Eurostat, the statistical office of the European Union

F4: Income and living conditions; Quality of life

2920 Luxembourg LUXEMBOURG

The European Health Interview Survey (EHIS) aims at measuring on a harmonised basis and with a high degree of comparability among Member States (MS) the health status (including disability), health determinants (lifestyle) of the EU citizens and use of health care services and limitations in accessing it.

The general coverage of the survey is the population aged 15 or over living in private households residing in the territory of the country.

EHIS was developed between 2003 and 2006. It consists of four modules on health status, health determinants, health care, and background variables (socio-demographic characteristics of the population).

Three waves of EHIS have currently been implemented. The first wave of EHIS (EHIS wave 1 or EHIS round 2008) was conducted between 2006 and 2009 in 17 EU Member States as well as Switzerland and Turkey.

The second wave (EHIS wave 2 or EHIS round 2014) was conducted between 2013 and 2015 in all EU Member States, Iceland, Norway and Turkey according to the Commission Regulation 141/2013. 

The third wave of EHIS was conducted in 2019. All Member States participated in the EHIS wave 3 in accordance with the Commission Regulation (EU) No. 2018/255. A derogation regarding the data collection period was granted for some countries: the data collection period was 2018 for Belgium, 2018-2020 for Austria and Germany, and 2019-2020 for Malta.

The questionnaire consists of the same four modules for all the EHIS waves and over the years, some changes to the questionnaire have been implemented to satisfy specific users’ needs. Also, countries are allowed to include additional questions in the specific submodules or even specific sub-modules in the survey if this does not have an impact on the results of the compulsory variable

EHIS includes the following topics:

Health status
This topic includes different dimensions of health status and health-related activity limitations:

• General health status (Minimum European health module): self-perceived health, chronic morbidity and activity limitation
• Disease-specific morbidity
• Accidents and injuries
• Health-related absenteeism from work
• Physical and sensory functional limitations (also cognitive limitations in wave 3)
• Difficulties in personal care activities / activities of daily living (such as eating and washing) and help received/needed
• Household activities / Instrumental activities of daily living (such as preparing meals and shopping) and help received/needed
• Pain
• Aspect of mental health (psychological distress and mental well-being in the first wave, depressive symptoms in the second and third waves)
• Work-related health problems (only in the first wave).

Health care
This topic covers the use of different types of medicines and formal and informal health and social care services, which are complemented by data on health-related expenditure, and limitations in access to and satisfaction with health care services:

• Hospitalisation (in-patient and day care)
• Consultations with doctors and dentists
• Visits to specific health professionals (such as physiotherapists or psychologists)
• Use of home care services
• Use of medicines (prescribed and non-prescribed)
• Healthcare preventive actions (such as influenza vaccination, breast examination, cervical smear test and blood tests)
• Unmet needs for health care
• Out-of-pocket payments for medical care (only in the first wave)
• Satisfaction with services provided by healthcare providers (only in the first wave)
• Visits to specific categories of alternative medicine practitioners (only in the first wave).

Health determinants
This topic includes various individual and environmental health determinants:

• Height and weight
• Physical activity/exercise
• Consumption of fruits, vegetables and juice
• Drinking sugar-sweetened soft drinks (only in the third wave)
• Tobacco smoking behaviour and exposure to tobacco smoke
• Use of e-cigarettes or similar electronic devices (only in the third wave)
• Alcohol consumption
• Social support
• Provision of informal care or assistance (only in the second and third waves)
• Illicit drug use (only in the first wave)
• Environment (home and workplace exposures, criminality exposure) (only in the first wave).

Background variables on demography and socio-economic characteristics.

All indicators are expressed as percentages within the population and statistics are broken down by age and sex and one other dimension such as educational attainment level, income quintile group, degree of urbanization, country of birth, country of citizenship, activity limitation are planned to be used.

EHIS results are produced in accordance with the relevant international classification systems:

• The regional codes are those from the classification of territorial units for statistics (NUTS) and the corresponding statistical regions for the EFTA and candidate countries;
• Educational attainment is compiled according to the 1997 version (for wave 1) and 2011 version (for wave 2) of the International standard classification of education (ISCED);
• Occupation in employment uses the 2008 version of the International standard classification of occupations (ISCO-08);
• The economic sector in employment is collected according to the section level (one letter) of the 2008 version of the statistical classification of economic activities in the European Community (NACE Rev. 2).

EHIS is a general population survey and health variables describe general population health, health determinants and use of health care services.

The following main indicators are disseminated:

Health status

Self-perceived health and well-being

• Current depressive symptoms: Distribution of the population according to current depressive symptoms using modalities:

- Major depressive symptoms: if item MH1A or MH1B and five or more items of MH1A to MH1H score at least ‘more than half the days’
- Other depressive symptoms: if item MH1A or MH1B and two, three or four items of MH1A to MH1H score at least ‘more than half the days’
- Any depressive symptoms: if ‘major depressive symptoms’ or ‘other depressive symptoms’ are recorded.

• Severity of current depressive symptoms: Distribution of the population according to severity of current depressive symptoms. Depending on the number and frequency of symptoms, their severity can be characterised: 'None to minimal, Mild, Moderate, Moderately severe and Severe'.

• Severity of bodily pain: Distribution of the population according to the severity of bodily pain using modalities 'None, Very mild, Mild, Moderate, Severe or Very severe'.

Functional and activity limitations

• Physical and sensory functional limitations: Prevalence of physical and sensory functional limitations according to the severity using modalities 'None, Moderate, Severe (including not able at all)'. The indicator refers to the most severe limitation based on reporting on vision, hearing and walking.
• Difficulties in personal care activities: Distribution of population aged 65 years and over (55 years and over in wave 3) according to the severity of difficulties in doing without help any kind of personal care activities: 'Feeding oneself, Getting in and out of a bed or chair, Dressing and undressing, Using toilets, Bathing or showering'. The modalities used for disseminating the level of activity limitation are: ‘Moderate, Severe, Limited (Moderate + Severe), None’.
• Difficulties in household activities: Distribution of population aged 65 years and over (55 years and over in wave 3) according to the severity of difficulties in doing without help significant household activities: 'Preparing meals, Using the telephone, Shopping, Managing medication, Light housework, Occasional heavy housework, Taking care of finances and everyday administrative tasks'. The modalities used for the level of activity limitation are: ‘Moderate, Severe, Limited (Moderate + Severe), None’.

Self-reported chronic morbidity

• Persons reporting specific chronic diseases: Proportion of the population reporting a specific chronic condition in the past 12 months. Statistics on 15 diseases or chronic conditions are presented:

A. Asthma (allergic asthma included)

B. Chronic bronchitis, chronic obstructive pulmonary disease, emphysema

C. Myocardial infarction (heart attack) or chronic consequences of myocardial infarction

D. Coronary heart disease or angina pectoris

E. High blood pressure (hypertension)

F. Stroke (cerebral haemorrhage, cerebral thrombosis) or chronic consequences of stroke

G. Arthrosis (arthritis excluded)

H. Low back disorder or other chronic back defect

I. Neck disorder or other chronic neck defect

J. Diabetes

K. Allergy, such as rhinitis, hay fever, eye inflammation, dermatitis, food allergy or other allergy (allergic asthma excluded)

L. Cirrhosis of the liver

M. Urinary incontinence, problems in controlling the bladder

N. Kidney problems

O. Depression

P. High blood lipds (only in wave 3)

Injuries from accidents

• Persons reporting having had an accident: Proportion of people reporting to have had an accident during the past 12 months, which resulted in injury. Statistics on three types of accidents are presented: Road traffic accident, Home accident, Leisure accident.

• Medical intervention for an accident: Proportion of people reporting to have received medical care treatment for the most serious accident in the past 12 months, which resulted in injury. Only road traffic, home and leisure accidents are covered. Statistics of the following types of medical intervention are presented: 'Health care (including Hospitatlisation and Ambulatory care), No health care'. 

Absence from work due to health problems

• Absence from work due to personal health problems: Proportion of people reporting an absence from work due to health problems in the past 12 months.

Health determinants

Body mass index

• Body mass index (BMI): Distribution of the population according to their body mass index (BMI). BMI is defined as the weight in kilos divided by the square of the height in meters. For dissemination purpose, the following modalities are used:

- Underweight: BMI less than 18.5
- Normal weight: BMI between 18.5 and less than 25
- Pre-obese: BMI between 25 and less than 30
- Obese: BMI equal or greater than 30
- Overweight: BMI equal or greater than 25 (Pre-obese + Obese)

Physical activity

• Performing health-enhancing physical activity: Proportion of people reporting doing health-enhancing physical activity at least once a week. Physical activities considered include aerobic and muscle-strengthening activities.

• Effort involved in performing work-related physical activity: Distribution of the population according to the intensity of work-related physical activity using modalities:

- Heavy (mostly heavy labour or physically demanding work),

- Moderate (mostly walking or tasks involving moderate physical effort),

- None or light (i.e. either not performing any working tasks or mostly sitting or standing)

• Performing (non-work-related) physical activities: Proportion of people reporting doing non-work-related physical activities at least once a week. Physical activities included are sports, cycling to get to and from places, walking to get to and from places and muscle strengthening activities.

• Time spent on health-enhancing (non-work-related) aerobic physical activity: Distribution of the population according to the time spent on health-enhancing (non-work-related) aerobic physical activity (in minutes per week). Physical activities included are sports and cycling to get to and from places. The modalities used are: 'Not performing the activities, 1 to less than 150 min, 150 to less than 300 min, 300 min and more'.

Consumption of fruits and vegetables

• Daily consumption of fruit and vegetables: Distribution of the population according to the number of portions of fruit and vegetables consumed per day. The following modalities are used: 'Not eating fruit or vegetables daily, 1 to 4 portions per day, 5 or more portions per day'.
• Frequency of fruit and vegetables consumption: Distribution of the population according to the frequency of consumption of fruit and vegetables. The following modalities are used: 'Once or more a day, 4 to 6 times a week, 1 to 3 times a week, Less than once a week or never'.
• Frequency of drinking pure fruit or vegetable juice: Distribution of the population according to the frequency of drinking pure fruit or vegetable juice. The following modalities are used: 'Once or more a day, 4 to 6 times a week, 1 to 3 times a week, Never or occasionally' (only in wave 3).
• Frequency of drinking sugar-sweetened soft drinks: Distribution of the population according to the frequency of drinking sugar-sweetened soft drinks. The following modalities are used: 'Once or more a day, 4 to 6 times a week, 1 to 3 times a week, Never or occasionally' (only in wave 3).

Tobacco consumption

• Smoking of tobacco products: Distribution of the population according to tobacco products smoking habits, using modalities Daily smoker, Occasional smoker, Non-smoker and Current smoker (Daily + Occasional smoker).
• Daily smokers of cigarettes: Proportion of people who smoke (manufactured and hand-rolled) cigarettes daily according to the level of cigarette smoking using modalities 'Less than 20 cigarettes per day', '20 or more cigarettes per day' and 'Total daily smokers of cigarettes'.
• Daily exposure to tobacco smoke indoors: Distribution of the population according to the level of exposure to tobacco smoke indoors, using the following modalities: ‘Never or almost never, Less than 1 hour per day, 1 hour or more a day’.
• Former daily tobacco smokers: Proportion of people being former daily tobacco smoker.
• Duration of daily tobacco smoking: Distribution of the population according to the number of years of smoking tobacco on a daily basis, using the following groups: 'Less than 1 year, From 1 to 5 years, From 5 to 10 years, 10 years or over'.
• Use of electronic cigarettes or similar electronic devices: Distribution of the population according to the use of electronic cigarettes or similar electronic devices, using the following modalities: 'Every day, Formerly, Occasionally, Never'.

Alcohol consumption

• Frequency of alcohol consumption: Distribution of the population according to the frequency of alcohol consumption using modalities 'Every day, Every week (but not daily), Every month (but not weekly), Less than once a month, Not in the last 12 months (Former drinkers), Never (Lifetime abstainers)'.
• Hazardous alcohol consumption: Proportion of the population reporting to have had an average rate of consumption of more than 20 grams pure alcohol daily for women and more than 40 grams daily for men (only in wave 2).
• Frequency of heavy episodic drinking: Distribution of the population according to their frequency of heavy episodic drinking (which is ingesting more than 60g of pure ethanol on a single occasion) using modalities 'At least once a week, Every month (but not weekly), Less than once a month, Never or not in the last 12 months'.

Social environment

• Overall perceived social support: Distribution of the population according to the overall perceived social support (close people to count on, concern shown by other people, practival help from neighbours in case of need), according to the modalities: ‘Poor, Intermediate, Strong’.
• Persons providing informal care or assistance: Proportion of people providing care or assistance to persons suffering from some age problem, chronic health condition or infirmity, at least once a week. Modalities used in the dissemination: ‘Assistance provided mainly to relatives, assistance provided mainly to non-relatives, no assistance provided’.

Health care

Consultations

• Self-reported time elapsed since last visit to a medical professional: Distribution of the population according to the last occurrence of consulting a medical practitioner, which includes 'Medical doctors, Generalist medical practioners, Specialist medical practitioners, dentists'. The modalities used in the dissemination are: 'Less than 6 months, Less than 1 year, from 6 to 12 months, 1 year or over, Never'.
• Self-reported consultations of a medical professional: Distribution of the population according to the number of consultations of a medical doctor in the past 4 weeks. Medical doctors include generalist medical practitioners and specialist medical practitioners. The modalities used for the number of contacts are: 'No contacts, 1 contact, 2 contacts, 3 contacts or more'.
• Self-reported consultation of mental healthcare or rehabilitative care professionals: Proportion of people who consulted a psychologist, psychotherapist or psychiatrist in the past 12 months.

Preventive services

• Self-reported last breast examination by X-ray among women: Distribution of women population according to the last occurrence of mammography examination. Age group 50-69 is mostly used for policy purposes.
• Self-reported last cervical smear test among women: Distribution of women population according to the last occurrence of cervical smear test. Age group 20-69 is mostly used for policy purposes.
• Self-reported last faecal occult blood test (colorectal cancer screening): Distribution of the population according to the last occurrence of faecal occult blood test. Age group 50-74 is mostly used for policy purposes.
• Self-reported last colonoscopy: Distribution of the population according to the last occurrence of a colonoscopy.
• Self-reported vaccination against influenza: Percentage of the population vaccinated against flu during the past 12 months. Age group 65 or over is mostly used for policy purposes.
• Self-reported screening of cardiovascular diseases: Distribution of the population according to the duration since last measurement of blood pressure or blood cholesterol or blood sugar by a health professional.

Medicine use

• Self-reported use of prescribed medicines: Proportion of the population who used medicines prescribed by a doctor in the past 2 weeks.
• Self-reported use of non-prescribed medicines: Proportion of the population who used medicines not prescribed by a doctor in the past 2 weeks.

Home care and help

• Self-reported use of home care services: Proportion of people who used home care services for personal needs in the past 12 months.

 Unmet needs for healthcare

• Self-reported unmet needs for health care: Proportion of people in need of health care reporting to have experienced delay in getting health care in the previous 12 months for reasons of financial barriers, long waiting lists, distance or transportation problems.
• Self-reported unmet needs for specific health care-related services: Proportion of people in need of health care reporting that they could not afford it in the previous 12 months. The kind of care covered are medical care, dental care, prescribed medicines and mental health care.

Indicators on unmet needs for medical and dental examination are also collected from the European Survey on Income and Living conditions (EU-SILC). The differences between the indicators compiled from EHIS and EU-SILC are that (a) the EHIS survey includes individual questions corresponding to the reasons behind unmet needs in health care are in place, while the EU-SILC survey only asks for the main reason behind unmet needs for medical care, (b) the percentages disseminated from EU-SILC are calculated over the entire population aged 16 and over, while the percentages from the EHIS are calculated over the population aged 15 and over that were in need of health care in the previous 12 months prior to the survey, (c) the sequence of questions is not the same between the EHIS and EU-SILC and the two surveys differ in terms of their concept and context.

EHIS uses the following main breakdowns for presenting statistics:

Sex: females, males.

Age: the age completed at the time of the interview. 10-year age groups (15-24, 25-34, ..., 75+) are used by default for most indicators. In addition, other age groups varying among indicators are used.

Educational attainment level: the education attainment levels of individuals are classified according to the International Standard Classification of Education (ISCED) version of 1997 (wave 1) and version of 2011 (wave 2) and are grouped as follows:

• Less than primary, primary and lower secondary education
• Upper secondary and post-secondary non-tertiary
• Tertiary education

Income quintile group: is computed on the basis of the total equivalised disposable income attributed to each member of the household (for more details on the definition, please consult EU-SILC reference metadata file).

The data (of each person) are ordered according to the value of the total equivalised disposable income. Four cut-point values (the so-called quintile cut-off points) of income, dividing the survey population into five groups equally represented by 20 % of individuals each, are found:

• First quintile
• Second quintile
• Third quintile
• Fourth quintile
• Fifth quintile

The first quintile group represents 20 % of population with lowest income and the fifth quintile group 20 % of population with highest income.

Degree of urbanisation: is the classification that maps geographical areas (at level Local Administrative Units–Level 2; municipalities or equivalent) into three categories with low, medium or high degree of urbanisation. It reflects the type of locality the individual/household is living in, namely whether that is a city (densely-populated area), town and suburbs (intermediate-populated area), or rural area (thinly-populated area).

Country of birth: is the country where a person was born, defined as the country of usual residence of mother at the time of the birth, or by default, the country in which the birth occurred. The following broad categories are used in the dissemination: reporting country, EU countries except reporting country, non-EU countries nor reporting country, foreign country.

Country of citizenship: is defined as the particular legal bond between an individual and his/her State and grouped into the categories: reporting country, EU countries except reporting country, non-EU countries nor reporting country, foreign country.

Disability (activity limitation): the disability concept is operationalized by using the Global Activity Limitation Indicator (GALI) for observing limitation in activities people usually do because of one or more health problems. The limitation should have lasted for at least the past six months. The levels used for activity limitation are: ‘severe’, ‘moderate’, ‘limited’ (including severe and moderate) or ‘none’.

The statistical unit is the individual.

All persons aged 15 years or over living in private households and residing in the territory of the country.

EHIS wave 1 (2008 round): AT, BE, BG, CZ, CY, DE, EE, EL, ES, FR, HU, LV, MT, PL, RO, SI, SK and CH and TR. (Data not available and disseminated for CH)

EHIS wave 2 (2014 round): EU Member States, Iceland, Norway and Turkey. 

EHIS wave 3 (2019 round): EU Member States, Iceland, Norway, Serbia and Turkey. Other countries might be considered for dissemination later on once the data will be available (for instance, Albania).

Note: Results from EHIS wave 1 are temporarily disseminated under 'Historical data'.

The first wave of EHIS was carried out in the years and countries indicated below:

• 2006: Estonia and Austria
• 2007: Slovenia and Switzerland
• 2008: Belgium, Bulgaria, the Czech Republic, France, Cyprus, Latvia, Malta, Romania and Turkey
• 2009: Germany, Greece, Spain, Hungary, Poland and Slovakia.

The second wave of EHIS was implemented as follows:

• 2013: Belgium and the United Kingdom
• 2014: Bulgaria, the Czech Republic, Estonia, Greece, Spain, France, Croatia, Italy, Cyprus, Latvia, Lithuania, Luxembourg, Hungary, Malta, Netherlands, Austria, Poland, Portugal, Romania, Slovenia, Slovakia, Finland and Sweden
• 2015: Denmark, Germany, Ireland, Italy, Iceland and Norway.

The third wave of EHIS was conducted as follows:

• 2018: Belgium
• 2019: Bulgaria, Czechia, Denmark, Estonia, Ireland, Greece, Spain, France, Croatia, Italy, Cyprus, Latvia, Lithuania, Luxembourg, Hungary, Netherlands, Austria, Poland, Portugal, Romania, Slovenia, Slovakia, Finland, Sweden, Iceland, Norway, Serbia, Turkey and the United Kingdom
• 2020: Malta, Germany, and Albania

Not applicable.

The first wave was conducted on the basis of a gentlemen’s agreement (in other words, without a legal obligation) established in the framework of Eurostat Working Group on "Public Health Statistics".

According to the Regulation 1338/2008 on Community statistics on public health and health and safety at work EHIS is to be conducted every five years. EHIS wave 2 was conducted in all EU Member States and in Iceland and Norway between 2013 and 2015 according to the Commission Regulation 141/2013 and its subsequent amendment to take account of the accession of Croatia to the EU (European Commission Regulation (EU) No 68/2014) as regards statistics based on the European Health Interview Survey (EHIS).

Derogations from Regulation (EC) No 1338/2008, as implemented by the Commission, concerning statistics based on the European Health Interview Survey (EHIS) are described in the Commission Implementing Decision of 19 February 2013.

EHIS wave 3 was conducted in all EU Member States, Iceland, Norway, Albania Serbia and Turkey, between 2018 and 2020, according to the Commission Regulation 2018/255 as regards statistics based on the European Health Interview Survey (EHIS). A Commission Implementing Decision (EU) 2018/257 granted derogations to certain Member States with respect to the transmission of statistics for certain variables.

Not applicable.

Regulation (EC) No 223/2009 on European statistics (recital 24 and Article 20(4)) of 11 March 2009 (OJ L 87, p. 164), stipulates the need to establish common principles and guidelines ensuring the confidentiality of data used for the production of European statistics and the access to those confidential data with due account for technical developments and the requirements of users in a democratic society.

EHIS microdata are available to researchers carrying out statistical analyses for scientific purposes (wave 3 microdata will be available in autumn 2022). The microdata do not contain any administrative information such as names or addresses that would allow direct identification. In order to ensure high level of confidentiality, a set of anonymisation rules was applied, including dropping of some variables or grouping answer categories. For more details about access to microdata see: http://ec.europa.eu/eurostat/web/microdata/introduction.

For the purposes of dissemination of aggregated data the following rules are applied:

• An estimate should not be published if it is based on fewer than 20 sample observations or if the non-response for the item concerned exceeds 50%.
• An estimate should be published with a flag "low reliability" if it is based on 20 to 49 sample observations or if non-response for the item concerned exceeds 20% and is lower or equal to 50%.
• An estimate shall be published in the normal way when based on 50 or more sample observations and the item's non-response does not exceed 20%.

There is no release calendar.

Not applicable.

In line with the European Union legal framework and the European Statistics Code of Practice Eurostat disseminates European statistics on Eurostat's website (see item 10 - 'Accessibility and clarity') respecting professional independence and in an objective, professional and transparent manner in which all users are treated equitably. The detailed arrangements are governed by the Eurostat protocol on impartial access to Eurostat data for users.

Not available.

EHIS data are included in various health-oriented and cross-cutting Eurostat online publications: Health in the European Union – facts and figures and Disability statistics.

Statistical articles using data from the European health interview survey:

• Self-perceived health
• Functional and activity limitations
• Cardiovascular diseases
• Specific cancers
• Respiratory diseases
• Mental health and related issues
• Accidents and injuries
• Overweight and obesity
• Consultations
• Preventive services
• Medicine use
• Tobacco consumption
• Nutritional habits
• Health enhancing physical activity
• Alcohol consumption
• Mental well-being and social support
• Quality of life indicators — health
• Disability statistics - elderly needs for help or assistance

Please consult free data on-line at: http://ec.europa.eu/eurostat/web/health/introduction under respective sections:

• Health status (hlth_state)
• Health determinants (hlth_det)
• Health care (hlth_care).

Due to the confidential character of the EHIS microdata, direct access to the anonymised data will be only provided by means of research contracts. Access is in principle restricted to universities, research institutes, national statistical institutes, central banks inside the EU, as well as to the European Central Bank. Individuals cannot be granted direct access. For more details about access to microdata see: http://ec.europa.eu/eurostat/web/microdata.

Eurostat internet address: http://ec.europa.eu/eurostat

General description of EHIS methodology is described in the article European health interview survey - methodology.

Methodological guidelines as well as other relevant documents are available at:

• EHIS wave 1 methodological documents (available in Circabc, interest group Public Health statistics, only to registered users)
• EHIS wave 2 methodological manual
• EHIS wave 3 methodological manual

EHIS wave 1 - assessment (available in Circabc, interest group Public Health statistics, only to registered users)

EHIS wave 2 - assessment

EHIS wave 3 - assessment

EHIS aims at achieving an input standardisation. A model questionnaire (questions, answer categories, filters, etc.) as well as conceptual guidelines and rationales were prepared. Conceptual translation into all EU languages was requested. 

Recommendations on the questionnaire are complemented with guidelines on data collection methods and procesing of data.

Eurostat also applies consistency and integrity checks on the microdata so that minimum output quality standard is reached. In addition, data are accompanied with quality reports stating the accuracy, coherence and comparability of the data. 

National surveys implementing the first wave of EHIS were conducted in different ways; Member States have had the flexibility to adopt different practices, for example in terms of the extent to which the common questionnaire was adapted and aligned with national needs, the modes of data collection and administration used, the data collection period, etc.

Some of the practices are highlighted here.

In most cases the first wave of EHIS was conducted as a stand-alone survey, whereas in France and Germany it was integrated into existing health interview surveys. Germany, Estonia, France, Austria and Turkey excluded some parts of at least one of the four EHIS modules. In some countries a different sequence of questions was followed from that foreseen in the common questionnaire. The majority of questions which were added or modified in national questionnaires were related to socio-demographic questions such as employment and also changes to the list of chronic conditions. More information on the harmonisation of national questions with EHIS standard questionnaire for the first wave can be found in the Comparison of EHIS source questions with national survey questions. In some cases, modified questions were used in sections related to alcohol, drug consumption and health care services.

Countries used different ways of conducting the first wave of EHIS and performed differently according to various quality-related indicators, which could also have had an impact on results.

• Target population: inclusion or exclusion of people living in institutions (such as homes for the elderly).
• Various types of sampling frame were used (notably results of a population census, population registers, dwelling registers and telephone lists).
• Conducting interviews with one or more persons in the household.
• Modes of data collection: face-to-face interviews (paper and pen or computer assisted interviews) or telephone interviews, supplemented in just less than half of the national surveys by self-administered questionnaires.
• Use of proxy respondents in cases when the intended interviewee could not answer and different reasons for the use of proxy interviews; and substitution of respondents.
• Year when the survey was conducted (2006–10) and data collection period (varied from 1 to 12 months between countries).
• Unit response rates are available for 13 national surveys (from the first wave of EHIS) and these ranged from 56 % to 89 %.

Regarding the national implementation of EHIS wave 2, an overview of the practices adopted is presented below.

The second wave of EHIS was conducted either as a stand-alone survey (in 20 countries), or as an element of another survey (in Belgium, the Czech Republic, Germany, Estonia, Ireland, France, the Netherlands, Norway) or as a follow-up of another survey (the Czech Republic, Austria, the United Kingdom (as far as Great Britain is concerned). Across countries, the same set of variables was collected following the Commission implementing Regulation on EHIS. However, in ten countries, national questionnaires comprised additional questions than those specified in the Commission Regulation, for national purposes. Most countries did not change the order of submodules or questions in their national questionnaires. More information on the modifications and adaptions applied at national level with reference to the EHIS standard questionnaire for the second wave can be found in the EHIS wave 2 - assessment.

Some of the modifications listed below may have influenced the accuracy or comparability of the results, but in general, an overall good quality level of the resulting data and indicators was achieved in EHIS wave 2.

• Target population: In limited cases, countries expanded the survey population to younger age groups, but respondents were excluded when calculating the respective effective sample size and when deriving the EHIS statistical indicators. In all countries persons living in collective households and institutions were excluded from the target population.
• Various types of sampling frames were used; notably results of a population census (five countries), population registers (15 countries), dwelling registers (three countries) or other statistical sources (seven countries).
• Conducting interviews with one or more persons in the household (depending on the selected sampling unit: dwelling, household, individual).
• Modes of data collection: postal questionnaire, face-to-face interviews (paper and pen or computer assisted interviews), telephone interviews or web questionnaires, or a combination of these modes. A self-administered mode (postal or web questionnaires) was exclusively used in five countries.
• Use of proxy respondents in cases when the intended interviewee could not answer and different reasons for the use of proxy interviews; and substitution of respondents (in limited cases). Proxy interviews were not allowed at all in Denmark, Germany, Estonia, Ireland, Luxembourg, Hungary, the Netherlands, Portugal, Slovakia and Sweden as well as Norway and Iceland.
• Incentives offered by seven countries to encourage respondents to participate in the survey.
• Reference year: spread over 2013 and 2015.
• Data collection period: on average 8 months (it varied from three to 21 months between countries); covering at least one month of the autumn season (September – November).
• Unit response rates: ranged from 30 % to about 84 %, with the respective rate exceeding 60 % in 17 countries.

The third wave of EHIS was conducted according to the Commission Implementing Regulation (EU) No. 2018/255 of 19 February 2018.

• Target population: "persons aged 15 and over usually residing in private households in the territory of the Member State concerned at the time of the data collection. In limited cases, countries expanded the survey population to younger age groups, but respondents were excluded when calculating the respective effective sample size and when deriving the EHIS statistical indicators. In all countries, persons living in collective households and institutions were excluded from the target population.
• Various types of sampling frames were used notably results of a population census (five countries), population registers (16 countries), dwelling registers (4 countries) or also a combination of these three frames.
• Conducting interviews with one or more persons in the household (depending on the selected sampling unit: dwelling, household, individual).
• Modes of data collection: The data collection was either self-administered or with an interviewer and the means were either a postal questionnaire, face-to-face interviews (paper and pen or computer assisted interviews), telephone interviews or web questionnaires and interviews, or a combination of these modes. Most countries used a mixed mode.
• Use of proxy respondents in cases when the intended interviewee could not answer and different reasons for the use of proxy interviews; and substitution of respondents (in limited cases). Proxy interviews were not allowed at all in Denmark, Germany, Luxembourg, Hungary, the Netherlands, Portugal, Slovakia, Sweden and Norway.
• Incentives offered by eight countries to encourage respondents to participate in the survey.
• Reference year: spread over 2019 (for some countries also partially including months in 2018 and 2020).
• Data collection period: according to the guidelines, "the collection of data shall be spread over at least 3 months including at least 1 month of the period from September to December.
• Unit response rates:ranged from 25 % to about 88 %, with the respective rate exceeding 60 % in 13 countries.

More information on data quality can be found in a synthesis of national quality reports for the first wave, second wave and third wave.

EHIS answers mainly to DG SANTE and DG EMPL policy needs. Data are also be used by researchers to make in-depth analyses on specific health issues. The EHIS aims at measuring on a harmonised basis and with a high degree of comparability among EU Member States the health status (including disability), health determinants and health care services (use and unmet needs) of the EU citizens. The topics included in the questionnaire both answer to policy driven needs and to scientific purposes. Within this framework, the EHIS concentrates on the main elements needed at EU level and does not intend to cover all detailed health aspects which can better be carried out via specific surveys or survey modules at national level, or at EU level when necessary.

The main users of the EHIS data are:

• Institutional users like other Commission services, particularly DG SANTE and DG EMPL for their needs in relation to the open method of coordination for social protection and social inclusion (Social OMC), JAF Health and European Core Health Indicators (ECHI) as well as national administrations (mainly those in charge of the monitoring of public health, or other international organisations such as OECD);
• Statistical users in Eurostat or in Member States National Statistical Institutes to feed sectoral or transversal publications such as the Eurostat yearbook and online publications, among other reports;
• Researchers having access to microdata;
• End users - including the media - interested in public health in the EU.

Not available.

EHIS covers only people living in private households (all persons aged 15 and over within the household are eligible for the operation), i.e. children 0-14 and persons living in collective households or in institutions are excluded from the target population.

Not available.

Standard errors of key indicators are commonly used as a measure of the reliability of data collected through sample survey. In their national quality reports, Member states provided the standard error for 5 indicators:

• Proportion of respondents in good or very good health (variable HS1)
• Proportion of respondents with a longstanding illness (variable HS2)
• Proportion of respondents severely limited in activities people usually do because of health problems for at least the past 6 months (variable HS3)
• Proportion of respondents having been hospitalized in the past 12 months (variable HO1)
• Proportion of respondents being obese (variable BMI)

The term 'non-sampling error' is a generic one that encompasses any errors other than sampling errors. The non-sampling errors discussed in this section are: coverage errors, measurement and processing errors, and non-response errors.

Coverage errors 

Coverage errors are caused by the imperfections of a sampling frame for the target population of the survey.

In EHIS two main groups can be defined in terms of the sampling frame used:

• Some countries have relied on individual information from population registers. In order to make the best coverage of the target population, registers have to be updated frequently. It means any modification in the population (both people moving in and people moving out) must be reported as quickly as possible.
• Other countries have used a sampling frame based on the Census. The databases also have to be updated to represent the units that have come into being after the Census and thus ensure the representativeness of the sample.

 A systematic source of coverage problems is the time lag between the reference date for the selection of the sample and the fieldwork period, which should be made the shortest.

In the second and third wavea of EHIS, the quality of the sampling frames was high across all participating countries, since the time lag between their update and the time of actual sampling was, in most cases, narrow and the coverage was high. Exceptions could be considered countries using the 2011 census as sampling frame.

Measurement and processing errors

Generally, measurement errors arise from the questionnaire, the interviewer, the interviewee and the data collection method used.

It is vital in a survey like EHIS, which collects a multitude of health components with different time period references, that the questionnaire is constructed so that the interviewee can provide all the correct information. In particular, experiences from pilot surveys were used in order to optimize the data collection process. The questionnaires were also tested (cognitive testing) in order to identify potential sources of problems. Especially in EHIS wave 2, pre-testing and pilot testing were used by 22 countries for optimizing the data collection process and identifying potential sources of problems.

Due to the complexity and the sensitivity of the survey, the interviewees could not or did not want to give information on specific topics (their alcohol consumption, their income, accidents and injuries, etc).

For EHIS wave 3, pre-testing and/or pilot testing were used by 14 countries for optimizing the data collection process and identifying potential sources of problems.

Non-response errors

All surveys have to deal with non-response, i.e. information missing for some of the sample units. Unit non-response happens when no interview can be obtained, while item non-response does when only some of the items are missing. EHIS suffers from these two types of non-response:

• Unit non-response: when an individual refuses to cooperate or is away during the fieldwork period. Other reasons can explain unit non-response: the questionnaire is lost; the individual is unable to respond because of incapacity or illness...
• Item non-response: typically happens to questions the interviewee does not answer because he considers them personal or not easily understandable.

Non-response is a potential source of bias particularly if the non-responding units have specific survey patterns ('non-ignorable' non-response). For instance, persons with limitations (physical or sensorial) are less keen to give health information to an interviewer, thus some groups with particular features are under-represented in the sample and the estimates downwardly biased.

More specifically in EHIS wave 2, the variables that recorded more frequently an item non-response rate greater than 10 % were “Need to receive help or more help with one or more self-care activities” (PC3), “Time spent on doing sports, fitness or recreational physical activities in a typical week” (PE7), “Time spent on bicycling to get to and from places on a typical day” (PE5), “Need for help or more help with one or more domestic activities” (HA3) and “Net monthly equivalised income of the household” (HHINCOME).

A majority of the countries applied calibration methods (i.e. changes in the weighting factors) in order to correct for non-response.

Finally, in EHIS wave 3, the variables that recorded more frequently an item non-response rate greater than 10 % were “Net monthly equivalised income of the household” (HHINCOME), Country of birth of father and mother (variables BIRTHPLACEFATH and BIRTHPLACEMOTH). Ireland had more than 50% of missing answers for the variable "weight without clothes and shoes" and consequently, the results for the indicator Body Mass Index are unreliable. Similarly, Norway only had few valid answers to some of the variables about difficulties with personal care activities. Furthermore, additional filters were used for these variables. For these reasons, the results for the indicator "Difficulties with personal care activities" are not disseminated.

There was no fixed time for transmitting data on EHIS wave 1 collection to Eurostat.

Regulation on EHIS wave 2 (Commission Regulation 141/2013) specified that "Microdata shall be made available at the latest by 30 September 2015 or nine months after the end of the national data collection period in cases where the survey is carried out beyond December 2014."

Regulation on EHIS wave 3 (Commission Regulation 2018/255) specified that "Member States shall transmit the pre-checked microdata within 9 months after the end of the national period for collecting the data."

Not applicable for EHIS wave 1.

For EHIS waves 2 and 3, the majority of countries provided their microdata to Eurostat on time (September 2015 or October 2015 for wave 2 and September 2020 or October 2020 for wave 3).

EHIS aims at achieving an input standardisation. A standard model questionnaire (questions, answer categories, filters, etc.) as well as conceptual guidelines and rationales were prepared. Conceptual translation into all EU languages was requested. 

An assessment of the implementation of standard model questionnaire in EHIS wave 2 showed major modifications / adaptations in a couple of countries regarding the definitions used as regards:

• Italy: indicators on alcohol consumption,
• Sweden: indicator on preventive services (breast examination, cervical smear test, colonoscopy examination and blood test)

Disseminated indicators are accompanied by a flag "d: definition differs", which shows the cases where the national definition differs from the definition in methodological guidelines and this deviation is supposed to have impact on the results.

Estimates of the EU average for EHIS wave 2 indicators derived from variables for which country coverage is not complete are flagged with "e: estimated”. This concerns the following indicators, since at least one country has been granted derogation:

• Current depressive symptoms
• Healthcare preventive actions as far as blood tests are concerned
• Physical activity (work-related and non-work-related)
• Alcohol consumption

For EHIS wave 3, derogations were granted to:

• Belgium on the collection of some of the variables for unmet needs
• Finland on the collection of some of the variables for functional limitations, physical activity and alcohol consumption
• The Netherlands on the collection of some of the variables for diseases and chronic conditions, functional limitations, dietary habits and smoking.

In addition, Norway used slightly different answer categories in some variables on alcohol consumption and preventive services and no data for this country is disseminated when these variables are used in the computation of the related indicators. Belgium transmitted incorrect codes for the variable on daily exposure to tobacco consumption and consequently, no data is disseminated for this country. 

Between EHIS waves 1 and 2 implementation, modifications in the model questions were limited in order to safeguard the comparability of the results over time. An assessment of the degree of comparability of the EHIS wave 2 model questionnaire with the respective wave 1 model questionnaire as well as a description of the change that might have been implemented is provided in the EHIS wave 2 methodological manual.

At country level, an overall assessment of the comparability of the national questions between the two waves is reflected in the Comparability assessment of the data between EHIS wave 1 and 2 (available only to registered users of the Circabc interest Group "Health Interviewx Survey"). The analysis undertaken shows a number of differences between the data collected through the two waves across countries, which more frequently stem from divergences and differentiations in the implementation of the EHIS wave 1 questions at national level.

In the EHIS wave 3 methodological manual, an evaluation of comparability of the variables withthe ones from wave 2 is provided using the scale: "identical question"; "slight revision of question", "strong revision of question", or "none: new question in EHIS wave 3".

EHIS and EU-SILC includes exactly the same three questions of the MEHM. An analysis performed in the past revealed differences in national adaptations of MEHM between EHIS wave 1 and EU-SILC for some countries.

The assessment of the implementation of MEHM in EHIS wave 2 and EU-SILC also revealed differences across some countries. Those cannot be attributed to major differentiations in the wording the national questions between the two survey items but rather to the product of differences in the methods of measurement, data collection period, order of questions and context effects in the framework of the different concepts served by the surveys. The analysis is reflected in the paper Comparison of EHIS and SILC MEHM questions (available in Circabc, interest group Health Interview Survey, only to registered users).

Not applicable.

None

Tables will be updated for countries for which data were not available at the time of last update.

The data are collected via national surveys. EHIS may be implemented as a separate national survey or can be integrated into an existing national survey (i.e. national health interview survey, labour force survey, other household survey). In such a way Member States have had the maximum flexibility for implementation. However, across the EU the same data were collected according a common list of variables and answer categories.

Every 5 years. First data collection took place between 2006 and 2009 (2008 round), the second round between 2013 and 2015 (2014 round) and the third round between 2018 and 2020 (2019 round). The next round (EHIS wave 4) is planned for 2025 and afterwards at regular six-year interval (2031, 2037, etc.).

Data are collected via questionnaires and are obtained through face-to-face interviews, telephone interviews, self-administered questionnaires or by a combination of these means, depending on the country (in an electronic or non-electronic version).

Flags, codes added to each strata and defining a specific characteristic of the statistics in that strata, are used for dissemination purposes. Strata must be understood as the number of respondents belonging to the measured subgroup; for example the men in Bulgaria between 54 and 65 years old and having upper secondary and post-secondary non-tertiary education. The strata sizes of the different samples were calculated as well as the missing percentages on the answers. Flags for eliminating too small strata and for indicating unreliable strata were applied as follows:

• ":" no information available or the strata size is less than 20 sample observations or the item non-response exceeds 50%.
• published with a flag "u: unreliable" if the estimate is based on 20 to 49 sample observations, or if the item non-response exceeds 20 % and is lower than or equal to 50 %.
• no flag if the strata size is greater than 50 and the item non-response is below 20%.

"c: confidental" is set for data of Germany for EHIS wave 1 where strata sizes are below 20 observations. (Germany delivered aggregated data and indicated those cells).

Due to different time periods and incomplete coverage reasons, no EU aggregates are calculated from EHIS wave 1.

EU aggregate is calculated from EHIS waves 2 and 3. An EU aggregate is disseminated if the underlying data covers at least 70 % of the target population. If the EU aggregate is not based on data from all EU countries, it is flagged as 'e' (estimated).

No imputation was applied in Eurostat but may have been applied on national level.

Personal/individual weights (not available for MT and EHIS wave 1) were applied to calculate national and EU aggregates.