National Health Survey 2011-2012

Summary

Strengths: The survey has a multidimensional approach on health, includes data about the whole population to analyse health determinants and health services accessibility, and has tools for public health policy design. Weaknesses: There is a lack of standardization - definitions, wordings, thresholds on variables, etc. - in some areas and questions in the eight ENS issues.

Type of data

Data Source
Survey

Type of Study
Survey different
Crosssection regular

Data gathering method
Face-to-face

Access to data

Conditions of access
On their website, there is free access to all the provided data: - Statistical tables on health status and accident rate, health care and health determining factors. - Statistical tables on sampling errors. - Standardised Methodological Report, General Methodology, Questionnaires and Non-response analysis report. - Survey microdata files for scientific purpose and elaboration (ASCII), with register designs of the ASCII files. - Press release All the above-mentioned documents are open access, downloadable files: (i) INE: Tables: http://www.ine.es/jaxi/menu.do?type=pcaxis&path=%2Ft15/p419&file=inebase&L=1 Microdata: http://www.ine.es/en/prodyser/micro_ensalud_en.htm (ii) MSSSI: http://www.msssi.gob.es/en/estadEstudios/estadisticas/sisInfSanSNS/home.htm In many cases, the demand for information by users can be met (unpublished special tabulations, data with a greater territorial or sectorial breakdown level, etc...). These demands are fulfilled by the Ministry of Health, Social Service and Equality.

Type of available data (e.g. anonymised microdata, aggregated tables, etc.)
Aggregated and elaborated tables, plus raw anonymised microdata.

Formats available
Microdata are available in an ASCII zip file following a register design file (EXCEL format). Tables are available in Pc-Axis, Excel and CSV files. Questionnaires and reports are available in PDF format.

Coverage

Coverage Years of collection, reference years, and sample sizes
Spanish Statistical Institute (INE) in collaboration with the Ministry of Health (since this issue, a homogenized data series is carried out): Wave 1 (2003): Data was collected from April 2003 to March 2004. The sample consisted of approximately 22,000 dwellings distributed among 1,844 census tracts. Wave 2 (2006): Data was collected from June 2006 to June 2007. The sample consisted of approximately 31,300 dwellings distributed among 2,236 census tracts. Wave 3 (2009): (first wave of the European Health Survey in Spain) Data was collected from April 2009 to March 2010. The sample consisted of approximately 23,000 dwellings distributed among 1,927 census tracts. 22,188 interviews were conducted. Wave 4 (2011-12): Data was collected from July 2011 to June 2012. Interviews were conducted (in 21,508 households) with 21,007 adults (aged 15 or over) and with 5,495 children aged 14 and under, by interviewing his or her mother, father or guardian. A total of 26,502 interviews were carried out.

First year of collection
1987

Stratification if applicable
A stratified tri-stage sample type is used. The first stage units are census tracts. The second stage units are the main family dwellings. All households whose regular residence is within said dwellings are studied. Within each household, one adult person (aged 15 and over) is selected to complete the individual questionnaire. Where there are children (aged between 0 and 14 years), a minor is also selected to complete the minor questionnaire. A sample has been selected of approximately 24,000 dwellings distributed among 2,000 census tracts. The sample is distributed among Autonomous Communities (Spanish regions), assigning one portion uniformly and another in proportion to the size of the Autonomous Community, such that, besides being representative at a national level, it is also representative at an Autonomous Community level, at least for the main variables. Ratio estimators have been used to estimate all population characteristics. Re-weighting techniques have been applied to them, taking as auxiliary variables age groups, sex and nationality of the population of each Autonomous Community.

Base used for sampling

Geographical coverage and breakdowns
National data, Regional data (NUTS 2 breakdown)

Age range
Depending on variables, the whole Spanish population in 2011-12, minors (aged 14 and under) and adults (aged 15 and over).

Statistical representativeness
Regional representative, please specify

Coverage of main and cross-cutting topics
Main topics covered: National Health Survey allows a detailed study of the following items: I. Health status and accident rate: perceived health status, chronic or long-term evolution problems, quality of life related to health, limitation of activities due to health problems, accidents, restriction of habitual activities due to health problems, hearing difficulties, vision problems and mental health. II. Health care: medical consultations (time elapsed since the last visit, average number of consultations, place, reasons, etc.), consultations to the dentist (idem), hospital admissions, emergencies service, inaccessibility to medical assistance, health care coverage `public/private`, drugs and medicines consumption, preventive health. III. Health determining factors: Tobacco and alcohol consumption, body mass index, physical activity, special diet, consumption pattern of certain foods, social support received, care of children or persons with any limitations. - Residential and social environment. - Social, economic, demographic and geographical features (sex, age group, social class based on the occupation of the reference person, country of birth, Autonomous Community (Spanish regions), educational level and current relationship with the economic activity. Statistical tables of the health variables researched are provided, classified by the following socio-demographic characteristics: sex, age group, social class based on the occupation of the reference person, country of birth, Autonomous Community (Spanish regions), educational level and current relationship with the economic activity. The general aim of NHS 2011-2012 is to provide the necessary information on the health of the population in order to be able to plan and assess actions on health issues. It is designed for: 1. Providing information regarding the assessment of the general state of both physical and mental health and identifying the main health problems faced by citizens: chronic illnesses, ailments, accidents and functional limitations. 2. Ascertaining the degree of access to and use of health services. 3. Ascertaining the determining health factors: lifestyle habits and characteristics of the physical and social environment that pose a health risk. 4. Analysing the differences with which health problems are faced, the risk factors and the use of services among the different population subgroups (by sex, age, social class, country of origin, studies, economic activity and Autonomous Community). The survey has three questionnaires: A Household Questionnaire, an Adults Questionnaire with +150 questions, and a Minors Questionnaire with 80 questions. The method used to collect information is a computer-assisted personal interview (CAPI), directly in the case of adults, and in the case of children aged 14 and under, the mother, father or guardian answers questions on behalf of the minor. The questionnaire consists of four large blocs: socio-demographic, health status, health care and health determining factors.

Linkage

Standardisation
The latest ENS waves follow some statistical procedures to assess estimates and sampling errors and sampling incidents in dwellings, households and interviewees, and solutions provided. A methodological report (http://www.ine.es/metodologia/t15/t153041912.pdf), as well as a Lack of response report (http://www.ine.es/daco/daco42/sanitarias/evaluacion12.pdf) are available in Spanish. ENS 2011-12 keeps the ESCoP principles (Institutional Environment, Process and Products) to assess data quality through a number of indicators. To assess quality, other tools are provided by Eurostat, such as the Self- Assessment (DESAP), Peer Review, Quality Audits and user satisfaction surveys. Use of internationally harmonised standards: * Educational level classified with the ISCED codes * Economic sector in employment classified with CNAE-2009 codes `CNAE codes are the Spanish equivalence/adaptation of NACE Rev.2 codes since 2009` * Occupation in employment classified with CNO-2011 codes `CNO codes are the Spanish equivalence/adaptation of ISCO-08 codes since 2011`

Possibility of linkage among databases
No. The survey of each reference year is obtained with a different sample

Data quality

Entry errors if applicable
To analyze the lack of response from the National Health Survey 2011-2012, a questionnaire was designed to assess the lack of response. Information was collected on the basic characteristics of the units that failed to cooperate in the survey, ie. data on housing and household inhabitants, household characteristics (size and type) and some characteristics of the reference person(sex, age, marital status, education level, relationship with the activity and nationality). The questionnaire was completed for target households due to refusal, absence or inability to answer. A series of measures have been implemented to help ensure the quality of the process and the results, such as: - Specific revision of the questionnaire in a working group to introduce new internationally validated instruments. - Data collection through a CAPI application to detect errors and warnings on incompatibility or inconsistency between the survey responses. - Periodic inspection fieldwork. - Housing replacement in non-response situations to ensure a sample closer to the population structure. - Comprehensive review of the codifications of some sensitive questions. - Handling errors and warnings after collection in order to confirm correctness and prevent systematic errors. General methodological information on ENS 2003, 2006 and 2011 can be retrieved from http://www.ine.es/jaxi/menu.do?type=pcaxis&path=%2Ft15/p419&file=inebase&L=0, and data quality assessment from http://www.ine.es/jaxi/menu.do?type=pcaxis&path=%2Ft15/p419&file=inebase&L=0

Breaks
A complete description about variable definitions and temporal changes on these definitions can be retrieved in Spanish from http://pestadistico.msc.es/PEMSC25/ArbolNodos.aspx (See ANEXOS: ENCUESTA NACIONAL DE SALUD DE ESPAÑA. SERIE HISTÓRICA. ANEXOS. Definición de variables) Different responsible teams: * Responsible organisation - Ministry of Health: 1987, 1993, 1995, 1997, 2001 * Responsible organisation - Ministry of Health `in collaboration with Spanish Statistics Institute` (since this issue, a homogenized data series is carried out): 2003, 2006, 2011-12 * Responsible organisation - Spanish Statistical Institute `in collaboration with Ministry of Health` – EHIS wave 1 in 2009, EHIS wave 2 in 2014 (work in progress). Comparability among years could be high, medium or low depending on the studied variable. The wording of questions is not always the same among different

Consistency of terminology or coding used during collection
See the above Comparability among years could be high, medium or low depending on the studied variable. Standard classifications at each time are used to code educational levels, economic sectors or occupations.

Governance

Contact information
Ministry of Health - Sub-Directorate Health Information and Innovation / Spanish Statistical Office (INE) - Sub-Directorate of Social Statistics
Ministry of Health, Social Services and Equality (MSSSI)
Paseo del Prado 18-20
28071 Madrid Spain Phone: 901 400 100, 91 583 91 00
Email: infoine(at)ine.es
Url: MSSSI: http://www.msc.es/en/estadEstudios/estadisticas/sisInfSanSNS/home.htm

Timeliness, transparency
The collection of information has taken place throughout the year from July 2011 to June 2012. Interviews were conducted (in 21,508 households) with 21,007 adults (aged 15 or over) and with 5,495 children aged 14 and under, by interviewing his or her mother, father or guardian. A total of 26,502 interviews were carried out. Statistical tables of the health variables researched are provided, along with tables of sampling errors for the main variables, methodological characteristics and analysis of non-response are also published. Final microdata files, questionnaires and metadata have been available on INE website since March 14th, 2013.