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Ischemic heart disease

1. Key messages

  • In 2018, 1.3% of the population reported suffering from angina pectoris. This percentage increases with age, reaching 3.8% in people aged 65 years and over.
  • In people aged 65 years and over, the self-reported prevalence of angina pectoris was higher in men in the three regions.
  • Between 2008 and 2018, the percentage of people aged 65 years and over reporting to suffer from angina pectoris has decreased in the three regions, in both genders, and more in women than in men.
  • In 2016, the number of people having been diagnosed with an acute myocardial infarction (AMI) was estimated at 19,948 in Belgium (177 cases per 100,000 inhabitants). Among them, 66.5% were men. The incidence rate of AMI increases with age and is higher in men in all age groups.
  • In 2016, in both genders, the age-adjusted incidence rate of myocardial infarction was higher in Wallonia, followed by Flanders and Brussels.
  • Between 2008 and 2016 (2015 not included), the age-adjusted incidence of myocardial infarction has decreased in both genders.

2. Background

Ischemic heart disease (IHD) is the main cause of death worldwide except in lowest-income countries. IHD, also called coronary heart disease, refers to heart problems caused by a narrowing of the coronary arteries (atherosclerosis), resulting in a reduced blood flow and oxygen supply (ischemia) to the heart muscle. In atherosclerosis, the arteries are narrowed when plaques build up inside, containing fat, cholesterol from low-density lipoproteins (LDL), fibrous tissues and sometimes calcium.

Many people do not experience any symptoms in the early stages of IHD. However, if left untreated, atherosclerosis progresses and symptoms may occur, which can be very disabling. The discomfort experienced when the heart muscle is lacking of oxygen is called angina pectoris. When the blockage of the blood flow is complete, the heart cells may die or suffer from serious damages, and this is what is called a myocardial infarction or a heart attack.

The main risk factors for IHD include physical factors such as high blood pressure, high cholesterol risk factor, diabetes, and behavioral factors such as tobacco use, unhealthy diet, alcohol abuse, and lack of exercise, which means that a part of the risk may be preventable by adopting a healthy lifestyle.

Two indicators are presented in the following sections:

  • The prevalence of angina pectoris refers to people who have reported suffering from angina pectoris during the last 12 months, and is derived from the Belgian Health Interview Survey [1]. We shall first describe the global prevalence in people aged 15 years and more; then we will focus on people aged 65 and over.
  • Different indicators can be defined to describe the occurrence of acute myocardial infarction (AMI). The "attack rate" (or incidence by episode) represents all first or recurrent events, while the term "incidence" means a first-ever event. Based on the availability of the data, we defined the yearly incidence as the first event in a given year. This indicator is built using the hospital discharge data from the Federal Public Service Health, Foodchain safety and Environment [2] from which infarction cases that were hospitalized and discharged alive are derived. It has to be noted that data of 2015 are not available due to the change of classification system from ICD-9 to ICD-10. To these cases have been added the cases of people who died of a heart attack (in hospital or not), extracted from the Sciensano Standardized Procedures for Mortality Analysis (SPMA) [3].

3. Angina pectoris prevalence

Situation in 2018

Belgium

In 2018, 1.3% of the population reported suffering from angina pectoris, a symptom of coronary heart disease. This percentage increases with age, going up from 0% in people aged 15-24 to 3.8% in people aged 65 years and over, and to 4.7% in people aged 75 and over.

Angina pectoris was more commonly reported among men, except in the 25-34 and 55-64 age groups. The age-adjusted self-reported prevalence of angina pectoris was higher in men (1.8%) than in women (1%).

Among people aged 65 and over, the prevalence was 3.8%.

The gender difference was more pronounced in people aged 65 and over, in whom the prevalence of angina pectoris was 2.5 times as high in men.

Self-reported prevalence of angina pectoris by age and sex, Belgium, 2018
Source: Health Interview Survey, Sciensano [1]
Regional differences

In 2018, among people aged 65 and over, the age-adjusted prevalence of angina pectoris was higher in men in all regions, with the most pronounced difference in Brussels.

Self-reported prevalence of angina pectoris in people aged 65 and over, by sex and region, 2018
Source: Own calculations based on Health Interview Survey, Sciensano [1]

Trends

Belgium

In people aged 65 and over, between 2008 and 2018, the age-adjusted prevalence of angina pectoris has decreased in both genders, but to a lesser extent in men (-24%, and not statistically significant) compared to women (-61%).

Regional differences

Among men aged 65 and over, the regional patterns have fluctuated over time and do not allow clear conclusions about the evolution.

Among women aged 65 and over, the prevalence of angina pectoris has steadily decreased in Flanders between 2008 and 2018. In Brussels, it has decreased between 2008 and 2013 and remained stable between 2013 and 2018. In Wallonia the decrease was not significant.

  • Men
  • Women

Self-reported prevalence of angina pectoris in men aged 65 and over, Belgium, 2008-2018
Source: Own calculations based on the Health Interview Survey, Sciensano [1]

Self-reported prevalence of angina pectoris in women aged 65 and over, Belgium, 2008-2018
Source: Own calculations based on the Health Interview Survey, Sciensano [1]

Socio-economic disparities

The crude self-reported prevalence of angina pectoris is higher in people with a low level of education, but after adjustment for age, there are no socio-economic disparities between the different levels of education, even among people aged 65 and over.

4. Acute myocardial infarction incidence

Situation in 2016

Belgium

In 2016, the number of persons having been diagnosed with an acute myocardial infarction (AMI) was estimated at 19,948 (177 diagnoses per 100,000 inhabitants), among which 15,545 were discharged alive and 4,403 died.

Among people with AMI, 66.5% were men. The number of persons having suffered of AMI was higher in men except in the oldest age groups (85+ years). This number was highest in age group 65-69 among men, and in age group 85-89 among women.

The incidence rate of AMI increases with age and is higher in men in all age groups.

  • Number of cases
  • Incidence rates

Incidence of myocardial infarction, number of cases by age and sex, Belgium, 2016
Source: Own calculations based on FPS Health, Food Chain Safety and Environment [2] and SPMA [3]

Incidence of myocardial infarction, incidence rate by age and sex, Belgium, 2016
Source: Own calculations based on FPS Health, Food Chain Safety and Environment [2] and SPMA [3]

Regional differences

In 2016, the crude and age-adjusted incidence rate of AMI was the lowest in Brussels, which means that it is not due to the younger age structure of the population in the capital.

In Wallonia, the age-adjusted incidence rate of AMI was 291 per 100,000 among men and 113 per 100,000 among women, which was above the Belgian incidence rate (respectively 263 per 100,000 and 103 per 100,000).

  • Men
  • Women

Incidence of myocardial infarction in men by region, Belgium, 2016
Source: Own calculations based on FPS Health, Food Chain Safety and Environment [2] and SPMA [3]

Incidence of myocardial infarction in women by region, Belgium, 2016
Source: Own calculations based on FPS Health, Food Chain Safety and Environment [2] and SPMA [3]

Trends

Belgium

Between 2008 and 2016 (2015 not included), the age-adjusted incidence of myocardial infarction has decreased in both genders, going from 357 per 100,000 in 2008 to 263 per 100,000 in 2016 in men and from 149 per 100,000 in 2008 to 103 per 100,000 in 2016 in women. This decrease was less pronounced in men (-26%) than in women (-31%).

Incidence of myocardial infarction by sex, Belgium, 2008-2016*
Source: Own calculations based on FPS Health, Food Chain Safety and Environment [2] and SPMA [3]
* 2015 not included
Regional differences

Between 2008 and 2016 (2015 not included), in both genders, the crude incidence of myocardial infarction has decreased in the three regions. Among men, this decrease was higher in Brussels (-23%) compared to Flanders (-19%) and Wallonia (-18%). Among women, the change was more pronounced in Flanders (-28%) compared to Brussels (-25%) and Wallonia (-23%).

  • Men
  • Women

Crude incidence of myocardial infarction among men, Belgium, 2008-2016*
Source: Own calculations based on FPS Health, Food Chain Safety and Environment [2] and SPMA [3]
* 2015 not included

Crude incidence of myocardial infarction among women, Belgium, 2008-2016*
Source: Own calculations based on FPS Health, Food Chain Safety and Environment [2] and SPMA [3]
* 2015 not included

5. Read more

View the metadata for this indicator

Definitions

Angina pectoris or angor
Angina pectoris, or angor, is one of the symptoms of coronary heart disease. Angor is defined as a pain or discomfort in the chest or adjacent areas, precipitated by exercise, emotion or a heavy meal, caused by a reduced supply of oxygen to the heart (ischemia) due to a stenosis (narrowing) or blockage of the coronary arteries.
Acute myocardial infarction
Acute myocardial infarction (AMI), also called heart attack, is a necrosis (death) of the heart cells, resulting from an acute obstruction of a coronary artery. The symptoms include chest pain or discomfort, dyspnea (shortness of breath), and nausea. In some cases, AMI can be asymptomatic. The main risk factors are age, tobacco, high blood pressure, high blood cholesterol, alcohol abuse, obesity and diabetes.

References

  1. Health Interview Survey, Sciensano, 1997-2018. https://his.wiv-isp.be/
  2. Federal Public Service Health, Food Chain Safety, and Environment. https://www.health.belgium.be/en/node/22892
  3. Standardized Procedure for Mortality Analysis (SPMA), Sciensano. https://spma.wiv-isp.be/SitePages/Methods_mortality.aspx

Suicide

1. Key messages

  • Suicidal behaviors (thoughts, attempts, and actual suicides) represent an important problem for public health and society in Belgium.
  • 4.3% of the population seriously considered suicide and 0.2% attempted to commit suicide in the last 12 months. Women and middle-aged people were more at risk. Suicidal thoughts and suicide attempts were more common in the lowest educated group compared to the higher educated groups.
  • 1903 suicide deaths were recorded in 2016. The highest numbers were found in the 45-95 age group.
  • While more women consider and attempt to commit suicide, more men succeed: 1360 suicides were recorded in men and 543 in women in 2016. The mortality rate was 24.5 (per 100 000) in men and 9.5 in women.
  • Nearly 1 out of 3 deaths in men between 15 and 29 years was due to suicide; 1 out of 5 deaths in women between 15 and 34 years was due to suicide.
  • A comprehensive multisectoral suicide prevention strategy is needed.

2. Background

Suicide and suicide attempts are important societal and public health issues. They have ripple effects on families, friends, colleagues, communities, and society on the whole. Suicide occurs throughout the lifespan and was the second leading cause of death among the 15-29-year-olds in the world in 2016. Suicide is preventable and its prevention has been prioritized by the World Health Organization (WHO) as a global target and included as an indicator in the United Nations Sustainable Development Goals (SDGs) [1]. To effectively develop suicide prevention strategies, we need an efficient registration and monitoring of suicide as well as to identify specific groups at risk.

While the link between suicide and mental disorders is well established, many suicides happen impulsively in moments of crisis. Further risk factors include experience of loss, loneliness, discrimination, a relationship break-up, financial problems, chronic pain and illness, violence, abuse, and conflict. The strongest risk factor for suicide is a previous suicide attempt [2].

To apprehend this complex and important phenomenon, we use several indicators:

  • Suicidal thoughts, which are an important risk factor for future suicide and important for prevention.
  • Suicide attempts, which are a strong risk factor for completed suicide and a key moment to provide help to the person [3].
  • Suicide deaths: we report the number of deaths, the mortality rate, and the share of total deaths that are due to suicide at a particular age. Since suicides are commonly misclassified, these numbers are probably underestimated [4–7]. Misclassifications can occur when the exact cause of deaths is unknown (suicide may thus be classified as ‘unknown cause’); when the intention is not clear (suicide may thus be classified as ‘deaths of undetermined intent’); or when the intention is wrongly evaluated (suicide may thus be classified as ‘accidents’ or ‘homicides’). It may also be possible that the doctor avoids mentioning suicide to protect the family from different problems (insurance, administration, religion, …). Additionally, administrative procedures can lead to misclassifications. For example, in Brussels, the prosecution office fails to deal with all violent deaths (suicides, homicides), leading to a consequent under-reporting of suicides which are then classified as deaths of undetermined intent. Moreover, the reasons for misclassification strongly vary across countries, which limits the interpretation of international comparisons.

Suicide attempts and suicide deaths show different age and sex patterns. Women are more at risk to attempt to commit suicide than men and men are more at risk of succeeding (suicide deaths). Moreover, the risk of suicide deaths increases with age while the risk of suicide attempts decreases with age. Thus, younger people and women attempt more to commit suicide while men and older people have more success in completing suicide [3,8].

3. Suicidal thoughts

Situation in 2018

Belgium

In 2018, in Belgium, 14% of the population aged 15 years and over had at least once in their life seriously considered suicide; within this group, one in three (or 4.3% of the total population) had thought about committing suicide in the last 12 months. More women (16%) than men (12%) reported suicidal thoughts in their life, while there were no gender differences in suicidal thoughts in the past year (4.4% in women vs 4.2% in men). People aged 65 years and over were less likely to report suicidal thoughts in their life or in the past year than people younger than 64 years. Women in the age group 45-54 years had a particularly high prevalence.

Prevalence of suicidal thoughts in the last 12 months among the population aged 15 years and over, Belgium, 2018
Source: Health Interview Survey, Sciensano [9]
Regional differences

Lifetime suicidal thoughts were more frequent in Wallonia (16%) than in Flanders (13%); suicidal thoughts in the last year were more prevalent in Wallonia (5.9%) and Brussels (5.1%) than in Flanders (3.3%).

Trends

Belgium

The proportion of people that considered suicide in the last 12 months (as well in their lifetime) is lower in 2018 than in 2013, but the proportion is still higher than the values observed in 2008 (differences are not significant).

Regional differences

The prevalence of suicidal thoughts decreased in Flanders between 2013 and 2018 while it remained relatively stable in Brussels and Wallonia.

  • Men
  • Women

Prevalence of suicidal thoughts in the last 12 months among men aged 15 years and over by region, Belgium, 2008-2018
Source: Own calculations based onHealth Interview Survey, Sciensano [9]

Prevalence of suicidal thoughts in the last 12 months among women aged 15 years and over by region, Belgium, 2008-2018
Source: Own calculations based onHealth Interview Survey, Sciensano [9]

Socio-economic disparities

Suicidal thoughts (lifetime and in the past year) are linked with the educational level. People from the lowest educational group were 1.5 more likely to have considered suicide in their life and 2.5 more likely to have considered it in the last year compared to people from the highest educational group.

Prevalence of suicidal thoughts in the lifetime and in the past year among the population aged 15 years and over by educational level, Belgium, 2018
Source: Own calculations based on Health Interview Survey, Sciensano [9]

4. Suicide attempts

Situation in 2018

Belgium

In 2018, in Belgium, 4.3% of the population aged 15 years and over reported to have attempted to commit suicide in their lifetime and 0.2% in the last year. More women (5.4%) than men (3.1%) tried to commit suicide in their lifetime and in the last year (0.3% in women and 0.2% in men). The prevalence of lifetime suicide attempts was higher in people aged between 35 and 54 years. Younger people (15-24 years) and 45-54 years were more likely to report a suicide attempt in the last year.

Prevalence of lifetime suicide attempts among the population aged 15 years and over, Belgium, 2018
Source: Own calculations based on Health Interview Survey, Sciensano [9]
Regional differences

People from Wallonia were more likely to have attempted to commit suicide (6%) than people from Brussels (4.2%) and Flanders (3.3%).

Trends

Trends in the prevalence of lifetime suicide attempts are relatively stable in Belgium and its regions. Suicide attempts decrease between 2013 and 2018 in men and women in Brussels but this was not significant.

  • Men
  • Women

Prevalence of lifetime suicide attempts among men aged 15 years and over by region, Belgium, 2004-2018
Source: Own calculations based on Health Interview Survey, Sciensano [9]

Prevalence of lifetime suicide attempts among women aged 15 years and over by region, Belgium, 2004-2018
Source: Own calculations based on Health Interview Survey, Sciensano [9]

Socio-economic disparities

Suicide attempts (lifetime and in the past year) were linked with the educational levels. People from the highest educational group were less likely to attempt suicide than people from the lower educational group.

Prevalence of lifetime and past year suicide attempts among the population aged 15 years and over by educational level, Belgium, 2018
Source: Own calculations based on Health Interview Survey, Sciensano [9]

5. Suicide deaths

Number of deaths

In 2016, in Belgium, 1903 deaths from suicide were registered. There were more deaths by suicide in men (1360) than in women (543). The highest numbers of suicide deaths occurred in the 45-59 age group. Suicide deaths may be misclassified for different reasons; in Brussels, there is a problem in the certification of suicide deaths since 2009, meaning that these numbers are an underestimation of the actual number of suicides.

Number of suicide deaths by age and sex, Belgium, 2016
Source: Own calculations based on the death certificates database, Statbel [10]

Share of suicide deaths

Since few deaths occur at younger ages, the share of the total deaths attributed to suicide at younger ages is important. Due to the increase in the number of deaths and the concurrent causes of deaths at older ages, the share of suicide deaths decreases with age.

Suicide deaths represent nearly 30% of deaths in men between 15 and 29 years. In women, suicide deaths represent around 20% of deaths between 15 and 34 years of age.

Share of the total number of suicide deaths by age and sex, Belgium, 2016
Source: Own calculations based on the death certificates database, Statbel [10]

Mortality rate due to suicide

The mortality rate due to suicide was 16.8 (per 100 000 people) in 2016 in Belgium. It was 2.6 times higher in men (24.5) than in women (9.5). The suicide rate by age group shows a different pattern than the number of suicide deaths because the denominator (number of people in a given age group) is smaller at old ages. The highest mortality rate due to suicide was found in men between 80 and 94 years old and in women between 45 and 54 years old.

Suicide mortality rate (per 100 000) by age and sex, Belgium, 2016
Source: Own calculations based on the death certificates database, Statbel [10]

Trends

Belgium

Suicide mortality rates are decreasing in men and, to a smaller extent, in women.

Regional differences

Suicide mortality rates are decreasing among men both in Flanders and Wallonia (starting from 2008). Among women, the suicide mortality rates stayed stable at a much lower level than among men in both the Walloon and the Flemish Regions.

The suicide mortality rate in Brussels cannot be interpreted due to the delay of the Brussels public prosecutor's office in confirming suicide cases.

  • Men
  • Women

Suicide age-adjusted mortality rates among men by region, Belgium, 2000-2016
Note: The rates of suicide in Brussels are underestimated.
Source: Own calculations based on the death certificates database, Statbel [10]

Suicide age-adjusted mortality rates among women by region, Belgium, 2000-2016
Note: The rates of suicide in Brussels are underestimated.
Source: Own calculations based on the death certificates database, Statbel [10]

International comparison

Belgium has the highest apparent suicide rates among the EU-15 countries in men and women. However, international comparison of suicide mortality rates should be interpreted with caution as differences in socio-cultural context and data quality hampers the accurate recording of suicide and the comparability between countries. However, this warning should not serve to minimize the problematic higher rates of Belgium.

  • Men
  • Women

Suicide age-adjusted mortality rates among men by country, EU-15, 2016 or latest year
Source: OECD health data [11]

Suicide age-adjusted mortality rates among women by country, EU-15, 2016 or latest year
Source: OECD health data [11]

6. Read more

View the metadata for this indicator

Statbel  Causes of death
SPMA: Standardized Procedures for Mortality Analysis (SPMA)
HISIA: Health Interview Survey Interactive Analysis (HISIA)

Definitions

Age-adjusted prevalence
Most indicators are linked to age. Since the Belgian population is ageing over time and that differences are observed within regions and within educational groups, the prevalences are standardized by age with a standard population to allow for comparability.
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.

References

  1. WHO. Suicide in the world. https://www.who.int/publications-detail/suicide-in-the-world
  2. WHO. Suicide. https://www.who.int/westernpacific/health-topics/suicide
  3. Centre de prévention du suicide. LE SUICIDE UN PROBLEME MAJEUR DE SANTE PUBLIQUE Introduction à la problématique du suicide en Belgique Chiffres de 2014. Bruxelles, Belgique: Centre de prévention du suicide; 2017 Sep. 
  4. De Spiegelaere M, Wauters I, Haelterman E. Le suicide en Région de Bruxelles-Capitale: Situation 1998-2000. Brussels: Observatoire de la santé et du social de Bruxelles- Capitale; 2003. 
  5. Ohberg A, Lonnqvist J. Suicides hidden among undetermined deaths. Acta Psychiatr Scand. 1998;98(3):214–8.
  6. Jougla E, Pequignot F, Chappert J, Rossollin F, Le TA, Pavillon G. [Quality of suicide mortality data]. RevEpidemiolSante Publique. 2002;50(1):49–62.
  7. Moens GFG. The reliability of reported suicide mortality statistics: An experience from Belgium. Int J Epidemiol. 1985;14(2):272–5.
  8. Gisle L, Drieskens S, Demarest S, Van der Heyden J. Enquête de santé 2018 : Santé mentale [Internet]. Bruxelles, Belgique: Sciensano; 2020 Jan. Report No.: D/2020/14.440/3. https://his.wiv-isp.be/fr/Documents%20partages/MH_FR_2018.pdf 
  9. Health Interview Survey, Sciensano, 1997-2018. https://his.wiv-isp.be/
  10. Causes of death, Statbel. https://statbel.fgov.be/en/themes/population/mortality-life-expectancy-and-causes-death/causes-death
  11. OECD health statistics. https://stats.oecd.org/

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

View the metadata for this indicator

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

View the metadata for this indicator

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

In 2018, around one in ten person had an anxiety disorder and/or a depressive disorder.The prevalence of anxiety disorders remained at the same level as in 2013 (11% vs 10%) but was still higher than in the period 2001-2008 (just over 6%).

In 2018, 12% of the population reported the use of sleeping pills or tranquilizers in the last 2 weeks, and 8% reported recent use of antidepressants. The consumption of sleeping pills or tranquilizers started to decrease in 2008, while the consumption of antidepressants continued to increase.

Anxiety and depression are more prevalent in women. In general, the indicators of mental health show a better situation in the Flemish region compared to the two other regions. Mental health also differs by educational level: mental health disorders and consumption of psychotropic medicines were more frequent in the lowest educated group compared to the highest educated group.

2. Background

Mental health is the capacity of each 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.

Among the various dimensions of mental health that are monitored in this survey, we focus on the following three indicators:

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 and thus are not obtained by clinical diagnostic tools, which may be more nuanced. Nevertheless, the results of general population health surveys are generally in line with the findings of specific mental health surveys.

More serious mental health disorders like schizophrenia and bipolar disorders are not presented here. Indeed, health interview surveys are not a valid instrument to capture such complex conditions. Moreover, information about suicidal thoughts and attempts can be found on a specific page (in preparation).

3. Mental health disorders

Situation in 2018

Belgium

Based on the assessment of the psychometric instruments, in 2018, 11.2% of the total Belgian population had an anxiety disorder and 9.4% had a depressive disorder. For both disorders, women had a higher prevalence (14.2% for anxiety and 10.7% for depression) than men (7.9% for anxiety and 8% for depression).

  • Anxiety disorders
  • Depressive disorders

Prevalence of anxiety disorders by age and sex, Belgium, 2018
Source: Health Interview Survey, Sciensano, 2018 [2]

Prevalence of depressive disorders by age and sex, Belgium, 2018
Source: Health Interview Survey, Sciensano, 2018 [2]

Regional specificities

Wallonia had a higher prevalence of anxiety and depressive disorders than Brussels and Flanders and Brussels had a higher prevalence than Flanders.

Trends

Belgium

Between 2008 and 2013, the prevalence of anxiety disorders increased in Belgium in both genders and has stayed more or less stable since then.

Between 2008 and 2013, the prevalence of depressive disorders increased in both genders. It slightly decreased in men and more clearly decreased in women in 2018.

However, since the questionnaires used were changed between the 2013 and 2018 surveys, trends should be interpreted with caution.

Regional specificities

Between 2008 and 2013, the prevalence of anxiety disorders increased in all regions. Between 2013 and 2018, it continued to sharply increase in Wallonia in both genders, but not in the other regions.

The prevalence of depressive disorders was lower in Flanders than in Brussels and Wallonia in all years in women and since 2004 in men.

  • Men
  • Women

Prevalence of anxiety disorders in men in Belgium and its regions, 2001-2018b
break in series, change of instrument
Source: Own calculations based onHealth Interview Survey, Sciensano, 2001-2018 [2]

Prevalence of anxiety disorders in women in Belgium and its regions, 2001-2018b
break in series, change of instrument
Source: Own calculations based onHealth Interview Survey, Sciensano, 2001-2018 [2]

  • Men
  • Women

Prevalence of depressive disorders in men in Belgium and its regions, 2001-2018b
break in series, change of instrument
Source: Own calculations based onHealth Interview Survey, Sciensano, 2001-2018 [2]

Prevalence of depressive disorders in women in Belgium and its regions, 2001-2018b
break in series, change of instrument
Source: Own calculations based onHealth Interview Survey, Sciensano, 2001-2018 [2]

Socio-economic disparities

There is a strong socio-economic gradient in the prevalence of mental health disorders. After age-adjustment, anxiety disorders were 2.3 times more frequent in people from the lowest educational group compared to the highest educational group. Depressive disorders were 3 times more frequent in people from the lowest educational group compared to the highest educational group.

Prevalence of anxiety and depressive disorders by educational level, Belgium, 2018
Source: Own calculations based on Health Interview Survey, Sciensano, 2018 [2]

4. Consumption of psychotropic medicines

Situation in 2018

Belgium

In 2018, 12.3% of the population used sedatives (sleeping pills or tranquilizers) and 7.6% used antidepressants in the past 2 weeks. More women than men consumed sedatives (15% in women vs 9.5% in men) and antidepressants (9.8% vs 5.3%).

The consumption of sedatives increased with age, particularly after 45 years in women and after 65 years in men.

The consumption of antidepressants is particularly high in women after 45 years of age.

  • Sleeping pills and tranquillizers
  • Antidepressants

Consumption of sleeping pills or tranquillizers by age and sex, Belgium, 2018
Source: Health Interview Survey, Sciensano, 2018 [2]

Consumption of antidepressants by age and sex, Belgium, 2018
Source: Health Interview Survey, Sciensano, 2018 [2]

Regional specificities

In 2018, the consumption of sedatives is slightly higher in Wallonia and in Flanders than in Brussels, but the regional differences are narrow and not significant.

The consumption of antidepressants is slightly lower in Flanders than in the other regions, but the differences are only significant in women.

Trends

Belgium

From 1997 to 2008, the consumption of sedatives in the population increased, then it decreased in 2013 and in 2018 when considering both genders together. In men the consumption remained stable round 10%, while it decreased from 19% in 2008 to 15% in 2018 in women.

Since 1997, the consumption of antidepressants has doubled in both genders.

Regional specificities

The consumption of sedatives used to be significantly lower in Flanders than in the 2 other regions until 2008 in both genders. After 2008, as the use of sedatives continued to increase in Flanders while slightly decreasing in the other regions, the regional differences narrowed and quasi disappeared by 2018.

  • Men
  • Women

Consumption of sleeping pills or tranquillizers in men in Belgium and its regions, 1997-2018
Source: Own calculations based on Health Interview Survey, Sciensano, 1997-2018 [2]

Consumption of sleeping pills or tranquillizers in women in Belgium and its regions, 1997-2018
Source: Own calculations based on Health Interview Survey, Sciensano, 1997-2018 [2]

The consumption of antidepressants followed a same evolution in both genders and in all regions, that is, it has significantly increased since 1997.

  • Men
  • Women

Consumption of antidepressants in men in Belgium and its regions, 1997-2018
Source: Own calculations based on Health Interview Survey, Sciensano, 1997-2018 [2]

Consumption of antidepressants in women in Belgium and its regions, 1997-2018
Source: Own calculations based on Health Interview Survey, Sciensano, 1997-2018 [2]

Socio-economic disparities

There was a socio-economic gradient in the consumption of sedatives and antidepressants. A higher proportion of people from the lowest educational group consumed sedatives (17.7% vs 12.3%) and antidepressants (10.3% vs 6%) than from the highest educational group.

Consumption of sleeping pills or tranquilizers and antidepressants, by educational level, Belgium, 2018
Source: Own calculations based on Health Interview Survey, Sciensano, 2018 [2]

5. Read more

View the metadata for this indicator

HISIA: Interactive Analysis of the Belgian Health Interview Survey

Definitions

GAD-7: General Anxiety Disorder 7-item
The GAD-7 is a screening tool for general anxiety disorder. Participants are asked to evaluate the frequency, if ever, of experiencing 7 core symptoms in the last 2 weeks. The scores obtained allow to evaluate the symptom severity.
Anxiety disorders
Participants with a score of 10 or over out of 21 in the GAD-7 tool were considered to have an anxiety disorder.
PHQ-9: Patient Health Questionnaire 9-item depression scale
The PHQ-9 is a screening tool for major depressive disorder and other depressive disorders. Participants are asked to evaluate the frequency in which they have been bothered by 9 problems in the last 2 weeks.
Depressive disorders
Participants with a combination of answers meeting the criteria specific for major depressive disorder and other depressive disorders for the PHQ-9 were considered to have a depressive disorder.

References

  1. https://www.canada.ca/en/public-health/services/health-promotion/mental-health/mental-health-promotion.html
  2. Health Interview Survey, Sciensano, 1997-2018. 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/