National Health Index
Relevance of statistical data
The statistics are based on the Act on the National Institute for Health and Welfare (668/2008), under which THL’s duties include studying and monitoring the welfare and health of the population (Section 2). As part of this work, THL and Kela produce the National Health Index which is a collection of statistical data on the prevalence of the main disease groups with public health importance and the prevalence of work disability in regions and municipalities. The dataset will be released regularly in cooperation with the Finnish Centre for Pensions and Statistics Finland.
The indices allow municipalities and regions to compare their disease burden and work disability among their own population to that of the entire country and other regions. This information helps wellbeing services counties and municipalities to prevent the development of problems and to take measures that best promote well-being and health.
On a national scale, the statistics can be used to monitor the development and regional differences in the morbidity and work disability of the population. The National Health Index indicators are part of the indicators for monitoring the national objectives of the organisation of social welfare and healthcare (1). The statistics provide key indicators describing regional needs for health and social services and are used e.g. for the annual performance assessment of the health and social services system conducted by THL (2).
Methodology
The statistics of the National Health Index are divided into
- The total morbidity index (short name morbidity index) and its ten disease-specific subindices. The disease groups included in the total index are cancers, coronary disease, cerebrovascular diseases, musculoskeletal disorders, men-tal health disorders, accidents, memory disorders, respiratory diseases (chronic diseases), diabetes and alcohol-related diseases.
- The total work disability index (short name work disability index) and its three subindices: disability pensions, sickness allowances and decisions granting vocational rehabilitation.
The total indices and their subindices describe the prevalence of illnesses and work disability among the examined area's population in relation to the morbidity and work disability of the country's entire population (the whole country = 100). The more common morbidity or work disability in the region, the greater the index value.
Several comprehensive administrative register datasets, maintained by THL, Kela, the Finnish Centre for Pensions and the Finnish Cancer Registry, are combined to define the indicators. The register data sources considered in the definition of each indicator, and e.g. the diagnosis codes and age groups covered by the indicators are described in Appendix 1. Morbidity indices are calculated among each region’s population which is determined using information on the municipality of residence at the end of the year in question obtained from the Population Information System of the Digital and Popula-tion Data Services Agency. Certain disease-specific indices are defined among a population of specified age group if the disease is rare among younger people, and it is therefore not feasible to report.
In defining the indices, data on morbidity and work disability from three consecutive years is used to ensure a sufficient number of cases even in regions with small population and to reduce the influence of random variation on the results. The index results can therefore be interpreted as three-year averages in morbidity and work disability.
Both an age-standardised and a non-standardised version of each index is released. Age-standardisation is based on the indirect method. The entire country's population structure is used as the reference in age-standardisation, and it is determined from the most recent three-year period (2020–2022) from Statistics Finland's population structure statistics. For indices describing work disability, the population base and age-standardisation are implemented with Kela’s population statistics data, which describe the situation at the end of January following the index year. Age-standardisation is carried out for each index using data grouped into five-year age groups.
The total indices of morbidity and work disability are summary indicators, which are formed as weighted sums of the subindices they contain. The work disability index considers the benefit recipients aged 16 to 64 years who live in Finland and their propor-tion in the population of the corresponding age. Of recipients of disability pension, the recipients of both earnings-related pension and Kela’s pension in December each year are included. The weight given to recipients of partial disability pension is 0.5 in the total index. Of recipients of sickness allowance, those who have received the allowance for at least 90 days per year have been considered. The weight given to recipients of a positive decision on vocational rehabilitation is 0.5 in the total index.
In the total morbidity index, each disease-specific subindex is weighted according to its contribution to the overall mortality, work disability, quality of life and healthcare and social welfare costs. The rationale of the weighting is to give emphasis to the societal burden related to each disease group and to reflect their different impacts on an individual. In the calculation of the total morbidity index, each of the four weighting domains (mortality, work disability, quality of life, social and healthcare costs) is scaled to give an equal proportion of the weighting (25%). Mental disorders, which are key causes of work disability and a decrease in the quality of life, have the greatest weight in the total morbidity index. The data and methods used in determining the weighting factors are described in Appendix table 2.
When examining the time series of morbidity indices, it should be noted that the index values of previous years will change along with a new update of the statistics, because the figures are calculated in relation to the morbidity rate in the whole country in the most recent three-year period of the statistics. It should also be noted that the morbidity indicators of the National Health Index statistics are not comparable with the previous THL morbidity index.
Accuracy and reliability of the data
The calculation of the indicators of the National Health Index is based on nationwide administrative registers maintained by THL, Statistics Finland, the Finnish Centre for Pensions, the Finnish Cancer Registry and the Social Insurance Institution of Finland (Kela). The correctness of the index results depends on the comprehensiveness and accuracy of these registers, described in their quality descriptions (Appendix1).
When looking at the time series, it should be noted that the values for previous years change along with a new release of the statistics. Both an age-standardised and a non-standardised version of the indices is released, and their interpretations differ. Several diseases are strongly age-dependent, which means that the age structure of the population of a geographical area has a marked influence the region’s level of morbidity. The age-standardised index describes the differences in morbidity between various regions regardless of the age structure. The non-standardised index, on the other hand, provides a better description of the actual morbidity burden in the area. Age-standardisation is based on the indirect method (3).
The indicators of the National Health Index have been developed to describe regional differences in the population’s morbidity and work disability. Various factors contribute to differences in morbidity and work disability. Regarding lifestyle factors, at the individual level, particularly smoking and heavy use of alcohol increase morbidity. At the regional level, the population’s age structure, employment situation as well as educational and income level may have an impact on the morbidity level observed in the population. Several health risks and illnesses tend to accumulate in population groups with a lower educational attainment, low income and long-term unemployment. Because of this, the index results should not be used to draw conclusions on the performance of the healthcare system in various areas; other factors affecting morbidity, work ability and functional capacity that underlie regional differences should also be considered. Regional differences in the work disability index are influenced by regional factors related to the provision of healthcare and social welfare services. These include differences in the availability of physicians and other healthcare personnel, and the functioning of occupational healthcare as a factor of preventing work ability problems and providing health guidance.
Between regions there are also differences in healthcare treatment practices, diagnostics of diseases, drawing up of medical statements required for granting benefits, and in customs of recording patient-level medical information that are independent of morbidity and the functional capacity of the population. These differences may explain some statistical anomalies especially in individual municipalities, but also at the level of wellbeing services counties. For example, differences in the mental health index may partly reflect differences in how medical information such as diagnostic codes are recorded in healthcare providers’ information systems. The healthcare system itself may also skew the findings: well-functioning healthcare in a region may result in a seemingly high morbidity rate due to more active screening, diagnosis and treatment of diseases. Such factors may be reflected, for example, in the cancer index: an index value higher than average may illustrate higher cancer morbidity or indicate that the region is successful in the early diagnostics of cancer.
When examining the time series of the work disability index, it should be noted that the index values of municipalities and regions are influenced not only by the development of work disability prevalence in the region itself but also by the simultaneous develop-ment in the level of the entire country. The age-standardised index describes the part of regional differences that are not caused by differences in age structures. The non-standardised index in turn reflects better the prevalence of work disability in the area and, for example, the service need caused by it in comparison to the national level.
Timeliness and promptness of data
The indicators of the National Health Index statistics describe the prevalence of morbidity and work disability with a delay of approximately two years. The delay is due to data availability for morbidity indicators where data from the Causes of Death Register are used as a source. However, remarkable variations in the prevalence of the disease groups included in the statistics are not generally observed in the short term. In the short term, index results could be affected by significant changes in treatment practices or disruptions in the availability of treatment.
Availability and clarity of data
The index results and their metadata are published in THL’s statistics and indicator bank Sotkanet and Kela’s Info Tray.
In Sotkanet, the last year of each three-year calculation period is displayed in the year variable of the database. For example, for index results calculated from the period 2020–2022 the year 2022 is displayed as the year of the index results.
The National Health Index statistics has websites both at THL and KelaLink to an external websiteAvautuu uudessa välilehdessä.
Comparability and coherence and of data
In connection with the update of the morbidity indices, the indices of all previous years are calculated again based on the most recent classification of municipalities. Other information is updated retrospectively as well, if it has changed.
In the Care Register for Health Care, classifications describing visits and hospitalizations in the primary and specialised healthcare have been revised in 2019 (THL 2018Link to an external websiteAvautuu uudessa välilehdessä). The revision applies to the register’s variables describing the service sector and mode of arrival, which have been replaced with entirely new variables on contact method and urgency of care. Because of this, it is possible that there are breaks in the temporal comparability of the morbidity indices in some regions. This applies particularly to the indicators of the following disease groups, which are defined using information on the incidence of treatment episodes in hospitals: coronary diseases, cerebrovascular diseases and self-harm (component of the mental health index).
There may be temporal and regional variations in the coverage and quality of the Care Register for Health Care. In morbidity subindices where the data sources used also include data from outpatient care in primary healthcare, it should be noted that comprehensive data have not been received from all health centres for all years because of problems with information systems, and there may be deficiencies in the coverage of reasons for visit. It is known that especially in Helsinki and in the wellbeing services county of Vantaa and Kerava, there are deficiencies in the data accumulated in the Care Register system because of issues with the transfer of data in the patient information system. There may also be deficiencies in specialised healthcare data because of miss-ing entries. In addition, since the beginning of 2020, the coverage of data from private providers in the Care Register of Health Care has improved significantly.
Index results are not released for the municipalities of the Åland Islands. Administrative register data for the Åland Islands residents are known to contain issues in coverage, which may be caused by health services used and treatment received in Sweden. Deficiencies in data coverage may be reflected as abnormally low index results. However, it is likely that morbidity in Åland is somewhat lower than in it is in mainland Finland.
Statistical report 2020-2022 special issues
The possible impacts of the postponed service and treatment provision that accumulat-ed during the COVID-19 pandemic may be reflected in the results described in this sta-tistical report. Diseases that do not cause clearly identifiable symptoms (e.g. certain cancers, lung diseases initially causing mild symptoms, or type 2 diabetes) or do not require urgent treatment, may have been diagnosed in smaller numbers during the pandemic than in normal times.
In connection with the release of the data in this statistical report, the definitions of coronary disease and cerebrovascular disease indices have been modified so that their definitions only consider the main diagnoses in the Care Register for Health Care. Previ-ously, their definitions also included secondary diagnoses. This modification of the indices’ definitions is due to changes in medical records observed in the register, which affected the reliability of the secondary diagnosis records. The definition has been changed to cover the entire time series of indices available in Sotkanet.
References
1. KUVA indicators, THL. Available at: https://thl.fi/fi/web/sote-palvelujen-johtaminen/arviointi-ja-seuranta/sosiaali-ja-terveydenhuollon-jarjestamisen-arviointi/kuva-mittaristo Accessed 29 April 2024.
2. National Objectives for the Organisation of Healthcare and Social Welfare. Publica-tions of the Ministry of Social Affairs and Health 2024:2. http://urn.fi/URN:ISBN:978-952-00-5448-9
3. Sipilä P, Parikka S, Härkänen T, Juntunen T, Koskela T, Martelin T, Koskinen S. Kuntien väliset erot sairastavuudessa – THL:n sairastavuusindeksin tuloksia. Suomen Lääkärilehti 45/2014. https://urn.fi/URN:NBN:fi-fe201501091087
4. Finnish Institute for Health and Welfare. THL's Morbidity Index 2019. Large regional differences in morbidity. Statistical report 19/2022. https://urn.fi/URN:NBN:fi-fe2022042530303
