequalities as in Eurothine

add up for person years and nb of deaths Apply the GBD methodolog

take data for one year, possibly +-1 year in order to get more deaths and person-years

New list of causes of death

New list that accounts for the GBD needs We used the classification proposed by the GBD

group Some very specific causes of death

Will be studied with other causes of death

Example: High BMI IHD, ischemic stroke, hypertensive disease, diabetes

mellitus, cancer of corpus uteri, colon cancer, kidney cancer, postmenopausal breast cancer

Small inconsistency with CSU datasets Colorectal cancer, kidney and bladder cancer

Risk factors

Data on socioeconomic inequalities in mortality (total and by cause of death), self-reported morbidity (self-assessed health, functional impairment), selected diseases (incidence of ischemic heart disease, cancers) and risk factors (smoking, alcohol, physical inactivity, overweight/obesity, high blood pressure, cholesterol, high blood glucose) in 2000-2005 will be collected from national and international data sources.

Data sources include national and regional longitudinal census-linked mortality studies, national and international health interview and health examination surveys, and regional and national disease incidence registries.

An effort will be made to cover as many countries of the European Union (including neighboring countries like Norway, Switzerland, Russia, …) as possible. Based on the experiences of a previous project (Eurothine, which covered the 1990s) we expect to be able to include more than 20 countries in the database.

Risk factors

National health surveys (NHS) collected for Eurothine Self-reported risk factors Self-reported morbidity

Completed with International surveys National surveys with measured risk factors

NHS

NHS

Risk factors collected Socio and demographic variable (age, sex, education)

Smoking Alcohol (poor comparability) Diet Leisure time physical activity BMI (self-reported)

International surveys

Characteristics of the survey Representative of the general population Information on risk factors, collected with comparable

questionnaires Collected around the 2000s Information for all European countries (West&East)

Extensive review of what is available

Not many surveys with these criteria

International surveys

European Working Conditions Survey Available for Western and Eastern European countries 2000 & 2001 Work related factors

Physical work factors, working time, work organisation, information and consultation, psychosocial factors…

Eurobarometer Data for Eastern European countries in 2005 Norway and Switzerland are missing Smoking, alcohol, height, weight, physical activity

Measure of SES in these surveys Variable available

Age when finishing full time education

Problem Lower vs upper secondary education Upper secondary education (vocational) vs university

The European Quality of Life Survey characterises education with the two following variables Tertiary/secondary/primary education Age when finishing full time education

Surveys with measured risk factors The GBD methodology requires measured and not

self-declared risk factors (BMI, blood measurements, blood pressure)

Relevant studies should be defined in relation with mortality data No use to get detailed measured risk factors if we do

not have the mortality data in the correct format Example : Health Survey for England 2003

Interviewer visit: height and weight measurement Nurse visit: blood pressure, blood sample (total&HDL

cholesterol, C-reactive protein), eating habits (salt, fat)

Milestones for the coming months

Mortality data Collection of last mortality datasets

7 countries/populations missing, including France and NL

Solving problems for E&W, Scotland and Slovenia Harmonisation of variables

Education level Occupational class

Preparation of datasets for the « classical » socioeconomic inequalities analyses Inequalities in mortality and morbidity, and in

summary measures (WP7 & WP8) Specification file for mortality datasets

Milestones for the coming months

GBD analyses In collaboration with WP4, WP6 & WP9

Preparation of the mortality datasets

National and international health surveys Collection of surveys (national) Overview of variables available Harmonisation of variables when relevant Definition of education level

Milestones for the coming months

GBD analyses Computation of

Mortality rates all cause/cause specific By age group and SES RR for the different risk factors by age and SES

This will be done also after M12 when the analyses will be conduted