Belgian health-related data in three international databases.

AIMS OF THE STUDY: This study wants to examine the availability of Belgian healthcare data in the three main international health databases: the World Health Organization European Health for All Database (WHO-HFA), the Organisation for Economic Co-operation and Development Health Data 2009 and EUROSTAT. METHODS: For the indicators present in the three databases, the availability of Belgian data and the source of these data were checked. MAIN FINDINGS: The most important problem concerning the availability of Belgian health-related data in the three major international databases is the lack of recent data. Recent data are available for 27% of the indicators of the WHO-HFA database, 73% of the OECD Health Data, and for half of the Eurostat indicators. Especially recent data about health status (including mortality-based indicators) are lacking. DISCUSSION: Only the availability of the health-related data is studied in this article. The quality of the Belgian data is however also important to examine.The main problem concerning the availability of health data is the timeliness. One of the causes of this lack of (especially mortality) data is the reform of the Belgian State. Nowadays mortality data are provided by the communities. This results in a delay in the delivery of national mortality data. However several efforts are made to catch up.

High incidence of primary pulmonary hypertension associated with appetite suppressants in Belgium.

Primary pulmonary hypertension is a rare, progressive and incurable disease, which has been associated with the intake of appetite suppressant drugs. The importance of this association was evaluated in Belgium while this country still had no restriction on the prescription of appetite suppressants. Thirty-five patients with primary pulmonary hypertension and 85 matched controls were recruited over 32 months (1992-1994) in Belgium. Exposure to appetite-suppressants was assessed on the basis of hospital records and standardized interview. Twenty-three of the patients had previously taken appetite suppressants, mainly fenfluramines, as compared with only 5 of the controls (66 versus 6%, p<0.0001). Five patients died before the interview, all of them had taken appetite suppressants. In 8 patients the diagnosis of primary pulmonary hypertension was uncertain, 5 of them had taken appetite suppressants. The patients who had been exposed to appetite suppressants tended to be on average more severely ill, and to have a shorter median delay between onset of symptoms and diagnosis. A policy of unrestricted prescription of appetite suppressants may lead to a high incidence of associated primary pulmonary hypertension. Intake of appetite suppressants may accelerate the progression of the disease.

Mortality in the elderly and ambient ozone concentration during the hot summer, 1994, in Belgium.

Extensive investigations were carried out to study the relationship between daily mortality in the elderly, outdoor air temperature, and ozone concentration observed in Belgium during the hot summer, 1994. The two environmental variables were assessed through mean daily temperature and 24-hr ozone concentration, both measured the day before and averaged over the country. Data were stratified by terciles of mean daily temperature in order to reduce the degree of collinearity between the investigated environmental variables. In the first stratum, which ranged from 9.9 to 15.4 degrees C (41 days), mean daily temperature and 24-hr ozone concentration were not correlated while the mean number of daily deaths was higher when 24-hr ozone concentration increased from 45 to 55 micrograms/m3 (P < 0.05). In the second stratum, which ranged from 15.6 to 20.3 degrees C (42 days), mean daily temperature and 24-hr ozone concentration were strongly correlated (r = 0.54, P < 0.0001). In this stratum, the number of daily deaths did not depend on the mean daily temperature but increased linearly with 24-hr ozone concentration within the range 25 to 85.5 micrograms/m3 (P < 0.001). After having examined the possible confounding effect of sulfur dioxide, nitrogen dioxide, fine particulates, and humidity, ozone was found to be the only investigated variable contributing to the increased daily mortality. In the third stratum, which ranged from 20.4 to 27.6 degrees C (40 days), mean daily temperature and 24-hr ozone concentration were also strongly correlated (r = 0.71, P < 0.0001). Daily mortality, in this stratum, was correlated more with mean daily temperature (r = 0.68, P < 0.001) than with 24-hr ozone concentration (r = 0.55, P < 0.001). Nonparametric regression analyses were performed to model the number of daily deaths in the whole range of temperatures. These analyses confirmed the effect of 24-hr ozone concentration on daily mortality already uncovered by the least-squares regression analysis in the second stratum of mean daily temperature. In addition, at levels exceeding 20 degrees C, the effect of ozone concentration on daily mortality was enhanced by temperature owing to a positive interaction between these two variables. The present study thus demonstrated a statistical association between daily mortality, observed in the elderly during the hot summer, 1994, in Belgium, and ambient ozone concentration. This relationship was dependent on the range of temperatures.

Results of an epidemiological study on drug-treated intraocular hypertension in Belgium.

Some epidemiological aspects of drug-treated intraocular hypertension in Belgium were established in 1992 from questionnaires filled in by 1513 patients who attended a sample of 209 pharmacies open to the public. The mean age of the patients was 67 years (range: 3-95). After standardization for age, the prevalence of diabetes mellitus among patients was found to be 1.7 times higher than in the general population. Family history of glaucoma and/or blindness was reported by 28% of the patients. Beta-blocker eye drops were used by 96% of the sample. An ophthalmologist was consulted more than four times a year by 24% of the patients who had been drug-treated for less than one year; the proportion, however, decreases to 11% for those treated for at least five years. The annual consumed dose of eye drops containing parasympathomimetics, beta-blockers, and epinephrine or dipivefrine was 12.4, 13.6, and 12.3 bottles, respectively, and that of ointments containing parasympathomimetics was 9.9 tubes. From these results and using sales figures, the prevalence of drug-treated intraocular hypertension was found to be 77 per 10,000 inhabitants (95% CI: 31-123).

Temperature, ambient ozone levels, and mortality during summer 1994, in Belgium.

The number of daily deaths, temperature, relative humidity, and 24-hr concentrations of main air pollutants observed during a heat wave (June 27-August 7, 1994) in Belgium were compared with those recorded before and after this heat wave. All these variables were averaged over the country. Expected mortality was calculated from daily deaths observed during the summers of 1985-1993. The influence of meteorological and air pollution variables on daily mortality was analyzed using generalized least-squares method. Mortality recorded during the heat wave was higher than expected: it increased by 9.4% in the age group 0-64 years (236 excess deaths; P < 0.001) and by 13.2% in the elderly (1168 excess deaths; P < 0.001). After the heat wave, mortality in the elderly was lower than expected (178 deficit deaths; P< 0.05); the net excess of mortality in the whole population amounted to 1226 deaths when accounting for this deficit. This increased mortality was associated with unusually high outdoor temperatures (range of daily mean: 15.3-27.5 degrees C) and elevated ozone levels (range of 24-hr concentration: 34.5-111.5 microg/m3). The duration of the ozone overexposure during the heat wave was also uncommon: half-hour concentrations of ozone exceeded, on an average, 100 microg/m3 for 8 consecutive hr. The number of daily deaths was mostly correlated with the mean daily temperature and 24-hr ozone concentration, both measured the day before. A synergy between temperature and ozone in their effects on mortality was also highlighted in both age groups. The product of the logarithm of temperature by the logarithm of ozone concentration, both measured the day before, contributed to 39.5% of the variance of the logarithm of daily deaths in elderly and to 4.5% in the age group 0-64 years. In conclusion, elevated outdoor temperatures combined with high ozone concentrations were assumed to be the likely cause of the important excess mortality observed in Belgium during the summer, 1994.

Estimate of disease prevalence using drug consumption data.

A simple method is presented to estimate the prevalence for chronic diseases treated with drugs that are specific to the disease and must be taken continuously. Data required for the computations involve the total amount of drugs sold in a given region and the mean intake of these drugs, which can be based on the defined daily doses, the prescribed daily doses, or the consumed daily doses. The prevalence of the studied disease is the most accurate using the consumed daily doses estimated in a sample of patients with the disease of interest. Data on diabetes mellitus and intraocular hypertension collected in Belgium in 1990 and 1992, respectively, were used to illustrate the applicability of this quick and inexpensive method. For these two diseases, the precision of the prevalence estimated with the present method is comparable to that achieved with conventional cross-sectional studies, but at a lower cost.

[Epidemiological study on neonatal septicemia and meningitis in Belgium]. / Etude épidémiologique sur les septicémies et méningites néonatales en Belgique.

Epidemiological data were collected for 219 cases of neonatal septicaemia and/or meningitis. In two thirds of the cases the diagnosis was made in newborns aged 4 days or less. Risk factors related to the delivery, to the health status of the infant at birth and to pregnancy were mentioned respectively in 74, 63 and 36% of the cases. Half of the newborns given antibiotics in prophylaxis received an association of aminopenicillin and aminoside. In more than four fifths of the cases the bacterium was only isolated from blood. In newborns aged 4 days or less at the time of diagnosis, S. agalactiae was the most frequently isolated agent (50%). In newborns aged 5 days or more at the time of diagnosis, E. coli was the most frequent isolate (23%), followed by S. agalactiae and coagulase-negative Staphylococcus (20%). The lethality was 18%. About three fourths of the children dying from the infection, died during the first week of life. For the children who did not die during their stay in hospital, the duration of hospitalization was longer than 4 weeks in 41%.

Pharmacoeconomics of immunisation: a review.

The effects of immunisation programmes that have existed for several decades in developed countries are demonstrated by the decrease and even eradication of smallpox, poliomyelitis, measles, mumps and hepatitis B. Cost, health policy and spontaneous evolution in the incidence of communicable diseases have a decisive influence on the use of a vaccine. Investment in vaccination policy has to be encouraged to maintain this progress made in the control of infectious diseases and to meet new challenges. Studies re-evaluating ongoing immunisation programmes are scarce. Nevertheless, it can be concluded that for vaccination against hepatitis B in professionally exposed at-risk populations, arguments for positive returns are consistent. The same holds for vaccination against S. pneumoniae and for influenza virus in the elderly. The results of the economic evaluation of revaccination against measles, when insufficient coverage exists, are inconclusive. Universal vaccination of children against Haemophilus influenzae type b (Hib) and of children of hepatitis B-positive mothers against hepatitis may require costs to be paid in order to gain extra health benefits.

[Trends in pneumococcal infections in Belgium from 1986 to 1991]. / Evolution des infections à pneumocoques en Belgique de 1986 à 1991.

Streptococcus pneumoniae is one of the most frequent causes of pneumonia, meningitis, and otitis media. Persons at high risk are young children, elderly, and individuals with immunodeficiency or with an underlying disease. Thanks to a network ot 111 laboratories spread all over Belgium, the evolution of the number of deep isolates of S. pneumoniae has been followed from 1986 to 1991: the recorded frequency increased with a mean number of isolations per laboratory and per year rising from 3.6 in 1986 to 6.2 in 1991. The objectives of this paper are to study the evolution of age and sex distribution of the patients, and of the origin of the isolates, and to propose solutions for slowing down this evolution.

Prevalence of drug-treated diabetes mellitus in Belgium. Results of a study with the collaboration of a network of pharmacies.

Within the framework of a European concerted action on diabetes mellitus (EURODIAB SubArea C), an epidemiological study was established in Belgium in 1990 in order to estimate the prevalence of drug-treated diabetes mellitus. An assessment was made of the sales of insulin and oral antidiabetic drugs and the average daily dose used. A sample of people with diabetes, clients of 107 pharmacies, provided the data to establish average daily doses. Those pharmacies, spread over the 9 provinces of the country, represent 2% of all private pharmacies in Belgium. Over a 2 month period each pharmacist presented a questionnaire to each client receiving an antidiabetic drug. In 1990, 164 per 10,000 inhabitants were treated with antidiabetic drugs, which means that there were approximately 163,000 drug-treated diabetics in Belgium. At the time of the survey 65% of the diabetics in the sample were 60 years or older. Overall, 38% of drug-treated diabetics took insulin, and 30% of them took only human insulin. Treatment type varied by the province where the pharmacy was located. The provinces of Hainaut and Luxembourg-Namur had a higher percentage of diabetics on oral treatment. This is the first description in Belgium of the prevalence of drug-treated diabetes and of the pattern of prescribing of these drugs.

Sero epidemiological characteristics of hepatitis C encountered in general practice in Belgium.

A study carried out between 1982 and 1984 established by exclusion diagnosis that 35% of viral hepatitis cases registered in Belgium were due to non A, non B (NANB) viruses. Recently, a new anti-hepatitis C virus (HCV) detection test was used to analyse the sera of patients in whom NANB hepatitis was diagnosed in that study. Using this new serological test for HCV, 29% of the NANB group was found to be positive for anti-HCV. In the 1982-84 study on viral hepatitis diagnosed by general practitioners, the number of clinically recognized infections was estimated at 14,700 (+/- 2,170; confidence interval at 95%) per year. By combining these data and the results of the present study, the following estimates could be calculated: HAV (7,129 +/- 1,054/year), HBV (2,426 +/- 358/year), HCV (1,470 +/- 216/year) and non-identified hepatitis viruses (3,675 +/- 543/year).

Declining trends in some sexually transmitted diseases in Belgium between 1983 and 1989.

OBJECTIVE: To examine trends in some sexually transmitted diseases in Belgium and to discuss them in the light of the European background. DESIGN: Analysis of the time trends of C trachomatis and N gonorrhoeae infections diagnosed by a network of microbiological laboratories, and of male urethritis diagnosed by a network of general practitioners. SETTING: Belgium. SUBJECTS: Reports of C trachomatis and N gonorrhoeae infections by a network of microbiological laboratories, and of male urethritis by a network of general practitioners, to the Institute of Hygiene and Epidemiology. RESULTS: Whereas an increase in the number of C trachomatis infections, more pronounced among women, was observed up to 1986, a small decrease has been observed afterwards in males. The mean number of chlamydial infections per laboratory and per year was 4.2 in 1983, 15.7 in 1986 and 13.9 in 1989. A decrease in the number of N gonorrhoeae infections, more pronounced among men, has been observed. The mean number of cases of gonorrhoea per laboratory and per year was 10.9 in 1983 and only 2.2 in 1989. The same declining trend has been observed in another surveillance programme of male urethritis, based on a network of general practitioners. The number of cases of male urethritis per 100 patient encounters went down from 0.06 in 1982-3 to 0.04 in 1988-9. CONCLUSION: The declining trend in Western Europe in incidence of gonococcal infections and of urethritis in men is also occurring in Belgium, but genital chlamydial infections remain an important public health problem.

A sentinel network of microbiological laboratories as a tool for surveillance of infectious diseases in Belgium.

In the development of a surveillance programme for infectious diseases in Belgium, a national network of microbiological laboratories has been responsible, since February 1983, for the weekly registration of certain pathogenic agents. Thus, the main epidemiological features of a selected number of infections in Belgium can be characterized.

[Epidemiologic aspects of infections due to Neisseria gonorrhoea in Belgium]. / Aspects épidémiologiques des infections à Neisseria gonorrhoeae en Belgique.

In the context of a surveillance programme for communicable diseases in Belgium, a network of microbiological laboratories has, since February, 1983, made weekly registrations of a number of pathogenic agents, among them, N. gonorrhoeae. Some epidemiological characteristics of N. gonorrhoeae in Belgium are discussed. Although only a portion of Belgian laboratories participate in the programme, the total of cases registered from 1983 through 1986 was 2 to 5 times greater than obtained through the notifiable diseases reporting system. More than 75% of the cases registered concerned those between 20 and 39 years of age, with a maximum for the 20-29-year age group. In 1985, 82% of the diagnoses were based on one culture alone (or one + ELISA); in 1986, this percentage was only 66%.

[Epidemiological aspects of Campylobacter infections in Belgium]. / Aspects épidémiologiques des infections à Campylobacter en Belgique

In the context of a surveillance programme for infectious diseases in Belgium, a network of microbiological laboratories, since February 1983, weekly registers the isolation of a number of pathogenic agents, among which Campylobacter. Some epidemiological characteristics of Campylobacter in Belgium are discussed. Between 54 and 58% of the isolations are reported from males. About 50% of the cases are observed in children under 5 years of age. The mean weekly number of isolations per laboratory is rising in May and remains high until October-November.

[Study of neonatal septicemia and meningitis]. / Etude des septicémies et méningites néonatales.

Departments of pediatrics and hospital laboratories gather, since September 1986, epidemiological data about babies with bacterial septicaemia and/or meningitis in the first 27 days of life. About 30 hospitals are at present participating to the program on a voluntary basis. The present study was undertaken to determine the factors predisposing to the development of these serious infections, in order to help identify infants at high risk of infection. The data are completed on a special report form which is sent back to the Service of Epidemiology of the Institute of Hygiene and Epidemiology, which is coordinating the programme. Recorded data include demographic characteristics, risk factors during pregnancy and during labor and delivery, newborn factors, laboratory findings about newborn and maternal infections, use of invasive procedures, treatment and outcome. A feedback system is organized which returns the analyzed data by means of six-monthly reports.

[Various sero-epidemiological characteristics of viral hepatitis in general medicine: results of a pilot survey performed in Belgium]. / Quelques caractéristiques séro-épidémiologiques des hépatites virales en médecine générale: résultats d'une enquête-pilote réalisée en Belgique.

A study was made of 110 cases of viral hepatitis diagnosed by general practitioners between 31 May 1982 and 30 June 1984. Hepatitis A was diagnosed in 53 patients, hepatitis B in 18 patients, hepatitis of both types A and B in one patient, and--by exclusion--hepatitis non-A non-B in 38 patients. Hepatitis A appears to be generally acquired by contact with infected persons or by travelling in endemic regions. In more than 50% of the hepatitis B cases, a hospital stay and/or ambulatory treatment were mentioned. All patients with hepatitis A became negative for anti-HA/IgM within 9 months after the diagnosis. 30% of the patients with hepatitis B remained positive for HBs Ag 9 months after diagnosis.

Tool for validation of the network of sentinel general practitioners in the Belgian health care system.

Morbidity registration by a network of sentinel general practitioners (SGPs) in Belgium raises a number of problems related to possible biases in the network procedure, such as unequal geographical distribution, non-participation of a segment of the target population of practitioners and difficulties in the estimation of the denominator population at risk for the health problems under study. Through the application of two hierarchical clustering procedures, the initial number of 43 districts in the country has been reduced to 15 homogeneous district clusters. These represent the new geographical framework from which the geographical spread of the network is checked. This network is subsequently corrected for such socio-demographic parameters as age, sex and occupation in order to match more closely the total population of Belgian general practitioners (GPs). The population covered by the network is estimated on the basis of the annual number of patient contacts. Application of the described procedures should result in a network allowing valid estimations for a number of health issues as seen by Belgian GPs.