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 as from 2023. The dataset of the National Health Index replaces the data of the previous THL’s Morbidity Index1, 2 and Kela's Health Barometer.
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 index data can be used to monitor the development and regional differences in the morbidity and work disability of the population. National Health Index is included in the indicators used for monitoring the achievement of the national healthcare and social welfare objectives between 2023 and 20263. In addition, the index is a key indicator describing the regional need for services, which THL uses for the performance assessment of the health and social services system4. The statistics of National Health Index is now published for the first time, and the morbidity and work disability indices and their subindices are available for the periods of 2017–2019, 2018–2020 and 2019–2021.
Methodology
The statistics of the National Health Index are divided into
- The total morbidity index and its subindices. The disease groups included in the morbidity index are cancers, coronary disease, cerebrovascular diseases, musculoskeletal disorders, mental health disorders, accidents, memory disorders, respiratory diseases (chronic diseases), diabetes and alcohol-related diseases (definitions in Appendix table 1). Index results describing the prevalence of accidents, included in the morbidity index, could not be produced in spring 2023 because of changes in the data definitions in the National Care Registers for Social Welfare and Health Care (Hilmo), among other things. For this reason, the data on the prevalence of accidents included in the morbidity index has been frozen to the level of 2019 in this statistical publication.
- The work disability index and its subindices, which include indices for the prevalence disability pensions, sickness allowances and positive decisions on vocational rehabilitation.
The indices describe the prevalence of illnesses and work disability in a specific age group compared to the morbidity and work disability of that age group nationwide (entire country = 100). The more common morbidity or work disability in the region, the greater the index value. The morbidity and work disability indices equal 100 for the entire country in the most recent three-year period of the statistics.
The disease groups of the morbidity index were selected to the previous THL’s Morbidity Index (cancers, coronary disease, cerebrovascular diseases, musculoskeletal disorders, mental health disorders, accidents, memory disorders) in 2012 and, as a result of development work carried out in 2021–2023, the morbidity index was extended to cover three new disease groups (respiratory diseases, diabetes and alcohol-related diseases). The justification for including the diseases in the index was that they are major public health problems that cause the majority of deaths and disability pensions among Finns, they create a significant part of healthcare and social welfare costs, and reliable data on their prevalence is available in the national registers. In 2019, almost 79% of the years of life lost in people aged under 80 were caused by the disease groups included in the index (Appendix table 2). The same year approximately 74% of work disability pensions were granted due to diseases included in the index. In addition, they accounted for approximately 55% of the costs of health and social services. Other important selection criteria included the availability of data for calculation, regular updating of datasets and suitability for describing morbidity in particular, instead of reflecting regional differences in practices of the service system. Age limits were chosen for each disease group if the disease in question is very rare among people who are younger than the selected age limit, making it not feasible to collect data on them.
In the total morbidity index, the prevalence of each disease group is weighted based on its significance in terms of mortality, work disability, quality of life and healthcare and social welfare costs. The purpose of the weighting is to highlight the societal burden related to morbidity or caused by it and the different impacts on an individual. In the calculation of the morbidity index, each of the four weighting factors (mortality, work disability, quality of life, social and healthcare costs) is given an equal proportion of the weighting (25%). The total morbidity index figure for the region is the weighted sum calculated from the subindices of morbidity. Mental disorders, which are key causes of work disability and a decrease in the quality of life, receive the greatest weight in the morbidity index. The data sources and methods used in determining the weighting factors are described in Appendix table 2.
The work disability index takes into account the benefit recipients aged 16–64 years who live in Finland and their proportion in the population of the corresponding age. Of recipients of work 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 work 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 taken into account. The weight given to recipients of a positive decision on vocational rehabilitation is 0.5 in the total index.
To reduce random variation, the calculation of the indices is based on data from three consecutive years at all regional levels. For example, calculation of the 2021 indices is based on the data from the years 2019–2021. When looking at the time series of the morbidity indices, it should be noted that the index values for previous years also change with the new update. It should also be noted that the new index values are not comparable with the previous THL’s Morbidity Index.
Accuracy and reliability of the data
Calculation of the indicators of National Health Index is based on the data from the national registers of 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 data depends on the comprehensiveness and accuracy of these registers, described in their quality descriptions (Appendix table 1).
When looking at the time series, it should be noted that the values for previous years change each time when new statistics are released. Both an age-standardised and a non-standardised version of the index is produced, and their interpretations differ. Several diseases are heavily age-dependent, which means that the age structure of the population of a geographical area has a remarkable effect on the level of morbidity. The age-standardised index describes the difference 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 method1.
The calculation of the population sizes and age-standardisation of the morbidity indices are carried using mid-year population statistics obtained from Statistics Finland’s statistics on population structure. The population structure used in age-standardisation is that of the entire country and it calculated from the most recent three-year period (2019–2021) in the statistics of National Health Index. For indices describing work disability, the population sizes and age-standardisation are implemented with Kela’s population statistics, which are based on Finnish population at the end of January following the index year. For each index, age-standardisation is carried out by using a dataset tabulated into five-year age groups.
The indicators of National Health Index have been developed to describe regional differences in the Finnish population’s morbidity and work disability. There are many reasons behind the differences in morbidity and work disability. With regard to lifestyle, particularly smoking and heavy use of alcohol increase morbidity. The population’s age structure, employment situation as well as educational and income level contribute to morbidity. 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 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. The differences in work disability index are influenced by regional factors related to the provision of healthcare and social welfare, such as a shortage of doctors and the functioning of occupational health care as a factor preventing work ability problems and providing guidance.
There are also differences in healthcare practices, diagnostics of diseases, drawing up of the medical statements required for granting benefits and recording practices between regions that are independent of morbidity and the functional capacity of the population. These may explain some statistical anomalies especially in individual municipalities, but also in wellbeing services counties. For example, differences in the mental health index from one region to the next may simply be caused by varying practices in recording medical information. The healthcare system itself may also skew the findings: well-functioning health care may result in an apparently high morbidity that is actually due to more efficient screening, diagnosing and treating of diseases. Such factors may be reflected in the cancer index, for example: an index value higher than average may illustrate higher cancer morbidity or mean that the region is successful in the early diagnostics of cancer.
When looking at the time series of the work disability index, it should be noted that the index figures for municipalities and regions are influenced not only by the development of work disability in the region but also by the simultaneous development of the entire country. The age-standardised index describes the part of regional differences that are not due to differences in age structures. The non-standardised index in turn better reflects the prevalence of work disability in the region and, for example, the service need caused by it in comparison to the national level.
Timeliness and promptness of data
The new National Health Index combines the traditions of THL’s Morbidity Index and Kela’s Health Barometer. The index describes the prevalence of diseases of public health importance in Finland with an average delay of two years. This is due to the schedule of the completion of the causes of death register. However, changes in the incidence and prevalence of the main diseases included in the calculation of the indices cannot usually be observed over a short period of time. Only significant changes, for example, in the availability of screening or treatment could have an impact even in the short term.
Data on three consecutive years have been used in calculating the indices to ensure a sufficient number of cases even in regions with the smallest population size and to reduce the influence of random variation on the figure.
Availability and clarity of data
The index figures and their metadata will be published in THL’s statistics and indicator bank Sotkanet and Kela’s Info Tray, first by wellbeing services county. The statistics will be supplemented with municipality-specific data during 2023. The results for each statistical year are calculated based on the data for three consecutive years and recorded as the data for the last year of the three-year period (e.g. for 2021 for the period 2019–2021).
The statistics also have their own websites at THL and Kela.
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.
Classifications describing a care event in healthcare and specialised healthcare in the Care Register for Health Care have been reformed with the reform applying since the data collection of the year 2019 (THL 2018). The reform applies to the register’s variables for service sector and mode of arrival, which have been replaced with entirely new variables for contact mode and urgency. Because of this reform, it is possible that there are differences in the comparability of the morbidity indices in terms of time periods in some regions before and after 2019. This applies particularly to the indicators of the following disease groups, which are defined based on the incidence of hospitalisation episodes: coronary disease, cerebrovascular diseases and self-harm (as part of the dataset of the mental health index).
In those subindices where the data sources also include data from outpatient care in primary healthcare, it should be noted that comprehensive data has not been received from all health centres for all years because of problems with information systems, and there are deficiencies in the recording 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 problems with the transfer of data in the patient information system. There may also be deficiencies in the data accumulated on specialised healthcare because of missing entries. The quality and coverage of the data may vary from one year to another and one region to another. A high index figure may indicate high morbidity and/or the fact that the diseases included in the calculation of the index are identified and treated particularly actively in the region.
References
1 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.
2 Parikka S, Koskela T, Pietilä A, Koponen P, Koskinen S. THL's Morbidity Index 2019. Large regional differences in morbidity. Statistical report 19/2022.
3 Sosiaali- ja terveydenhuollon valtakunnalliset tavoitteet vuosille 2023–2026. Sosiaali- ja terveysministeriön julkaisuja 2022:18.
4 KUVA-mittaristo, THL. Accessed 8 May 2023.
