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To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/S0277-9536(96)00080-9 Byline: Herman Van Oyen, Jean Tafforeau, Marc Roelands Abstract: Mortality differs substantially between the Flemish and Walloon regions in Belgium. The question remains as to whether the health status of both populations varies in a similar way. The difference in healthy life expectancy, an indicator of population health, between the Flemish and Walloon regions was therefore assessed. In 1989-1990 a cross-sectional survey in the general population was performed in which 2640 persons were selected by a multistage random process. Perceived health status was determined through a validated question: 'On the whole, how would you describe your health for the moment? Would you say it is very good/good/fair/rather bad/bad?' The prevalence of 'being in good health (very good to fair)' was combined with mortality data (Sullivan method) to estimate the healthy life expectancy (HLE), and the following results were found. Among males, life expectancy (LE) and HLE at age 15 was 58.9 years and 56.5 years in the Flemish region, compared with 56.6 and 50.2 years in the Walloon region. At age 65, LE and HLE in the Flemish region was 14.3 and 13.3 years, and only 13.2 and 9.2 years in the Wallon region. Women at age 15 had an LE and HLE in the Flemish region of 65.2 years and 61.3 years, compared to 63.9 and 58.1 years in the Walloon region. At age 65, both the LE and the HLE in the Flemish region were higher, with LE at 18.5 versus 17.7 years, and HLE at 16.0 versus 14.3 years. Similar results were obtained when the criteria of 'being in good health' were restricted to those indicating their health to be very good or good. In conclusion, the data indicate that the population in the Walloon region not only has a shorter life but apparently also has a shorter healthy life. Research is needed to explain what proportion of these differences can be attributed to differences in the prevalence of diseases, cultural differences and socio-economic differences. Author Affiliation: Center for Operational Research in Public Health, Department of Epidemiology, Institute of Hygiene and Epidemiology, J. Wytsmanstraat 14, 1050, Brussel, Belgium

Background The validity of self-reported mammography uptake is often questioned. We assessed the related selection and reporting biases among women aged 50–69 years in the Belgian Health Interview Survey (BHIS) using reimbursement data for mammography stemming from the Belgian Compulsory Health Insurance organizations (BCHI). Methods Individual BHIS 2013 data (n  = 1040) were linked to BCHI data 2010–13 (BHIS–BCHI sample). Being reimbursed for mammography within the last 2-years was used as the gold standard. Selection bias was assessed by comparing BHIS estimates reimbursement rates in BHIS–BCHI with similar estimates from the Echantillon Permanent/Permanente Steekproef (EPS), a random sample of BCHI data, while reporting bias was investigated by comparing self-reported versus reimbursement information in the BHIS–BCHI. Reporting bias was further explored through measures of agreement and logistic regression. Results Mammography uptake rates based on self-reported information and reimbursement from the BHIS–BCHI were 75.5% and 69.8%, respectively. In the EPS, it was 64.1%. The validity is significantly affected by both selection bias {relative size = 8.93% [95% confidence interval (CI): 3.21–14.64]} and reporting bias [relative size = 8.22% (95% CI: 0.76–15.68)]. Sensitivity was excellent (93.7%), while the specificity was fair (66.4%). The agreement was moderate (kappa = 0.63). Women born in non-EU countries (OR = 2.81, 95% CI: 1.54–5.13), with high household income (OR = 1.27, 95% CI: 1.02–1.60) and those reporting poor perceived health (OR = 1.41, 95% CI: 1.14–1.73) were more likely to inaccurately report their mammography uptake. Conclusions The validity of self-reported mammography uptake in women aged 50–69 years is affected by both selection and reporting bias. Both administrative and survey data are complementary when assessing mammography uptake. [ABSTRACT FROM AUTHOR]

Background The European Health Interview Survey (EHIS) provides cross-national data on health status, health care and health determinants. So far, 10 of the 30 member states (MS) opted for web-based questionnaires within mixed-mode designs but none used it as the sole mode. In the context of future EHIS, the response rate and net sample composition of a web-only approach was tested. Methods A Belgian study with a target sample size of 1000 (age: 16–85) was organized using the EHIS wave 3 model questionnaire. The sample was selected according to a multistage, clustered sampling procedure with geographical stratification. Field substitution was applied; non-participating households were replaced by similar households regarding statistical sector, sex and age. There was one reminder letter and a €10 conditional incentive. Results Considering all substitutions, a 16% response rate was obtained after sending one reminder. Elderly, Brussels Capital inhabitants, people living without a partner and those with a non-Belgian nationality were less responding. By design, there were no differences between the initial and final net sample regarding substitution characteristics. Nevertheless, people living without a partner, non-Belgians and lower educated people remain underrepresented. Conclusion There was a low response rate, particularly for some population groups. The response rate was lower than those of MS using mixed-mode designs including web, especially these comprising interviewer-based approaches. Despite the long and complex questionnaire, there was a low break off rate. So far, web-only data collection is not an acceptable strategy for population-based health surveys but efforts to increase the response should be further explored. [ABSTRACT FROM AUTHOR]