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Diseases

10% of the population is diagnosed with diabetes, and 67 820 new cancer diagnoses are made.

Diabetes

1. Key messages

In 2017, 6.1% of the Belgian population was diagnosed with diabetes. However, more than one in three people with diabetes do not know they have the disease, which brings the estimated true prevalence of diabetes to 10%.
Diabetes prevalence is increasing over time as a result of both the ageing of the population and a true increase in the risk of developing diabetes.
The risk of developing diabetes is higher in Wallonia and Brussels than in Flanders, and is higher for individuals with a lower socio-economic status. Socioeconomic differences in the prevalence of diabetes are especially found for the prevalence of unknown or insufficiently controlled diabetes.

2. Background

Diabetes is a condition that is characterized by recurrent high blood sugar levels. If left untreated, diabetes may cause long-term complications such as foot ulcers, damage to the eyes, chronic kidney disease, and cardiovascular disease. A diabetic diet and exercise are important parts of diabetes management, but in a large number of cases, drug therapy will also be required.

A distinction is made between three main types of diabetes:

  • Type 1 diabetes, resulting from an autoimmune destruction of the insulin-producing beta cells in the pancreas;
  • Type 2 diabetes, due to the body's inefficient use of insulin, mainly caused by a combination of excessive body weight and insufficient exercise; and
  • Gestational diabetes, occurring in pregnant women without a previous history of diabetes.

In absence of an exhaustive diabetes register, information on the use of antidiabetic treatment or on diabetes referring nomenclature is considered a good proxy of the prevalence of the diagnosed diabetes. In Belgium, this information is available through the InterMutualistic Agency (IMA-AIM), a platform where data gathered from the seven Belgian health insurance funds are collected and analyzed. IMA-AIM data are, amongst others, made available through the IMA-AIM Atlas [1].

In the IMA-AIM database, diabetes prevalence is estimated based on the number of insured people with delivery of antidiabetics (ATC code A10) or with diabetes referring nomenclature (diabetes convention, diabetes pass, diabetes care trajectory). Women who gave birth during the year under review are excluded in order to exclude gestational diabetes.

Socio-economic characteristics are scarce in the IMA-AIM database. The status of “insured people having right to an increased compensation” is the only available proxy indicator, and it has only two values, yes or no. Persons with a low income or specific medical characteristics such as invalidity are entitled to an increased compensation status.

Since diabetes is a disease with insidious onset, many cases remain undiagnosed. Information on non-diagnosed diabetes prevalence is available in the first edition of the Belgian Health Examination Survey 2018 (BELHES) [2], which aims to collect objectives indicators on the health of the population in representative sample of people aged 18+. In the BELHES, diabetes prevalence is estimated based on measurement of fasting blood glucose and glycated hemoglobin linked with the self-reported data on diabetes from the Health Interview Survey [3].

3. Diabetes prevalence

Belgium

In 2017, 6.1% of the Belgian population was diagnosed with diabetes according to IMA-AIM database. The prevalence of diabetes increases with age, and is higher among men, especially in the older age groups. However, the results of the BELHES showed that more than one in three people with diabetes do not know they have the disease. When taking into account these undiagnosed cases, the diabetes prevalence increases to 10%.

The BELHES further showed that 18% of the patients on diabetes medication are not well controlled. In other words, 5% of the population is suffering from diabetes either without being aware of it, or without proper diabetes control.

Prevalence of diabetes by age and sex, Belgium, 2017
Source: IMA-AIM Atlas [1]

Trends and regional differences

The prevalence of diabetes is highest in Wallonia and lowest in Flanders, despite the relatively higher age of the Flemish population. The relatively low diabetes prevalence in Brussels is the result of the young age structure: when corrected for age, the diabetes prevalence in Brussels becomes higher than the Belgian average. In Wallonia more people are unaware that they have the disease than in Brussels and Flanders.

From 2007 to 2017, the prevalence of diabetes has increased in all three regions, as a result of both the ageing of the populations and a true increase in the risk of developing diabetes.

  • Crude
  • Age-standardized

Crude prevalence of diabetes in Belgium and its regions, 2007-2017
Source: IMA-AIM Atlas [1]

Age-standardized prevalence of diabetes in Belgium and its regions, 2007-2017
Source: Own calculations based on IMA-AIM Atlas [1]

Socio-economic differences

The risk of developing diabetes is nearly twice as high among individuals with an increased compensation status than among individuals with a normal compensation status. The prevalence of diabetes has been increasing evenly in both groups. The BELHES has shown that people with a lower education are significantly more likely to suffer from ignored or poorly controlled diabetes compared to people with a higher education (RR=3.6, adjusted for age and gender). This could indicate that there are socioeconomics inequalities in the screening and follow up of diabetes.

Age-standardized prevalence of diabetes by compensation status, Belgium, 2007-2017
Source: Own calculations based on IMA-AIM Atlas [1]

4. Read more

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Definitions

Age-standardized prevalence
The age-standardized prevalence is a weighted average of the individual age-specific prevalences using an external standard population. It is the prevalence that would be observed if the population had the age structure of the standard population. Since age has an important influence on the risk of diabetes, this standardization is necessary when comparing several populations that differ with respect to their age structure. Here, the Belgian 2017 mid-year population is used as standard population. 
Increased compensation status
Persons with a low income are entitled to an increased compensation status. They pay less for healthcare and have other financial benefits. Currently, this is the only variable available in the IMA-AIM Atlas that allows assessing socio-economic differences.

References

  1. InterMutualistic Agency Atlas. http://atlas.aim-ima.be/base-de-donnees
  2. Belgian Health Examination Survey (BELHES), Sciensano, 2018. https://his.wiv-isp.be
  3. Belgian Health Interview Survey (BHIS), Sciensano, 1997-2018. https://his.wiv-isp.be

Cancer

1. Key messages

In 2017, 68,702 new diagnoses of cancer were made, including 36,977 new cases in men and 31,725 in women. The most frequently diagnosed cancers were prostate, lung and colorectal cancer in men, and breast, colorectal and lung cancer in women.
Since 2006, the number of new cancer diagnoses has increased for both men and women, partly due to the ageing of the population. After adjustment for age, incidence rates however only increased in women.
Age-adjusted incidence rates are highest in the Walloon Region.
Since 2006, the age-adjusted incidence of lung cancer has gone up with 46% in women, while it decreased by 13% in men. Over the same time period, the age-adjusted incidence of melanoma has increased by 103% in men and 83% in women.

2. Background

Cancer is a broad family of diseases that involve abnormal cell growth with the potential to invade or spread to other parts of the body. It is one of the most important disease groups in terms of premature mortality, ill health, and healthcare expenditure. Cancer can be caused by inherited genetic traits, but the vast majority is due to genetic mutations occasioned by carcinogenic agents related to lifestyle, and metabolic or environmental factors.

Data on new cancer cases in Belgium are collected by the Belgian Cancer Registry Foundation. The Belgian Cancer Registry is nationally representative and exhaustive. It collects and records both clinical and pathological data. The recording of data (topography and morphology) is done using the International Classification of Diseases for Oncology.

The total number of cancer cases is usually presented excluding non-melanoma skin cancers. Although frequently occurring, these cancers are typically not clinically significant. In addition, there is large heterogeneity in the registration of these cancers, impeding comparisons and trend analyses.

Incidence figures include crude and age-adjusted incidence rates. They are calculated and published yearly by the Cancer Registry. Prevalence data refer to the number of people living with cancer at a given period after initial diagnosis. Cancer prevalence for the year 2013 has been calculated by the Cancer Registry.

3. Cancer incidence

Belgium

In 2017, 68,702 new diagnoses of cancer (excluding non-melanoma skin cancer) were made, including 36,977 new cases in men and 31,725 new cases in women.

Cancer incidence shows a clear association with age, with the highest incidence rate in the 80-84 age group. Before the age of 55, cancers are more commonly diagnosed among women, while in the older age groups, cancer diagnoses become more common among men.

Cancer incidence by age and sex, Belgium, 2017
Source: Belgian Cancer Registry [1]

Trends and regional disparities

Crude incidence rates are highest in Flanders in men and in Wallonia in women, while age-adjusted incidence rates are highest in Wallonia in both genders. When adjusted for age, incidence rates in Flanders fall below the national average in both genders.

In Belgium, the crude incidence rate has increased between 2006 and 2017 in both men and women. When adjusted for age, the incidence rate only increased in women while it has decreased in men.

Between 2006 and 2017, crude incidence rates of cancer increased for both men and women in Flanders and Wallonia. In Brussels, however, a decreasing trend is observed. These evolutions are mainly driven by the ageing patterns of the populations, as evidenced by the age-adjusted incidence rates; in men, incidence rates were more or less stable in Wallonia and Brussels, while slightly decreasing in Flanders. In women, age-adjusted incidence rates increased in Flanders and Wallonia, while staying stable in Brussels.

  • Men
  • Women

Crude cancer incidence per 100,000 men in Belgium and its regions, 2006-2017
Source: Belgian Cancer Registry [1]

Crude cancer incidence per 100,000 women in Belgium and its regions, 2006-2017
Source: Belgian Cancer Registry [1]

  • Men
  • Women

Age-adjusted cancer incidence per 100,000 men in Belgium and its regions, 2006-2017
Source: Belgian Cancer Registry [1]; Age-adjustment based on European Standard Population.

Age-adjusted cancer incidence per 100,000 women in Belgium and its regions, 2006-2017
Source: Belgian Cancer Registry [1]; Age-adjustment based on European Standard Population.

Site-specific cancer incidence

In 2017, prostate cancer and breast cancer were the most frequently diagnosed cancers among men and women, respectively. The incidence of breast cancer in women is stable, while the age-adjusted incidence of prostate cancer has decreased in men between 2006 and 2017.

Lung cancer is the second most frequent cancer in men and third most frequent in women. The age-adjusted incidence of bronchus and lung cancer has gone up with 46% between 2006 and 2017 in women, while it decreased by 13% in men.

Colorectal cancer diagnoses remained stable between 2006 and 2017 in both men and women, and showed a peak in 2014, when a colorectal cancer screening program was introduced in Flanders.

The incidence of melanoma is increasing in both genders. In men, the age-adjusted incidence has increased by 103% between 2006 and 2017 while it has increased by 83% in women, ranking melanoma 4th among the most frequently diagnosed cancers since 2010, ahead of cervical cancer. A more active screening can have played some role in the apparent increase of incidence, but most probably does not account for the totality of the change.

  • Crude
  • Age-adjusted

Crude incidence of the six most commonly diagnosed cancers (excluding non-melanoma skin cancer) in men, Belgium, 2006-2017
Source: Belgian Cancer Registry [1]

Age-adjusted incidence of the six most commonly diagnosed cancers (excluding non-melanoma skin cancer) in men, Belgium, 2006-2017
Source: Belgian Cancer Registry [1]; Age-adjustment based on European Standard Population.

  • Crude
  • Age-adjusted

Crude incidence of the six most commonly diagnosed cancers (excluding non-melanoma skin cancer) in women, Belgium, 2006-2017
Source: Belgian Cancer Registry [1]

Age-adjusted incidence of the six most commonly diagnosed cancers (excluding non-melanoma skin cancer) in women, Belgium, 2006-2017
Source: Belgian Cancer Registry [1]; Age-adjustment based on European Standard Population.

International comparison

Crude cancer incidence per 100,000 is higher in Belgium than the EU-15 average, both for men and women. Compared to the countries with the lowest incidence rates, the incidence per 100,000 in Belgium is 35% higher among men and 46% higher among women.

International comparisons should be interpreted with caution, given the various methods of data collection in different countries (registers versus routine reporting systems), with different level of accuracy. Data for Greece and Spain were not available.

  • Men
  • Women

Cancer incidence per 100,000 men, EU-15 countries, 2015 or nearest year
Source: WHO-EURO Health For All Database [2]

Cancer incidence per 100,000 women, EU-15 countries, 2015 or nearest year
Source: WHO-EURO Health For All Database [2]

4. Cancer prevalence

331,776 persons (3% of the total Belgian population) were alive by the end of 2013 after having been diagnosed with cancer (excluding non-melanoma skin cancer) between 2004 and 2013. This number included 161,166 men and 170,610 women. The crude prevalence per 100,000 was highest in the Flemish Region, while the age-adjusted prevalence per 100,000 was highest in the Walloon Region.

Prostate cancer was the most prevalent cancer type among men (67,892 cases, or 1.2% of the total male population in Belgium). Among women, breast cancer was the most prevalent cancer type (80,099 cases, or 1.4% of the total female population in Belgium). Another 31,370 Belgians were alive by the end of 2013 after having been diagnosed with colon cancer in the past 10 years.

Information on the prevalence of cancer yields a different picture than the information on the incidence of cancer. Indeed, cancer prevalence is a function of cancer incidence and survival, and the latter may be very different from one cancer to another. Lung cancer, for instance, has a low survival rate, such that few survivors will be alive at a given moment, despite the high incidence. On the other hand, prostate and breast cancer have both high incidence and survival rates, explaining their predominance in prevalence estimates.

  • Men
  • Women

Ten-year prevalence (absolute numbers) of the most common cancer types among men, Belgium, 2013
Source: Cancer burden in Belgium [3]

Ten-year prevalence (absolute numbers) of the most common cancer types among women, Belgium, 2013
Source: Cancer burden in Belgium [3]

5. Read more

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Definitions

EU-15
The EU-15 corresponds to all countries that belonged to the European Union between 1995 and 2004: Austria, Belgium, Denmark, Finland, France, Germany, Greece, Ireland, Italy, Luxembourg, the Netherlands, Portugal, Spain, Sweden and the United Kingdom. We compare the Belgian health status to that of the EU-15 because these countries have similar socioeconomic conditions.
Age-adjusted incidence
The age-adjusted incidence rate is a weighted average of the individual age-specific rates using an external standard population. Here, the European Standard Population is used as standard population. It is the incidence that would be observed if the population had the age structure of the standard population. Since age has a powerful influence on the risk of cancer, this standardization is necessary when comparing several populations that differ with respect to their age structure.
Crude incidence
The crude incidence rate is calculated by dividing the number of new cases observed during a given time period by the corresponding number of people in the population at risk. The crude rate is expressed as the number of new cases per 100,000 person years.
Ten-year prevalence
Ten-year prevalence data were estimated with an index date of 31st December 2013, representing people living in Belgium who were diagnosed with at least one invasive malignancy in the period from 1st January 2004 to 31st December 2013 and who were still alive at the end of 2013. Persons with more than one malignancy were included as prevalent cases in each cancer type, but were counted only once in analysis regrouping multiple tumour sites.

References

  1. Belgian Cancer Registry. https://kankerregister.org/
  2. Health For All Database. WHO EURO. https://gateway.euro.who.int/en/datasets/european-health-for-all-database/
  3. Cancer burden in Belgium 2004-2013, Belgian Cancer Registry, Brussels 2015. https://kankerregister.org/media/docs/publications/BCR_publicatieCancerBurden2016_web160616.pdf

Mental health

1. Key messages

Many indicators of mental health and emotional well-being point to a worsening of these conditions in the Belgian population. The percentage of people with depressive feelings, anxiety disorders, and/or severe sleep problems has lately shown a strong increase. More people report that they have (had) suicidal thoughts, although the figures for attempted suicide remain constant. A parallel increase in the use of antidepressants is identified, while the use of sleeping pills or tranquillizers remains constant or even decreases.
In general, the indicators of mental health and emotional well-being show a better situation in the Flemish Region than in the other two regions of the country.
Except for the indicators on suicidal behaviours, all indicators related to psychological problems occur more often in women than in men. An important point of attention seems to be women in the 15-24 age group, where a significant increase in depressive and anxiety disorders is observed.
All examined mental health indicators are linked to the educational level. Emotional disorders, suicidal behaviours and use of psychotropic medicines were more frequent in the lowest educated groups compared with the higher educated.

2. Background

Mental health is the capacity of each and all of us to feel, think, and act in ways that enhance our ability to enjoy life and deal with the challenges we face. It is a positive sense of emotional and spiritual well-being that respects the importance of culture, equity, social justice, interconnections and personal dignity [1] Due to the high frequency of mental problems in western societies and the significance of their costs in human, social and economic terms, mental health is now regarded as a public health priority. In Belgium, the Health Interview Survey is one of the main sources of systematic data on mental health parameters in the general population aged 15 or older [2]. Among the various dimensions of mental health that are monitored in this survey, we focus on the following three indicators:

  • Indicators of specific psychological problems, based on the self-report psychometric instrument SCL-90-R (Symptom Checklist-90-R)
  • Indicators concerning suicidal thoughts and attempts
  • Indicators concerning the use of psychotropic medicines

However, it should be noted that the evaluation of mental health problems in the population through a health survey has a number of limitations. These are mainly related to the fact that the estimates are based on screening instruments for psychological problems or on the reporting of the individuals themselves, and thus are not obtained by clinical diagnostic tools, which are often more nuanced. Nevertheless, the results of general population health surveys are generally in line with the findings of specific mental health surveys.

3. Psychological disorders

The assessment of specific psychological disorders indicated that, in 2013, 15% of the population older than 15 was experiencing depressive disorders, 10% had anxiety disorders, and 30% reported severe sleeping problems. Compared to the previous survey years, the prevalence of all three types of disorders increased significantly, both at the national and the regional levels. All three disorders have a lower prevalence in the Flemish Region than in Brussels and the Walloon Region.

  • Depressive disorders
  • Anxiety disorders
  • Sleeping problems

Prevalence of depressive disorders in Belgium and its regions, 2001-2013
Source: Own calculations based on Health Interview Survey, Sciensano, 2001-2013 [2]

Prevalence of anxiety disorders in Belgium and its regions, 2001-2013
Source: Own calculations based on Health Interview Survey, Sciensano, 2001-2013 [2]

Prevalence of severe sleeping problems in Belgium and its regions, 2001-2013
Source: Own calculations based on Health Interview Survey, Sciensano, 2001-2013 [2]

All three psychological disorders are more common among women than among men. Depressive and anxiety disorders are common among all age groups. An important point of concern are the recent trends among young women aged 15-24 years, with steep increases in the prevalence of depressive disorders (from 7% in 2008 to 21% in 2013) and anxiety disorders (from 5% in 2008 to 15% in 2013).

  • Depressive disorders
  • Anxiety disorders
  • Sleeping problems

Prevalence of depressive disorders by age and sex, Belgium, 2013
Source:  Health Interview Survey, Sciensano, 2013 [2]

Prevalence of anxiety disorders by age and sex, Belgium, 2013
Source:  Health Interview Survey, Sciensano, 2013 [2]

Prevalence of severe sleeping problems by age and sex, Belgium, 2013
Source:  Health Interview Survey, Sciensano, 2013 [2]

Psychological disorders are less common in the group with the highest level of education than in the groups with lower educational levels.

Prevalence of psychological disorders by educational level, Belgium, 2013
Source: Own calculations based on Health Interview Survey, Sciensano, 2013 [2]

4. Suicidal ideation and attempts

More people in the Belgian population aged 15 and older report that they have had suicidal thoughts (in their lifetime or recently). In contrast, the percentage of people who have actually tried to commit suicide (in their lifetime or recently) has not evolved. In 2013, 5% of the population said that they had seriously thought about committing suicide in the past 12 months and 0.4% reported having actually attempted suicide in this time period. 4% of the Belgian population aged 15 and older reported at least one suicide attempt during their lifetime.

In the Flemish Region, the figures are more favorable than in the other two regions of the country for suicide (thoughts and attempts) ever in life, but these regional differences are not observed for recent suicidal thoughts and attempts (<12 months).

  • Suicidal thoughts
  • Suicide attempts

Prevalence of suicidal thoughts during the past 12 months in Belgium and its regions, 2008-2013
Source: Own calculations based on Health Interview Survey, Sciensano, 2008-2013 [2]

Lifetime prevalence of suicide attempts in Belgium and its regions, 2004-2013
Source: Own calculations based on Health Interview Survey, Sciensano, 2004-2013 [2]

Recent suicidal thoughts and attempts are as common in men as in women. On the other hand, more women than men report that they have tried to put an end to their lives at least once in their lives.

The indicators of suicidal thoughts and attempts (lifetime or recent) do not show a clear age pattern. Although suicidal thought and attempts are less reported by the elderly (75+), this is in contradiction with the effective suicide figures, which are high among the oldest people, especially so for men.

  • Suicidal thoughts
  • Suicide attempts

Prevalence of suicidal thoughts during the past 12 months by age and sex, Belgium, 2013
Source: Health Interview Survey, Sciensano, 2013 [2]

Lifetime prevalence of suicide attempts by age and sex, Belgium, 2013
Source: Health Interview Survey, Sciensano, 2013 [2]

Suicidal thoughts (in lifetime or recently) are not related to the level of education, but the transition to the act would be: fewer people from high education households have attempted to commit suicide, both in their lifetime and in the past 12 months.

Prevalence of recent suicidal ideation and lifetime suicidal attempts by educational level, Belgium, 2013
Source: Own calculations based on Health Interview Survey, Sciensano, 2013 [2]

5. Consumption of psychotropic medicines

In 2013, 16% of the population reported using one of the following medicines in the two weeks preceding the survey (sometimes in combination): sleeping pills or tranquillizers (13%) and antidepressants (8%).

The use of psychotropic medicines is higher in the Walloon Region (19%) than in Brussels (13%) and the Flemish Region (16%). This difference is mainly explained by the higher use of antidepressants in the Walloon Region (9.5% versus 6.9% and 6.7% in Brussels and the Flemish Region, respectively).

During the period 1997-2013, the use of sleeping pills or tranquillizers has remained constant among the residents of the Flemish Region, and has even declined in the Brussels and Walloon Region. The use of antidepressants, on the other hand, shows a rising trend over time in the three regions of the country. For Belgium as a whole, applying these figures on a standardized population in terms of age and sex, the use of antidepressants almost doubled over the 15-year time period (from 4.2% in 1997 to 7.7% in 2013).

  • Sleeping pills or tranquillizers
  • Antidepressants

Consumption of sleeping pills or tranquillizers in Belgium and its regions, 1997-2013
Source: Own calculations based on Health Interview Survey, Sciensano, 1997-2013 [2]

Consumption of antidepressants in Belgium and its regions, 1997-2013
Source: Own calculations based on Health Interview Survey, Sciensano, 1997-2013 [2]

Proportionally, women use psychotropic medicines more often than men (20% versus 12%, respectively). The gender difference is particularly evident for the use of sleeping pills or tranquillizers (16% versus 10%), but also for the use of antidepressants (9.5% versus 5.6%).

The use of psychotropic medicines was also much more frequent after the age of 45, especially in the most elderly age group. This increase with age was more pronounced for women than for men.

  • Sleeping pills or tranquillizers
  • Antidepressants

Consumption of sleeping pills or tranquillizers by age and sex, Belgium, 2013
Source: Health Interview Survey, Sciensano, 2013 [2]

Consumption of antidepressants by age and sex, Belgium, 2013
Source: Health Interview Survey, Sciensano, 2013 [2]

The use of psychotropic medicines, whatever they are, is more common in households with the lowest level of education.

Consumption of psychotropic medicines by educational level, Belgium, 2013
Source: Own calculations based on Health Interview Survey, Sciensano, 2013 [2]

6. Read more

View the metadata for this indicator

HISIA: Interactive Analysis of the Belgian Health Interview Survey

Definitions

Symptom Checklist-90-Revised
The "Symptom Checklist-90-Revised" (SCL-90-R) was used to gauge psychological disorders. It examines the current symptomatology of the person (in the past week). From a technical point of view, the subscales of SCL-90-R correspond to different disorders derived from a factor structure. It is an instrument that has acceptable psychometric criteria and is commonly used in general population studies. The subscales included in the 2013 Health Interview Survey are limited to those of depressive disorders, anxiety disorders, and sleep problems.

References

  1. https://www.canada.ca/en/public-health/services/health-promotion/mental-health/mental-health-promotion.html
  2. Health Interview Survey, Sciensano, 1997-2013. https://his.wiv-isp.be/

Overview

1. Key messages

In 2018, 29% of the Belgians aged 15 years and over reported living with a chronic disease. This percentage increases strongly with age: 44% of the population over 75 years reports living with a chronic disease. The prevalence of chronic diseases is higher in women (31%) compared with men (27%).
The most commonly reported chronic diseases in the population are low back disorders, high blood pressure, allergy, arthrosis, high blood cholesterol, and neck disorders. The prevalence of the most frequent chronic diseases has increased between 1997 and 2018.
Individuals with a lower educational level usually suffer more frequently from chronic diseases.
The prevalence of multimorbidity has significantly increased since 1997, mainly because of the aging of the population.

2. Background

Non-communicable diseases (NCDs) are medical conditions or diseases that are not caused by infectious agents. Chronic diseases are defined by their longstanding nature. Since most NCDs are also chronic diseases, both terms are sometimes used interchangeably. This is however not entirely correct: some NCDs are acute, e.g. myocardial infarction; conversely, some chronic diseases may be caused by infectious agents, e.g. cervix cancer or tuberculosis. For the sake of simplicity, however, the term "chronic disease" will be used here as a synonym of NCDs.

Chronic diseases are by far the leading causes of (premature and general) mortality. In addition, they are also one of the most relevant health problems with a potential impact on the health-related quality of life, especially for the elderly, and are one of the main reasons for the use of healthcare services. Especially among older individuals, multiple chronic diseases can be present simultaneously. This phenomenon, referred to as multimorbidity, has a considerable impact on the functional status and the quality of life of the population. It also causes an increase in healthcare consumption and a higher risk of complications due to a larger use of medication, and thus requires important resources mobilization.

Most of the main chronic diseases are preventable, e.g. by adopting policies that promote healthier lifestyles, better environment and facilitate healthcare access. The prevalence of chronic diseases is, therefore, an important indicator of the level of (ill) health in the population.

The Belgian Health Interview Survey (HIS) is one of the main sources of information on the prevalence of chronic diseases at the population level. The advantage of this source is that it also takes into account people who rarely or never make use of health care facilities. The results are weighted to match the population structure as much as possible. It is therefore a valuable tool to obtain representative information on chronic diseases prevalence at the population level (for the whole country or at the regional level), and to monitor this prevalence over time. However, the results must be interpreted with caution because the information is self-reported, and thus reflects individual perceptions of health that may differ from the actual health state. Indeed, some people may not report an illness because they are not (yet) aware of it, or because the disease is perceived as socially unacceptable.

In the HIS 2018, a first question was asked on the presence of a chronic disease/condition/handicap in general, followed by a list of questions on the presence of 38 specific chronic diseases. Multimorbidity was measured as the simultaneous presence of at least two out of the following six chronic diseases: heart disease, chronic respiratory disease, diabetes, cancer, arthritis and/or arthrosis, and hypertension.

This overview is only based on the self-reported diseases as reported in the Health Interview Survey. In Belgium, other sources are available on diagnosis-based prevalence of chronic diseases such as specific registries, general practitioner networks or health insurance databases. These sources will be used to provide in-depth information on selected chronic diseases. Since the prevalence of chronic diseases and conditions is strongly related to age, the comparisons over time or between regions have been made after correction for the age-structure (age-adjustment). The adjustment has been performed using direct standardization based on the Belgian population of 2018 as reference. The weighting related to the design of the HIS was taken into account when calculating standardized rates.

3. Prevalence of chronic disease

Belgium

In 2018, 29% of the population aged 15 years and over reported suffering from at least one chronic disease. This percentage increases considerably with age, going up from 14% for people aged 15-24 to 44% for the people aged 75 or over.

The prevalence of chronic disease is significantly higher in women (31%) compared to men (27%).

Self-reported prevalence of chronic disease by age and sex, Belgium, 2018
Source: Health Interview Survey, Sciensano, 2018 [1]

Trends and regional disparities

Between 2001 and 2018, the percentage of people reporting to suffer from a chronic disease increased from 25% to 29% (+17%). This increase is partly due to the aging of the population, but not entirely since there is still an increase after adjustment for age.

Some differences are observed between the regions: the age-adjusted percentage of self-reported chronic diseases is higher in the Walloon region (33%) than in the Flemish and Brussels regions (respectively 27% and 31%). In the Brussels region, the crude self-reported prevalence of chronic diseases has dropped below the national average, but it is not the case when compared with the age-adjusted prevalence, which suggests an effect of the younger age structure of the Brussels region.

  • In the Flemish region, the percentage of self-reported chronic diseases has significantly increased from 21% in 2001 to 28% in 2018 (+34%). This increase is less important but still remains after standardization for age (+22%).
  • In the Brussels region, the age-adjusted percentage of people reporting to live with a chronic disease has decreased significantly from 34% in 2013 to 31% in 2018.
  • In the Walloon region, the crude and the age-adjusted percentage of people with a chronic disease remained stable since 2001.

  • Crude
  • Age-adjusted

Crude self-reported prevalence of chronic disease in Belgium and its regions, 2001-2018
Source: Health Interview Survey, Sciensano, 2001-2018 [1]

Age-adjusted self-reported prevalence of chronic disease in Belgium and its regions, 2001-2018
Source: Own calculations based on Health Interview Survey, Sciensano, 2001-2018 [1]

Socio-economic disparities

The percentage of people reporting to suffer from a chronic disease is higher in people with no diploma or a primary school education (41%) compared to those with higher levels of education. Similarly, people with a secondary (low or high) level of education report more often living with a chronic disease than those with the highest level of education (27%).

Self-reported prevalence of chronic disease by educational level, Belgium, 2018
Source: Own calculations based on Health Interview Survey, Sciensano, 2018 [1]

4. Multimorbidity

Belgium

In 2018, 15% of the Belgian population over 15 years of age reported suffering from at least two of the following diseases in the past year: heart disease, chronic respiratory disease, diabetes, cancer, arthritis and/or arthrosis, and hypertension. This percentage increases strongly with age, going up from 0.8% for people aged 15-24, to 42% for the people aged 75 and over. The prevalence of multimorbidity is higher in women, but this difference is no longer statistically significant after adjustment for age.

Prevalence of multimorbidity by age and sex, Belgium, 2018
Source: Health Interview Survey, Sciensano, 2018 [1]

Trends and regional disparities

Between 1997 and 2018, the crude prevalence of multimorbidity increased from 8.9% to 15% (+71%). When considering the age-adjusted prevalence estimates, the increase is less important but still significant (+26%), which means that the increase is partly, but not only, due to the aging of the population.

In the Walloon and the Flemish regions, the age-adjusted prevalence of multimorbidity is higher (respectively 17% and 15%) than in the Brussels region (14%), where it has decreased since 2013. However, this decrease is not significant.

  • Crude
  • Age-adjusted

Crude self-reported prevalence of multimorbidity in Belgium and its regions, 1997-2018
Source: Health Interview Survey, Sciensano, 1997-2018 [1]

Age-adjusted self-reported prevalence of multimorbidity in Belgium and its regions, 1997-2018
Source: Own calculations based on Health Interview Survey, Sciensano, 1997-2018 [1]

Socio-economic disparities

The percentage of people reporting living with at least two chronic diseases decreases as their educational level increases, from 19.8% in people with no diploma or only a primary school education, to 13.3% in people with the highest level of education.

Self-reported prevalence of multimorbidity by educational level, Belgium, 2018
Source: Own calculations based on Health Interview Survey, Sciensano, 2018 [1]

5. Major chronic diseases

The top 6 of the most commonly reported chronic diseases is the same in men and women, although the order differs. The top 6 comprises three problems of the musculoskeletal system (low back disorders, neck disorders, and arthrosis), two cardiovascular risk factors (high blood pressure and high blood cholesterol), and allergy.

Prevalence of 20 most commonly reported non-communicable diseases among men and women, Belgium, 2018
Source: Health Interview Survey, Sciensano, 2018 [1]
hsr en prev slopegraph 2018

Since 2013, the top 6 remained the same in men but not among women, for whom allergy and neck disorders have taken the place of high blood pressure and high blood cholesterol as third and fourth most important disease, respectively.

The evolution in terms of prevalence differs in function of the specific disease:

1. Between 1997 and 2018, significant increases were observed in the prevalence of high blood pressure, low back disorders, neck disorders, arthrosis, diabetes, thyroid disorders, and allergy. These increases may in part be explained by the aging of the population; however, even after adjustment for age, the increases remained significant.

  • The age-adjusted prevalence of thyroid disorders has strongly increased, from 3.5% in 1997 to 7.0% in 2018 (+100%); this increase is not due to the aging of the population.
  • The age-adjusted prevalence of diabetes has increased by 67%, from 3.6% in 1997 to 6.0% in 2018; this increase is partly due to the aging of the population.
  • The age-adjusted prevalence of allergy remained stable between 1997 and 2013 (at around 14%), but increased in 2018 to 19%.

2. On the other hand, since 2001, the prevalence of a number of other chronic diseases has decreased, including coronary heart disease, chronic obstructive pulmonary disease, severe headache and migraine, and osteoporosis.

  • Crude
  • Age-adjusted
Crude prevalence of selected chronic diseases, Belgium, 1997-2018
Age-adjusted prevalence of selected chronic diseases, Belgium, 1997-2018
Source: Own calculations based on Health Interview Survey, Sciensano, 1997-2018 [1]

Regional disparities

Regional differences in the prevalence of the included diseases are generally quite limited. The following differences are observed:

  • Arthrosis and thyroid disorders are more commonly reported in the Walloon and Flemish regions than in the Brussels region, even after adjustment for age.
  • High blood pressure is more often reported in the Walloon region than in the two other regions, after standardization for age.

Socio-economic disparities

The socio-economic status, measured in this report by the educational level, is one of the main determinants of chronic diseases. Most chronic diseases included in the HIS occur more frequently in people with lower educational levels. This applies in particular to serious chronic diseases such as cardiovascular diseases, diabetes, and chronic respiratory diseases. One notable exception is allergy, which occurs more frequently with increasing educational levels.

6. Read more

View the metadata for this indicator

HISIA: Interactive Analysis of the Belgian Health Interview Survey

Definitions

Chronic disease
In the Belgian Health Interview Survey, a global question is asked on the presence of one or more chronic diseases, chronic conditions or handicaps, without specifying the nature of the disease, condition or handicap. For the sake of simplicity, this indicator is referred to in this report as the presence of “chronic disease”.
Non-communicable diseases
Non-communicable diseases (NCDs) are medical conditions or diseases that are not caused by infectious agents. While sometimes referred to as synonymous with "chronic diseases", NCDs are distinguished only by their non-infectious cause, not necessarily by their duration, though some chronic diseases of long duration may be caused by infections.

References

  1. Health Interview Survey, Sciensano, 1997-2018. https://his.wiv-isp.be/