National Household Health Survey in Turkey
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The WHO Regional Office for Europe The World Health Organization (WHO) is a specialized agency of the United Nations created in 1948 with the primary responsibility for international health matters and public health. The WHO Regional Office for Europe is one of six regional offices throughout the world, each N Republic of Turkey with its own programme geared to the particular health A conditions of the countries it serves. TIONAL HOU Ministry of Health Member States Albania Andorra S Armenia EHOLD Austria NATIONAL Azerbaijan Belarus H Belgium E HOUSEHOLD HEALTH A Bosnia and Herzegovina L Bulgaria TH SU Croatia SURVEY IN TURKEY Cyprus R V Czechia EY IN TURKE PREVALENCE OF Denmark Estonia Finland NONCOMMUNICABLE France Georgia Y DISEASE RISK FACTORS Germany PR Greece E Hungary V ALENCE OF NONCOMM Iceland 2017 Ireland Israel Italy Kazakhstan Kyrgyzstan Latvia Lithuania Luxembourg U Malta NI Monaco C Montenegro ABLE DI Netherlands Norway Poland S E Portugal A S Republic of Moldova E RISK Romania Russian Federation San Marino F A Serbia C Slovakia T O Slovenia R S Spain , 2 Sweden 0 Switzerland 17 Tajikistan The former Yugoslav Republic of Macedonia Turkey World Health Organization Regional Office for Europe Turkmenistan UN City, Marmorvej 51, DK-2100 Copenhagen Ø, Denmark Ukraine Tel.: +45 45 33 70 00 Fax: +45 45 33 70 01 United Kingdom Email: [email protected] Uzbekistan Website: www.euro.who.int Republic of Turkey Ministry of Health NATIONAL HOUSEHOLD HEALTH SURVEY IN TURKEY: PREVALENCE OF NONCOMMUNICABLE DISEASE RISK FACTORS, 2017 ABSTRACT This publication reports the results of the National Household Health Survey – Prevalence of Noncommunicable Disease Risk Factors in Turkey, conducted in 2017 using the WHO-approved STEPwise survey method. The main objectives of the survey were: to determine the prevalence of the most common behavioural and biological risk factors for noncommunicable diseases (NCDs) in the general population aged ≥ 15 years; and to determine differences in the prevalence of risk factors between the sexes, across five age groups and across 12 regions described by level-1 Nomenclature of Territorial Units for Statistics. The risk conditions were grouped into behavioural factors understood as modifiable (tobacco use, harmful alcohol consumption, low consumption of fruits and vegetables, and physical inactivity etc.) and biological factors considered controllable (hypertension, overweight and obesity, high blood sugar and increased total cholesterol etc.). The results obtained in the study show the current prevalence of NCD risk factors among the Turkish population. In addition to obtaining valuable information on NCD risk factors for people of five different age groups, both sexes and 12 regions, the results of the survey provide a significant input for policy-makers. Keywords NONCOMMUNICABLE DISEASES PREVENTION AND CONTROL RISK FACTORS TURKEY STEPWISE APPROACH Address requests about publications of the WHO Regional Office for Europe to: Publications WHO Regional Office for Europe UN City, Marmorvej 51 DK-2100 Copenhagen Ø, Denmark Alternatively, complete an online request form for documentation, health information, or for permission to quote or translate, on the Regional Office website (http://www.euro.who.int/pubrequest). ISBN 9789289053136 Suggested citation: National Household Health Survey – Prevalence of Noncommunicable Disease Risk Factors in Turkey 2017 (STEPS). Üner S, Balcılar M, Ergüder T editors. World Health Organization Country Office in Turkey, Ankara, 2018. © World Health Organization 2018 All rights reserved. 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Data source: Ministry of Environment and Urbanization, Republic of Turkey Map production: WHO Country Office in Turkey ii National Household Health Survey in Turkey: Prevalence of Noncommunicable Disease Risk Factors, 2017 CONTENTS iii TABLES vi FIGURES viii ABBREVIATIONS x FOREWORD xi PREFACE xiv ACKNOWLEDGEMENTS xvi CONTRIBUTORS xviii EXECUTIVE SUMMARY xx 1. BACKGROUND OF THE SURVEY 2 CONTENTS 1.1. Noncommunicable diseases 2 1.2. Risk factors 3 1.3. NCDs and risk factors in Turkey 4 1.4. STEPwise approach 5 2. SURVEY GOAL AND OBJECTIVES 8 2.1. Survey goal 8 2.2. Survey objectives 8 2.3. Rationale for the survey 8 3. SURVEY METHODOLOGY 10 3.1. Inclusion criteria 10 3.2. Exclusion criteria 10 3.3. Sample size 11 3.4. Effective sample 11 3.5. Sampling frame 11 3.6. Sampling design 11 3.7. Selection of individuals 16 3.8. Survey design 16 3.9. Weighting of the survey 17 3.10. Data collection 19 3.11. Training of the field survey staff 20 3.12. Field work 21 3.13. Data management and consolidation 21 3.14. Measurement and determination of risk factors 21 3.14.1. Step 1 21 3.14.1.1. Tobacco use 21 3.14.1.2. Consumption of alcohol 21 3.14.1.3. Consumption of fruits and vegetables 22 iii CONTENTS 3.14.1.4. Physical activity 22 3.14.2. Step 2 22 3.14.2.1. Blood pressure 23 3.14.2.2. BMI 23 3.14.2.3. Waist and hip circumference 23 3.14.3. Step 3 24 3.14.3.1. Glycaemia 24 3.14.3.2. HbA1c 24 3.14.3.3. Total cholesterol 25 3.14.3.4. Triglycerides 25 3.14.3.5. HDL cholesterol 25 3.14.3.6. Urinary sodium and creatinine 25 4. SURVEY RESULTS 28 4.1. Sampling and participation 28 4.2. Demographic indicators 28 4.2.1. Age and sex characteristics 29 4.2.2. Marital status 30 4.2.3. Education 32 4.2.4. Employment 36 4.2.5. Income 37 4.3. Tobacco use 39 4.3.1. Conclusions 46 4.4. Alcohol consumption 46 4.4.1. Conclusions 49 4.5. Use of addictive drugs (substances) 49 4.5.1. Conclusions 51 4.6. Diet: fruit and vegetable consumption 51 4.6.1. Conclusions 53 4.7. Dietary salt 53 4.7.1. Conclusions 55 4.8. Physical activity 55 4.8.1. Conclusions 58 4.9. History of raised blood pressure 58 4.9.1. Conclusions 60 4.10. History of diabetes 60 4.10.1. Conclusions 61 4.11. History of raised total cholesterol 61 4.11.1. Conclusions 62 4.12. History of CVD 63 4.12.1. Conclusions 64 iv National Household Health Survey in Turkey: Prevalence of Noncommunicable Disease Risk Factors, 2017 4.13. Family history of chronic diseases 64 4.13.1. Conclusions 65 4.14. History of asthma, chronic obstructive pulmonary disease or cancer 65 4.14.1. Conclusions 67 4.15. Lifestyle advice 67 4.15.1. Conclusions 69 4.16. Awareness of harm to health from selected risk factors for NCDs 69 4.16.1. Conclusions 71 4.17. Cancer screening tests 71 4.17.1. Conclusions 72 4.18. Accidents and injuries 72 4.18.1. Conclusions 73 4.19. Ambulatory or inpatient care 73 4.19.1. Conclusions 74 4.20. Ambulatory diagnosis, treatment and home care 74 4.20.1. Conclusions 76 4.21. Physical measurements 76 4.21.1. Conclusions 80 4.22. Biochemical measurements 80 4.22.1. Conclusions 86 4.23. CVD risk 86 4.23.1. Conclusions 88 4.24. Summary of combined risk factors 88 4.24.1. Conclusions 90 4.25. Health perception 90 4.25.1. Conclusions 90 CONCLUSION 92 REFERENCES 94 ANNEX 1. FIELD TEAMS BY REGION 98 ANNEX 2. NATIONAL HOUSEHOLD HEALTH SURVEY IN TURKEY – PREVALENCE OF NONCOMMUNICABLE DISEASE RISK FACTORS, 2017 FACT SHEET 100 ANNEX 3. WHO STEPS INSTRUMENT FOR NATIONAL HOUSEHOLD HEALTH SURVEY IN TURKEY: PREVALENCE OF NONCOMMUNICABLE DISEASE RISK FACTORS, 2017 (SURVEY INFORMATION QUESTIONNAIRE) 107 v TABLES Table 1. NUTS regions in Turkey 12 Table 2. Sample clusters and households by NUTS-1 regions 15 Table 3. Distribution of nonresponding household numbers by clusters and NUTS regions 17 Table 4. Data for two-way sex–age poststratification 18 Table 5. Data for two-way sex-education poststratification 18 Table 6. Data for NUTS-1 region poststratification 19 Table 7. Equipment and supplies used for the field implementation 19 Table 8.