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Last Updated: 04 September 2024

• cerebrovascular diseases

1. Key messages

2. Stroke prevalence

More men than women report to have suffered from stroke

In 2018, 0.7% of the population with an aged 15 years and over reported having a stroke in the past year. This percentage increases with age, up to 1.7% in people aged 65 years and over, and to 2.4% in people aged 75 and over.

The age-adjusted self-reported prevalence of stroke was 2.0%. Stroke was more commonly reported among men across all age groups. The age-adjusted self-reported prevalence of stroke was higher in men (3.5%) than in women (0.9%).

The gender difference was more pronounced in people aged 65 and over, in whom the prevalence of stroke was 3 to 6 times as high in men.

Stroke prevalence is higher in men than women across all regions

In 2018, among people aged 65 and over, the age-adjusted prevalence of stroke was higher in men in all regions, with the most pronounced difference in the Flemish Region. The number of women that report to have experienced a stroke in the past year is the highest in the Walloon Region, followed by the Brussels Capital Region, and the lowest in the Flemish Region. The small number of women aged 65 and over that report to have experienced a stroke in the Flemish region could be due to the small subgroup and fluctuations in the study sample.

Prevalence of stroke decreases in women aged 65 and over and increases in men aged 65 and over 

In women aged 65 and over, between 1997 and 2018, the age-adjusted prevalence of stroke has dropped resulting in an overall decrease by 87% (mainly caused by an observed drop between 1997 and 2001). In men aged 65 and over, there is an increase in self-reported prevalence of 40% since 1997. However, the observed rise in prevalence among men aged 65 and over was not significant.

Among men aged 65 and over, the regional patterns have fluctuated over time and do not allow clear conclusions about the evolution. Among women aged 65 and over, the prevalence of stroke has decreased in all regions between 1997 and 2018.

Stroke prevalence is linked to education levels.

The crude self-reported prevalence of stroke in the population with an age of 65 and older is higher in people with a low level of education (3.4%) compared to people with a middle (0.9%) or high (1.4%) level of education. Even after adjustment for age, these important differences remain between different levels of education. Education level is used as an indicator for socio-economic status at the individual level. These findings suggest that the population aged 65 and over with a lower socio-economic status report a higher prevalence of stroke compared to people with higher socio-economic status.

3. Stroke incidence

Highest hospital admission rate for stroke among men in the age group 80-84, and among women in the age group 85-89

In 2021, the number of persons having been diagnosed with an acute stroke at hospital admission was estimated at 15,359 (133 diagnoses per 100,000 inhabitants), among which 13,153 were discharged alive and 2,206 died. The total number of people with an acute stroke, including those who died without being admitted to the hospital, was estimated at 18,550 in Belgium (161 cases per 100,000 inhabitants).

Among people with acute stroke, 50.6% were men. The number of people admitted to the hospital because of acute stroke was higher in men in younger age groups and higher in women in older age groups (80+ years). The highest number of acute stroke was observed in the age group 80-84 among men, and in the age group 85-89 among women. The incidence rate of stroke increases with age and was higher in men in all age groups except for the 95+ age group.

Lower stroke incidence in Brussels compared to other Belgian regions in 2021

In the Brussels Capital Region the age-adjusted incidence of acute stroke in 2021 was 167 per 100,000 among men and 121 per 100,000 among women, and hence lower compared to the other regions in both genders. In the Walloon Region, the age-adjusted incidence rate of acute stroke was 186 per 100,000 among men and 140 per 100,000 among women, which is comparable to the age-adjusted Belgian incidence rate (respectively 191 per 100,000 and 141 per 100,000). In the Flemish region, the age-adjusted incidence rate of acute stroke was 195 per 100,000 among men and 145 per 100,000 among women.

Belgium sees decline in acute stroke incidence from 2016 to 2021 

Between 2016 and 2021, the age-adjusted incidence of acute stroke has decreased in both genders in Belgium, going from 214 per 100,000 in 2016 to 190 per 100,000 in 2021 in men and from 160 per 100,000 in 2016 to 136 per 100,000 in 2021 in women. This decrease was more pronounced among women (-15%) compared to men (-11.2%).

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Background

Cerebrovascular diseases are one of the main causes of death and disability world-wide, except in lowest-income countries. Cerebrovascular diseases, of which stroke is the most common manifestation, refers to all diseases in which the blood vessels of the brain are primarily involved. Cerebrovascular diseases could lead to serious symptoms, although they can also be present without any acute symptoms. The current chapter will focus on the occurrence of stroke within Belgium, which includes ischemic and hemorrhagic stroke. An ischemic stroke occurs if an artery to the brain becomes occluded, while hemorrhagic stroke occurs if brain vessels rupture.

Epidemiological studies have identified many risk factors of stroke. The most important non-modifiable risk factors include higher age, low birth weight or genetic predisposition. Important modifiable risk factors include among others hypertension, high cholesterol levels, cardiac disease, diabetes, obesity and smoking. Hypertension is the most important modifiable risk factor for both ischemic and hemorrhagic stroke, as it is found to explain 35% of all occurrences [1].

Two indicators are presented in the following sections:

• The self-reported prevalence of stroke refers to people who have reported suffering from stroke (including cerebral hemorrhage and cerebral thrombosis) in the past 12 months, and is derived from the Belgian Health Interview Survey [1]. We shall first describe the global prevalence in people aged 15 years and more; then we will focus on people aged 65 and over.
• Different indicators can be defined to describe the occurrence of acute stroke. The "rate" (or incidence by episode) represents all first or recurrent events, while the term "incidence" means a first-ever event. Based on the availability of the data, we defined the yearly incidence as the first event in a given year. This indicator is built using the hospital discharge data from the Federal Public Service Health, Foodchain safety and Environment [2] from which infarction cases that were hospitalized and discharged alive are derived. To these cases have been added the cases of people who died of a stroke (in hospital or not), extracted from the Sciensano Standardized Procedures for Mortality Analysis (SPMA) [3].

For information concerning mortality, please consult the following pages: Overall mortality by cause and Premature mortality by cause.

Definitions

Stroke

Stroke, a medical emergency, occurs when blood flow to the brain is disrupted, leading to tissue damage. It manifests in two forms: ischemic, caused by a blood clot blocking an artery, and hemorrhagic, resulting from a ruptured blood vessel. Symptoms include sudden numbness, confusion, speech difficulties, and severe headache. Prompt treatment is crucial to limit brain damage. An acute stroke lasts less than 24 hours, starts suddenly, and worsens rapidly.

Age-adjusted prevalence or incidence

Age-adjusted prevalence or incidence is a method to compare disease rates in different populations by adjusting for age differences. It helps provide a fair comparison by estimating what the disease rates would be if all populations had the same age distribution, making comparisons more meaningful.

References

1. Health Interview Survey, Sciensano, 1997-2018. https://his.wiv-isp.be/
2. Federal Public Service Health, Food Chain Safety, and Environment. https://www.health.belgium.be/en/node/22892
3. Standardized Procedure for Mortality Analysis (SPMA), Sciensano. https://spma.wiv-isp.be/SitePages/Methods_mortality.aspx

Please cite this page as: Sciensano. Non-Communicable Diseases: Cerebrovascular diseases, Health Status Report, 30 Aug 2024, Brussels, Belgium, https://www.healthybelgium.be/en/health-status/non-communicable-diseases/cerebrovascular-diseases

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Last Updated: 12 August 2024

• adolescents

1. Key messages

2. Self-perception of health

Boys are more likely to report excellent perceived health compared to girls

In 2018, the proportion of adolescents aged 11 to 18 years with excellent self-perceived health was 35% for boys and 24% for girls in Belgium. As they get older, fewer adolescents, especially girls, report themselves to be in excellent health. Between the ages of 11 and 18, the figures drop from 39% to 31% for boys, and from 33% to 16% for girls.

Health perceived as excellent does not vary much between the two communities

The differences in self-perceived health are small between the two communities. The proportion of boys who perceive their health as excellent was slightly higher among the adolescents from the French Community (36% vs 34%) and, among girls, the proportion was slightly higher among the adolescents from the Flemish Community (25% vs 24%).

There is an important gap in health perception between adolescents of low and high levels of family affluence in the Flemish Community

Among 15 year-old adolescents, excellent perceived health status was associated with high family affluence in the Flemish Community. Boys and girls from the most affluent families were respectively 1.7 times and 2 times more likely to report being in excellent health than those in lower affluent families. In the French Community, the difference in affluence was only observed in girls, with girls from the most affluent families being 1.2 times more likely to report an excellent health status than girls from the lowest affluent families. 

Some differences between the Communities were also observed by family affluence group:  among the low affluence families, boys from the French Community were 1.6 times more likely to report being in excellent health than boys from the Flemish Community. Among both the low affluence families and the high affluence families, girls from the French Community were respectively 2.5 and 1.5 times more likely to report excellent perceived health than girls from the Flemish Community. 

Belgium ranks lower than the EU-15 average in health perception in 2018

The 2018 HBSC international report reveals that for the EU-15 countries, 34% of 15-year-old boys and 21% of 15-year-old girls rated their health as excellent. This proportion ranged from 19% to 53% across countries for boys and 12% to 33% for girls. With 33% of 15-year-old Belgian boys and 18% of 15-year-old Belgian girls describing their health as excellent, Belgium is below the EU-15 averages.

3. Self-reported symptoms

Sleep difficulties, feeling nervous, and feeling irritable are the top 3 symptoms reported by boys and girls in Belgium

In 2018, for all adolescents aged 11 to 18 years old, the most frequently symptoms reported daily or more than once a week were sleep difficulties (29% for boys, 36% for girls), feeling nervous (24% for boys, 32% for girls) and feeling irritable (19% for boys, 28% for girls). Conversely, feeling dizzy, headache and stomach pain were the least frequently reported symptoms.

Across all school grade levels, more girls than boys reported having experienced each type of symptom more than once a week. In addition, the order of frequency with which symptoms were reported remained the same for boys and girls.

Symptoms increased with age, particularly in girls 

Among girls, several symptoms were much more common at age 15 than at age 11. Feeling nervous increases from 21% to 34%, feeling irritable from 18% to 32%, feeling low from 15% to 26%, back pain from 10% to 19%, headaches from 12% to 22%, and feeling dizzy from 8% to 14%. Stomach pain remained more or less stable and only sleep difficulties decreased consistently with age.

For boys, reporting back pain was more common at age 15 than at age 11, as did, to a lesser extent, feeling nervous, feeling irritable, and feeling dizzy. Sleep difficulties became significantly less frequent with age, from 33% at age 11 to 24% at age 15. Stomach pain also decreased with age. 

Boys and girls in the French Community had more symptoms than those in the Flemish Community

Boys and girls in the French Community reported symptoms more frequently than those in the Flemish Community. This difference is even more pronounced for girls than for boys, especially for sleep difficulties, feeling nervous, and feeling low.

Family affluence has an impact on some of the reported symptoms

In 2018 at age 15, in the French Community, boys from low affluence families reported more frequently feeling nervous (30% vs. 22%) and feeling irritable (24% vs. 12%) than those from a high affluence background. The frequency of psychosomatic symptoms in boys was not different by family affluence in the Flemish Community.

In both Communities, the proportion of girls feeling irritable was higher in low affluence families (26% on average) than in high affluence families (18% on average). The same was true for feeling low (24% in low affluence families and 14% in high affluence families). Girls from less affluent families were also more likely to report headaches in both Communities (18% vs 13%), although the difference was not statistically significant for those from the French Community.

Belgian numbers are close to the EU-15 average for multiple health complaints in 2018 

The 2018 HBSC international report reveals that for the EU-15 countries, on average 30% of 15-year-old boys and 49% of 15 year-old girls reported multiple health complaints (MHC) more than once a week. This proportion ranges from 19% to 44% for boys and 40% to 75%  for girls. With 30% of 15 year-old Belgian boys and 50% of 15 year-old Belgian girls reporting MHC, Belgium was comparable to the European average for boys and slightly below the EU average for girls.

4. Life satisfaction

Boys were more satisfied with their lives than girls

The proportion of adolescents who felt they were moderately or very satisfied with their lives was 92% for boys and 87% for girls in 2018 in Belgium. This proportion varied little with age for boys, but dropped sharply for girls between ages 11 and 16, then rose slightly at ages 17 and 18.

Adolescent boys and girls were feeling more satisfied with their lives in 2018 than in 2014 in both Communities

In both Communities, the proportion of boys reporting moderate to high satisfaction with their lives increased between 2014 and 2018 (from 88 to 91% for the French Community and from 91 to 95% for the Flemish Community). In the Flemish Community, the proportion of girls with moderate to high life satisfaction increased between 2014 (85%) and 2018 (91%), while in the French Community, it remained stable. 

For both genders, the proportion of adolescents reporting moderate to high satisfaction with their lives was higher in the Flemish Community than in the French Community.

Adolescents living in affluent families had a higher life satisfaction

For 15 year-old adolescents of both genders and both Communities, living in a high affluence family was generally associated with a higher life satisfaction score. The greatest difference was observed among adolescents from the Flemish Community with a mean satisfaction score difference of 0.6 points (among girls and boys). By gender, the score was fairly similar across Communities when family affluence level was taken into account. 

Belgian adolescents reported an above average life satisfaction among EU-15 countries 

The 2018 HBSC International Report reveals that for EU-15 countries, the average life satisfaction score for 15 year-olds was 7.5 for boys and 7.1 for girls. This variable ranges from 6.7 to 7.9 for boys and from 6.7 to 7.4 for girls. With an average life satisfaction score of 7.6 for Belgian 15 year-old boys and 7.2 for Belgian 15 year-old girls, Belgium is above the EU average.

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HBSC Fédération Wallonie-Bruxelles

HBSC Vlaanderen

Background

According to the WHO (World Health Organization), in 2021, one in seven 10-19 year-olds experiences a mental disorder, accounting for 13% of the global burden of disease in this age group [4]. Depression, anxiety and behavioral disorders are among the leading causes of illness and disability among adolescents. The consequences of failing to address adolescent mental health conditions extend to adulthood, impairing both physical and mental health and limiting opportunities to lead fulfilling lives as adults.

According to the latest UNICEF estimates, more than 16.3% of young people aged 10 to 19 in Belgium are diagnosed with a mental disorder in line with the World Health Organization's definition [5]. They suppose that these estimates are probably the tip of the iceberg because many children are not diagnosed and the COVID-19 pandemic has raised immense concerns regarding young people’s well-being.

On 30 March 2015, the Interministerial Conference on Public Health (IMC) approved the “Guide to a new mental healthcare policy for children and young people (GMCY)” [6]. Almost immediately, 11 GMCY networks were set up, focusing on children and young people within their area of action. A GMCY network provides a comprehensive and integrated range of services for all children and young people aged 0-23 with mental and/or psychiatric problems. The aim is to respond to the needs of these children, young people and their context or environment as quickly and continuously as possible.

Although networks offering mental health support to young people are developing in Belgium, to date there are relatively few studies that provide national estimates on children’s mental health, especially among the youngest age groups. In 2018, the Belgian Health Interview Survey (HIS) [7] extended for the first time its field of investigation to include child mental health difficulties, thus providing new elements on the subject. The HBSC (Health Behaviour in School-aged Children) surveys currently provide the most information on the emotional well-being of Belgian youth aged 11 to 18 years.

We used the HBSC surveys to describe three aspects of adolescent mental well-being in Belgium: 

• Self-perceived health, measuring the proportion who consider their health to be excellent.
• Self-reported symptoms, with a list of 8 symptoms and their frequency.
• Life satisfaction, assessing how satisfied they are with their life based on the Cantril scale.

Definitions

Self-reported symptoms (psychosomatic symptom)

Symptoms caused by stress and worry, rather than by a physical problem such as an infection. This HBSC indicator includes a list of eight symptoms, for which adolescents were asked to report the frequency with which they have experienced them over the past six months. Five frequency categories, ranging from "about every day" to "rarely or never," were provided.

Multiple Health Complaints (MHC)

In the HBSC international study, adolescents reporting at least two of the eight listed symptoms with a frequency of at least weekly were classified as having MHC.

Self-perceived health

The perceived state of health of teenagers attending school was assessed in the HBSC studies by using the question: "Would you say that your health is...". Four response categories were proposed: "excellent", "good", "rather good" and "not very good". Students who rated their health as "rather good" or "not very good" were considered to have a rather negative perception of their health.

Life satisfaction

In the Belgian HBSC studies, adolescents’ level of satisfaction with their lives is measured using the Cantril scale. It is graduated from 0 to 10, with the value 10 representing "the best possible life" and the value 0, "the worst possible life". Following the international protocol of the HBSC study, adolescents with a level between 6 and 10 were considered to have moderate to high satisfaction with their lives.

Family affluence

To classify different socioeconomic groups, HBSC studies use the Family Affluence Scale (FAS), which asks young people about household material possessions using a six-item questionnaire. Responses are scored and summed to form an HBSC FAS score, which has been shown to be a valid indicator of relative affluence. The affluence score is then used to identify groups of young people in the lowest 20% (low affluence), the middle 60% (medium affluence) and the highest 20% (high affluence).

References

1. HBSC Fédération Wallonie-Bruxelles, ULB, 2018. http://sipes.ulb.ac.be/
2. HBSC Communauté flamande, UGent, 2018. https://www.jongeren-en-gezondheid.ugent.be/ 
3. Spotlight on adolescent health and well-being. Findings from the 2017/2018 Health Behaviour in School-aged Children (HBSC) survey in Europe and Canada. International report. Volume 2. Key data, WHO Regional Office for Europe, 2020. https://www.who.int/europe/health-topics
4. Mental health of adolescents. https://www.who.int/news-room/fact-sheets/detail/adolescent-mental-health/
5. Rapport des enfants et des jeunes. https://www.unicef.be/sites/default/files/2022-06/Rapport%20What%20do%20you%20think%202022%20FR%20LR.pdf/
6. Networks in mental healthcare for children and young people. https://www.healthybelgium.be/en/key-data-in-healthcare/mental-healthcare/mental-healthcare-for-children-and-young-people/organisation-of-the-care-offering-for-children-and-young-people/networks-in-mental-healthcare-for-children-and-young-people/
7. https://www.sciensano.be/en/projects/health-interview-survey

Please cite this page as: Sciensano. Mental health: Adolescents mental health, Health Status Report, 11 Aug 2023, Brussels, Belgium, https://www.healthybelgium.be/en/health-status/mental-health/adolescents-mental-health 

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Last Updated: 26 August 2024

• musculoskeletal disorders

1. Key messages

2. Prevalence of musculoskeletal disorders

7% to 18% of all Belgians reported suffering from a musculoskeletal disorder

Musculoskeletal disorders refer to complaints that are located in the musculoskeletal system and include, among others, low back pain, neck pain, and osteoarthritis. These complaints are often limiting people in their day-to-day activities, and they might become chronically painful and disabling diseases. Often disregarded due to their low fatality rate, musculoskeletal disorders account for the greatest proportion of persistent pain, affecting physical function and mental health, increasing the risk of developing other chronic health conditions.

In Belgium in 2018, 12% of the population reported suffering from low back pain, 7.8% from neck pain, and 18% from osteoarthritis. In general, the occurrence of musculoskeletal disorders increased with age with 24% of people over 75 years of age reporting suffering from low back pain, 13.2% from neck pain, and 44% from osteoarthritis.

When analyzing the age-adjusted self-reported prevalence for men, the prevalence of low back pain, neck pain, and osteoarthritis was 11%, 5.3%, and 15%, respectively. In women, the age-adjusted prevalence of low back pain, neck pain, and osteoarthritis was 13%, 10%, and 22% respectively.

Low back pain, neck pain, and osteoarthritis were more commonly reported among women for all age groups. An exception is observed for low back pain in the group of people between 25 and 34 years old, where men showed a higher prevalence than women.

The gender difference was more pronounced in people aged 45 and over, for whom the prevalence of low back pain was between 1.1 and 1.5 times higher in women, the prevalence of neck pain was between 1.5 and 2.9 times higher in women, and the prevalence of osteoarthritis was between 1.4 and 1.5 times higher in women.

The highest prevalence of musculoskeletal disorders was found in the Flemish Region and Walloon Region

In 2018, for every musculoskeletal disorder, the highest age-adjusted prevalence was observed in the Walloon Region, followed by the Flemish Region, and the Brussels Capital Region, in men and women. The age-adjusted prevalence of every musculoskeletal disorder was higher in women in all regions.

The number of people that suffer from a musculoskeletal disorder is increasing over time

Between 2008 and 2018, the age-adjusted prevalence of low back pain and neck pain increased in both genders. The number of people suffering from low back pain increased by 26% in men, and 3.9% in women, while the number of people suffering from neck pain increased by 23% in men and 20% in women. For osteoarthritis, data is only available from 2013 onwards, whereby the number of people suffering from osteoarthritis increased between 2013 and 2018 by 16% in men, and 4.8% in women.

Among men

In men, the age-adjusted prevalence of low back pain, neck pain, and osteoarthritis have generally increased over time in the Flemish Region and the Walloon Region between 2008 and 2018, and it has remained stable or even decreased in the Brussels Capital Region.

Among women

In women, the age-adjusted prevalence of low back pain, neck pain, and osteoarthritis have generally increased over time in the Flemish Region and the Walloon Region between 2008 and 2018, and it has remained stable or even slightly decreased in the Brussels Capital Region.

3. Read more

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Background

Musculoskeletal disorders are one of the main causes of morbidity worldwide, particularly in high-income countries. Musculoskeletal disorders include disorders that primarily affect the musculoskeletal system, and the most common musculoskeletal disorders include low back pain, neck pain, and osteoarthritis. Low back pain and neck pain are disorders that are characterized by pain reported in a specific area, for which in 90% of the cases no specific structural cause can be identified. Osteoarthritis is a degenerative joint disease that most frequently occurs in the hands, hips, and knees.

Health determinants for musculoskeletal disorders include socio-demographic, occupational, and lifestyle factors. These socio-demographic factors include low education, middle age, and sex (i.e. women have a higher risk compared to men). Occupational factors include performing manual work, and lifestyle factors include smoking, physical inactivity, and sedentary behavior.

The indicators that are presented on this page:

• The prevalence of low back pain, neck pain, and osteoarthritis refer to people who have reported suffering from a specific musculoskeletal disorders during the last 12 months and is derived from the Belgian Health Interview Survey [1]. The prevalence estimates are calculated based on a population aged 15 years and more.

Definitions

Low back pain

Low back pain is defined as pain in the lumbosacral region, usually accompanied by painful limitation of motion, influenced by strain and the adoption of certain postures, and which may be associated with referred pain. When diagnosed as non-specific low back pain, it is assumed that there are no underlying conditions such as fractures, spondylitis, direct trauma, or neoplastic, infectious, vascular, metabolic, or endocrinology-related processes that might cause pain. The diagnosis is based on the self-reported symptomatology of patients.

Neck pain

Neck pain is defined as pain that starts in the neck and can be associated with radiating pain down one or both of the arms. When diagnosed as non-specific neck pain, it is assumed that there are no underlying conditions such as fractures, spondylitis, direct trauma, or neoplastic, infectious, vascular, metabolic, or endocrinology-related processes that might cause pain. The diagnosis is based on the self-reported symptomatology of patients.

Osteoarthritis

Osteoarthritis is defined as a type of degenerative joint disease that results from the breakdown of joint cartilage and underlying bone. The most common symptoms are joint pain and stiffness. The diagnosis is made with reasonable certainty based on history and clinical examination, using radiographic imaging.

References

1. Health Interview Survey, Sciensano, 1997-2018. https://his.wiv-isp.be/

Please cite this page as: Sciensano. Non-communicable Diseases: Musculoskeletal disorders, Health Status Report, 15 Dec 2022, Brussels, Belgium, https://www.healthybelgium.be/en/health-status/non-communicable-diseases/musculoskeletal-disorders 

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Last Updated: 26 August 2024

• cardiovascular diseases

1. Key messages

2. Background

Ischemic heart disease (IHD) is the main cause of death worldwide except in lowest-income countries. IHD, also called coronary heart disease, refers to heart problems caused by a narrowing of the coronary arteries (atherosclerosis), resulting in a reduced blood flow and oxygen supply (ischemia) to the heart muscle. In atherosclerosis, the arteries are narrowed when plaques build up inside, containing fat, cholesterol from low-density lipoproteins (LDL), fibrous tissues and sometimes calcium.

Many people do not experience any symptoms in the early stages of IHD. However, if left untreated, atherosclerosis progresses and symptoms may occur, which can be very disabling. The discomfort experienced when the heart muscle is lacking of oxygen is called angina pectoris. When the blockage of the blood flow is complete, the heart cells may die or suffer from serious damages, and this is what is called a myocardial infarction or a heart attack.

The main risk factors for IHD include physical factors such as high blood pressure, high cholesterol risk factor, diabetes, and behavioral factors such as tobacco use, unhealthy diet, alcohol abuse, and lack of exercise, which means that a part of the risk may be preventable by adopting a healthy lifestyle.

Two indicators are presented in the following sections:

• The prevalence of angina pectoris refers to people who have reported suffering from angina pectoris during the last 12 months, and is derived from the Belgian Health Interview Survey [1]. We shall first describe the global prevalence in people aged 15 years and more; then we will focus on people aged 65 and over.
• Different indicators can be defined to describe the occurrence of acute myocardial infarction (AMI). The "attack rate" (or incidence by episode) represents all first or recurrent events, while the term "incidence" means a first-ever event. Based on the availability of the data, we defined the yearly incidence as the first event in a given year. This indicator is built using the hospital discharge data from the Federal Public Service Health, Foodchain safety and Environment [2] from which infarction cases that were hospitalized and discharged alive are derived. It has to be noted that data of 2015 are not available due to the change of classification system from ICD-9 to ICD-10. To these cases have been added the cases of people who died of a heart attack (in hospital or not), extracted from the Sciensano Standardized Procedures for Mortality Analysis (SPMA) [3].

For information concerning mortality, please consult the following pages: Overall mortality by cause and Premature mortality by cause.

3. Angina pectoris prevalence

Situation in 2018

Belgium

In 2018, 1.3% of the population reported suffering from angina pectoris, a symptom of coronary heart disease. This percentage increases with age, going up from 0% in people aged 15-24 to 3.8% in people aged 65 years and over, and to 4.7% in people aged 75 and over.

Angina pectoris was more commonly reported among men, except in the 25-34 and 55-64 age groups. The age-adjusted self-reported prevalence of angina pectoris was higher in men (1.8%) than in women (1%).

Among people aged 65 and over, the prevalence was 3.8%.

The gender difference was more pronounced in people aged 65 and over, in whom the prevalence of angina pectoris was 2.5 times as high in men.

Regional differences

In 2018, among people aged 65 and over, the age-adjusted prevalence of angina pectoris was higher in men in all regions, with the most pronounced difference in Brussels.

Trends

Belgium

In people aged 65 and over, between 2008 and 2018, the age-adjusted prevalence of angina pectoris has decreased in both genders, but to a lesser extent in men (-24%, and not statistically significant) compared to women (-61%).

Regional differences

Among men aged 65 and over, the regional patterns have fluctuated over time and do not allow clear conclusions about the evolution.

Among women aged 65 and over, the prevalence of angina pectoris has steadily decreased in Flanders between 2008 and 2018. In Brussels, it has decreased between 2008 and 2013 and remained stable between 2013 and 2018. In Wallonia the decrease was not significant.

Socio-economic disparities

The crude self-reported prevalence of angina pectoris is higher in people with a low level of education, but after adjustment for age, there are no socio-economic disparities between the different levels of education, even among people aged 65 and over.

4. Acute myocardial infarction incidence

Situation in 2017

Belgium

In 2017, the number of persons having been diagnosed with an acute myocardial infarction (AMI) was estimated at 20,253 (178 diagnoses per 100,000 inhabitants), among which 15,928 were discharged alive and 4,325 died.

Among people with AMI, 67.4% were men. The number of person having suffered of AMI was higher in men at any age excepted in oldest age groups (+85 years). The highest number of AMI was observed in age group 60-65 among men, and in age group 85-89 among women. The incidence rate of AMI increases with age and was higher in men in all age groups.

Regional differences

In Brussels, in 2017 the age-adjusted incidence of AMI was 227 per 100,000 among men and 81 per 100,000 among women, and hence lower compared to the other regions in both genders. In Wallonia, the age-standardized incidence rate of AMI was 284 per 100,000 among men and 108 per 100,000 among women, which was above the age-standardized Belgian incidence rate (respectively 269 per 100,000 and 102 per 100,000). In Flanders, the age--standardized incidence rate of AMI was 251 per 100,000 among men and 92 per 100,000 among women.

Trends

Belgium

Between 2008 and 2017 (2015 not included), the age-adjusted incidence of myocardial infarction has decreased in both genders, going from 301 per 100,000 in 2008 to 269 per 100,000 in 2017 in men and from 134 per 100,000 in 2008 to 102 per 100,000 in 2017 in women. This decrease was less pronounced among men (-10.6%) compared to women (-23.9%).

Regional differences

Between 2008 and 2017 (2015 not included), in both genders, the age-adjusted incidence of myocardial infarction has decreased in the three regions. Among men, this decrease was similar across all regions with a decrease of 11.3% in Flanders, a decrease of 10.6% in Brussels, and a decrease of 11.5% in Wallonia. Among women, the change was more pronounced in Brussels (-26.4%) and Flanders (-26.4%) compared to Wallonia (-21.7%).

5. Read more

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Definitions

Angina pectoris or angor

Angina pectoris, or angor, is one of the symptoms of coronary heart disease. Angor is defined as a pain or discomfort in the chest or adjacent areas, precipitated by exercise, emotion or a heavy meal, caused by a reduced supply of oxygen to the heart (ischemia) due to a stenosis (narrowing) or blockage of the coronary arteries.

Acute myocardial infarction

Acute myocardial infarction (AMI), also called heart attack, is a necrosis (death) of the heart cells, resulting from an acute obstruction of a coronary artery. The symptoms include chest pain or discomfort, dyspnea (shortness of breath), and nausea. In some cases, AMI can be asymptomatic. The main risk factors are age, tobacco, high blood pressure, high blood cholesterol, alcohol abuse, obesity and diabetes.

References

1. Health Interview Survey, Sciensano, 1997-2018. https://his.wiv-isp.be/
2. Federal Public Service Health, Food Chain Safety, and Environment. https://www.health.belgium.be/en/node/22892
3. Standardized Procedure for Mortality Analysis (SPMA), Sciensano. https://spma.wiv-isp.be/SitePages/Methods_mortality.aspx

Please cite this page as: Sciensano. Non-Communicable Diseases: Ischemic heart disease, Health Status Report, 29 Nov 2021, Brussels, Belgium, https://www.healthybelgium.be/en/health-status/non-communicable-diseases/ischemic-heart-disease 

Details

Last Updated: 12 August 2024

• suicide

1. Key messages

2. Suicidal behaviour from 2020 onwards

Suicidal thoughts stay high among young women (18-29 years old)

10% of people in November 2023 said they had seriously considered suicide in the last 12 months. The number of young women (aged 18-29) who have had suicidal thoughts has increased by 30% since February 2023 to 23%.

0.6% of people in November 2023 said they had attempted suicide in the last 12 months.

3. Suicidal thoughts

Middle-aged women are more likely to report suicidal thoughts

In 2018, in Belgium, 14% of the population aged 15 years and over had at least once in their life seriously considered suicide; within this group, one in three (or 4.3% of the total population) had thought about committing suicide in the last 12 months. More women (16%) than men (12%) reported suicidal thoughts in their life, while there were no gender differences in suicidal thoughts in the past year (4.4% in women vs 4.2% in men). People aged 65 years and over were less likely to report suicidal thoughts in their life or in the past year than people younger than 64 years. Women in the age group 45-54 years had a particularly high prevalence.

No clear trends in suicidal thoughts are observed

The proportion of people who considered suicide in the last 12 months (as well as in their lifetime) is lower in 2018 than in 2013, but the proportion is still higher than the values observed in 2008 (differences are not significant).

Suicidal thoughts are more frequent in the Walloon Region and the Brussels Capital Region

Lifetime suicidal thoughts were more frequent in the Walloon Region (16%) than in the Flemish Region (13%); suicidal thoughts in the last year were more prevalent in the Walloon Region (5.9%) and in the Brussels Capital Region (5.1%) than in the Flemish Region (3.3%). The prevalence of suicidal thoughts decreased in the Flemish Region between 2013 and 2018 while it remained relatively stable in the Brussels Capital Region and in the Walloon Region.

Suicidal thoughts are more frequent in the lowest educational group

Suicidal thoughts (lifetime and in the past year) are linked with the educational level. People from the lowest educational group were 1.5 more likely to have considered suicide in their life and 2.5 more likely to have considered it in the last year compared to people from the highest educational group.

4. Suicide attempts

More women have a failed suicide attempts

In 2018, in Belgium, 4.3% of the population aged 15 years and over reported to have attempted to commit suicide in their lifetime and 0.2% in the last year. More women (5.4%) than men (3.1%) tried to commit suicide in their lifetime and in the last year (0.3% in women and 0.2% in men). The prevalence of lifetime suicide attempts was higher in people aged between 35 and 54 years. Younger people (15-24 years) and 45-54 years were more likely to report a suicide attempt in the last year.

Trends in suicide attempts are stable

Trends in the prevalence of lifetime suicide attempts are relatively stable in Belgium and its regions. Suicide attempts decreased between 2013 and 2018 in men and women in the Brussels Capital Region but this was not significant.

Suicide attempts are more frequent in the Walloon Region

People from the Walloon Region were more likely to have attempted to commit suicide (6%) than people from the Brussels Capital Region (4.2%) and the Flemish Region (3.3%).

Suicidal attempts are more frequent in the lowest educational group

Suicide attempts (lifetime and in the past year) were linked with educational levels. People from the highest educational group were less likely to attempt suicide than people from the lower educational group.

5. Completed suicide

The number of deaths by suicide decreased to 1641 in 2021

In 2021, the number of deaths by suicide in Belgium fell to 1,641 (compared with 1,736 in 2020). There were more deaths by suicide among men (1174) than among women (467). The highest number of deaths by suicide occurred in the 45-64 age group. These figures are probably underestimated due to the limitations mentioned in the "context" section.

The mortality rate due to suicide is higher in men

The age-adjusted mortality rate due to suicide was 14.3 (per 100,000 people) in 2021 in Belgium. It was 2.6 times higher in men (21.3) than in women (8.0).

Suicide rates by age group are presented pooled over 3 years to avoid jumps due to small numbers. Suicide rates are higher for men than for women at any age, showing a gender difference in suicide. Suicide rates are the highest for men aged over 85 and for women between 45 et 64 years old.

Suicide represents a high share of deaths among young people

The share of deaths due to suicide by age group represents the relative importance of this cause in all deaths occurring in that age group. This has a different age distribution from that of the suicide mortality rates because the denominator of the share (all deaths in a given age group) is much larger at older ages, whereas the denominator of the rates (number of people in a given age group) is smaller at older ages.

Suicide accounts for a large proportion of deaths among young people: 27% of deaths among men and women aged 15 to 24 are due to suicide. Suicide accounts for 24% of deaths among men aged 25 to 44 and 13% among women aged 25 to 44.

Due to the increase in the number of deaths from concomitant causes at higher ages, the share of suicide deaths decreases with age.

Trends in suicide deaths are better understood together with deaths of undetermined intent

Between 2011 and 2021, suicide mortality rates decreased by 26% for both men and women. However, if we group suicides with deaths linked to events of undetermined intent, we see a smaller decrease of 8% for both men and women.

Deaths from suicide tend to decrease in all regions

Between 2011 and 2021, suicide rates among men decreased by 27% in the Flemish Region and by 22% in the Walloon Region. For women, suicide rates are, over the whole period, at a much lower level than for men in all regions. Between 2011 and 2021, rates decreased by 22% in the Flemish Region and by 32% in the Walloon Region.

When pooling suicide with the deaths from events of undetermined intent, the rates are decreasing slower or even increasing in the Flemish Region.

Between 2020 and 2021, age-adjusted mortality rates decreased in the Brussels-Capital Region, stagnated in the Walloon Region, and decreased among men and stagnated among women in the Flemish Region.

The high suicide rate in Belgium must be interpreted with caution

Belgium has the highest apparent suicide rate among women and the second highest among men. The rates are 1.4 times higher for men and 1.7 times higher for women than the average rate for the EU-14 countries. However, international comparisons of suicide mortality rates should be interpreted with caution as differences in socio-cultural context and data quality hamper the comparability between countries. Nevertheless, this warning should not serve to minimize the problematic suicide rates in Belgium.

6. Read more

View the metadata for this indicator

Statbel — Causes of death
SPMA: Standardized Procedures for Mortality Analysis (SPMA)
HISIA: Health Interview Survey Interactive Analysis (HISIA)

If you are in distress or in need of emotional/psychological support, do not hesitate to call 02 648 40 14 for the community help service helpline, or visit the Community Help Service online.

Background

Suicide and suicide attempts are important societal and public health issues. They have ripple effects on families, friends, colleagues, communities, and society on the whole. Suicide occurs throughout the lifespan and was the second leading cause of death among 15-29-year-olds in the world in 2016. Suicide is preventable and its prevention has been prioritized by the World Health Organization (WHO) as a global target and included as an indicator in the United Nations Sustainable Development Goals (SDGs) [8]. To effectively develop suicide prevention strategies, efficient monitoring of suicide as well as identification of specific groups at risk is needed.

Suicidal thoughts never have just one cause but arise due to an interaction of risk and protective factors. These risk factors are always a combination of biological, psychological, social, and psychiatric risk factors. Suicidal thoughts also do not evolve linearly but with ups and downs. An entire process always precedes suicide [9]. The strongest risk factor for suicide is a previous suicide attempt [10]. The current COVID-19 crisis is particularly affecting the population's mental health and has a negative impact on some of the risk factors linked to suicide.

To apprehend this complex phenomenon, we use several indicators:

• Suicidal thoughts are an important risk factor for future suicide and important for prevention.
• Suicide attempts are a strong risk factor for completed suicide and a key moment to provide help to the person [11,16].
• Suicide deaths: we report the number of deaths, the mortality rate, and the share of total deaths that are due to suicide by age group. As suicides are often poorly recorded, these numbers are probably underestimated [12-15]. Misclassifications can occur when the exact cause of death is unknown (suicide may thus be classified as ‘unknown cause’); when the intention is not clear (suicide may thus be classified as 'deaths of undetermined intent'); or when the intention is wrongly evaluated (suicide may thus be classified as ‘accidents’ or ‘homicides’). It may also be possible that the doctor avoids mentioning suicide to protect the family from different problems (insurance, administration, religion, …). Additionally, administrative procedures can lead to misclassifications. For example, in Brussels, for certain years, the prosecution office failed to classify violent deaths (suicides, homicides), leading to a consequent under-reporting of suicides which were then classified as deaths of undetermined intent [11]. Moreover, the reasons for misclassification strongly vary across countries, which limits the interpretation of international comparisons. To partly reduce these biases in the interpretation of trends, we present, in addition to the suicide mortality rates, mortality rates grouping suicides (codes X60-X84; Y87.0) and events of undetermined intent (codes Y10-Y34; Y87.2).

First, we give an overview of suicidal thoughts and attempts during the COVID-19 crisis based on the data collected through online COVID-19 health surveys. Then, we go more in-depth into the suicidal thoughts and attempts based on the previous health interview surveys. Finally, we look at mortality due to suicide.

Definitions

Age-standardized rates (prevalence, incidence, or mortality)

Since most health indicators are strongly influenced by age, comparisons (among regions, educational levels, and over time) need to be standardized by age. The age-standardization removes the impact of differences in the age structure between populations or over time. The age-standardized rate is a weighted average of age-specific rates. The weights are derived from the same reference (standard) population.

EU-14

The EU-14 corresponds to all countries that belonged to the European Union between 1995 and 2004: Austria, Belgium, Denmark, Finland, France, Germany, Greece, Ireland, Italy, Luxembourg, the Netherlands, Portugal, Spain, and Sweden. We compare the Belgian health status to that of the EU-14 because these countries have similar socioeconomic conditions. Note: The United Kingdom is not included since 2020.

References

1. Sixième enquête de santé COVID-19 : résultats préliminaires. Deposit number D/2021/14.440/30. Brussels: Sciensano; 2021. doi: 10.25608/j877-kf56
2. Septième enquête de santé COVID-19 : résultats préliminaires. Deposit number D/2021/14.440/50. Brussels: Sciensano; 2021. doi: 10.25608/ht7a-8923
3. Belgian Health and Well-being Cohort (BELHEALTH) - Bulletin 2, Brussels: Sciensano; 2023. https://www.sciensano.be/fr/biblio/bulletin-ndeg-2-belhealth-en 
4. Belgian Health and Well-being Cohort (BELHEALTH) - Bulletin 4, Brussels: Sciensano; 2024. https://www.sciensano.be/en/biblio/bulletin-ndeg4-belhealth 
5. Health Interview Survey, Sciensano, 1997-2018. https://www.sciensano.be/fr/projets/enquete-de-sante 
6. Causes of death, Statbel. https://statbel.fgov.be/en/themes/population/mortality-life-expectancy-and-causes-death/causes-death
7. Eurostat. https://ec.europa.eu/eurostat/databrowser/view/TPS00122/default/table?lang=en
8. WHO. Suicide in the world. https://www.who.int/publications-detail/suicide-in-the-world
9. 1813 zelfmoord. Oorzaken en suïcidaal proces. https://www.zelfmoord1813.be/feiten-en-cijfers/oorzaken-en-su%C3%AFcidaal-proces
10. WHO. Suicide. https://www.who.int/westernpacific/health-topics/suicide
11. Centre de prévention du suicide. LE SUICIDE UN PROBLEME MAJEUR DE SANTE PUBLIQUE Introduction à la problématique du suicide en Belgique Chiffres de 2014. Bruxelles, Belgique: Centre de prévention du suicide; 2017 Sep.
12. De Spiegelaere M, Wauters I, Haelterman E. Le suicide en Région de Bruxelles-Capitale: Situation 1998-2000. Brussels: Observatoire de la santé et du social de Bruxelles- Capitale; 2003.
13. Ohberg A, Lonnqvist J. Suicides hidden among undetermined deaths. Acta Psychiatr Scand. 1998.
14. Jougla E, Pequignot F, Chappert J, Rossollin F, Le TA, Pavillon G. Quality of suicide mortality data. RevEpidemiolSante Publique. 2002.
15. Moens GFG. The reliability of reported suicide mortality statistics: An experience from Belgium. Int J Epidemiol. 1985.
16. Gisle L, Drieskens S, Demarest S, Van der Heyden J. Enquête de santé 2018 : Santé mentale [Internet]. Bruxelles, Belgique: Sciensano; 2020 Jan. Report No.: D/2020/14.440/3. https://www.sciensano.be/fr/biblio/enquete-de-sante-2018-sante-mentale 

Please cite this page as: Sciensano. Mental Health: Suicidal behaviour, Health Status Report, 24 Apr 2024, Brussels, Belgium, https://www.healthybelgium.be/en/health-status/mental-health/suicidal-behaviour

Details

Last Updated: 14 August 2024

• diabetes

1. Key messages

2. Diabetes prevalence

Five percent of Belgians are not aware of their diabetes

In 2022, 7.1% of the Belgian population was diagnosed with diabetes according to the IMA-AIM Atlas. The prevalence of diabetes increases with age and is higher among men, especially in the older age groups.

According to the BELHES in 2018, the estimated total prevalence of diabetes reached 10%, which includes more than one in three people with diabetes (37%) that is unaware of their diabetes status. 7.7% of people used diabetes medication. Still, among those, 19% have diabetes which is not well controlled. In other words, 5% of the population is suffering from diabetes either without awareness or proper diabetes control.

The prevalence of diabetes is increasing over time

The prevalence of diagnosed diabetes is the highest in the Walloon Region and the lowest in the Flemish Region, despite the relatively higher age of the Flemish population. The relatively low diagnosed diabetes prevalence in the Brussels Capital Region is probably the result of the younger age of its population. When corrected for age, the diagnosed prevalence of diabetes in the Brussels Capital Region becomes higher than the Belgian average. The BELHES has also shown that in the Walloon Region, more people are unaware of their diabetes status compared to the Brussels Capital Region and the Flemish Region.

From 2007 to 2022, the prevalence of diagnosed diabetes has increased in all three regions, as a result of both the ageing of the populations and a true increase in the risk of developing diabetes that could, for example, be related to an increase in overweight/obesity. The age-adjusted prevalence of diabetes increased by 29% in the Walloon Region, with 31% in the Brussels Capital Region and the Flemish Region with 27%.

Belgians with an increased compensation status have an increased risk of diabetes

The prevalence of diagnosed diabetes (IMA) is nearly twice as high among individuals with an increased compensation status than among individuals with a normal compensation status. The prevalence of diagnosed diabetes has been increasing in both groups over time.

The BELHES has shown that people with a lower education are significantly more likely to suffer from ignored or poorly controlled diabetes compared to people with a higher education (RR=3.6, adjusted for age and gender). This could indicate that there are socioeconomic inequalities in the screening and follow-up of diabetes.

3. Read more

View the metadata for this indicator

Background

Diabetes is a condition that is characterized by recurrent high blood sugar levels. If left untreated, diabetes may cause long-term complications such as foot ulcers, damage to the eyes, chronic kidney disease, and cardiovascular disease. A diabetic diet and exercise are important parts of diabetes management, but in a large number of cases, drug therapy will also be required.

A distinction is made between three main types of diabetes:

• Type 1 diabetes, resulting from autoimmune destruction of the insulin-producing beta cells in the pancreas;
• Type 2 diabetes, due to the body's inefficient use of insulin, mainly caused by a combination of excessive body weight and insufficient exercise; and
• Gestational diabetes occurs in pregnant women without a previous history of diabetes.

In the absence of an exhaustive diabetes register, several sources of information can be used in Belgium:

• The InterMutualistic Agency (IMA-AIM) is a platform where data gathered from the seven Belgian health insurance funds are collected and analyzed. IMA-AIM data are, amongst others, made available through the IMA-AIM Atlas [1].
• Surveys in the general population, namely the Health Interview Surveys (HIS) [3] and mainly the Belgian Health Examination Survey (BELHES) [2], which occurred for the first time in 2018; the BELHES aimed to collect objective indicators on the health of the population in a representative sample of people aged 18+.

In the IMA-AIM database, information is found on the use of antidiabetic treatment or on diabetes referring nomenclature. This is considered a good proxy for the prevalence of diagnosed diabetes. Socio-economic characteristics are scarce in the IMA-AIM Atlas. The status of “insured people having the right to an increased compensation” is the only available proxy indicator, and it has only two values, yes or no. Persons with a low income or specific medical characteristics such as invalidity are entitled to an increased compensation status.

Since diabetes is a disease with insidious onset, many cases remain undiagnosed. Information on undiagnosed diabetes prevalence is available in the BELHES. The BELHES used self-reported data on diabetes medication use from the Health Interview Survey and objective measurements on blood samples (blood glucose and glycated haemoglobin) to estimate the total diabetes prevalence.

In this report, we mainly described:

• The prevalence of diagnosed diabetes according to IMA, since trends are available for this indicator.
• The estimated total diabetes prevalence according to the BELHES.

For information concerning mortality, please consult the following pages: Causes of death and Causes of premature death.

Definitions

Age-standardized prevalence

The age-standardized prevalence is a weighted average of the individual age-specific prevalences using an external standard population. It is the prevalence that would be observed if the population had the age structure of the standard population. Since age has an important influence on the risk of diabetes, this standardization is necessary when comparing several populations that differ with respect to their age structure. Here, the Belgian 2018 mid-year population is used as standard population.

Increased compensation status

Persons with a low income are entitled to an increased compensation status. They pay less for healthcare and have other financial benefits. Currently, this is the only variable available in the IMA-AIM Atlas that allowsfor assessing socio-economic differences.

Diagnosed diabetes prevalence

The diagnosed diabetes prevalence is estimated based on the number of insured people with the delivery of antidiabetics (ATC code A10) or with another diabetes referring nomenclature (diabetes convention, diabetes pass, diabetes care trajectory). Women who gave birth during the year under review are excluded in order to exclude gestational diabetes.

Estimated total diabetes prevalence

The estimated total diabetes prevalence is defined as fasting blood glucose ≥ 126 mg/dl or glycosylated haemoglobin (HbA1C) ≥ 6.5% or the use of anti-diabetic drugs (self-reported).

References

1. Intermutualistic Agency Atlas. http://atlas.aim-ima.be/base-de-donnees
2. Belgian Health Examination Survey (BELHES), Sciensano, 2018. https://www.sciensano.be/en/projects/health-examination-survey
3. Belgian Health Interview Survey (BHIS), Sciensano, 1997-2018. https://www.sciensano.be/en/projects/health-interview-survey

Please cite this page as: Sciensano. Non-Communicable Diseases: Diabetes, Health Status Report, 08 August 2024, Brussels, Belgium, https://www.healthybelgium.be/en/health-status/non-communicable-diseases/diabetes

Details

Last Updated: 02 August 2024

• cancer

Please note that the following numbers should be interpreted in the context of COVID-19

1. Key messages

2. Cancer incidence

The number of registered new cancer cases increased from 68,967 in 2020 to 74,998 in 2021

In 2021, 74,998 new diagnoses of cancer (excluding non-melanoma skin cancer) were registered, including 40,615 new cases in men and 34,383 new cases in women.

Cancer incidence increases with age, with the highest incidence in the 80-84 age group. Before the age of 55, cancers are more commonly diagnosed among women, while in the older age groups, cancer diagnoses become more common among men.

The number of new cases is the highest in the Flemish Region in 2021

Trends in unadjusted incidence in Belgium, show an overall increase between 2006 and 2021 for both men and women. After adjusting for age the trend patterns changed; the incidence increased from 486 per 100,000 in 2006 to 588 per 100,000 women in 2021 while the age-adjusted incidence decreased from 508 per 100,000 to 506 per 100,000 in men in the same period.

In men, unadjusted incidences are the highest in the Flemish Region followed by the Walloon Region, and the Brussels Capital Region. In women, unadjusted rates are similar in the Walloon Region and the Flemish Region, with lower rates in the Brussels Capital Region. This pattern is mainly driven by the age structure as the differences are greatly reduced once they are adjusted for age. A large drop in the unadjusted and age-adjusted incidence was observed in 2020, the first year of the COVID-19 pandemic. This drop may have more to do with reduced capacity for diagnosis rather than reflecting a true reduction in incidence and therefore, should be interpreted with caution.

From 2006 to 2021, the overall number of new cancer cases increased for both men and women in the Flemish Region and the Walloon Region, but decreased in the Brussels Capital Region. When considering age differences, the situation varies: In the Walloon Region, the Brussels Capital Region, and the Flemish Region, the age-adjusted incidence of cancer in men remained unchanged. However, in women, the age-adjusted incidence of cancer increased in the Flemish Region and the Walloon Region, while it remained stable in the Brussels Capital Region.

Prostate and breast cancer rank number one among men and women

In 2021, prostate cancer and breast cancer were the most frequently diagnosed cancers among men and women, respectively. The age-adjusted incidence of breast cancer in women was stable, while the age-adjusted incidence of prostate cancer decreased in men between 2006 and 2014, but has slightly increased since then.

Lung cancer has been the second most frequent cancer in men and since 2018 has also been the second most frequently diagnosed cancer in women. The age-adjusted incidence of lung cancer increased by 67% between 2006 and 2021 in women, while it decreased by 19% in men.

Colorectal cancer diagnoses decreased between 2006 and 2021 by 28% in men and 9.1% in women. When the colorectal screening program was introduced in the Flemish Region, a peak in age-adjusted incidence was observed in 2014.

The incidence of melanoma increased in both sexes. In men, the age-adjusted incidence increased by 130% between 2006 and 2021, while in women it increased by 107%, ranking melanoma 4th among the most frequently diagnosed cancers since 2010 ahead of cervical cancer. Greater awareness and more active screening can play some role in the observed increase in incidence, but these factors likely do not explain the entire increase.

The incidence of cancer is higher compared to the EU average in Belgium

Crude cancer incidence per 100,000 is higher in Belgium than the EU-14 average for men and women. Compared to the EU-14 average, the incidence per 100,000 in Belgium is 4.8% higher among men and 2.0% higher among women.

International comparisons should be interpreted with caution, given the various methods of data collection in different countries (registers versus routine reporting systems), with different levels of accuracy. Data for Greece and Spain are not available.

3. Cancer prevalence

4 in 100 people in Belgium are living with cancer

In 2021, 464,930 persons (4.0% of the total Belgian population) were living with cancer (including non-melanoma skin cancer) and had been diagnosed between 2012 and 2021. This number included 233,940 men and 230,990 women. The crude and age-adjusted prevalence per 100,000 was highest in the Flemish Region compared to the other Regions.

Prostate cancer was the most prevalent cancer type among men (71,231 cases, or 1.3% of the total male population in Belgium). Among women, breast cancer was the most prevalent cancer type (88,512 cases, or 1.5% of the total female population in Belgium). Another 49,010 patients with cancer were alive by the end of 2021 after having been diagnosed with colon cancer in the past 10 years.

Information on the prevalence of cancer yields a different picture than the information on the incidence of cancer. Indeed, cancer prevalence is a function of cancer incidence and survival, and the latter may be very different from one cancer to another. Lung cancer, for instance, has a low survival rate, such that few survivors will be alive at a given point in time, despite the high incidence. On the other hand, prostate and breast cancer have both high incidence and survival rates, explaining their predominance in prevalence estimates.

4. Read more

View the metadata for this indicator

View the prevalences in a dynamic application

Background

Cancer is a broad family of diseases that involve abnormal cell growth with the potential to invade or spread to other parts of the body. It is one of the most important causes of premature mortality, ill health, and healthcare expenditure. Cancer can be caused by inherited genetic traits, but the vast majority is due to genetic mutations caused by carcinogenic agents related to behavioral, metabolic, and/or environmental factors.

Data on new cancer cases in Belgium are collected by the Belgian Cancer Registry Foundation. The data from the Belgian Cancer Registry are nationally representative and exhaustive. They collect and record both clinical and pathological data. The recording of data (topography and morphology) is done using the International Classification of Diseases for Oncology.

The total number of cancer cases is usually presented excluding non-melanoma skin cancers. Although these cancers frequently occur, they are typically not clinically significant. In addition, there is large heterogeneity in the registration of these cancers, making comparisons and trend analyses very difficult.

Facts and figures about cancer are calculated and published every year by the Cancer Registry. These figures include the crude and age-standardized incidence, which refer to new cases; and prevalence, which refer to the number of people living with cancer at a given period after initial diagnosis. In this chapter, the presented cancer prevalence estimates from the year 2013 onwards have been calculated in the framework of the Belgian Burden of Disease project.

For information concerning cancer-related mortality, please consult the following pages: Causes of death and Causes of premature death.

Definitions

EU-14

The EU-14 corresponds to all countries that belonged to the European Union between 1995 and 2004: Austria, Belgium, Denmark, Finland, France, Germany, Greece, Ireland, Italy, Luxembourg, the Netherlands, Portugal, Spain and Sweden. We compare the Belgian health status to that of the EU-14 because these countries have similar socioeconomic conditions. Since the United Kingdom left the EU, the EU-15 was changed into the EU-14 group of countries.

Age-standardized incidence

The age-standardized incidence is a weighted average of the individual age-specific incidence using an external standard population. Here, the European Standard Population is used as standard population. It is the incidence that would be observed if the population had the age structure of the standard population. Since age has a powerful influence on the risk of cancer, this standardization is necessary when comparing several populations that differ with respect to their age structure.

Unadjusted incidence

The unadjusted incidence is calculated by dividing the number of new cases observed during a given time period by the corresponding number of people in the population at risk. The unadjusted incidence is expressed as the number of new cases per 100,000 person years.

Ten-year prevalence

Ten-year prevalence data were estimated with an index date of 31st December 2021, representing people living in Belgium who were diagnosed with at least one invasive malignancy in the period from 1st January 2012 to 31st December 2021 and who were still alive at the end of 2021. Persons with more than one malignancy were included as prevalent cases in each cancer type but were counted only once in analysis regrouping multiple tumor sites.

References

1. Belgian Cancer Registry. https://kankerregister.org/
2. Health For All Database. WHO EURO. https://gateway.euro.who.int/en/datasets/european-health-for-all-database/
3. Gorasso, V., Silversmit, G., Arbyn, M., Cornez, A., De Pauw, R., De Smedt, D., ... & Speybroeck, N. (2022). The non-fatal burden of cancer in Belgium, 2004–2019: a nationwide registry-based study. BMC cancer. doi: https://doi.org/10.1186/s12885-021-09109-4

Please cite this page as: Sciensano. Non-Communicable Diseases: Cancer, Health Status Report, 06 Feb 2024, Brussels, Belgium, https://www.healthybelgium.be/en/health-status/non-communicable-diseases/cancer

Details

Last Updated: 03 July 2024

1. Key messages

2. Background

Mental health is the capacity of each of us to feel, think, and act in ways that enhance our ability to enjoy life and deal with the challenges we face. It is a positive sense of emotional and spiritual well-being that respects the importance of culture, equity, social justice, interconnections, and personal dignity [1]. Due to the high frequency of mental problems in western societies and the significance of their costs in human, social, and economic terms, mental health is now regarded as a public health priority. In Belgium, the Health Interview Survey is one of the main sources of systematic data on mental health parameters in the general population.

Among the various dimensions of mental health that are monitored in this survey, we focus on the following three indicators:

• Prevalence of anxiety disorders and depressive disorders, based on the self-report psychometric instruments GAD-7 and PHQ-9 respectively.
• Indicators concerning the use of psychotropic medicines.

However, it should be noted that the evaluation of mental health problems in the population through a health survey has a number of limitations. These are mainly related to the fact that the estimates are based on screening instruments for psychological problems and thus are not obtained by clinical diagnostic tools, which may be more nuanced. Nevertheless, the results of general population health surveys are generally in line with the findings of specific mental health surveys.

More serious mental health disorders like schizophrenia and bipolar disorders are not presented here. Indeed, health interview surveys are not a valid instrument to capture such complex conditions. Moreover, information about suicidal thoughts and attempts can be found on a specific page (in preparation).

3. Mental health disorders

Situation in 2018

Belgium

Based on the assessment of the psychometric instruments, in 2018, 11.2% of the total Belgian population had an anxiety disorder and 9.4% had a depressive disorder. For both disorders, women had a higher prevalence (14.2% for anxiety and 10.7% for depression) than men (7.9% for anxiety and 8% for depression).

Regional specificities

Wallonia had a higher prevalence of anxiety and depressive disorders than Brussels and Flanders and Brussels had a higher prevalence than Flanders.

Trends

Belgium

Between 2008 and 2013, the prevalence of anxiety disorders increased in Belgium in both genders and has stayed more or less stable since then.

Between 2008 and 2013, the prevalence of depressive disorders increased in both genders. It slightly decreased in men and more clearly decreased in women in 2018.

However, since the questionnaires used were changed between the 2013 and 2018 surveys, trends should be interpreted with caution.

Regional specificities

Between 2008 and 2013, the prevalence of anxiety disorders increased in all regions. Between 2013 and 2018, it continued to sharply increase in Wallonia in both genders, but not in the other regions.

The prevalence of depressive disorders was lower in Flanders than in Brussels and Wallonia in all years in women and since 2004 in men.

Socio-economic disparities

There is a strong socio-economic gradient in the prevalence of mental health disorders. After age-adjustment, anxiety disorders were 2.3 times more frequent in people from the lowest educational group compared to the highest educational group. Depressive disorders were 3 times more frequent in people from the lowest educational group compared to the highest educational group.

4. Consumption of psychotropic medicines

Situation in 2018

Belgium

In 2018, 12.3% of the population used sedatives (sleeping pills or tranquilizers) and 7.6% used antidepressants in the past 2 weeks. More women than men consumed sedatives (15% in women vs 9.5% in men) and antidepressants (9.8% vs 5.3%).

The consumption of sedatives increased with age, particularly after 45 years in women and after 65 years in men.

The consumption of antidepressants is particularly high in women after 45 years of age.

Regional specificities

In 2018, the consumption of sedatives is slightly higher in Wallonia and in Flanders than in Brussels, but the regional differences are narrow and not significant.

The consumption of antidepressants is slightly lower in Flanders than in the other regions, but the differences are only significant in women.

Trends

Belgium

From 1997 to 2008, the consumption of sedatives in the population increased, then it decreased in 2013 and in 2018 when considering both genders together. In men the consumption remained stable round 10%, while it decreased from 19% in 2008 to 15% in 2018 in women.

Since 1997, the consumption of antidepressants has doubled in both genders.

Regional specificities

The consumption of sedatives used to be significantly lower in Flanders than in the 2 other regions until 2008 in both genders. After 2008, as the use of sedatives continued to increase in Flanders while slightly decreasing in the other regions, the regional differences narrowed and quasi disappeared by 2018.

The consumption of antidepressants followed a same evolution in both genders and in all regions, that is, it has significantly increased since 1997.

Socio-economic disparities

There was a socio-economic gradient in the consumption of sedatives and antidepressants. A higher proportion of people from the lowest educational group consumed sedatives (17.7% vs 12.3%) and antidepressants (10.3% vs 6%) than from the highest educational group.

5. Read more

View the metadata for this indicator

HISIA: Interactive Analysis of the Belgian Health Interview Survey

Definitions

GAD-7: General Anxiety Disorder 7-item

The GAD-7 is a screening tool for general anxiety disorder. Participants are asked to evaluate the frequency, if ever, of experiencing 7 core symptoms in the last 2 weeks. The scores obtained allow to evaluate the symptom severity.

Anxiety disorders

Participants with a score of 10 or over out of 21 in the GAD-7 tool were considered to have an anxiety disorder.

PHQ-9: Patient Health Questionnaire 9-item depression scale

The PHQ-9 is a screening tool for major depressive disorder and other depressive disorders. Participants are asked to evaluate the frequency in which they have been bothered by 9 problems in the last 2 weeks.

Depressive disorders

Participants with a combination of answers meeting the criteria specific for major depressive disorder and other depressive disorders for the PHQ-9 were considered to have a depressive disorder.

References

1. https://www.canada.ca/en/public-health/services/health-promotion/mental-health/mental-health-promotion.html
2. Health Interview Survey, Sciensano, 1997-2018. https://his.wiv-isp.be/

Details

Last Updated: 26 August 2024

• diabetes
• cancer
• cardiovascular diseases
• musculoskeletal disorders
• respiratory diseases
• mental health
• alcohol
• cerebrovascular diseases
• dementia
• drug use

1. Key messages

2. Background

Non-communicable diseases (NCDs) are medical conditions or diseases that are not caused by infectious agents. Chronic diseases are defined by their longstanding nature. Since most NCDs are also chronic diseases, both terms are sometimes used interchangeably. This is however not entirely correct: some NCDs are acute, e.g. myocardial infarction; conversely, some chronic diseases may be caused by infectious agents, e.g. cervix cancer or tuberculosis. For the sake of simplicity, however, the term "chronic disease" will be used here as a synonym of NCDs.

Chronic diseases are by far the leading causes of (premature and general) mortality. In addition, they are also one of the most relevant health problems with a potential impact on the health-related quality of life, especially for the elderly, and are one of the main reasons for the use of healthcare services. Especially among older individuals, multiple chronic diseases can be present simultaneously. This phenomenon, referred to as multimorbidity, has a considerable impact on the functional status and the quality of life of the population. It also causes an increase in healthcare consumption and a higher risk of complications due to a larger use of medication, and thus requires important resources mobilization.

Most of the main chronic diseases are preventable, e.g. by adopting policies that promote healthier lifestyles, better environment and facilitate healthcare access. The prevalence of chronic diseases is, therefore, an important indicator of the level of (ill) health in the population.

The Belgian Health Interview Survey (HIS) is one of the main sources of information on the prevalence of chronic diseases at the population level. The advantage of this source is that it also takes into account people who rarely or never make use of health care facilities. The results are weighted to match the population structure as much as possible. It is therefore a valuable tool to obtain representative information on chronic diseases prevalence at the population level (for the whole country or at the regional level), and to monitor this prevalence over time. However, the results must be interpreted with caution because the information is self-reported, and thus reflects individual perceptions of health that may differ from the actual health state. Indeed, some people may not report an illness because they are not (yet) aware of it, or because the disease is perceived as socially unacceptable.

In the HIS 2018, a first question was asked on the presence of a chronic disease/condition/handicap in general, followed by a list of questions on the presence of 38 specific chronic diseases. Multimorbidity was measured as the simultaneous presence of at least two out of the following six chronic diseases: heart disease, chronic respiratory disease, diabetes, cancer, arthritis and/or arthrosis, and hypertension.

This overview is only based on the self-reported diseases as reported in the Health Interview Survey. In Belgium, other sources are available on diagnosis-based prevalence of chronic diseases such as specific registries, general practitioner networks or health insurance databases. These sources will be used to provide in-depth information on selected chronic diseases. Since the prevalence of chronic diseases and conditions is strongly related to age, the comparisons over time or between regions have been made after correction for the age-structure (age-adjustment). The adjustment has been performed using direct standardization based on the Belgian population of 2018 as reference. The weighting related to the design of the HIS was taken into account when calculating standardized rates.

For information concerning mortality, please consult the following pages: Causes of death and Causes of premature death.

3. Prevalence of chronic disease

Belgium

In 2018, 29% of the population aged 15 years and over reported suffering from at least one chronic disease. This percentage increases considerably with age, going up from 14% for people aged 15-24 to 44% for the people aged 75 or over.

The prevalence of chronic disease is significantly higher in women (31%) compared to men (27%).

Trends and regional disparities

Between 2001 and 2018, the percentage of people reporting to suffer from a chronic disease increased from 25% to 29% (+17%). This increase is partly due to the aging of the population, but not entirely since there is still an increase after adjustment for age.

Some differences are observed between the regions: the age-adjusted percentage of self-reported chronic diseases is higher in the Walloon region (33%) than in the Flemish and Brussels regions (respectively 27% and 31%). In the Brussels region, the crude self-reported prevalence of chronic diseases has dropped below the national average, but it is not the case when compared with the age-adjusted prevalence, which suggests an effect of the younger age structure of the Brussels region.

• In the Flemish region, the percentage of self-reported chronic diseases has significantly increased from 21% in 2001 to 28% in 2018 (+34%). This increase is less important but still remains after standardization for age (+22%).
• In the Brussels region, the age-adjusted percentage of people reporting to live with a chronic disease has decreased significantly from 34% in 2013 to 31% in 2018.
• In the Walloon region, the crude and the age-adjusted percentage of people with a chronic disease remained stable since 2001.

Socio-economic disparities

The percentage of people reporting to suffer from a chronic disease is higher in people with no diploma or a primary school education (41%) compared to those with higher levels of education. Similarly, people with a secondary (low or high) level of education report more often living with a chronic disease than those with the highest level of education (27%).

4. Multimorbidity

Belgium

In 2018, 15% of the Belgian population over 15 years of age reported suffering from at least two of the following diseases in the past year: heart disease, chronic respiratory disease, diabetes, cancer, arthritis and/or arthrosis, and hypertension. This percentage increases strongly with age, going up from 0.8% for people aged 15-24, to 42% for the people aged 75 and over. The prevalence of multimorbidity is higher in women, but this difference is no longer statistically significant after adjustment for age.

Trends and regional disparities

Between 1997 and 2018, the crude prevalence of multimorbidity increased from 8.9% to 15% (+71%). When considering the age-adjusted prevalence estimates, the increase is less important but still significant (+26%), which means that the increase is partly, but not only, due to the aging of the population.

In the Walloon and the Flemish regions, the age-adjusted prevalence of multimorbidity is higher (respectively 17% and 15%) than in the Brussels region (14%), where it has decreased since 2013. However, this decrease is not significant.

Socio-economic disparities

The percentage of people reporting living with at least two chronic diseases decreases as their educational level increases, from 19.8% in people with no diploma or only a primary school education, to 13.3% in people with the highest level of education.

5. Major chronic diseases

The top 6 of the most commonly reported chronic diseases is the same in men and women, although the order differs. The top 6 comprises three problems of the musculoskeletal system (low back disorders, neck disorders, and arthrosis), two cardiovascular risk factors (high blood pressure and high blood cholesterol), and allergy.

Prevalence of 20 most commonly reported non-communicable diseases among men and women, Belgium, 2018
Source: Health Interview Survey, Sciensano, 2018 [1]

Since 2013, the top 6 remained the same in men but not among women, for whom allergy and neck disorders have taken the place of high blood pressure and high blood cholesterol as third and fourth most important disease, respectively.

The evolution in terms of prevalence differs in function of the specific disease:

1. Between 1997 and 2018, significant increases were observed in the prevalence of high blood pressure, low back disorders, neck disorders, arthrosis, diabetes, thyroid disorders, and allergy. These increases may in part be explained by the aging of the population; however, even after adjustment for age, the increases remained significant.

• The age-adjusted prevalence of thyroid disorders has strongly increased, from 3.5% in 1997 to 7.0% in 2018 (+100%); this increase is not due to the aging of the population.
• The age-adjusted prevalence of diabetes has increased by 67%, from 3.6% in 1997 to 6.0% in 2018; this increase is partly due to the aging of the population.
• The age-adjusted prevalence of allergy remained stable between 1997 and 2013 (at around 14%), but increased in 2018 to 19%.

2. On the other hand, since 2001, the prevalence of a number of other chronic diseases has decreased, including coronary heart disease, chronic obstructive pulmonary disease, severe headache and migraine, and osteoporosis.

Regional disparities

Regional differences in the prevalence of the included diseases are generally quite limited. The following differences are observed:

• Arthrosis and thyroid disorders are more commonly reported in the Walloon and Flemish regions than in the Brussels region, even after adjustment for age.
• High blood pressure is more often reported in the Walloon region than in the two other regions, after standardization for age.

Socio-economic disparities

The socio-economic status, measured in this report by the educational level, is one of the main determinants of chronic diseases. Most chronic diseases included in the HIS occur more frequently in people with lower educational levels. This applies in particular to serious chronic diseases such as cardiovascular diseases, diabetes, and chronic respiratory diseases. One notable exception is allergy, which occurs more frequently with increasing educational levels.

6. Read more

View the metadata for this indicator

HISIA: Interactive Analysis of the Belgian Health Interview Survey

Definitions

Chronic disease

In the Belgian Health Interview Survey, a global question is asked on the presence of one or more chronic diseases, chronic conditions or handicaps, without specifying the nature of the disease, condition or handicap. For the sake of simplicity, this indicator is referred to in this report as the presence of “chronic disease”.

Non-communicable diseases

Non-communicable diseases (NCDs) are medical conditions or diseases that are not caused by infectious agents. While sometimes referred to as synonymous with "chronic diseases", NCDs are distinguished only by their non-infectious cause, not necessarily by their duration, though some chronic diseases of long duration may be caused by infections.

References

1. Health Interview Survey, Sciensano, 1997-2018. https://www.sciensano.be/en/projects/health-interview-survey

Please cite this page as: Sciensano. Non-Communicable Diseases: Overview, Health Status Report, 22 Dec 2019, Brussels, Belgium, https://www.healthybelgium.be/en/health-status/non-communicable-diseases/overview