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Between 2014 and 2015 a second National Food Consumption Survey was conducted in Belgium in order to evaluate the habitual food consumption in the general Belgian population and to compare it with food-based dietary guidelines (FBDG) and results of the 2004 Food Consumption Survey. A representative sample of the Belgian population was randomly selected from the National Population Register following a multistage stratified sampling procedure. Information on dietary intake was collected from 3146 subjects between 3 and 64 year old through two non-consecutive 24-hour dietary recalls using GloboDiet®. In addition, a self-administered food frequency questionnaire was completed. The distribution of habitual food consumptions and proportion of persons who did not meet the recommendations were estimated with SPADE. For most of food groups analysed, the habitual consumption did not comply with FBDG. The consumption of nutrient-poor and energy-dense foods (e.g. alcohol, soft drinks and snacks) was excessive (35% of total energy intake), while the consumption of most other food groups was below the minimum recommended. A large majority of the population had an inadequate consumption of dairy products (98%), vegetables (95%), fruit (91%), potatoes, rice and pasta (88%) bread and cereals (83%) and water and sugar-free drinks (73%). Males had higher consumption of most food groups than females, thereby complying more often with FBDG. For all food groups, except dairy products and fruit, the consumption increased with age. The proportion of individuals meeting FBDG was the highest among young children (3-5 years) and the worst among adolescents aged 14-17 years old. Habitual consumption remained stable between 2004 and 2014 in the population aged 15-64 years old for all food groups except for increased consumption of water and sugar-free drinks (1180 to 1289 g/d) and decreased consumption of spreadable and cooking fat (27 to 19 g/d), red meat (34 to 25 g/d) and bread and cereals (173 to 142 g/d). The habitual food consumption of the Belgian population (3-64 years) in 2014-2015 deviates largely from FBDG, particularly among adolescents aged between 14 and 17 years old. Few improvements were observed between 2004 and 2014 in the population between 15 and 64 years old. Further efforts are therefore necessary to improve dietary habits in Belgium, in order to prevent and reduce diet-related diseases.

This study aimed 1) to assess whether the contribution of chronic conditions to disability varies according to the educational attainment, 2) to disentangle the contributions of the prevalence and of the disabling impact of chronic conditions to educational disparities. Data of the 2008–09 Disability Health Survey were examined (N= 23,348). The disability indicator was the Global Activity Limitation Indicator (GALI). The attribution method based on an additive hazard model was used to estimate educational differences in disabling impacts and in the contributions of diseases to disability. Counterfactual analyses were used to disentangle the contribution of differences in disease prevalence vs. disabling impact. In men, the main contributors to educational difference in disability prevalence were arthritis (contribution to disability prevalence: 5.7% (95% CI 5.4–6.0) for low-educated vs. 3.3% (3.0–3.9) for high-educated men), spine disorders (back/neck pain, deformity) (3.8% (3.6–4.0) vs. 1.9% (1.8–2.1)), chronic obstructive pulmonary diseases (2.4% (2.3–2.6) vs. 0.6% (0.5–0.7)) and ischemic heart /peripheral artery diseases (4.1% (3.9–4.3) vs. 2.4% (2.2–3.0)). In women, arthritis (9.5% (9.1–9.9) vs. 4.5%, (4.1–5.2)), spine disorders (4.5% (4.3–4.7) vs. 2.1% 1.9–2.3) and psychiatric diseases (3.1% (3.0–3.3) vs. 1.1% (1.0–1.3)) contributed most to education gap in disability. The educational differences were equally explained by differences in the disease prevalence and in their disabling impact. Public health policies aiming to reduce existing socioeconomic disparities in disability should focus on musculoskeletal, pulmonary, psychiatric and ischemic heart diseases, reducing their prevalence as well as their disabling impact in lower socioeconomic groups.

National and international efforts like the 1000 Genomes Project are leading to increasing insights in the genetic structure of populations worldwide. Variation between different populations necessitates access to population-based genetic reference datasets. These data, which are important not only in clinical settings but also to potentiate future transitions towards a more personalized public health approach, are currently not available for the Belgian population. To obtain a representative genetic dataset of the Belgian population, participants in the 2013 National Health Interview Survey (NHIS) were invited to donate saliva samples for DNA analysis. DNA was isolated and single nucleotide polymorphisms (SNPs) were determined using a genome-wide SNP array of around 300,000 sites, resulting in a high-quality dataset of 189 samples that was used for further analysis. A principal component analysis demonstrated the typical European genetic constitution of the Belgian population, as compared to other continents. Within Europe, the Belgian population could be clearly distinguished from other European populations. Furthermore, obvious signs from recent migration were found, mainly from Southern Europe and Africa, corresponding with migration trends from the past decades. Within Belgium, a small north-west to south-east gradient in genetic variability was noted, with differences between Flanders and Wallonia. This is the first study on the genetic structure of the Belgian population and its regional variation. The Belgian genetic structure mirrors its geographic location in Europe with regional differences and clear signs of recent migration.

The global phenomenon of population ageing is creating new challenges in both high and middle income countries, as functional limitations are expected to increase with age. The attribution method has been proposed to identify which conditions contribute most to disability using cross-sectional data. Although the original method was based on binary outcomes, we recently proposed an extension to multinomial responses, since different disability levels are often investigated in surveys. This is the first application of the extended method to evaluate differences in the contribution of chronic conditions to functional limitations in the older population of Brazil and Belgium. Representative data from individuals aged ≥65 years who participated in the 2008 or 2013 Health Interview Surveys in Belgium (N= 4521) or in the 2008 National Household Sample Survey in Brazil (N= 28,437) were analysed. Individuals were classified as without, moderate or severe functional limitations, based on three activities of daily living: eating, showering, and toileting. Six chronic conditions common to the surveys – diabetes, heart diseases, musculoskeletal conditions, depression, chronic respiratory diseases, and cancer – were included in the analysis. Separate multinomial additive hazards models by gender for each country were fitted. The prevalence of moderate functional limitations was larger in men in Brazil (8.4%) compared to Belgium (6.0%) and similar in women (approximately 12.0%). Conversely, the severe prevalence in men was similar in the two countries (around 8.0%) and higher in women from Belgium (16.6%) than from Brazil (9.1%). Musculoskeletal conditions were the main contributors to the prevalence of functional limitations in men and women in Belgium but only in men and women with moderate functional limitations in Brazil. Depression and heart diseases contributed most to the severe prevalence of functional limitations in men and women in Brazil, respectively. Our findings provide a better understanding of differences in the prevalence of different levels of functional limitations in Brazil and Belgium. These differences can be related to differences in socioeconomic conditions, health care access and quality, disease diagnosis, stage of epidemiology transition, life expectancy, and the prevalence of lifestyle risk factors in the two countries.

In Belgium, socio-economic inequalities in mortality have long been described at country-level. As Belgium is a federal state with many responsibilities in health policies being transferred to the regional levels, regional breakdown of health indicators is becoming increasingly relevant for policy-makers, as a tool for planning and evaluation. We analyzed the educational disparities by region for all-cause and cause-specific premature mortality in the Belgian population. Residents with Belgian nationality at birth registered in the census 2001 aged 25–64 were included, and followed up for 10 years though a linkage with the cause-of-death database. The role of 3 socio-economic variables (education, employment and housing) in explaining the regional mortality difference was explored through a Poisson regression. Age-standardised mortality rates (ASMRs) by educational level (EL), rate differences (RD), rate ratios (RR), and population attributable fractions (PAF) were computed in the 3 regions of Belgium and compared with pairwise regional ratios. The global PAFs were also decomposed into the main causes of death. Regional health gaps are observed within each EL, with ASMRs in Brussels and Wallonia exceeding those of Flanders by about 50% in males and 40% in females among Belgian. Individual SE variables only explained up to half of the regional differences. Educational inequalities were also larger in Brussels and Wallonia than in Flanders, with RDs ratios reaching 1.8 and 1.6 for Brussels versus Flanders, and Wallonia versus Flanders respectively; regional ratios in relative inequalities (RRs and PAFs) were smaller. This pattern was observed for all-cause and most specific causes of premature mortality. Ranking the cause-specific PAFs revealed a higher health impact of inequalities in causes combining high mortality rate and relative inequality, with lung cancer and ischemic heart disease on top for all regions and both sexes. The ranking showed few regional differences. For the first time in Belgium, educational inequalities were studied by region. Among the Belgian, educational inequalities were higher in Brussels, followed by Wallonia and Flanders. The region-specific PAF decomposition, leading to a ranking of causes according to their population-level impact on overall inequality, is useful for regional policy-making processes.

Statistical methods to model the usual dietary intake of foods in a population generally ignore the additional information on the never-consumers. The objective of this study is to determine the added value of Food Frequency Questionnaire (FFQ) data allowing distinguishing the never-consumers from the non-consumers while modeling the usual intake distribution. Three food items with a different proportion of never-consumers were selected from the database of the Belgian food consumption survey of 2004 (N= 3200). The usual intake distribution for these food items was modeled with the Statistical Program for Analysis of Dietary Exposure (SPADE) and modeling parameters were extracted. These parameters were used to simulate (a) a new database with two 24-h recalls per respondent and (b) a “true” usual intake distribution. The usual intake distribution from the new database was obtained by modeling the 24-h recalls with SPADE, once without and once with the inclusion of the FFQ data on the never-consumers. Ratios were calculated for the different percentiles of the usual intake distribution: the modeled usual intake (g/day) (for both SPADE with and without the inclusion of FFQ data on never-consumers) was divided by the corresponding percentile of the simulated “true” usual intake (g/day). The closer the ratio is to one, the better the model fits the data. Inclusion of the FFQ information to identify the never-consumers did not improve the estimation of the higher percentiles of the usual intake distribution. However, taking into account this FFQ information improved the estimation of the lower percentiles of the usual intake distribution even when the proportion of never-consumers was low. The inclusion of FFQ information to identify the never-consumers is beneficial when interested in the whole usual intake distribution or in the lower percentiles only, no matter how low the proportion of never-consumers for that food item may be. However, when interest is only in the higher percentiles of the usual intake distribution, inclusion of FFQ information to identify the never-consumers will have no benefit.

The adequacy of micronutrient intake is a public health concern, as both insufficient and excessive intake levels may result in adverse health effects. Data on dietary intake are needed to evaluate potential problems regarding inadequate intake at population level and to formulate effective public health and food safety recommendations. Assessing the intake of micronutrients in population subgroups such as infants, toddlers, pregnant and lactating women is challenging and requires specific approaches. This paper describes the Belgian VITADEK study, developed to assess fat-soluble vitamin intake from the consumption of food, fortified foods and supplements in four vulnerable groups namely infants, toddlers, pregnant and lactating women. Subjects were selected according to a multi-stage stratified sampling design with a selection of clusters proportionate to the population size. Recruitment occurred in collaboration with Belgian child health consultation centres and obstetric clinics. Participants were asked to complete a self-administered online food frequency questionnaire (FFQ) or to answer the questionnaire by phone if online participation was not possible. The questionnaire was tailored to the specific diet of the different target populations. In order to capture vitamin intake from the consumption of foods, fortified foods and supplements, a market study was conducted to take an inventory of the fortified foods and supplements available on the Belgian market. The food list of the FFQ was based on both this inventory and the top 90% food groups that contribute to fat-soluble vitamin intake. Since fortification differs at brand level, food groups and subgroups were split up to the level of the brand of foods. Brand pictures were used as mnemonics to facilitate the recall of the consumed food items and portion pictures were used to facilitate the reproduction of the consumed portion sizes. Finally a composition table was compiled allowing for the computation of vitamin intake from all sources providing as such more accurate estimates of fat-soluble vitamin intake. The results will allow assessing inadequate micronutrient intake by comparison of vitamin intake with dietary reference values. The data will further allow describing the most contributing food groups as well as the contribution of fortified foods and supplements to total vitamin intake. The data will enable evaluating whether infants, toddlers, pregnant and/or lactating women are reached by the actual Belgian fortification and supplementation programmes. Finally the retrieved data will reveal the potential for voluntary fortification and the need for future fortification and supplementation programmes.

Pooled analysis of secondary data increases the power of research and enables scientific discovery in nutritional epidemiology. Information on study characteristics that determine data quality is needed to enable correct reuse and interpretation of data. This study aims to define essential quality characteristics for data from observational studies in nutrition. First, a literature review was performed to get an insight on existing instruments that assess the quality of cohort, case-control, and cross-sectional studies and dietary measurement. Second, 2 face-to-face workshops were organized to determine the study characteristics that affect data quality. Third, consensus on the data descriptors and controlled vocabulary was obtained. From 4884 papers retrieved, 26 relevant instruments, containing 164 characteristics for study design and 93 characteristics for measurements, were selected. The workshop and consensus process resulted in 10 descriptors allocated to “study design” and 22 to “measurement” domains. Data descriptors were organized as an ordinal scale of items to facilitate the identification, storage, and querying of nutrition data. Further integration of an Ontology for Nutrition Studies will facilitate interoperability of data repositories.

BackgroundReducing socioeconomic inequalities in mortality, a key public health objective may be supported by a careful monitoring and assessment of the contributions of specific causes of death to the global inequality.MethodsThe 1991 and 2001 Belgian censuses were linked with cause-of-death data, each yielding a study population of over 5 million individuals aged 25–64, followed up for 5 years. Age-standardised mortality rates (ASMR) were computed by educational level (EL) and cause. Inequalities were measured through rate differences (RDs), rate ratios (RRs) and population attributable fractions (PAFs). We analysed changes in educational inequalities between the 1990s and the 2000s, and decomposed the PAF into the main causes of death.ResultsAll-cause and avoidable ASMR decreased in all ELs and both sexes. Lung cancer, ischaemic heart disease (IHD), chronic obstructive pulmonary disease (COPD) and suicide in men, and IHD, stroke, lung cancer and COPD in women had the highest impact on population mortality. RDs decreased in men but increased in women. RRs and PAFs increased in both sexes, albeit more in women. In men, the impact of lung cancer and COPD inequalities on population mortality decreased while that of suicide and IHD increased. In women, the impact of all causes except IHD increased.ConclusionAbsolute inequalities decreased in men while increasing in women; relative inequalities increased in both sexes. The PAFs decomposition revealed that targeting mortality inequalities from lung cancer, IHD, COPD in both sexes, suicide in men and stroke in women would have the largest impact at population level.

There is strong evidence to indicate that regular moderate intensity physical activity is associated with health benefits. Furthermore, sedentary behavior has been related with an increased risk for all-cause mortality. The accurate measurement of physical activity and sedentary behavior is therefore vital to evaluate their health impact and provide evidence for the development of public health recommendations. This paper describes the methodology used for assessing physical activity and sedentary behavior in the Belgian population in the context of the Belgian National Food Consumption Survey 2014 (BNFCS2014). Data about physical activity and sedentary behavior were collected as part of the cross-sectional BNFCS2014 between February 2014 and May 2015. A nationally-representative sample of children (3–9 years) and adolescents (10–17 years) were asked to wear an accelerometer (Actigraph® GT3X) during their waking hours for 7 consecutive days. Data were recorded in 15-second epochs and respondents with at least 2 valid week days (i.e., 10 h of wear-time) and 1 valid week-end day (i.e., 8 h of wear-time) were retained for the analyses. The Evenson cut points were used to assess the time spent in each physical activity intensity level: sedentary, low, moderate and vigorous. Complementary, diaries were provided to register the activities performed when the accelerometer was removed; these activities were added to the measures provided by the accelerometers. In addition, age-specific self-reported questionnaires (ToyBox and FPAQ) were completed to provide contextual information about the type of activities performed. Due to financial constraints, physical activity in adults (18–64 years) was assessed and described through the self-reported International Physical Activity Questionnaire (IPAQ long version) only. Data were collected in the context of the BNFCS2014 to provide a comprehensive picture of the physical activity and sedentary behavior in the Belgian population, with a special focus on children (3–9 years) and adolescents (10–17 years). Levels of physical activity and sedentary behavior can be compared to international guidelines and analyzed according to several background variables, such as age, gender, Body Mass Index, education level and region. Such results are aimed to underpin future policies in the field of physical activity.

Dietary patterns are one of the major determinants as far as health and burden of disease is concerned. Food consumption data are essential to evaluate and develop nutrition and food safety policies. The last national food consumption survey in Belgium took place in 2004 among the Belgian population aged 15 years and older. Since dietary habits are prone to change over time a new Belgian National Food Consumption Survey (BNFCS2014) was conducted in 2014–2015. The BNFCS2014 is a cross-sectional study. A representative sample (n= 3200) of the Belgian population aged 3 to 64 years old was randomly selected from the National Population Register following a multistage stratified sampling procedure. Data collection was divided equally over the four seasons and days of the week in order to incorporate seasonal effects and day-to-day variation in food intake. Information on food intake was collected in adults with two non-consecutive 24-h dietary recalls (using the GloboDiet® software). In children food intake was collected with two non-consecutive one-day food diaries followed by a completion interview with GloboDiet. Additional data on socio-demographic characteristics, eating habits, lifestyle, food safety (at household level), physical activity and sedentary behaviour were collected with a face-to-face questionnaire using a computer-assisted personal interviewing technique. In the time between the two visits, participants were asked to complete a self-administered food frequency questionnaire and health questionnaire. Height, weight and waist circumference were measured. In addition, children and adolescents were asked to wear an accelerometer and keep a logbook for seven consecutive days to objectively measure physical activity and sedentary behaviour. The main objective of the BNFCS2014 is to evaluate the habitual food, energy and nutrient intake in the Belgian population and to compare these with recommendations from the national dietary guidelines. A second objective is to monitor eating habits and food safety aspects of the food consumption in Belgium. The results of this dietary monitoring survey, together with the information on the level of physical activity, may underpin future nutrition, food safety and physical activity policies at national and European level.

Population aging accompanied by an increased longevity with disability has raised international concern, especially due to its costs to the health care systems. Chronic diseases are the main causes of physical disability and their simultaneous occurrence in the population can impact the disablement process, resulting in different severity levels. In this study, the contribution of chronic diseases to both mild and severe disability burden in Belgium was investigated. Data on 21 chronic diseases and disability from 35,799 individuals aged 15 years or older who participated in the 1997, 2001, 2004, or 2008 Belgian Health Interview Surveys were analysed. Mild and severe disability were defined based on questions related to six activities of daily living and/or mobility limitations. To attribute disability by severity level to selected chronic diseases, multiple additive hazard models were fitted to each disability outcome, separately for men and women. A stable prevalence of mild (5 %) and severe (2–3 %) disability was observed for the Belgian population aged 15 years or older between 1997 and 2008. Arthritis was the most important contributor in women with mild and severe disability. In men, low back pain and chronic respiratory diseases contributed most to the mild and severe disability burden, respectively. The contribution also differed by age: for mild disability, depression and chronic respiratory diseases were important contributors among young individuals, while heart attack had a large contribution for older individuals. For severe disability, neurological diseases and stroke presented a large contribution in young and elderly individuals, respectively. Our results indicate that the assessment of the contribution of chronic diseases on disability is more informative if different levels of disability are taken into consideration. The identification of diseases which are related to different levels of disability – mild and severe – can assist policymakers in the definition and prioritisation of strategies to tackle disability, involving prevention, rehabilitation programs, support services, and training for disabled individuals.

Reducing premature mortality is a crucial public health objective. The goal of this paper, beside updating previous mortality atlases with recent data, is to explore the relative between-districts disparity using a relative-scale map design. Causes of deaths and population data were provided by Statistics Belgium. All deaths occurring in the periods 1993–1999 and 2003–2009, in people aged 1–74 residing in Belgium were included. Age-adjusted rates by cause of death were computed for both periods; the 2003-2009 rates were classified using a relative scale with a 10% change between each level and represented on chloropleths maps with a green-to-red divergent colour scheme centred on the national mean. This particular design allows the comparability across all the maps since a same meaning is given to a specific colour. The variation coefficient and the decile ratio were calculated and compared between the 2 periods. A clear-cut regional divide at the disadvantage of Wallonia, and to some extent, of Brussels, was seen for all-cause, cardiovascular, cerebrovascular, diabetes, alcohol-related, mental and neurological diseases and non-transport accidents premature mortality. A NE-SW pattern parallel to the French border was observed for Lip, Oral Cavity, Pharynx, Larynx and oesophageal cancers, while various patterns are observed for the other cancers. The highest rates of road accident mortality are observed in the Southern districts. Many of those patterns are in continuity with earlier observations. However, the pattern of diabetes and mental and neurological diseases are new features. The variation coefficient and the decile ratios increased by 10% between the 1993-1997 and 2003-2009 periods. The use of a relative scale in the maps highlights the importance of the between-districts disparity in premature mortality, with for most causes, a clear-cut regional divide at the disadvantage of Wallonia; this health gap results of complex interactions between various factors, including the socioeconomic context, cultural habits and environmental influences, as well as public health policies. It should be considered as a warning signal, warranting the attention of the policy makers. Meanwhile, these results also highlight the potential for improvement in the more disadvantaged regions.

A domain-specific physical activity questionnaire (EHIS-PAQ) was developed in the framework of the second wave of the European Health Interview Survey (EHIS). This article presents the EHIS-PAQ and describes its development and evaluation processes. Research institutes from Belgium, Estonia and Germany participated in the Improvement of the EHIS (ImpEHIS) Grant project issued by Eurostat. The instrument development process comprised a non-systematic literature review and a systematic HIS/HES database search for physical activity survey questions. The developed EHIS-PAQ proposal was reviewed by survey experts. Cognitive testing of the EHIS-PAQ was conducted in Estonia and Germany. The EHIS-PAQ was further tested in a pilot survey in Belgium, Estonia and Germany in different modes of data collection, face-to-face paper and pencil interview (PAPI) and computer assisted telephone interview (CATI). The EHIS-PAQ is a rather pragmatic tool aiming to evaluate how far the population is physically active in specific public health relevant settings. It assesses work-related, transport-related and leisure-time physical activity in a typical week. Cognitive testing revealed that the EHIS-PAQ worked as intended. The pilot testing showed the feasibility of using the EHIS-PAQ in an international health interview survey setting in Europe. It will be implemented in all 28 European Union Member States via European Union implementing regulation in the period between 2013 and 2015. This will be a first opportunity to get comparable data on domain-specific physical activity in all 28 EU MS and to publish indicators at the EU level. The EHIS-PAQ is a short, domain-specific PA questionnaire based on PA questions which have been used in large-scale health interview surveys before. It was designed by considering the respondents’ perspective in answering PA questions.

Older people are a growing population. They live longer, but often have multiple chronic diseases. As a consequence, they are taking many different kind of medicines, while their vulnerability to pharmaceutical products is increased. The objective of this study is to describe the medicine utilization pattern in people aged 65 years and older in Belgium, and to estimate the prevalence and the determinants of excessive polypharmacy. Data were used from the Belgian Health Interview Survey carried out in 2008. Each respondent was asked to show to the interviewer all medicines that he/she had taken in the 24 h prior to the interview. Excessive polypharmacy was defined as the use of nine different kind of medicines or more in the past 24 h; the relation with the Region of residence, age, gender and additional factors, such as socioeconomic status, living situation, health status and contacts with health services, was explored through multivariate models. Eight percent of the older people (65 years or more) belong to the excessive polypharmacy group. Factors most strongly associated with excessive polypharmacy are: having a longstanding illness, chronic condition or handicap, at least 1 contact with a general practitioner in past 2 months and self-reported depression during the last year. Ninety percent of persons in the excessive polypharmacy group are taking medicines active on the cardiovascular system. In order to optimize the use of medicines, it is necessary to find a balance between adequate treatment of diseases and avoiding adverse effects of medicines. Interventions should aim to increase awareness among healthcare professionals and patients; they should focus on general practitioners and patients with cardiovascular diseases, those suffering from depression and those aged 80 years and over. Monitoring excessive polypharmacy in the older population remains important. Further studies should explore more in depth other and more specific determinants of excessive polypharmacy.

Reducing premature mortality is a crucial public health objective. After a long gap in the publication of Belgian mortality statistics, this paper presents the leading causes and the regional disparities in premature mortality in 2008–2009 and the changes since 1993. All deaths occurring in the periods 1993–1999 and 2003–2009, in people aged 1–74 residing in Belgium were included. The cause of death and population data for Belgium were provided by Statistics Belgium , while data for international comparisons were extracted from the WHO mortality database. Age-adjusted mortality rates and Person Year of Life Lost (PYLL) were calculated. The Rate Ratios were computed for regional and international comparisons, using the region or country with the lowest rate as reference; statistical significance was tested assuming a Poisson distribution of the number of deaths. The burden of premature mortality is much higher in men than in women (respectively 42% and 24% of the total number of deaths). The 2008–9 burden of premature mortality in Belgium reaches 6410 and 3440 PYLL per 100,000, respectively in males and females, ranking 4th and 3rd worst within the EU15. The disparities between Belgian regions are substantial: for overall premature mortality, respective excess of 40% and 20% among males, 30% and 20% among females are observed in Wallonia and Brussels as compared to Flanders. Also in cause specific mortality, Wallonia experiences a clear disadvantage compared to Flanders. Brussels shows an intermediate level for natural causes, but ranks differently for external causes, with less road accidents and suicide and more non-transport accidents than in the other regions. Age-adjusted premature mortality rates decreased by 29% among men and by 22% among women over a period of 15 years. Among men, circulatory diseases death rates decreased the fastest (-43.4%), followed by the neoplasms (-26.6%), the other natural causes (-21.0%) and the external causes (-20.8%). The larger decrease in single cause is observed for stomach cancer (-48.4%), road accident (-44%), genital organs (-40.4%) and lung (-34.6%) cancers. On the opposite, liver cancer death rate increased by 16%. Among female, the most remarkable feature is the 50.2% increase in the lung cancer death rate. For most other causes, the decline is slightly weaker than in men. Despite a steady decrease over time, international comparisons of the premature mortality burden highlight the room for improvement in Belgium. The disadvantage in Wallonia and to some extent in Brussels suggest the role of socio-economic factors; well- designed health policies could contribute to reduce the regional disparities. The increase in female lung cancer mortality is worrying.

Several European countries, including Belgium, still suffer from mild iodine deficiency. Thyroid stimulating hormone (TSH) concentration in whole blood measured at birth has been proposed as an indicator of maternal iodine status during the last trimester of pregnancy. It has been shown that mild iodine deficiency during pregnancy may affect the neurodevelopment of the offspring. In several studies, elevated TSH levels at birth were associated with suboptimal cognitive and psychomotor outcomes among young children. This paper describes the protocol of the PSYCHOTSH study aiming to assess the association between neonatal TSH levels and intellectual, psychomotor and psychosocial development of 4–5 year old children. The results could lead to a reassessment of the recommended cut-off levels of 5 > mU/L used for monitoring iodine status of the population. In total, 380 Belgian 4–5 year old preschool children from Brussels and Wallonia with a neonatal blood spot TSH concentration between 0 and 15 mU/L are included in the study. For each sex and TSH-interval (0–1, 1–2, 2–3, 3–4, 4–5, 5–6, 6–7, 7–8, 8–9 and 9–15 mU/L), 19 newborns were randomly selected from all newborns screened by the neonatal screening centre in Brussels in 2008–2009. Infants with congenital hypothyroidism, low birth weight and prematurity were excluded from the study. Neonatal TSH concentration was measured by the Autodelphia method in dried blood spots, collected by heel stick on filter paper 3 to 5 days after birth. Cognitive abilities and psychomotor development are assessed using the Wechsler Preschool and Primary Scale of Intelligence - third edition - and the Charlop-Atwell Scale of Motor coordination. Psychosocial development is measured using the Child Behaviour Check List for age 1½ to 5 years old. In addition, several socioeconomic, parental and child confounding factors are assessed. This study aims to clarify the effect of mild iodine deficiency during pregnancy on the neurodevelopment of the offspring. Therefore, the results may have important implications for future public health recommendations, policies and practices in food supplementation. In addition, the results may have implications for the use of neonatal TSH screening results for monitoring the population iodine status and may lead to the definition of new TSH cut-offs for determination of the severity of iodine status and for practical use in data reporting by neonatal screening centres.

A global question on chronic morbidity is included in many national health interview surveys. According to a recent EU Commission regulation, information on this item should be collected in all EU member states. However, little is known about the reliability and validity of such a question. The reliability of a global question on chronic morbidity was investigated among persons who participated in 2001 in both the Belgian health interview survey (HIS) and the national population census (n= 2,871) by using kappa statistics and logistic regression. In addition, data from the HIS 2001 and 2004 (n= 21,376) were used to study estimates and determinants of the sensitivity of this global chronic morbidity measure among people with specific chronic diseases. In terms of reliability, the kappa statistic showed only moderate agreement (0.559; 95 % CI 0.523–0.594). Additionally, the sensitivity of the global question on chronic morbidity ranged from 49.9 to 87.2 %, depending on the type of disease. A much higher sensitivity was observed among people who rated their health status to be moderate to bad (adjusted OR 3.85; 95 % CI 3.17–4.69). Self-reported chronic morbidity, measured by a single and global question, is a reasonably reliable instrument to measure ill health. The global instrument provides useful information on the burden of disease, because it takes into account the relevance of the diseases for the people themselves.

Field substitution and post-stratification adjustment have been proposed to reduce non-response bias in population surveys. We investigated if variables involved in those techniques in the Belgian health interview survey 2004 are associated with non-response and assessed the impact of field substitution and post-stratification adjustment on the survey results. Data were obtained from all selected households (n= 12.204). The association between non-response and the selected variables was explored through multilevel logistic regression models with municipality and statistical sector as random effects. All investigated variables were significantly related with non-response. Especially households that could not be contacted differed substantially from those who participated. Only post-stratification had a clear impact on the survey results. Even if variables used in the field substitution procedure of health surveys are strongly associated with non-response, the impact of field substitution on the survey results may be minimal, either because there was no bias of relevance or it was not captured. The usefulness of field substitution to correct for non-response bias in population health surveys seems to be quite limited.

The purpose of the Centre for Operational Research in Public Health (CORPH) is to optimize the accessibility to health information, thus making it possible to measure and follow up the health status of the Belgian population. The Standardized Procedures for Mortality Analysis (SPMA) software was developed in order to facilitate the use of vital statistics for health policy-makers and scientific researchers. Nowadays, SPMA is available on the Internet, because accessibility to health information is crucial. SPMA serves via a system of menus as the interface between databases (population, birth, and mortality) on one hand and statistical procedures on the other hand. Users can choose the parameters such as year, cause of death, geographical level, and statistical indicator, and so dynamic reports are produced 'on demand'. These procedures are available for the following modules: overall mortality, specific cause mortality, and perinatal statistics. Analysis can be carried out for one specific year or for a period over time. Pre-defined procedures accessible through menus make SPMA user-friendly, as it can be used without any preliminary knowledge of the statistical package. Tables, charts, or maps display the results. Users need only an Internet browser to access the application.

Obesity is a major public health issue with increasing prevalence among adults. However, in Belgium the regional time trends (1997?2008) differed: the prevalence of obesity increased in the Flemish and Brussels Regions, but remained stable in the Walloon Region, the latter still showing the highest prevalence. The purpose of the present study is to explore if the different time trends of obesity prevalence in the three Belgian regions is associated with lifestyle changes.

The Belgian Health Interview Survey (BHIS) is organised every 4 to 5 years and collects health information from around 10,000 individuals in a face-to-face setting. This manuscript describes the methodological choices made in the sampling design, the outcomes of the previous surveys in terms of participation rates and achieved targets and the factors to be accounted for in data-analysis.