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28th April 2023
Life expectancy in Belgium remains slightly above the EU average, but it temporarily fell sharply in 2020 because of deaths due to Covid-19.
While the Belgian health system provides good access to high-quality care, the Covid-19 pandemic highlighted important challenges with prevention and public health, the health workforce and quality of care in long-term care facilities for older people. The pandemic stimulated many innovative practices in Belgium that could be expanded to build a more resilient healthcare system.
Life expectancy in Belgium increased more than the EU average between 2010 and 2019, but fell by more than a year in 2020 because of deaths due to Covid-19. About 60% of the Covid-19 deaths in 2020 were among residents in long-term care facilities. As in many other countries, the mental health of many young people and adults in Belgium deteriorated greatly during the pandemic, with reports of anxiety and depression reaching much higher levels than in previous years.
Risk factors for health are major drivers of ill health and mortality in Belgium. While tobacco consumption has substantially decreased over the past two decades, 15% of adults were daily smokers in 2018. Nearly 30% of adults reported regular heavy alcohol consumption in 2018, a rate well above the EU average. About 16% of adults were obese in 2018, close to the EU average, but up from 12% in 2001. Overweight and obesity among 15-year-old adolescents have also increased to 17% in 2018, up from 11% in 2002.
Health spending per capita increased slowly between 2008 and 2019 and remains higher than the EU average. In 2019, health spending accounted for 10.7% of GDP, up from 9.6% in 2008, and also a higher share than the current EU average (9.9%). Public spending accounted for 77% of overall health spending – slightly less than the EU average of 80%.
Avoidable mortality was slightly lower than the EU average before the pandemic, but higher than in many other western EU countries. This suggests that more could be done to save the lives of people through health promotion and a reduction of risk factors and through better healthcare.
Although access to healthcare in Belgium is generally good, the Covid-19 pandemic significantly affected access to care in 2020: 22% reported forgone care during the first 12 months of the pandemic, which is close to the EU average of 21%. Growing use of teleconsultations helped maintain access to care during the pandemic.
Belgium was among the EU countries hardest hit by the Covid-19 pandemic in numbers of cases and deaths relative to its population size, particularly during the first wave. Belgium accelerated its vaccination campaign in the first half of 2021. By the end of August 2021, 70% of the population had received two doses (or equivalent) of a Covid-19 vaccine.
OECD/European Observatory on Health Systems and Policies (2021), Belgium: Country Health Profile 2021, State of Health in the EU, OECD Publishing, Paris/European Observatory on Health Systems and Policies, Brussels.
Life expectancy in Austria is higher than the EU average, but fell sharply in 2020 due to Covid-19 deaths.
While the Austrian health system generally provides good access to high-quality care, the Covid-19 pandemic underscored some structural issues, including the need to pursue reforms to overcome fragmentation and strengthen primary care.
A strong digital infrastructure offers Austria the potential to build a more integrated and resilient health system.
Although life expectancy in Austria in 2020 was more than half a year higher than the EU average, it fell by 0.7 year compared with 2019 because of the Covid-19 pandemic. Even before the pandemic, gains in life expectancy in Austria had slowed considerably between 2010 and 2019.
About 40% of all deaths in Austria in 2019 can be attributed to behavioural risk factors. Tobacco consumption among adults has fallen but remains slightly higher than the EU average. Alcohol consumption among adults in Austria is the second highest in the EU. Heavy alcohol consumption among adolescents is also higher than the EU average.
Spending on health per capita in Austria was the third highest in the EU in 2019. Austria spends substantially more than most countries on hospital inpatient care, while spending on prevention is lower than average. It also has relatively high numbers of physicians and hospital beds. While three quarters of all health expenditure is publicly funded, direct out-of-pocket spending by households is higher than the EU average.
Mortality from preventable and treatable causes in 2018 was lower in Austria than the EU average. Nevertheless, Austria lagged behind many other EU countries on preventable mortality, suggesting that more could be done to scale up prevention and reduce risk factors for cancer and other leading causes of death.
Access to healthcare is good in Austria, although Covid-19 created barriers to access. One in eight Austrians reported that they had forgone care during the first 12 months of the pandemic. Digital services helped to maintain access to care during the Covid-19 crisis: 35% of Austrians reported that they used teleconsultation services during the first year of the pandemic, which was slightly lower than the EU average.
Between March 2020 and August 2021, confirmed Covid-19 case numbers in Austria were similar to the EU average, although the death rate was lower. By the end August 2021, more than 60% of the population had received at least one dose of a Covid-19 vaccine, and 57% had received two doses or the equivalent. These proportions were close to the EU average.
OECD/European Observatory on Health Systems and Policies (2021), Austria: Country Health Profile 2021, State of Health in the EU, OECD Publishing, Paris/European Observatory on Health Systems and Policies, Brussels.
13th April 2022
A high proportion of cancer diagnoses occur through emergency care presentations and which are associated with a greater 12-month mortality compared to non-emergency care detected cancers. This was the main finding of a study by an international team of researchers.
There is some evidence to show that many patients with cancer are first diagnosed through an emergency presentation and which is associated with inferior clinical and patient-reported outcomes. Furthermore, one US study found that among patients with stage IV colon cancer, 34.6% presented as emergencies. The reasons for the high level of emergency care cancer diagnoses are complex and related to several different and interacting factors. For example, patients might experience no or only minimal symptoms prior to life-threatening complications requiring urgent medical or surgical attention. Secondly, patient-related factors e.g., knowledge, beliefs and attitudes, may also lead to ‘first presentation’ as an emergency diagnosis and thirdly, there could by any number of different and practical barriers that have prevented prior care.
For the present study, which formed part of the International Cancer Benchmarking Partnership, the researchers aimed to identify predictors and the consequences of cancer diagnoses made through an emergency presentation across 8 different cancer sites: stomach, colon, rectal, liver, pancreatic, lung and ovarian. For the purposes of the study, they defined an emergency presentation as one in which a cancer diagnosis was made within 30 days after an emergency hospital admission Countries for which data was collected included England, Norway, Denmark and several provinces such as Victoria (Australia) and Ontario (Canada).
Cancer diagnoses and emergency visits
A total of 857,068 patients with at least one of the 8 cancers mentioned above were included in the analysis. Across the different areas, the percentage of cancer diagnoses made through an emergency presentation ranged from 24% to 42.5%. The most commonly diagnosed cancer was pancreatic cancer, with an average of 46.1% but which ranged from 34.1% to 60.4%. The least commonly diagnosed cancer was rectal cancer, with an average of 12.1% and ranging from 9.1% to 19.8%.
Among factors associated with an emergency presentation cancer diagnosis were older age (85 years and older) and stomach and among stomach and colon cancer diagnoses, there was a J-shaped distribution by age, whereby patients aged 15 to 64, had the highest percentage of emergency presentation diagnoses.
The cancer stage adjusted odds ratios for 12-month mortality, compared with non-emergency presentations, were greater than 3.2 in all of the different areas studied, e.g. for Norway the odds ratio was 3.31 (95% CI 3.39 – 3.53).
Commenting on their findings, the authors suggested that the high level of emergency presentation diagnoses for pancreatic cancer probably reflected the low predictive value for symptoms such as abdominal or back pain. In contrast, rectal cancers were likely diagnosed less frequently due to the much clearer symptoms such as rectal bleeding.
The concluded that emergency presentations were frequent and associated with worse prognostic implications.
Citation
Mcphail S et al. Risk factors and prognostic implications of diagnosis of cancer within 30 days after an emergency hospital admission (emergency presentation): an International Cancer Benchmarking Partnership (ICBP) population-based study Lancet Oncol 2022
10th February 2022
Breast cancer scans for women with no recognisable risk factors for the disease has identified that around 40% of these women have a tumour, emphasising the need to continue scanning eligible women. This was the conclusion of a study by researchers from the Sydney School of Public Health, University of Sydney, Australia.
A 2015 systematic review of the benefits and harms of breast cancer screening concluded that for women of all ages and at average risk, screening was associated with a reduction in breast cancer mortality of approximately 20%. However, risk-stratification of breast cancer screening might improve the cost-effectiveness of the whole scanning process and at the same time, potentially reduce any associated risks. In fact, a 2018 study found that not offering breast cancer screening to women at lower risk could improve the cost-effectiveness of the screening programme, through reducing over diagnosis and at the same time, maintaining the benefits of screening. Nevertheless, little is known about the screening outcomes for women without any known breast cancer risk factors and who are therefore assumed to be at a lower risk.
For the present study, the Australian team examined the breast cancer scan outcomes for women deemed to be at the lower end of the risk spectrum. They undertook a retrospective analysis of clinical data routinely collected in the BreastScreen Western Australia (BSWA) program and included women aged 40 years and older. Although the program does stratify women in terms of their risk, i.e., those with > 2 affected first-degree relatives etc), women age 40 and over can volunteer to participate, despite not being in the target group. The researchers collected variables such as age, need for repeat scans together with information such as a previous history of breast or ovarian cancer, use of hormone replacement therapy etc. The scans were then categorised as having none of these factors verses at least one factor and age bands of 40 -49, 50 -59, 60 – 69 and > 70 years were created. The outcomes of interest were cancer detection rates at screening (CDR) per 10,000 screens and the interval cancer rates (ICR) per 10,000 women-years.
Breast cancer scans and detection of tumours
A total of 1,026,137 screens were performed including 323,082 in women aged > 40 years, who had a mean age of 58.5 years. Among the total scans, 44.7% of women had at least one risk factor although for 55.3% of screens, the women had none of the recorded risk factors.
In the screens without any risk factors, the CDR was 50 (95% CI 48 – 52) per 10,000 screens and the ICR was 7.9 (95% CI 7.4 – 8.4). Overall, in all of the scans in which cancer was detected, for 40.9% of cases, there were no recognised risk factors present.
The authors concluded that given how many of the scans identified cancers in women without risk factors, their finding did not justify less frequent screening of women without recognised risks.
Citation
Noguchi N et al. Evidence from a BreastScreen cohort does not support a longer inter-screen interval in women who have no conventional risk factors for breast cancer Breast 2022
1st September 2021
According to research presented at the European Stroke Organisation Conference (ESOC), non-traditional risk factors for cardiovascular disease, appear to be increasing more in women than men. Researchers from the University of Zurich, Switzerland, turned to data contained in the Swiss Health Survey. This was established in 1981/82 and designed to provide data from a representative sample on a number of health-related issues such as perceived health status, use of health services and demand for health care. Information is collected every 5 years and since 2010, the data formed part of the Swiss population census.
Using data obtained in 2007, 2012 and 2017 on 22,000 men and women, the researchers identified an increase in the number of women who reported non-traditional risk factors for cardiovascular disease. This change appeared to coincide with an increase in the proportion of women who reported working full-time, which had increased from 38% in 2007 to 44% by 2017. The data showed that the number of individuals reporting stress at work had risen from 59% in 2012 to 66% in 2017. Furthermore, the proportion reporting non-traditional factors such as being tired and fatigued had also increased from 23% to 29%, but had risen to 33% among women compared to 26% in men, with a slightly higher level of severe sleep disorders in women (8%) compared to men (5%).
Fortunately, the study observed that the more traditional cardiovascular disease risk factors had stabilised over the study period, with 27% having hypertension, 18% a raised cholesterol level and 5% diabetes. Nevertheless, while obesity had increased to 11%, the level of smoking had reduced slightly from 10.5 to 9.5 cigarettes per day though both obesity and levels of smoking were higher in men.
According to the study authors, Dr Martin Hänsel and Dr Susanne Wegener, “our study found men were more likely to smoke and be obese than women, but females reported a bigger increase in the non-traditional risk factors for heart attacks and strokes, such as work stress, sleep disorders, and feeling tired and fatigued.”
Reference
10-year trends in cardiovascular risk factors in Switzerland: non-traditional risk factors are on the rise in women more than in men. Presented at the European Stroke Organisation Conference, September 2021
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