Healthcare activities statistics - preventive services
Data extracted in September 2017 and May 2018
Planned article update: October 2019
In 2014, 11 % of women in the EU aged 50 to 69 years reported never having had an x-ray breast examination, while 14 % of women aged 20 to 69 years reported never having had a cervical smear test.
In 2015, 34 % of people aged 65 and over in the EU had been vaccinated against influenza.
In 2014, slightly more than half of the EU population reported having their blood cholesterol measured during the previous year.
Influenza vaccination rate, people aged 65 or over, 2015
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.
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).
Programme-based data are available for 19 EU Member States for 2014 (in some cases data are from 2012, 2013 or 2015, see Figure 1 for more details). In nine of these, breast cancer screening rates were below 60 %, falling to a low of 23.1 % in Slovakia (2013 data). The other four countries where less than half of all women aged 50-69 had been screened were also Member States that joined the EU in 2004 or more recently, namely, Cyprus, Latvia, Lithuania and Hungary (the latest data for each of these relates to 2013). Four EU Member States reported breast cancer screening rates of 75 % or above: the United Kingdom, Ireland, Slovenia and Finland (the latest data for the last three of these also relates to 2013).
Survey data indicate that the lowest screening rate for breast cancer among the EU Member States was in Romania, just 6.4 %, while fewer than half of all women aged 50-69 had been screened in Bulgaria (21.9 %) and Greece (49.5 %) — note that the latest information available for each of these was for 2008 and 2009 respectively. At the other end of the range, survey data indicate that in 2014 more than three quarters of all women aged 50-69 had been screened for breast cancer in Portugal and Spain. No data are available in Figure 1 for Sweden, but from the European health interview survey (EHIS), as shown in Figure 2, it can be seen that 90.4 % of Swedish women aged 50-69 had had an X-ray breast examination within the two years prior to the survey that was conducted in 2014.
A comparison of data for the two years shown in Figure 1 indicates that breast cancer screening rates increased between 2009 and 2014 in half of the 22 EU Member States for which data are available, with particularly large increases observed in Latvia, Lithuania and Czechia (note that for all three of these, the latest comparison available covers data from 2009 to 2013). In those Member States where screening rates fell, the reductions were usually relatively small; the Netherlands was an exception to this rule as the proportion of women aged 50 to 69 who had been screened for breast cancer fell from 81.5 % to 63.8 % between 2009 and 2014.
Figures 2 and 3 present self-reported data for the EU Member States, Iceland, Norway and Turkey from the EHIS, which was conducted between 2013 and 2015. Figure 2 shows an analysis of the female population aged 50-69 in terms of the period when they 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, 35.3 % of Bulgarian women and 79.0 % of Romanian women in this age group had never had such an examination.
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 having had an X-ray breast examination in the previous two years: it presents an analysis based on the highest completed level of education. In nearly all of the EU Member States for which data are available, 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 there was a clear link between educational attainment and the prevalence of screening, as the share of women having had an X-ray examination tended to be higher among those with a higher level of education. This was particularly the case in those EU Member States where a relatively low share of women aged 50-69 had had an X-ray, for example, in Bulgaria and Romania.
Women living in rural areas were more likely to have never had an X-ray breast examination
An analysis by degree of urbanisation shows that, on average, almost 14 % of women in rural areas had never had an X-ray breast examination (Figure 4). This share was lower for women living in cities or towns and suburbs. More specifically, one in 10 women in cities had never had such an examination, while the same holds for 9.7 % of women living in towns and suburbs. In the 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, Bulgaria and Romania, where the differences in the proportions between women living in cities and those in rural areas exceeded 15 percentage points.
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 to 69 having been screened for cervical cancer within the previous three years (or according to the specific screening frequency recommended in each country). Some of the data presented are administrative data from cervical cancer screening programmes although a majority of the data presented are from surveys: these are shown separately for reasons of comparability. Data are available for 26 EU Member States (although the latest period varies by EU Member State, see Figure 5 for more details).
There are nine EU Member States for which programme-based data are presented. Among these, cervical cancer screening rates ranged from highs of 71.5 % in Slovenia (2012 data) and 77.5 % in the United Kingdom, down to less than half of the female population in Lithuania and Italy (latest information is for 2009), a quarter of the female population in Latvia (2012 data) and less than one tenth (8.6 %) of the female population in Bulgaria (2012 data).
A similar analysis among those EU Member States with survey data for 2014 reveals that cervical cancer screening rates were higher than 70.0 % in Portugal, France, Austria (2012 data), Finland and Sweden. At the other end of the range, rates were below 50.0 % in Czechia (33.3 %), Romania (25.9 %; 2012 data) and Slovakia (23.2 %; 2015 data).
A small set of data exists to allow an analysis of developments between two different years (see Figure 5). Among the eight EU Member States for which data are available, there was often a relatively small change in the proportion of women aged 20-69 who had been screened for cervical cancer. However, in Germany and Slovakia (both 2007-2015), there was a sizeable reduction in the share of women being screened, down 22.8 and 38.8 percentage points respectively.
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. In 2014, some 14.1 % of the female population 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 % or lower, while just over a quarter of the female population in Estonia had never had a smear test, a share that reached 31.7 % in Bulgaria and peaked at 62.1 % in Romania; note that there was an even higher share in Turkey (68.5 %).
Women having completed at most lower secondary education were least likely to have had a recent cervical smear test
Across the EU-28, the proportion of women aged 20-69 having had a cervical smear test in the previous three years was lowest (59.9 %) among those women having completed at most a lower secondary level of education, climbing to more than three quarters (78.8 %) of the female population with a tertiary level of education. This pattern was repeated in each of the EU Member States, with the lowest screening rates consistently recorded among 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.
Colorectal cancer screening
In most EU Member States the majority of the population aged 50-74 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 had never been screened for colorectal cancer (at the time of the survey conducted in 2014). Germany and Austria had by far the highest proportion of their respective populations aged 50 to 74 years 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 %. By contrast, there were six Member States where less than half of all people aged 50-74 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 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 having completed tertiary education. Across the whole of the EU-28, some 58.8 % of those with no more than a lower secondary education had never had a screening test for colorectal cancer, a share that fell to 48.3 % among those with a tertiary level of education. An analysis for the EU Member States reveals that by far the greatest diversity in the proportion of the population never having been screened was in Croatia, with relatively large differences also observed in Slovenia and Latvia.
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 and over, with around one third (34.0 %) of the elderly population in the EU-28 having been vaccinated in 2015.
In the majority of 27 EU Member States for which data are available (incomplete data for Austria) the share of the elderly vaccinated against influenza was lower in 2015 than in 2010. The biggest declines (at least 10 percentage points) were recorded in Slovakia, Croatia, Italy and Germany (note there is a break in series). The Baltic Member States, Portugal, Finland and Greece were the only EU Member States to record a higher proportion of their populations aged 65 or over who were vaccinated against influenza in 2015 than in 2010.
Figure 10 also shows considerable differences between EU Member States in relation to the overall uptake of influenza vaccinations, with around 7 out of 10 elderly persons being vaccinated in the United Kingdom and a slightly lower share in the Netherlands (66.8 %), while less than 10.0 % were vaccinated in Poland (2014 data), Latvia, Bulgaria (2014 data) and Estonia.
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 or over. In Poland, Hungary, Cyprus, Greece, Czechia, Sweden, Slovenia, Slovakia and Croatia there were substantially higher shares of people having been vaccinated against influenza among people having completed tertiary education than among people with lower levels of completed education; this was also the case in Norway. The reverse situation was observed notably in Spain, the Netherlands, Ireland, France, Luxembourg, Italy and Portugal. In the rest of the EU Member States the differences in vaccination rates between people with different levels of education were not particularly large.
Screening of cardiovascular diseases
As well as questions measuring the use of preventive care services, such as vaccination, the second wave of the EHIS also included questions for checking important blood parameters related to 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 becomes one of the main concern 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 last year
In 2014, about 18 % of the EU-28 population reported that they had never had a blood cholesterol measurement (see Figure 12). This percentage varied from less than 8 % in Czechia, Spain, Portugal and Cyprus to more than one third of the population in the United Kingdom, Denmark, the Netherlands as well as Iceland, Norway and Turkey.
Conversely, more than half of the population in the EU-28 reported that they had a blood cholesterol measurement within the year prior to the 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 to one third of the population or less in the Netherlands, Denmark, Romania and Sweden. Iceland and Turkey also recorded relatively low shares.
As expected, the measurement of blood cholesterol was more pronounced among the elderly (Table 1). More than 7 out 10 elderly persons reported having had a blood cholesterol measurement within the year prior to the survey. A national exploration reveals that the share of the population aged 65 and over having had a blood cholesterol measurement exceeded 50 % across all EU countries. It reached its highest values in Czechia (81.3 %), Germany (82.4 %), Portugal (83.6 %), Luxembourg (86.0 %) and Spain (87.3 %). Middle aged persons (aged 45-64) and younger ones (aged 15-44) were less in need of measuring their blood cholesterol levels; the respective shares did not exceed 70 % for middle aged persons in the vast majority of the EU countries, while similarly this share accounted for less than half of the younger population in all EU countries except for Portugal (53.8 %) and Spain (56.8 %).
More than half of the EU-28 population reported having had a blood sugar measurement within the last year
Focusing on actions for the prevention of diabetes, it is observed that, on average, the percentage of the population aged 15 and over who reported never having had a blood sugar measurement by a health professional was almost 17 %. More specifically, in 8 out of 28 EU Member States this share was higher than the EU-28 average (Figure 13).
Similar to the blood cholesterol measurement, more than half of the Europeans have had a blood sugar measurement within the year prior to the survey. This share varied from about 36 % in Ireland, Sweden and Denmark to almost 62 % in Luxembourg, with Romania (30.9 %) below this range and Portugal and Spain above it (both 67.7 %). On the other side of the spectrum, the highest proportions of blood sugar measurement at a frequency of one to three years before the survey were recorded in Cyprus (38.7 %), Romania (36.1 %) and Finland (29.4 %).
Women were more likely than men to have had a blood sugar measurement within the last year
In 2014, women were more likely than men to report having had a blood sugar measurement within the last year. On average, the percentage of women reporting at having had a blood sugar measurement was almost 5 percentage points higher than for men (53.3 % for women and 48.5 % for men) — see Figure 14.
At country level, data indicate that women consistently recorded higher percentages than men with a couple of exceptions: United Kingdom and Finland, although the differences between sexes were small. The gender gap was widest in Latvia, Lithuania, Portugal and Bulgaria as well as Turkey (a difference of 10 percentage points or more). By contrast, the lowest gender gaps were observed in Ireland, the Netherlands and Germany (a difference of 3 percentage points or less).
Source data for tables and graphs
Data sources and availability
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 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 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 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 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 or 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 the 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.
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.
Note on tables: the symbol ':' is used to show where data are not available.
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, 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 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 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.
Health status — selected diseases and related health problems
General health statistics articles
- Health care (hlth_care)
- Preventive services (hlth_prev)
- Self-reported breast examination by X-ray by educational attainment level among women aged 50-69 (%) (hlth_ehis_pa7e)
- Self-reported cervical smear test by educational attainment level among women aged 20-69 (%) (hlth_ehis_pa8e)
- Self-reported colorectal cancer screening test by sex, age and educational attainment level among people aged 50-74 (%) (hlth_ehis_pa5e)
- Self-reported vaccination against influenza by sex, age and educational attainment level (%) (hlth_ehis_pa1e)
- Breast cancer and cervical cancer screenings (hlth_ps_scre)
- Self-reported screening of cardiovascular diseases and diabetes risks (hlth_ehis_pa2)
- Vaccination against influenza of population aged 65 and over (hlth_ps_immu)
- Preventive services (hlth_prev)
- Breast cancer and cervical cancer screenings (ESMS metadata file — hlth_ps_scre)
- European health interview survey (ESMS metadata file — hlth_det_esms)
- Vaccination against influenza of population aged 65 and over (ESMS metadata file — hlth_ps_immu_esms)