Healthcare activities statistics - preventive services

Data extracted in November 2019.

Planned article update: November 2020.

Highlights

In 2017, at least 80 % of women aged 50 to 69 years in Denmark, Finland and Spain had been screened for breast cancer (using a mammography) within the previous two years.

In 2017, more than three quarters of women aged 20 to 69 year in the United Kingdom, Luxembourg, Ireland and Sweden had been screened for cervical cancer within the previous three years.

In 2017, 44 % of people aged 65 years and over in the EU-28 had been vaccinated against influenza during the 12 months prior to the survey.

Influenza vaccination rate, people aged 65 years and over, 2017

This article presents an overview of European Union (EU) statistics related to preventive services, notably cancer screening and vaccination against influenza. It is one of a set of statistical articles concerning healthcare activities in the EU which forms part of an online publication on health statistics.

Full article

Breast cancer screening

The indicator covering breast cancer screening as presented in Figure 1 follows the 2003 Council Recommendation on cancer screening. Most of the data presented are administrative data from screening programmes although some are from surveys: these are shown separately for reasons of comparability. The data show the proportion of women aged 50-69 years who had received a mammography within the previous two years, prior to the reference year (or according to the specific screening frequency recommended in each country).

Data are available for 23 EU Member States for 2017 (in some cases data are for earlier reference periods, see Figure 1 for more details). In eight of these, breast cancer screening rates were below 50 %, with the lowest rates in Slovakia (30.7 %; definition differs), Bulgaria (20.6 %) and Romania (0.2 %). By contrast, there were five Member States that reported breast cancer screening rates of 75 % or above: the United Kingdom, the Netherlands (2015 data), Spain (survey data), Finland and Denmark (2016 data).

A comparison of data for the two years shown in Figure 1 indicates that breast cancer screening rates increased between 2012 and 2017 in almost half (10) of the 22 EU Member States for which data are available (see Figure 1 for coverage), with relatively large increases — double-digits in percentage point terms — in Latvia and Lithuania. There was no change in the screening rate in Croatia. In the 11 remaining Member States where screening rates fell, the reductions were usually relatively small; Germany (-5.3 percentage points; 2012-2016) and Luxembourg (-8.4 percentage points) recorded the biggest contractions.

Figure 1: Breast cancer screening, women aged 50 to 69 years, 2012 and 2017
(%)
Source: Eurostat (hlth_ps_scre)

Figures 2 and 3 present self-reported data for the EU Member States, Iceland, Norway and Turkey from the European health interview survey (EHIS), which was conducted between 2013 and 2015. Figure 2 shows an analysis of the female population aged 50-69 years in terms of the period when they had had their most recent X-ray breast examination. In Finland, Sweden, Portugal, Czechia, Austria and France, the share of women that had never had such an examination was below 5.0 % and in 10 other Member States it was within the range of 5.0-10.0 %. At the other end of the scale, more than one fifth of women in Latvia and Lithuania, 35.3 % of women in Bulgaria, and 79.0 % of women in Romania in this age group had never had such an examination.

Figure 2: Self-reported screening — proportion of women aged 50 to 69 years having had an X-ray breast examination within the specified time periods, 2014
(%)
Source: Eurostat (hlth_ehis_pa7e)

Women having completed tertiary education were most likely to have had a recent X-ray breast examination

Figure 3 also focuses on women aged 50-69 years having had an X-ray breast examination in the previous two years: it presents an analysis based on the highest level of educational attainment. While some two thirds (66.3 %) of women in the EU-28 having completed at most a lower secondary education reported in 2014 that they had had an X-ray breast examination within the previous two years, this share among women with a tertiary level of educational attainment was almost three quarters (72.5 %).

In nearly all of the EU Member States for which data for 2014 are available (see Figure 3 for more details of the coverage), the proportion of women having had an X-ray within the previous two years was lowest among those having completed at most a lower secondary education: the only exceptions to this were Germany, Luxembourg and Portugal where the lowest proportions were recorded among women with a tertiary education (although in all three cases, at least 70 % of women with a tertiary education had had such an examination). However, more generally the share of women having had an X-ray examination tended to be higher among those with a higher level of educational attainment. This was particularly notable in those EU Member States where a relatively low share of women aged 50-69 years had had an X-ray, for example, in Bulgaria and Romania, as well as in Cyprus, Greece, Poland and Latvia.

Figure 3: Self-reported screening — proportion of women aged 50 to 69 years having had an X-ray breast examination within the two years prior to the survey, by educational attainment level, 2014
(%)
Source: Eurostat (hlth_ehis_pa7e)

Women living in rural areas were more likely to have never had an X-ray breast examination

An analysis by degree of urbanisation for 2014 shows that almost 14 % of women living in rural areas of the EU-28 had never had an X-ray breast examination (Figure 4). This share was lower for women living in cities or in towns and suburbs. Approximately 1 in 10 women in cities (10.6 %) had never had such an examination, while the share was slightly lower for women living in towns and suburbs (9.7 %). In a majority of the EU Member States no significant differences were observed in the proportions of women who had never had an X-ray across cities, towns and suburbs and rural areas. The most significant gaps were recorded in Lithuania, Romania and Bulgaria, where the differences in the proportions between women living in cities and those in rural areas exceeded 15 percentage points.

Figure 4: Self-reported screening — proportion of women aged 50 to 69 years never having had an X-ray breast examination, by degree of urbanisation, 2014
(%)
Source: Eurostat (hlth_ehis_pa7u)

Cervical cancer screening

The indicator covering cervical cancer screening as presented in Figure 5 follows the 2003 Council Recommendation on cancer screening. It concerns the population of women aged 20-69 years having been screened for cervical cancer within the previous three years (or according to the specific screening frequency recommended in each country). A majority of the data presented are administrative data from cervical cancer screening programmes although some of the data presented are from surveys: these are shown separately for reasons of comparability. Data are available for all of the EU Member States (although the latest period and source varies by Member State, see Figure 5 for more details).

There are 19 EU Member States for which the most recent data are presented for the latest period (generally 2017; see Figure 5 for coverage). Among these, cervical cancer screening rates peaked at 82.9 % in Sweden and 80.2 % in Ireland, while screening rates were also higher than three quarters in Luxembourg and the United Kingdom. At the other end of the range, the proportion of women aged 20-69 years who had been screened for cervical cancer within the previous three years was less than one quarter in Malta (24.0 %), with lower shares in Bulgaria (13.4 %) and Romania (0.9 %).

Data exists for 17 of the EU Member States allowing an analysis of developments between 2012 and 2017 (see Figure 5 for coverage). Between these two years there was often a relatively small change in the proportion of women aged 20-69 years who had been screened for cervical cancer (within the previous three years). The largest reduction (8.3 percentage points) was recorded in the Netherlands, while increases of more than 10.0 points were registered in Ireland (note that there is a break in series), Latvia and particularly Luxembourg (up 25.8 points between 2013 and 2017).

Figure 5: Cervical cancer screening rate, women aged 20 to 69 years, 2012 and 2017
(%)
Source: Eurostat (hlth_ps_scre)

Figures 6 and 7 present data from the EHIS. The first of these shows an analysis of screening rates for cervical smear tests among the female population aged 20-69 years. In 2014, some 14.1 % of this female subpopulation in the EU-28 reported that they had never had a smear test. There were 11 EU Member States where the proportion of women that had never had such an examination was 10.0 % or lower, while just over a quarter (25.2 %) of the female population in Estonia had never had a smear test, 31.7 % in Bulgaria and a peak of 62.1 % in Romania; note that there was an even higher share recorded in Turkey (68.5 %).

Figure 6: Self-reported screening — proportion of women aged 20 to 69 years having had a cervical smear test within the specified time periods, 2014
(%)
Source: Eurostat (hlth_ehis_pa8e)

Women having completed at most lower secondary education were least likely to have had a recent cervical smear test

Across the EU-28 in 2014, the proportion of women aged 20-69 years having had a cervical smear test in the previous three years was lowest (59.9 %) among women having completed at most a lower secondary level of education, with a peak approaching four fifths (78.8 %) among the female population with a tertiary level of educational attainment. This pattern was repeated in nearly all of the EU Member States. The lowest screening rates were consistently recorded for those with no more than a lower secondary education. Generally, the highest proportions of women having had a cervical smear test within the previous three years were recorded for women with a tertiary education; Malta was the only exception, with a higher screening rate among women with at most upper secondary and post-secondary non-tertiary education (72.7 % compared with 65.2 % for those with a tertiary level of educational attainment).

Figure 7: Self-reported screening — proportion of women aged 20 to 69 years having had a cervical smear test within the three years prior to the survey, by educational attainment level, 2014
(%)
Source: Eurostat (hlth_ehis_pa8e)

Colorectal cancer screening

In most EU Member States the majority of the population aged 50-74 years had not been screened for colorectal cancer

The indicator covering colorectal screening presented in Figure 8 follows the 2003 Council Recommendation on cancer screening. The data presented come from the second wave of EHIS which asked respondents when they had most recently been screened for colorectal cancer. Overall, the rates were much lower than those reported for breast or cervical cancer screening, partly due to the fact that national colorectal screening plans were established only at the beginning of the 2000s, whereas breast cancer screening plans started in 1963 and cervical cancer screening plans in the 1980s.

Across the EU-28, some 53.2 % of the population aged 50-74 years had never been screened for colorectal cancer (at the time of the survey conducted in 2014). Germany and Austria had by far the highest proportions of this age group having been screened for colorectal cancer, around four fifths in both cases. A majority of respondents in Slovenia, Czechia, France and Latvia also reported that they had been screened for colorectal cancer. However, in 22 EU Member States a majority of respondents reported that they had never been screened, with this share peaking at over 90.0 % in Bulgaria, Cyprus and Romania.

In a large majority of the EU Member States, more than half of the people who had actually been screened reported that this screening took place within the previous two years; this share peaked in France at 85.4 %. By contrast, there were six Member States where less than half of all people aged 50-74 years who had been screened reported that their most recent screening had taken place within the previous two years — Greece, Latvia, Finland, Estonia, Poland and Hungary (which recorded the lowest share at 32.4 %).

Figure 8: Self-reported screening — proportion of people aged 50 to 74 years having had a colorectal cancer screening test within the specified time periods, 2014
(%)
Source: Eurostat (hlth_ehis_pa5e)

Figure 9 provides a further analysis of these data, focusing on the population that had never been screened for colorectal cancer. An analysis according to respondents’ highest completed level of education shows a similar pattern to that observed for breast and cervical cancer screening, namely that the proportion of the population never having been screened was generally higher for people having completed at most lower secondary education, while it was lowest for people with a tertiary level of educational attainment. Across the whole of the EU-28, some 58.8 % of those with no more than a lower secondary education in 2014 had never had a screening test for colorectal cancer, a share that was 48.3 % among those with a tertiary level of education. An analysis for the EU Member States reveals that there was a relatively high degree of variation in the proportion of the population never having been screened in Croatia (when analysed by level of educational attainment), with relatively large differences also observed in Slovenia and Latvia.

Figure 9: Self-reported screening — proportion of people aged 50 to 74 years never having had a colorectal cancer screening test, by educational attainment level, 2014
(%)
Source: Eurostat (hlth_ehis_pa5e)

Vaccination against influenza

More than 7 out of 10 elderly persons in the United Kingdom were vaccinated against influenza

Among the EU Member States there are a range of different policies with respect to making influenza vaccines available to the general public — often they are specifically targeted at older groups of people or other at-risk groups. Figure 10 shows the take-up of vaccinations against influenza among people aged 65 years and over, with more than two fifths (44.3 %) of the elderly population in the EU-28 having been vaccinated in 2017.

In approximately half (10) of the 21 EU Member States for which data are available (see Figure 10 for more information on the coverage), the share of the elderly vaccinated against influenza was lower in 2017 than it had been in 2012; there was no change in Croatia. The biggest declines (more than 10.0 percentage points) were recorded in Italy and Germany (note that there is a break in series). By contrast, the Baltic Member States, Portugal, Finland, Sweden, Czechia, Malta (2014-2017), Romania, and Ireland all recorded a higher proportion of their populations aged 65 years and over who were vaccinated against influenza in 2017 than in 2012.

Figure 10 also shows considerable differences between EU Member States in relation to the overall uptake of influenza vaccinations (recent data are available for 21 of the Member States). Around 7 out of 10 elderly persons (72.6 %) were vaccinated in the United Kingdom in 2017, with a slightly lower share in the Netherlands (64.0 %), while less than 10.0 % of the elderly population were vaccinated in Latvia and Estonia.

Figure 10: Influenza vaccination rate, people aged 65 years and over, 2012 and 2017
(%)
Source: Eurostat (hlth_ps_immu)

Self-reported data on influenza vaccination from the EHIS, conducted between 2013 and 2015, are presented in Figure 11; these data cover people aged 65 years and over. In Poland, Hungary and Slovenia there were substantially higher shares of people having been vaccinated against influenza among people having completed a tertiary level of educational attainment than among people with at most a lower secondary level of educational attainment; this was also the case in Norway. The reverse situation was observed notably in Spain, the Netherlands and Ireland.

Figure 11: Self-reported vaccination — proportion of people aged 65 years and over having been immunised against influenza during the 12 months prior to the survey, by educational attainment level, 2014
(%)
Source: Eurostat (hlth_ehis_pa1e)

Screening of cardiovascular diseases

As well as questions relating to the use of preventive care services, such as vaccination, the second wave of the EHIS also included questions concerning important blood parameters related to the risk of diseases of the circulatory system and diabetes. Diseases of the circulatory system are an important cause of death for the elderly, while diabetes is also one of the main concerns for health care. Preventive actions related to those risks are strategic elements for the sustainability of the health care systems.

More than half of the EU-28 population reported having had a blood cholesterol measurement within the previous year

In 2014, about 18 % of the EU-28 population (aged 15 years and over) reported that they had never had a blood cholesterol measurement (see Figure 12). This percentage varied from less than 8.0 % in Czechia, Spain, Portugal and Cyprus to more than one third of the population in the United Kingdom, Denmark and the Netherlands among the EU Member States, as well as in Norway, Turkey and Iceland.

Figure 12: Self-reported screening — proportion of people aged 15 years and over according to the last measurement of blood cholesterol, 2014
(%)
Source: Eurostat (hlth_ehis_pa2e)

Conversely, more than half (50.4 %) of the population in the EU-28 reported that they had had a blood cholesterol measurement within the year prior to the 2014 survey. Across the EU-28, the rates concerning the measurement of blood cholesterol within this time period differed widely; more than two thirds of the population in Portugal and Spain reported having had a blood cholesterol measurement by a health professional, compared with one third or less of the population in the Netherlands, Denmark, Romania and Sweden; Iceland also recorded a share that was less than one third.

As expected, the measurement of blood cholesterol was more pronounced among the elderly — those aged 65 years and over — than among younger generations (see Table 1). More than 7 out 10 elderly persons reported having had a blood cholesterol measurement within the year prior to the survey (which was in 2014). An analysis by EU Member State reveals that the share of the population aged 65 years and over having had a blood cholesterol measurement exceeded 50 % in all of the Member States (no data for Belgium); the highest shares were in Czechia (81.3 %), Germany (82.4 %), Portugal (83.6 %), Luxembourg (86.0 %) and Spain (87.3 %). A lower proportion of middle-aged persons (45-64 years) and younger persons (15-44 years) had had their blood cholesterol levels measured. For example, the share of younger people that were screened was less than half in all but two of the Member States; the exceptions were Portugal (53.8 %) and Spain (56.8 %).

Table 1: Self-reported screening — proportion of people aged 15 years and over having had a blood cholesterol measurement within the year prior to the survey, by age, 2014
(%)
Source: Eurostat (hlth_ehis_pa2e)

More than half of the EU-28 population reported having had a blood sugar measurement within the previous year

Concerning actions for the prevention of diabetes, almost 17 % of the EU-28 adult population (aged 15 years and over) reported in 2014 that they had never had a blood sugar measurement by a health professional. There were eight EU Member States which recorded shares that were higher than the EU-28 average, with a peak in Ireland, where almost two fifths (38.9 %) of the adult population had never had a blood sugar measurement (see Figure 13).

Figure 13: Self-reported screening — proportion of people aged 15 years and over having had a blood sugar measurement within the specified time periods, 2014
(%)
Source: Eurostat (hlth_ehis_pa2e)

Similar to blood cholesterol measurement, more than half (51.0 %) of all adults (aged 15 years and over) in the EU-28 had had a blood sugar measurement within the year prior to the 2014 survey. This share varied from just over one third of the population in Ireland, Sweden, Denmark and the Netherlands to almost 62 % in Luxembourg, with Romania (30.9 %) below this range and Portugal and Spain above it (both 67.7 %).

Women were more likely than men to have had a blood sugar measurement within the previous year

In 2014, women were more likely than men to report having had a blood sugar measurement within the previous year. On average, the percentage of women in the EU-28 reporting having had a blood sugar measurement was 4.8 percentage points higher than the corresponding share for men (53.3 % compared with 48.5 %) — see Figure 14.

Figure 14: Self-reported screening — proportion of people aged 15 years and over having had a blood sugar measurement within the year prior to the survey, by sex, 2014
(%)
Source: Eurostat (hlth_ehis_pa2e)

Among the EU Member States, higher shares of women (compared with men) tended to report that they had had a blood sugar measurement within the year prior to the survey. The only exceptions were the United Kingdom and Finland, although the differences between the sexes were relatively small in these two Member States. This gender gap was widest in Latvia, Lithuania, Portugal, Bulgaria and Greece, where the share for women was at least 10.0 percentage points higher than that for men; a similar situation was observed in Turkey.

Data sources

This article presents data on preventive services from two main sources of data, the first of which relies on a mixture of survey and screening programme data, whereas the other is based on self-reported information from population surveys.

Healthcare resources and activities

Statistics on healthcare resources and healthcare activities (such as cancer screening and influenza vaccination) are documented in the background article Healthcare non-expenditure statistics — methodology which provides information on the scope of the data, its legal basis, the methodology employed, as well as related concepts and definitions.

Breast cancer screening rates show the proportion of women (eligible for screening) that have been screened. This is based on the number of women aged 50-69 years who had received a bilateral mammography within the two years prior to the reference date (or according to the specific screening frequency recommended in each country) divided by the number of women aged 50-69 years answering survey questions on mammography (for survey-based data) or eligible for an organised screening programme (for programme-based data). Note: countries are invited to supply both survey data and programme data when these two sources are available.

Cervical cancer screening rates show the proportion of women (eligible for screening) that have been screened. This is based on the number of women aged 20-69 years who have been screened for cervical cancer within the three years prior to the reference date (or according to the specific screening frequency recommended in each country) divided by the number of women aged 20-69 years answering the survey question (for survey-based data) or eligible for an organised screening programme (for programme-based data). Note: countries are invited to supply both survey data and programme data when these two sources are available.

The extent of influenza vaccinations is based on the percentage of people aged 65 years and over who have been immunised against influenza (or ‘flu’) during the 12 months prior to the reference date. For country specific notes on these data collections, please refer to these background information documents:

The indicators on screening for cardiovascular diseases refer to the moment of last blood cholesterol, blood sugar or blood pressure measurement by a health professional. The data refer to measurements by a health professional and not by the respondents themselves. Health professionals are persons who by education, training, certification or licensure are qualified to and engaged in providing health care.

Health status

Self-reported statistics covering the health status of the population — including X-ray breast examinations, cervical smear tests and screening for colorectal cancer and screening for cardiovascular diseases — are provided by the European health interview survey (EHIS). This source is documented in more detail in the background article European health interview survey — methodology which provides information on the scope of the data, its legal basis, the methodology employed, as well as related concepts and definitions.

Symbols

Note on tables:

  • a colon ‘:’ is used to show where data are not available;
  • a dash ‘–‘ is used to show where data are not applicable/relevant.

Context

Primary prevention offers the most cost-effective, long-term strategy for reducing the burden of diseases across the EU. It involves tackling major health determinants (see Chapter 3), such as smoking, unhealthy diets and physical inactivity. The European Commission has supported many projects related to health determinants and health promotion in general.

Secondary prevention aims to reduce mortality by early detection, for example, the detection of cancer or cardiovascular diseases through screening. In December 2003, a Council Recommendation on cancer screening was adopted, setting out principles of best practice. This invited EU Member States to take common action to implement national population-based screening programmes for breast, cervical and colorectal cancer, with appropriate quality assurance at all levels. In December 2008, the European Commission adopted its first report on the implementation of the Council Recommendation, noting that much had been done to attain high standards of screening practices across the EU. In 2014, the European Commission released a report on the implementation of the 2009 Communication on action against cancer: European partnership and the second implementation report on the 2003 Council Recommendation. Indicators on breast, cervical and colorectal cancer screenings are included in the health services chapter of the European core health indicators (ECHI).

In 2004, the Council Conclusions on heart health urged for actions on the prevention of cardiovascular diseases. The Luxembourg Declaration further established an agreement to strengthen plans for cardiovascular disease prevention through the adoption of measures, policies and interventions across all the European countries. Necessary measures included the raising of awareness regarding the reduction of cardiovascular disease risk factors:

  • avoidance of tobacco consumption (zero tolerance);
  • adequate physical activity (at least 30 minutes per day);
  • healthy food choices;
  • avoidance of being overweight;
  • maintenance of blood pressure below 140/90 mmHg (millimetres of mercury);
  • maintenance of blood cholesterol below 5 mmol/l (millimoles per litre).

The World Health Organisation (WHO) programme works on the prevention and monitoring of cardiovascular diseases and develops strategies for the effective reduction of risk factors affecting cardiovascular health.

Influenza is an annual, seasonal virus that affects Europe in the winter. The majority of people who die from influenza are aged 65 years and over and many face other complications/illnesses, such as heart disease or chronic lung disease. During an influenza epidemic there may be significant costs for national health services (associated with caring for those who fall sick) and for businesses in general (lost production as a result of time taken off work). In 2009, the Council of the European Union adopted a Recommendation to promote seasonal flu vaccination for people at risk of becoming severely ill when catching flu. This encouraged EU Member States to vaccinate annually 75 % of older people against seasonal flu, with the aim of reaching this target by the winter of 2014-2015, as well as other risk groups, such as those with chronic medical conditions, and also healthcare workers. An indicator on flu vaccination is included in the health services chapter of the ECHI.

The European Centre for Disease Prevention and Control (ECDC) was established by European Parliament and Council Regulation (EC) No 851/2004 and became operational in May 2005. Its mission is to help strengthen Europe’s defences against infectious diseases, such as influenza, SARS and HIV/AIDS. The ECDC works in partnership with national health protection bodies to strengthen and develop continent-wide disease surveillance and early warning systems.

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Health care (hlth_care)
Preventive services (hlth_prev)
Self-reported last breast examination by X-ray among women by age and educational attainment level (hlth_ehis_pa7e)
Self-reported last cervical smear test among women by age and educational attainment level (hlth_ehis_pa8e)
Self-reported last colorectal cancer screening test by sex, age and educational attainment level (hlth_ehis_pa5e)
Self-reported vaccination against influenza by sex, age and educational attainment level (hlth_ehis_pa1e)
Self-reported screening of cardiovascular diseases and diabetes risks by sex, age and educational attainment level (hlth_ehis_pa2e)
Breast cancer and cervical cancer screenings (hlth_ps_scre)
Vaccination against influenza of population aged 65 and over (hlth_ps_immu)