- Methods and Projects
- Standards and Classifications
Standardised Methodological Report
Spain Health Survey
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1Contact
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1.1Contact organisation
National Statistics Institute of Spain
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1.5Contact mail address
Avenida de Manoteras 50-52 - 28050 Madrid
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1.1Contact organisation
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2Metadata update
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2.1Metadata last certified
28/05/2025
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2.2Metadata last posted
26/04/2021
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2.3Metadata last update
28/05/2025
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2.1Metadata last certified
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3Statistical presentation
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3.1Data description
The Spanish Health Survey (ESdE) is a statistical operation whose general objective is to provide information on the health of the Spanish population, in a harmonized and comparable manner at the European level, and with the aim of planning and evaluating health-related actions both nationally and internationally.
It is designed for providing information on:
1. Health status and morbidity2. Know the degree of access and utilization of health services.
3 To ascertain the determining health factors: living habits and characteristics of the physical and social environment that pose health risks.
4. Analyze differences that health problems show, the risk factors and the use of services among different population subgroups (gender, age, social class, economic activity, country of birth and Autonomous Community).
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3.2Classification system
- Clasificaciones utilizadas
The ESdE 2023 uses four standardized classifications in its exploitation of results:
National Classification of Economic Activities CNAE-2009: The activity is coded to a three-digit level.
National Classification of Occupations CNO 2011: The occupation is coded to a three-digit level.
National Classification of Education CNED2014: The level of studies reached is classified according aggregations NCED codes.
Social class: It was obtained according to the classification proposed in 2012 by the Working Group Determinants of the Spanish Society of Epidemiology (SEE), adapted for health surveys.
- Clasificaciones utilizadas
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3.3Sector coverage
The research is directed to all persons residing in main family homes across the country. Population living in institutions is not considered.
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3.4Statistical concepts and definitions
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3.5Statistical unit
The unit is the resident person in the main family dwelling.
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3.6Statistical population
The total population or universe to respect the Spanish Health Survey (ESdE) 2023 is the population residing in main family dwellings.
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3.7Reference area
The Spanish Health Survey is conducted throughout the country.
The target variables are provided with a level of territorial disaggregation of Autonomous Community.
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3.8Time coverage
The European Survey of Health in Spain (ESHS) is carried out every 3 years
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3.9Base period
The Spanish Health Survey is being conducted for the first time in 2023. However, it is the result of the convergence of the national and European health surveys in Spain, and provides continuity to these surveys. Therefore, although this edition can be considered the base period, there are variables comparable with those of the aforementioned surveys.
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3.1Data description
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4Unit of measure
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4.1Unit of measure
Number of persons
Percentages of persons
Indicators provide the mean and variance of certain indicators, such as children's quality of life or adult well-being, number of visits to a doctor or specialist, nights spent in hospital, etc.
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4.1Unit of measure
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5Reference period
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5.1Reference period
The ESdE 2023 data collection efforts took place between September 2023 and August 2023.
The time period covered by the data collected in the survey varies depending on the nature of the variables being investigated. The reference period can be 12 months (self-rated health), the last 4 weeks (medical visits), or the last 2 weeks (medication use).
Data referred to the period: A: 2023
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5.1Reference period
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6Institutional mandate
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6.1Legal acts and other agreements
The compilation and dissemination of the data are governed by the Statistical Law No. 12/1989 "Public Statistical Function" of May 9, 1989, and Law No. 4/1990 of June 29 on “National Budget of State for the year 1990" amended by Law No. 13/1996 "Fiscal, administrative and social measures" of December 30, 1996, makes compulsory all statistics included in the National Statistics Plan. The National Statistical Plan 2009-2012 was approved by the Royal Decree 1663/2008. It contains the statistics that must be developed in the four year period by the State General Administration's services or any other entity dependent on it. All statistics included in the National Statistics Plan are statistics for state purposes and are obligatory. The National Statistics Plan 2025-2028, approved by Royal Decree 1225/2024, of 3 December, is the Plan currently implemented. This statistical operation has governmental purposes, and it is included in the National Statistics Plan 2025-2028. (Statistics of the State Administration).
This statistical operation investigates variables listed in Article 11.2 of the LFEP (ethnic origin, political opinions, religious or ideological beliefs, and any other variables affecting personal or family privacy), and is therefore voluntary.
The Spanish Health Survey is a harmonized and comparable survey at the European level.
Although this edition is not subject to European Commission Regulations, as it is not part of the European Health Survey, which is conducted every six years, the questionnaires are adapted according to the guidelines applied to the latest European Health Survey of Spain, conducted in 2020.
There is a collaboration agreement between the INE and the Ministry of Health for the implementation of the survey, which includes variables of national interest, in addition to those already mentioned from international surveys.
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6.2Data sharing
The exchanges of information needed to elaborate statistics between the INE and the rest of the State statistical offices (Ministerial Departments, independent bodies and administrative bodies depending on the State General Administration), or between these offices and the Autonomic statistical offices, are regulated in the LFEP (Law of the Public Statistic Function). This law also regulates the mechanisms of statistical coordination, and concludes cooperation agreements between the different offices when necessary.
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6.1Legal acts and other agreements
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7Confidentiality
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7.1Confidentiality - policy
The Statistical Law No. 12/1989 specifies that the INE cannot publish, or make otherwise available, individual data or statistics that would enable the identification of data for any individual person or entity. Regulation (EC) No 223/2009 on European statistics stipulates the need to establish common principles and guidelines ensuring the confidentiality of data used for the production of European statistics and the access to those confidential data with due account for technical developments and the requirements of users in a democratic society
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7.2Confidentiality - data treatment
INE provides information on the protection of confidentiality at all stages of the statistical process: INE questionnaires for the operations in the national statistical plan include a legal clause protecting data under statistical confidentiality. Notices prior to data collection announcing a statistical operation notify respondents that data are subject to statistical confidentiality at all stages. For data processing, INE employees have available the INE data protection handbook, which specifies the steps that should be taken at each stage of processing to ensure reporting units' individual data are protected. The microdata files provided to users are anonymised.
In order to avoid indirect identification some variables, such as country of birth and country of nationality, have been removed from the microdata file
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7.1Confidentiality - policy
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8Release policy
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8.1Release calendar
The advance release calendar that shows the precise release dates for the coming year is disseminated in the last quarter of each year.
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8.2Release calendar access
The calendar is disseminated on the INEs Internet website (Publications Calendar)
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8.3User access
The data are released simultaneously according to the advance release calendar to all interested parties by issuing the press release. At the same time, the data are posted on the INE's Internet website (www.ine.es/en) almost immediately after the press release is issued. Also some predefined tailor-made requests are sent to registered users. Some users could receive partial information under embargo as it is publicly described in the European Statistics Code of Practice
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8.1Release calendar
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9Frequency of dissemination
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9.1Frequency of dissemination
The Spanish Health Survey (ESdE) is the first edition of this survey to be conducted under this name, but it is the result of the convergence of two surveys: the National Health Survey (ENSE) and the European Health Survey of Spain (EESE). It was designed to meet national and international demand and provide continuity to the results presented in these surveys.
It is published every three years.
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9.1Frequency of dissemination
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10Accessibility and clarity
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10.1News release
The results of the statistical operations are normally disseminated by using press releases that can be accessed via both the corresponding menu and the Press Releases Section in the web
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10.2Publications
The results of the survey are disseminated through the INE website, and some results are included in publications such as the Statistical Yearbook, INE Figures, etc...
The Ministry of Health, as established in the collaboration agreement
between the INE and the Ministry of Health, also disseminates the
results through its website and produces reports with the main results
of the operation, which are made public to all users.In the years corresponding to the European edition, Eurostat has the microdata file with the variables laid down in Regulation (EU) Nº255 / 2018. After analyzing the results of the member countries disseminate information on its website.
The users themselves disseminate the results of the survey by the articles, the result of their research, published in scientific journals of national and international prestige.
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10.3On-line database
INEbase is the system the INE uses to store statistical information on the Internet. It contains all the information the INE produces in electronic formats. The primary organisation of the information follows the theme-based classification of the Inventory of Statistical Operations of the State General Administration . The basic unit of INEbase is the statistical operation, defined as the set of activities that lead to obtaining statistical results on a determined sector or subject based on the individually collected data. Also included in the scope of this definition are synthesis preparation.
You can access all the information available ESdE 2023 via the following link :
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10.4Micro-data access
A lot of statistical operations disseminate public domain anonymized files, available free of charge for downloading in the INE website Microdata Section
The file anonymised microdata of ESdE 2023 is available at INE website:
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10.5Other
INE will answer users questions throught the InfoINE channel
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10.6Documentation on methodology
A detailed description of the methodology may be viewed at:
All fields in the IME are complete. The metadata completeness indicator AC3 = 100%.
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10.7Quality documentation
The INE conducts two specific analyzes for assessing the quality of data ESdE. In the first place, we obtain sampling errors published with the errors tabulation. Secondly, an analysis of the lack of response is carried out and published in the website. Both results can be found in the website of ESdE results dissemination:
Furthermore, sections 10.6 to 17.2 of this methodological report constitute the overall user-oriented quality report for this operation.
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10.1News release
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11Quality management
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11.1Quality assurance
Quality assurance framework for the INE statistics is based on the ESSCoP, the European Statistics Code of Practice made by EUROSTAT. The ESSCoP is made up of 16 principles, gathered in three areas: Institutional Environment, Processes and Products. Each principle is associated with some indicators which make possible to measure it. In order to evaluate quality, EUROSTAT provides different tools: the indicators mentioned above, Self-assessment based on the DESAP model, peer review, user satisfaction surveys and other proceedings for evaluation.
For the ESdE an amount of measures has been implemented and they help guarantee the process and results quality. Beyond them we can found the following:
- Adaptation of the questionnaire to national and international needs proposed by Eurostat.
- Data collection via a CAPI application with implementation or errors and incompatibility warnings between the survey answers in order to carry out the first filtering in the same dwelling where the information is obtained.
- Specific training to the interviewers.
- Periodic inspection of field work.
- Control of the surveys answered by proxies.
- Exhaustive review of the encodings of the questions (studies, activity and occupation).
- Control of errors and warnings to the collection back in order to confirm the proper functioning of the applications and avoid systematic errors in gathering.
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11.2Quality assessment
According to the measures implemented in the collection process and purification results described in the previous section, the strengths of the survey are:
- The completion of the questionnaire when collecting the different dimensions that may be included in a health survey.
- The absence of errors and inconsistencies between the questionnaire responses thanks to the electronic questionnaire applied to CAWI and CAPI, and an initial field debugging.
- Low level of responses provided by proxy to the individual questionnaire (2.86 % of all adults).
- Proper classification by sociodemographic variables because of the exhaustive debugging variables studies, activity, employment and household composition.
- Lack of slightly lower than the normal rates in response household surveys.
- Calibrated results by age, sex and nationality
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11.1Quality assurance
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12Relevance
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12.1User needs
The main users of the survey:
- Ministry of Health, Social Services and Equality
- Eurostat (if applicable to the European edition)
- Territorial Administrations (AACC)
- Other international institutions (OECD, WHO...)
- Researchers and universities
- The press and specialised media
- Individuals
The user needs models serve different purposes, to cite some examples, Eurostat needs healthcare internationally comparable information for EU policies, to the Ministry of Health, Social Services and Equality this type of information is an essential element for planning and action public health and is an essential tool in evaluating health policies and researchers focus on a detailed and specialized exploitation of information.
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12.2User satisfaction
The INE has carried out general user satisfaction surveys in 2007, 2010, 2013, 2016 and 2019 and it plans to continue doing so every three years. The purpose of these surveys is to find out what users think about the quality of the information of the INE statistics and the extent to which their needs of information are covered. In addition, additional surveys are carried out in order to acknowledge better other fields such as dissemination of the information, quality of some publications...
On the INE website, in its section Methods and Projects / Quality and Code of Practice / INE quality management / User surveys are available surveys conducted to date.(Click next link)
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12.3Completeness
The information collected allows us to address all requests for international and national variables.
Although this edition is not subject to European regulations, it includes the information required by the EU Regulation from the latest European Health Survey of 2020, and also includes information of national interest, proposed by the Ministry of Health.
R1=100%
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12.1User needs
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13Accuracy and reliability
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13.1Overall accuracy
The estimators used are ratio estimators with a large national sample size which ensures unbiased and small sampling error estimates for key variables.
Furthermore, techniques have been applied weighting (calibration) according to sex, age and nationality, to adjust the results of the deviations presented by the lack of common response in some groups within household surveys (eg, overrepresentation of seniors).
Besides they have been controlled and inspected possible sources of error factor interviewer own collection investigating deviations from the most elevated mean responses for the main variables, avoiding bias in the results by areas.
Finally, comprehensive and centralized filtering of encoded variables studies, activity, occupation and household members have ensured a homogeneous treatment and subsequent classifications controlled sample also avoiding bias in the results of certain areas or groups.
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13.2Sampling error
The coefficients of variation of key variables are published. The results may be found in the tabulation of the survey at the following link:
Main variables (EESE 2020):
Self-perceived health estatus: Very good (A1=2,02%); Good (A1=1,20%); Fair(A1=1,91%); Bad (A1=3,30%); Very bad(A1=6,61%)
Tabacco comsuption: Daily smoker (A1=1,98%)
Hospitalization: Yes (A1=2,92%)
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13.3Non-sampling error
The main source of sampling error was due to the lack of response of households. Health surveys are traditionally well received at rates of collaboration are often among the highest in household surveys.
https://ine.es/metodologia/t15/esde23_falta_res.pdf
Coverage rate A2= 0%
Non response rate (Not surveyed household / Surveyable Household ) A4= 37,6%
Non response by item (A5)=
- Health status perception: A5= 0%
- Traffic accidents during the last 12 months: A5= 0,15%- Household accidents during the last 12 months: A5=0,23 %
- Accidents during leisure time during the last 12 month: A5=0,23%
Hospitalizations during the last 12 months: A5= 0%
Medicine compsumtion: A5= 0%
Tabacco consumption: A5=0,53% BMI adults: A5= 4,74%
Editing rate (A7)=
Health status perception A7= 0,05%
Accidents during the last 12 months A7= 0%
Hospitalizations during the last 12 months A7= 0,13%
Prescription medicins consumption A7=0,08% Non prescription medicins consumption A7=0,20%
Tabacco consumption A7= 0%
A complete non-response analysis document is provided and can be found at the following link:
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13.1Overall accuracy
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14Timeliness and punctuality
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14.1Timeliness
The data collection period (reference period) was between September 2023 and August 2024.
The data are published in may 2025, nine months after the completion of field work.
TP2=9 months
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14.2Punctuality
The data are published on schedule.
Punctuality TP3=100% the calendar is fulfilled
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14.1Timeliness
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15Coherence and Comparability
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15.1Comparability - geographical
The sample design allows the comparison of results at regional level.
The sample size garantee the comparability at European level
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15.2Comparability - over time
The 2023 Spanish Health Survey is the first edition to be conducted, although, as it is the convergence of the National Health Survey and the European Health Survey in Spain, it allows for comparability of most variables with at least one of the two surveys.
Depending on the variable being compared, the available data period may vary:
- Data from the National Health Survey for the years 2006, 2012, and 2017 provide information on the entire population, including those under 14 years of age (pediatric age) and those over that age.
- Data from the European Health Survey in Spain for the years 2009, 2014, and 2020 provide information on people aged 15 and over.
Thus, for example:
Regarding self-perceived health status, comparable data has been available since 2006, although not for all ages. Depending on the information available, the number of comparable periods varies:
- For children under 15 years of age, there is information from the National Health Survey from the 2006, 2012, and 2017 editions for this variable (CC2=4).
- For people aged 15 and over, in addition to these, information is available from the European Health Survey from 2009, 2014, and 2020 for this variable (CC2=7).
For tobacco use, comparable data has been available since 2006, since it is collected for people aged 15 and over. For this variable, information is available from all editions of both surveys (CC2=7).
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15.3Coherence - cross domain
The Spanish Health Survey, resulting from the convergence of the European Health Survey in Spain and the National Health Survey, is the national and international benchmark for perceptions of health status and morbidity.
The survey includes the European minimum health status module, which is also included in the Living Conditions Survey and from which key indicators of health status and disability-free life expectancy are obtained. The results are comparable and show the same trend.
Health surveys are the main contribution of comprehensive information on the use of health services (including data on the use of public and private health care).
With regard to the determinants of health, the survey includes a range of modules that are themselves own studies (consumption of snuff, alcohol consumption, eating habits, physical exercise). The main contribution of the survey is the possibility of crossing these variables with the health status and health care.
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15.4Coherence - internal
Coherence between variables is contrasted from the time of capture of data in the home through the application (control of errors and warnings) and is reviewed in the purification process in office. This process has enabled to provide all the variables collected in the questionnaire.
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15.1Comparability - geographical
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16Cost and burden
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16.1Cost and burden
The use of electronic questionnaire can reduce the burden of reporting from the point of view of the time of interview.
Reducing the burden on informants also attended the Technical Working Group of Eurostat. An effort was made for reducing the number of the variables includin in the Regulation.
The use of the electronic questionnaire reduces the respondent burden in terms of interview time, and the multiple channels allow for responses in the most convenient way.
The average time for the in-person interview was 14 minutes for the household questionnaire, 45 minutes for the adult questionnaire, and 18 minutes for the child questionnaire.
The survey was conducted jointly by the National Institute of Statistics and Census (INE) and the Ministry of Health, so the costs are shared between the two agencies.
Budgetary appropriations required for financing in 2025:
1,391.74 thousand euros provided for in the INE budget and 275.34 thousand euros provided for in the MSND budget
The estimated budgetary appropriation required to fund this survey, conducted by the INE, is provided for in the 2023, 2024 and 2025 annual programs:
PA2025= €1,391.74 thousand.
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16.1Cost and burden
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17Data revision
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17.1Data revision - policy
The INE of Spain has a policy which regulates the basic aspects of statistical data revision, seeking to ensure process transparency and product quality. This policy is laid out in the document approved by the INE board of directors on 13 March of 2015, which is available on the INE website, in the section "Methods and projects/Quality and Code of Practice/INE’s Quality management/INE’s Revision policy" (link).
This general policy sets the criteria that the different type of revisions should follow: routine revision- it is the case of statistics whose production process includes regular revisions-; more extensive revision- when methodological or basic reference source changes take place-; and exceptional revision- for instance, when an error appears in a published statistic-.
Final data are published and are not subject to revision.
A preview of the ESdE 2023 was not published.
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17.2Data revision - practice
The data published are final data and it is not subject to revision.
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17.1Data revision - policy
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18Statistical processing
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18.1Source data
The data obtained for this statistical operation are based on three questionnaires:
- A household questionnaire: This collects all household members and some basic sociodemographic variables. It also collects information on the sociodemographic characteristics of the household reference person (the person who contributes the most to the household budget).Once the household composition has been determined, the collection application selects an adult, and if there are children under 15 years of age in the household, a minor, to conduct the corresponding individual interviews.
- An adult questionnaire: collects health information, in addition to other sociodemographic variables, from the person 15 years of age or older selected from the household.
- A minor questionnaire: collects health information, in addition to other sociodemographic variables, from the person under 15 years of age selected from the household.
To meet the survey's objectives of providing estimates with a certain degree of reliability at the national and regional levels, a sample of 37,500 households distributed across 2,500 census tracts was selected. The number of households selected in each census tract was 15.The collection method was a web-based questionnaire (CAWI) and a personal interview (CAPI).
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18.2Frequency of data collection
The Spanish Health Survey is conducted every 3 years.
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18.3Data collection
The data collection method was carried out using a web-based questionnaire (CAWI) and a personal interview (CAPI).
The collection period lasted one year, between September 2023 and August 2024.
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18.4Data validation
The process of monitoring information for quality assurance is carried out in two phases:
1 / During the course of the interview: The computer-aided personal interview (CAPI), can be incorporated into the electronic questionnaire validation rules errors and inconsistencies that need to be cleared at the time of the interview. It also allows to incorporate minor notices to be collated directly with the informant inconsistencies.
2 / Office functions: After receiving the data, a debugging application allows an exhaustive control of the data, analyzing errors, serious inconsistencies, minor inconsistencies, extreme values, tracking marginal distributions, cross tables ...
Complementarily crossings are scheduled or subsets of data are extracted to analyze specific variables.
Serious errors or invalid values, if any, are detected in the first weeks of the period of collection of information and allow perfecting the electronic questionnaire.
The errors may be due to misinterpretation of questions, the interviewers are transmitted to take it into account during the development of their work.
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18.5Data compilation
Among the processes applied to the initial data to the collection of aggregate data we can find:
1 / data filtering, as described in the previous section.
2 / periodic comparisons of the sample with the population pyramid pyramid to control the representativeness of the sample versus the variables age and sex.
3 / Control of the socioeconomic variables.
4 / Adjusting the lack of response and calibration
5 / Calculation and review of the elevation factors.
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18.6Adjustment
No temporary adjustments carried out.
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18.1Source data
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19Comment
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19.1Comment
There are no observations
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19.1Comment