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1º Inquérito Nacional de Saúde com Exame Físico (INSEF 2015): relatório metodológico
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Authors
Advisor(s)
Abstract(s)
O Inquérito Nacional de Saúde com Exame Físico
(INSEF), parte integrante do projeto “Improvement
of epidemiological health information to support
public health decision and management
in Portugal. Towards reduced inequalities, improved
health, and bilateral cooperation”, constitui o
núcleo central e principal do Projeto Pré-definido
do Programa Iniciativas em Saúde Pública das
EEA Grants. Este projeto foi coordenado pelo
Instituto Nacional de Saúde Doutor Ricardo
Jorge (INSA), através do seu Departamento de
Epidemiologia, e contou com a parceria do Instituto
Norueguês de Saúde Pública (INSP) e com
a colaboração institucional das Administrações
Regionais de Saúde (ARS) e das Secretarias Regionais
de Saúde (SRS) das Regiões Autónomas
dos Açores e da Madeira.
A finalidade do INSEF é a de contribuir para melhorar
a Saúde Pública e reduzir as desigualdades
em saúde na população residente em Portugal,
através da produção, disponibilização e comunicação
de informação epidemiológica de elevada
qualidade sobre o estado de saúde, determinantes
de saúde e utilização de cuidados de saúde
da população portuguesa.
O estudo epidemiológico observacional, transversal,
de prevalência teve como população-alvo
todos os indivíduos com idade compreendida
entre os 25 e os 74 anos, residentes em Portugal
Continental ou nas Regiões Autónomas dos
Açores e da Madeira há mais de 12 meses antes
da data da entrevista, não-institucionalizados e
que falem a língua portuguesa.
A seleção dos participantes do INSEF foi feita
por amostragem probabilística, por grupos em
duas etapas, estratificada por região e tipologia
de área urbana (TIPAU). Numa primeira etapa,
em cada região foram selecionadas aleatoriamente
as unidades primárias de amostragem (PSU),
com probabilidade de seleção proporcional à dimensão
da população residente com idade elegível.
Em cada unidade primária de amostragem
foram selecionados, numa segunda etapa, por
amostragem aleatória simples, a partir das listas
de utentes do Serviço Nacional de Saúde (SNS),
os indivíduos que constituem as unidades secundárias
de amostragem (SSU).
Após a seleção e recrutamento dos participantes,
a sua observação consistiu na recolha de informação
sobre características sociodemográficas,
estado de saúde, doença e incapacidade, determinantes
de saúde e fatores de risco, cuidados
de saúde preventivos e utilização de cuidados de
saúde.
Para este efeito, o inquérito incluiu três componentes:
o exame físico, com medição da tensão
arterial, da altura, do peso e dos perímetros da
cintura e da anca; a colheita de sangue para determinação
do perfil lipídico, da hemoglobina glicosilada
(HbA1c) e do hemograma, sem fórmula
leucocitária; e uma entrevista com aplicação de
um questionário geral de saúde. Todos estes
procedimentos foram implementados de acordo
com as recomendações do Inquérito Europeu de
Saúde com Exame Físico (EHES).
O INSEF como processo englobou várias etapas
após a fase inicial de concepção, planeamento e
financiamento que decorreu entre 2012 e 2013,
tendo implicado um planeamento estratégico de
cada fase. Este planeamento incluiu a definição
e implementação prévia de um conjunto de
métodos de avaliação e de monitorização que
asseguraram de forma contínua a qualidade
dos dados em todo o processo de recolha, tal
como a criação de manuais de procedimentos,
a formação harmonizada para todas as equipas
de campo, o controlo estatístico da qualidade
das medições obtidas e a participação dos laboratórios
regionais no Programa Nacional de Avaliação
Externa da Qualidade do INSA. Durante a
fase de validação da base de dados e de análise
dos dados foram desenhados e implementados
métodos e procedimentos para a garantia da
maior qualidade dos dados registados, da base
de dados alvo da análise e da própria análise
estatística.
A fase preparatória da implementação do INSEF
decorreu durante os anos 2013 e 2014, tendo o
trabalho de campo sido realizado durante o ano
de 2015. O INSEF foi implementado com sucesso
em todas as regiões de saúde de Portugal Continental
e nas Regiões Autónomas dos Açores e
da Madeira. No total, foram selecionados aleatoriamente
12289 indivíduos, tendo sido enviada
uma carta-convite aos 12098 que apresentavam
contactos na base de dados. Destes, 7784 eram
elegíveis, 1090 não elegíveis e 3224 possuíam
elegibilidade desconhecida, resultando numa
taxa de contacto a nível nacional de 69,5%. Dos
7802 elegíveis, participaram efetivamente 4911
indivíduos, traduzindo-se numa taxa de cooperação
de 62,9% e numa taxa de participação de
43,9%. Dos 4911 participantes, a totalidade realizou
o exame físico e a entrevista, foi possível
colher uma amostra de sangue a 4859 (98,9%) e
4852 realizaram as análises clínicas (98,7%).
Como primeiro inquérito geral de saúde, com
exame físico e recolha de sangue, de âmbito nacional,
realizado em Portugal de acordo com as
recomendações do Inquérito Europeu de Saúde
com Exame Físico, o INSEF contribuiu de forma
decisiva para capacitar as equipas nacionais e
regionais para a realização de inquéritos deste
tipo, bem como para cumprir a recomendação
europeia de aumentar a qualidade, comparabilidade
e acesso a informação de saúde de elevada
qualidade. Neste contexto, o presente relatório
tem como objetivo descrever, de forma sumária,
os materiais e métodos definidos e utilizados,
assim como a implementação do INSEF.
The National Health Examination Survey (INSEF), part of the project "Improvement of epidemiological health information to support public health decision and management in Portugal. Towards reduced inequalities, improved health, and bilateral cooperation", is the core of the Pre-defined project of the EEA Grants Public Health Initiatives Programme. This project was led by the National Health Institute Doutor Ricardo Jorge (INSA), through its Department of Epidemiology, in partnership with the Norwegian Institute of Public Health (INSP), and in institutional cooperation with the Regional Health Administrations (ARS) and the Regional Health Secretariats (SRS) of the Autonomous Regions of Azores and Madeira. INSEF aims to contribute to the improvement of public health and to the reduction of health inequalities in the population residing in Portugal, by providing and communicating high quality epidemiological information about the health status, determinants and use of health care services of the Portuguese population. The target population of this cross-sectional, observational, epidemiological study consisted of all individuals aged between 25 and 74 years old, residents in mainland Portugal or in the Autonomous Regions of Azores and Madeira for more than 12 months preceding the interview, who were not institutionalized and who could speak Portuguese. INSEF participants’ selection was stratified by region and type of urban area. In the first stage, in each region, primary sampling units were randomly selected with probability of selection proportional to the age-eligible population size. In the second stage, in each primary sampling unit, individuals, who correspond to the secondary sampling units, were selected by simple random sampling from the lists of the National Health Service (SNS) users. After the selection and recruitment of the participants, information on sociodemographic characteristics, health status, disease and disability, health determinants and risk factors, preventive health care and use of health care services was collected. For this purpose, the survey included three components: a health examination, which included measurement of blood pressure, height, weight and waist and hip circumferences; a blood sample collection to determine the participants’ lipid profile, glycated hemoglobin (HbA1c) and blood count; and an interview with a general health questionnaire. All these procedures were rigorously implemented in accordance with the European Health Examination Survey (EHES) recommendations. As a process, INSEF included several steps after the 2012/2013 planning and financing phases, and involved the strategic planning of each implementation stage. This included the definition and early implementation of a set of evaluation and monitoring methodologies that ensured continuous data quality throughout the collection process, such as the creation of manuals of procedures, harmonized training for all the field teams, statistical quality control of the obtained measurements and the participation of regional laboratories in the INSA’s National Program for External Quality Assessment. During the phases of database validation and data analysis, methods and procedures were designed and implemented that aimed at assuring that the data recorded, the database and the statistical analysis were of the highest quality. The preparatory phase of INSEF took place during 2013/2014 and the fieldwork was carried out during 2015. INSEF has been successfully implemented in all health regions of mainland Portugal and in the Autonomous Regions of Azores and Madeira. In total, 12289 individuals were randomly selected, and an invitation letter was sent to the 12098 who had valid contact information in the database. Of these, 7784 were eligible, 1090 were not elegible and 3224 had unknown eligibility, resulting in a contact rate at the national level of 69.5%. Of the 7784 eligible, 4911 individuals effectively participated in INSEF, translating into a cooperation rate of 63,1% and a participation rate of 43.9%. Of the 4911 participants, all completed the health examination and the interview. It was possible to collect a sample of blood from 4859 (98.9%) and blood tests were performed on 4852 (98.7%) participants. This was the first nationwide general health survey with health examination and blood collection conducted in Portugal in accordance with the recommendations of the European Health Examination Survey, and decisively contributed to capacitate the national and regional teams to carry out such a survey and to comply with the European recommendation to increase the quality, comparability and access to high quality health information. In this context, this report aims at briefly describing the materials and methods defined and used, as well as the INSEF implementation.
The National Health Examination Survey (INSEF), part of the project "Improvement of epidemiological health information to support public health decision and management in Portugal. Towards reduced inequalities, improved health, and bilateral cooperation", is the core of the Pre-defined project of the EEA Grants Public Health Initiatives Programme. This project was led by the National Health Institute Doutor Ricardo Jorge (INSA), through its Department of Epidemiology, in partnership with the Norwegian Institute of Public Health (INSP), and in institutional cooperation with the Regional Health Administrations (ARS) and the Regional Health Secretariats (SRS) of the Autonomous Regions of Azores and Madeira. INSEF aims to contribute to the improvement of public health and to the reduction of health inequalities in the population residing in Portugal, by providing and communicating high quality epidemiological information about the health status, determinants and use of health care services of the Portuguese population. The target population of this cross-sectional, observational, epidemiological study consisted of all individuals aged between 25 and 74 years old, residents in mainland Portugal or in the Autonomous Regions of Azores and Madeira for more than 12 months preceding the interview, who were not institutionalized and who could speak Portuguese. INSEF participants’ selection was stratified by region and type of urban area. In the first stage, in each region, primary sampling units were randomly selected with probability of selection proportional to the age-eligible population size. In the second stage, in each primary sampling unit, individuals, who correspond to the secondary sampling units, were selected by simple random sampling from the lists of the National Health Service (SNS) users. After the selection and recruitment of the participants, information on sociodemographic characteristics, health status, disease and disability, health determinants and risk factors, preventive health care and use of health care services was collected. For this purpose, the survey included three components: a health examination, which included measurement of blood pressure, height, weight and waist and hip circumferences; a blood sample collection to determine the participants’ lipid profile, glycated hemoglobin (HbA1c) and blood count; and an interview with a general health questionnaire. All these procedures were rigorously implemented in accordance with the European Health Examination Survey (EHES) recommendations. As a process, INSEF included several steps after the 2012/2013 planning and financing phases, and involved the strategic planning of each implementation stage. This included the definition and early implementation of a set of evaluation and monitoring methodologies that ensured continuous data quality throughout the collection process, such as the creation of manuals of procedures, harmonized training for all the field teams, statistical quality control of the obtained measurements and the participation of regional laboratories in the INSA’s National Program for External Quality Assessment. During the phases of database validation and data analysis, methods and procedures were designed and implemented that aimed at assuring that the data recorded, the database and the statistical analysis were of the highest quality. The preparatory phase of INSEF took place during 2013/2014 and the fieldwork was carried out during 2015. INSEF has been successfully implemented in all health regions of mainland Portugal and in the Autonomous Regions of Azores and Madeira. In total, 12289 individuals were randomly selected, and an invitation letter was sent to the 12098 who had valid contact information in the database. Of these, 7784 were eligible, 1090 were not elegible and 3224 had unknown eligibility, resulting in a contact rate at the national level of 69.5%. Of the 7784 eligible, 4911 individuals effectively participated in INSEF, translating into a cooperation rate of 63,1% and a participation rate of 43.9%. Of the 4911 participants, all completed the health examination and the interview. It was possible to collect a sample of blood from 4859 (98.9%) and blood tests were performed on 4852 (98.7%) participants. This was the first nationwide general health survey with health examination and blood collection conducted in Portugal in accordance with the recommendations of the European Health Examination Survey, and decisively contributed to capacitate the national and regional teams to carry out such a survey and to comply with the European recommendation to increase the quality, comparability and access to high quality health information. In this context, this report aims at briefly describing the materials and methods defined and used, as well as the INSEF implementation.
Description
O primeiro INSEF realizado em Portugal é promovido e coordenado pelo Instituto Ricardo Jorge através do seu Departamento de Epidemiologia, em parceria com o Instituto Norueguês de Saúde Publica e em colaboração com as Administrações Regionais de Saúde do Continente e Secretarias Regionais de Saúde das Regiões Autónomas dos Açores e da Madeira.
Ficheiro atualizado em 14/12/2016 (alterações no grafismo do relatório).
Ficheiro atualizado em 14/12/2016 (alterações no grafismo do relatório).
Keywords
Inquérito de Saúde com Exame Físico Vigilância Epidemiológica Estados de Saúde e de Doença Determinantes da Saúde e da Doença Metodologia Saúde Pública Portugal INSEF Portuguese National Health Examination Survey
Pedagogical Context
Citation
Instituto Nacional de Saúde Doutor Ricardo Jorge, IP. 1º Inquérito Nacional de Saúde com Exame Físico (INSEF 2015): relatório metodológico. Lisboa: INSA IP, 2016.
Publisher
Instituto Nacional de Saúde Doutor Ricardo Jorge, IP