National Health Index

Data description

Statistical presentation

The National Health Index is a statistical dataset produced jointly by the Finnish Institute for Health and Welfare (Terveyden ja hyvinvoinnin laitos, THL) and the Social Insurance Institution of Finland (Kansaneläkelaitos, Kela). It contains indicators on the prevalence of the main disease groups with public health importance and work disability among the population of wellbeing services counties and municipalities. 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 heart disease, cerebrovascular diseases, musculoskeletal disorders, mental 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: work disability pensions, sickness allowances and favourable decisions on vocational rehabilitation applications.

The indicators of the statistics are reported as regional index figures, where the reference value is the prevalence or incidence of the phenomenon described by the indicator among the population of the whole country. The index figure for the whole country takes the value 100. The higher the value of the index, the higher the prevalence of morbidity or work disability in the region’s population. The regional levels available for the indicators are municipalities, wellbeing services counties and collaborative areas for healthcare and social welfare. The indicators included in the statistics are available by sex and as total (men and women combined).

The index data are calculated based on a three-year rolling average number of cases to reduce the effect of random variation on the figures for the smallest population areas. The index data are available as a time series starting with data covering the years 2017–2019. This report covers the results from the most recent three-year period, 2021–2023.

The data described by the indicators are based on several compre-hensive administrative register datasets covering the whole Finnish population. These are combined to define the indicators. THL and Kela produce the data in cooperation with the Finnish Centre for Pensions and Statistics Finland. The statistics are published once a year.

Relevance

he ten disease groups included in the statistics have been selected based on their high prevalence and disease burden in the Finnish population. The burden of the diseases was evaluated analysing their contribution to premature mortality, work disability, health related decline in quality of life, and healthcare and social welfare utilisation costs among the Finnish population, using data mainly from 2019 (Appendix Table 2).

The work disability indices (work disability pensions, sickness allowance periods of more than 90 days and favourable decisions on vocational rehabilitation applications) were chosen because they describe work disability from different perspectives. As work disability pensions represent the most permanent work disability, they carry the most weight in the indicator calculation (Appendix Table 2).

The morbidity and work disability indicators included in the statistics enable municipalities and regions to compare the burden of disease and work disability in their own population and their trends in relation to the national level. This information will help regions and municipalities to prevent problems and develop actions to best pro-mote wellbeing and health. The indicators are used in the wellbeing reports produced by municipalities and wellbeing services counties.

At the national level, the statistics can be used to monitor trends and regional disparities in morbidity and work disability. The National Health Index statistics are part of the indicators for monitoring national targets for the organisation of social and health care. In addition, the indices are used as key indicators of regional service needs, for example, in annual expert assessments of the organisation of healthcare and social welfare conducted by THL (see KUVA indicators, website available in Finnish). The total indices of morbidity and work disability are also part of the dataset for strategic management in the wellbeing services counties (Johdon strateginen tilannekuva, JST, available in Finnish).

Data content of the statistics

The indicators of the statistics describe morbidity and work disability of the Finnish population. Demographic data used in the calculation of the morbidity indicators are based on the data for the last day of the year preceding the year of calculation, considering the population whose municipality of residence was in Finland. The demographic data for work disability indicators are based on Kela’s population statistics data, which describe the situation at the end of January following the index year.

Each of the indicators describe morbidity or work disability among the population in a specified age group. The work disability indicators consider the working-age population aged 16–64. Relevant age groups for each morbidity indicator have been specified considering the disease’s prevalence and the reliability of the diagnostic data in the selected age group.

The data content of the indicators of the statistics and the age limits are described in Appendix Table 1.

The main concepts and variables of the statistics are described as part of the statistical report.

Statistical processing

Source data

The statistics are based on several administrative register data maintained by THL, Kela, the Finnish Centre for Pensions and the Cancer Register. The source data for the statistics are the following registers:

Care Register for Health Care (THL)
Register of Primary Health Care Visits (THL)
Care Register for Social Welfare (THL)
Recipients of the social benefits of Kela: work disability pensions, sickness allowances and favourable decisions on vocational rehabilitation applications (Kela)
Medicine dispensations reimbursable under the National Health Insurance scheme register maintained by Kela (Kela)
Right to medicine reimbursement at a special rate register maintained by Kela
Pensions under the earnings-related pension scheme: disability pensions (Finnish Centre for Pensions and Kela)
Cancer Registry (Finnish Cancer Registry)
Causes of death (Statistics Finland)
Population Information System (Digital and Population Data Services Agency)

The source data are individual-level observations, and a pseudony-mised identifier is used to link data from different registers. Relevant data sources and criteria for definition have been defined individually for each morbidity and work disability indicator included in the statistics. These are summarised in Appendix Table 1.

Data collection

The data sources used to define the indicators of the statistics are obtained based on the data permit THL/3457/6.02.00/2023. The data are collected annually from the register maintainers, and the collected data relate to the calendar year preceding the collection date.

Unlike the other registers, the social and health care registers are continuously updated. The extraction of morbidity data from these registers is carried out annually in the spring in connection with the preparation of a new release of the National Health Index statistics.

Data validation

The morbidity indicators of the dataset are defined by combining data from different registers. The aim of this is to ensure that morbidity is observed as comprehensively as possible. For each indicator of the statistics, the data sources and definition criteria have been specified considering their relevance and validity to describe the morbidity or work disability prevalence in question.

The morbidity indicators are defined under the guidance of experts familiar with the diagnosis practices and treatment of the diseases as well as with regional differences in the service system functioning. When new indicator results are being prepared, experts are con-sulted to detect and clarify possible discrepancies. Discrepancies are solved by discussion and, where appropriate, by consulting with the register maintainers.

Data compilation

Data content for morbidity is based on the combination of data from several register datasets. In the definition of morbidity indicators describing chronic illnesses, the diagnostic history of patients has been retrospectively tracked. In indices that are based on disease incidence, healthcare contacts and admissions to inpatient care are considered, and one person can have more than one event in a year.

The total indices and their sub-indices describe the prevalence or incidence of diseases and work disability in the population of the region relative to the morbidity and work disability of the national population. The morbidity or work disability index for the country takes the value 100. Age-standardised and unstandardised versions of the indices are produced. Age-standardisation is based on the indirect method. The population information and age-standardisation of the sub-indices by disease group are based on the average population calculated from statistics on population structure from Statistics Finland. Age-standardisation is based on the population structure of the whole country observed from the most recent three-year period covered by the statistics. For work disability indices, population information used in index calculation and age-standardisation is based on data from the Kela population statistics, which include the situation at the end of January of the year following the index year. For each index, age-standardisation has been conducted with data grouped to five-year age groups.

The total indices included in the statistics are summary measures of morbidity and work disability. They are formed as the weighted sum of their subindices. The work disability index considers beneficiaries aged 16–64 years living in Finland and their share of 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 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 those with a favourable decision on vocational rehabilitation application 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 premature mortality, work disability, health related quality of life loss, and healthcare and social welfare utilisation costs observed among the total Finnish population. The rationale of the weighting is to give emphasis to the societal burden related to each disease group and to their varying impacts on an individual. In the calculation of the total morbidity index, each of the four weighting domains (mortality, work disability, quality of life, healthcare and social welfare costs) is scaled to give an equal proportion of the weighting (25%). Mental health disorders, which are leading causes of work disability and quality of life losses, have the greatest weight in the total morbidity index. The data and methods used to estimate the weighting factors are described in Appendix Table 2.

Data revision

With the new update of the morbidity indices, the index values for the previous reference years will change, as the figures are calculated in relation to the morbidity of the most recent three-year period of the statistics for the whole country. In the update, the indices for all previous years are calculated according to the municipality and region classification of the year of the update. Other data are revised retrospectively if they have changed, for example, because of data updates received by the register maintainers. At the time of the new release, the time series of the indices will be fully updated in the databases.

Quality assessment of the statistics

Accuracy and reliability

The indicators of the National Health Index have been developed to describe regional differences in morbidity and work disability of the population. The indicators are calculated based on data from nation-al registers maintained by THL, Statistics Finland, Finnish Centre for Pensions, Finnish Cancer Register and Kela. The accuracy of the in-dex data depends on the coverage and accuracy of these registers, which are described in the data descriptions available in their Data Catalogue and in the quality reports of the statistical publications that are regularly compiled from these registers (see Appendix Table 1).

However, there are differences between regions in healthcare treatment practices, drawing up of medical statements required for granting benefits, and in customs of recording patientlevel medical information that are independent of morbidity and the functional capacity of the population. Factors in regional social and health care provision, such as the shortage of physicians and the role of occupational health care in preventing and managing work disability problems, contribute to differences in the work disability index. The healthcare system itself may also influence morbidity observed from the registers: 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.

Differences in the population structure of regions are a key determinant of regional differences in morbidity and work disability. Many diseases are highly age-dependent, with the age structure of the region largely determining the level of morbidity. Age-standardised and non-standardised indices are available for the indicators in the dataset, with differing interpretations. The age-standardised index captures differences in morbidity between regions, irrespective of age structure. The non-standardised index, on the other hand, describes the actual burden of disease on the region. In addition, the indicators are also published separately for men and women, describing regional differences in morbidity and work disability by sex. For the sex-specific indices, morbidity or work disability among men and women in the whole country population is used as the reference. For example, regional index figures for men show the difference in morbidity or work disability relative to men in the whole country.

Timeliness and punctuality

The statistics are published with a delay of two calendar years. The delay is due to the availability of data for those morbidity indicators where data on causes of death is needed. However, in general, temporal variation in the prevalence or incidence of the main chronic diseases covered by the statistics is minor. In the short term, the index figures may be affected by changes in, for example, diagnosis or treatment practices or variation in access to treatment.

Coherence and comparability

As the reference period for the morbidity index and its sub-indices changes annually along with a new release of the statistics, the figures for the morbidity indicators are not comparable with those of the previous releases. With new release, the time series for each index at all available regional levels are updated to consider the morbidity observed in the whole country’s population during the most recent three-year period of the statistics as the reference. In addition, all indicators’ time series will be updated to align with the regional classification valid at the time of the release of the statistics. The updated index figures are made available on Sotkanet.

It should also be noted that the disease-specific indicators included in the National Health Index are not comparable with the previously published THL morbidity index and its disease-specific sub-indices, as their data content and calculation methods are different. The publication of the THL morbidity index has been discontinued.

There may be annual and regional variation in the coverage and quality of the data in the health and social care registers. For those disease-specific indices where data from the Register of Primary Health Care Visits has been used, it should be noted that there may be deficiencies in data availability from some health centers due to problems in information systems. In Helsinki and in the Vantaa and Kerava wellbeing services county, there are known to be gaps in the data accumulated in the Register of Primary Health Care Visits due to problems with the data transfer from the patient information system. There may also be gaps in data in specialised care due to missing records.

Since 2020, more comprehensive data from occupational healthcare and other private providers have become available in the health and social care registers. This may be reflected in the time series of the accidental injuries index, where the improvement in data coverage after 2020 increases the index figures causing a break in the time series. Similarly, for some disease groups (e.g. diabetes and respiratory diseases) where data from the Register of Primary Health Care Visits are included, the increase in the number of cases in the 2020s may be partly explained by an improvement in data coverage as data from different providers became more widely available.

The figures for Åland are not presented in this statistical publication. There are known to be gaps in the register data for Åland, due to, among other things, treatments and care received in Sweden. Short-comings in data coverage may be reflected in exceptionally low index figures and may hamper comparison with other regions. It is, however, likely that the morbidity rate in Åland is lower than in mainland Finland.

Institutional mandate

The production of the statistics is based on the Act on the Finnish Institute for Health and Welfare (688/2008) and the Statistics Act (280/2004). One of the official tasks of the Finnish Institute for Health and Welfare is to produce statistical data on the health and welfare of the population, the factors affecting them, and the use and functioning of healthcare and social welfare services to support decision-making, development and research. THL’s statistical production practices are guided by the instructions, recommendations and regulations of Eurostat and the Official Statistics of Finland as well as the principles of statistical ethics.

Data sharing and publishing

THL publishes the data at the time indicated in advance in the sta-tistics publication calendar. The data is made public to all users at the same time. The data are published on the Sotkanet statistical and indicator bank (THL) and on the InfoTray (Kela).
Statistics publication calendar
The statistical reports are public. However, register data is confiden-tial. The Finnish Social and Health Data Permit Authority Findata grants permits for using the data based on the Act on the Secondary Use of Health and Social Data (552/2019).
Findata website

Confidentiality

As an authority, the Finnish Institute for Health and Welfare has the obligation to produce compiled data on the health and well-being concerned with the entire country. The data used to draw up THL’s statistics is primarily confidential, and personal data may not be published. The protection of processed data is based on the Act on the National Institute for Health and Welfare (688/2008), the Statistics Act (280/2004), the Act on the Openness of Government Activities (621/1999), the EU General Data Protection Regulation (EU) 2016/679 and the Data Protection Act (1050/2018) as well as other regulations guiding the activities of the Institute.

THL’s datasets are secured at all stages of processing. Data and information systems can only be accessed by persons who have a permit to access certain data for clearly defined purposes. Others do not have the ability to view, process, change or delete data. Written instructions have been drawn up to ensure the data protection of completed statistics. All THL personnel are bound by a confidentiality obligation.

Special issues concerning the 2021-2023 statistics

The possible impacts of the postponed service and treatment provision that accumulated during the COVID-19 pandemic may be reflected in the results described in this statistical report. For example, 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 2023, gaps have been identified in the coverage of data on outpa-tient visits to specialised private healthcare in the Care Register for Health Care, which will affect the accidental injuries index. Due to the calculation method of three-year rolling average number of cases, the changes in the index figure will be small, but a decrease will be observed in the period 2021–2023 compared to the previous calculation period 2020–2022. Regions may also differ in the provision and utilisation of private health care services, and changes in data coverage may affect the regional differences in the accidental injuries index.

References

National Objectives for the Organisation of Healthcare and Social Welfare. Publications of the Ministry of Social Affairs and Health 2024:7. http://urn.fi/URN:ISBN:978-952-00-5448-9