- Methods and Projects
- Standards and Classifications
Standardised Methodological Report
European Health Survey
- 1Contact
- 1.1Contact organisation
National Statistics Institute of Spain
- 1.5Contact mail address
Avenida de Manoteras 50-52 - 28050 Madrid
- 1.1Contact organisation
- 2Metadata update
- 2.1Metadata last certified
23/04/2021
- 2.2Metadata last posted
26/04/2021
- 2.3Metadata last update
23/04/2021
- 2.1Metadata last certified
- 3Statistical presentation
- 3.1Data description
The European Health Interview Survey in Spain (EHIS) provides information periodically on the health of the spanish population,
The EHIS 2020 has the general objective of providing information on the health of the Spanish population, harmonized and comparable at an European level, in order to be able to plan and evaluate actions in health sector.
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).
- 3.2Classification system
- Clasificaciones utilizadas
The EESE 2020 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
- 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
- 3.4Statistical concepts and definitions
- Accident
A fortuituous and unforeseen occurrence which strikes the individual and causes him or her an identifiable corporal injury It includes falls, knocks, poisonings, burns and traffic accidents, both regarding driver, passengers or pedestrians
- Pap smear
The collection of a sample of cells for the early detection of cervical or vaginal cancer, and of certain infections.
- Visits to the dentist
Visit to a qualified professional (dentist, stomatologist or dental hygienist) for examining, advising, treating or reviewing dental or oral problems.
- Visit to the doctor
Visit (in person or by telephone) to a qualified medical professional for diagnosis, examination, treatment, follow-up, advice or any other procedure with a problem, discomfort or illness interviewee.
- Consumption of fast food
Consumption of food served in certain establishments and is characterized by quickly prepared and served and eaten quickly, as well as being economical.
- Consumption of fruits and vegetables
Consumption of fresh and frozen fruit, preserved fruit or dried fruit. It does not include juice. Vegetables exclude potatoes and vegetable juice.
- Regular alcohol consumption
Consumption of alcoholic beverages at least once a week during the last year.
- Intense alcohol consumption that jeopardises health
Consumption during a single session of 6 or more standard drinks (for men), or 5 or more standard drinks (for women). A single session is regarded as consumption during the same situation, during an approximate 4-6-hour interval.
- Health Determinants
A set of personal, social, economic and environmental factors that determine the state of health of individuals or populations.
- Chronic or long-term diseases
Illnesses or health problems lasting at least 6 months. They are not considered temporary problems, whereas seasonal or recurring problems are.
- General state of health (self-perceived)
The person's perception regarding his or her general state of health in the last twelve months.
- Hospitalisation
This is any admission to hospital to receive medical care or treatment involving at least one overnight stay or having a bed assigned.
- Body Mass Index (BMI)
Relationship between the weight of the individual (in kilograms) and the square of the height (in metres).
- Admission to outpatients
Admission to hospital for diagnosis and/or scheduled treatment and discharge before midnight the same day.
- Mammogram
The x-ray of the breasts for the purpose of the early detection of breast cancer. A mommogram is recommended every two years in women aged between 50 and 69 years old.
- Reference person
Also known as the main breadwinner, he or she is the household member who regularly contributes most (rather than occasionally) to the household budget, in order to defray the common expenses thereof. The main breadwinner is not the person with the highest income (main source), but the one contributing most to the common budget.
- Sedentary lifestyle
Not do exercise in his or her free time, spending almost all his or her time leading a physically inactive life.
- Accident and emergency services
These are services dealing with clinical processes, whatever their nature, which require urgent diagnostic or therapeutic guidance.
- Situación en relación con la actividad económica
Se refiere a la situación en que queda clasificada cada persona según su relación con la actividad económica: activo (ocupado o parado) o inactivo (jubilado, estudiando, incapacitado para trabajar, etc.), basada en los criterios OIT.
- Accident
- 3.5Statistical unit
The unit is the resident person 15 + years old in the main family dwelling.
- 3.6Statistical population
The total population or universe to respect the European Health Survey 2020 is the population residing in main family dwellings.
- 3.7Reference area
The European Health Interview Survey 2020 is conducted throughout the country.
The target variables are provided with a level of territorial disaggregation of Autonomous Community.
- 3.8Time coverage
The European Survey of Health in Spain (ESHS) is carried out every 5 years
- 3.9Base period
The first European Health Interview Suervey was carried out in 2009, althoug there are some modifications in the questionnaire in the other waves, we can consider 2009 as base period
- 3.1Data description
- 4Unit of measure
- 4.1Unit of measure
Number of persons
Percentages of persons
- 4.1Unit of measure
- 5Reference period
- 5.1Reference period
Field period of EESE 2020: july 2019-july 2020
The time period to which the data refer varies according to the nature of the variables to be investigated. The reference period may be 12 months (self-perceived health), the last 4 weeks (medical consultations) or the last two weeks (drug use).
Data referred to the period: EESE 2020
- 5.1Reference period
- 6Institutional mandate
- 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 2021-2024, approved by Royal Decree 1110/2020, of 15 December, is the Plan currently implemented. This statistical operation has governmental purposes, and it is included in the National Statistics Plan 2021-2024. (Statistics of the State Administration).
This statistical project investigates the variables mentioned in the article 11.2 from the Law of the Funtion of Public Statistics (ethnic origine, political opinions, religious conviction or ideologies and issues related to the personal or familiar intimacy) , for that reason it is voluntary.
The European Survey of Health 2020 in Spain is a harmonized and comparable survey at European level. Regulation (EU) No 255/2018 February 2020 Implementing Regulation (EC) No 1338/2008 of the European Parliament and of the Council on Community statistics on public health and health and safety at work, as regards statistics based on the European Health Interview survey (EHIS) establishes the physical changes of the survey application in all countries of the European Union. The Spanish version of this policy of the European Union is available from: https://www.ine.es/en/normativa/leyes/UE/minine_en.htm#54088
There is a collaboration agreement between INE and Ministry of Health for expanding EESE 2020 variables.
- 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.
- 6.1Legal acts and other agreements
- 7Confidentiality
- 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
- 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
- 7.1Confidentiality - policy
- 8Release policy
- 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.
- 8.2Release calendar access
The calendar is disseminated on the INEs Internet website (Publications Calendar)
- 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
- 8.1Release calendar
- 9Frequency of dissemination
- 9.1Frequency of dissemination
The European Health interview survey 2020 is the third wave of the European Health Interview Survey.
The European Survey of Health in Spain has a five-year basis. The first edition was held in 2009 and the second one in 2014
- 9.1Frequency of dissemination
- 10Accessibility and clarity
- 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
- 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...
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 Ministry of Health, , as set out in the collaboration agreement between INE and Ministry of Health for expanding variables EESE 2020, also disseminates the results through its website and produces reports with key operating results making public to all users.
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.
- 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 EESE 2020 via the following link :
- 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 EESE 2020 is available at INE website:
- 10.5Other
- 10.6Documentation on methodology
A detailed description of the methodology may be viewed at:
- 10.7Quality documentation
The INE conducts two specific analyzes for assessing the quality of data ESHS. 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 ESHS results dissemination:
Thus, the following sections of this methodological report constitute the quality global report oriented to the user for this operation.
- 10.1News release
- 11Quality management
- 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 EESE 2020 an amount of measures has been implemented and they help guarantee the process and results quality. Beyond them we can found the following:
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.
- 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 ICSC questionnaire and a first filtering in field.
- Low level of responses provided by proxy to the individual questionnaire (3% 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
- 11.1Quality assurance
- 12Relevance
- 12.1User needs
The main users of the survey:
- Eurostat
- Ministry of Health, Social Services and Equality
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.
- 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)
- 12.3Completeness
The available mandatory statistical results, calculated as the ratio between the number of data provided and the number of data required by the applicable regulations is 100%.
R1=100%
- 12.1User needs
- 13Accuracy and reliability
- 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.
- 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:
CV main variables:
Self-perceived health estatus: Very good (2,02); Good (1,20); Fair(1,91); Bad (3,30); Very bad(6,61)
Tabacco comsuption: Daily smoker (1,98)
Hospitalization: Yes (2,92)
- 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.
Coverage rate (A2)= 0%
Non response rate (Not surveyed household / Surveyable Household ) (A4)= 27,8%
Non response by item (A5)=
- Health status perception= 0%
- Traffic accidents during the last 12 months = 0,02%- Household accidents during the last 12 months=0,02 %
- Accidents during leisure time during the last 12 month = 0,02%
Hospitalizations during the last 12 months= 0%
Medicine compsumtion= 0%
Tabacco consumption= 0,17%
Editing rate (A7)=
Health status perception= 0%
Accidents during the last 12 months= 0,05%
Hospitalizations during the last 12 months= 0,05%
Medicins consumption=0,64%
Tabacco consumption= 0%
- 13.1Overall accuracy
- 14Timeliness and punctuality
- 14.1Timeliness
The reference period of the data is july 2019 to july 2020.
The data are published in april 2021, nine months after the completion of field work.
TP2= 9 months
- 14.2Punctuality
The data are published on schedule.
Punctuality (TP3)= the calendar is fulfilled
- 14.1Timeliness
- 15Coherence and Comparability
- 15.1Comparability - geographical
The sample design allows the comparison of results at regional level.
The sample size garantee the comparability at European level
- 15.2Comparability - over time
The three European Survey of Health in Spain: EESE 2020, EESE 2014 and EESE 2009 are comparable in all variables with the exception of those that have been modified
Length of the comparable series (CC2)=3
- 15.3Coherence - cross domain
The European Survey of Health and the National Health Survey are the national benchmark in the perception of health status and morbidity. Both surveys include the minimum European health module, which is also included in the Survey of Living Conditions and that key indicators of health status and life expectancy free of disability 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.
- 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.
- 15.1Comparability - geographical
- 16Cost and burden
- 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. The average time for the household questionnaire was 5 minutes and for the individual questionnaire was 20 minutes.
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 estimate of the budgetary credit needed to finance this survey under the annual programs from 2019 to 2021 (PA 2019= 2.109,59 thousands of euros PA 2020= 1.782,52 thousands of euros y PA 2021= 7,5 thousands of euros) and 250. 000 euros in the budget of the Ministry of Health.
- 16.1Cost and burden
- 17Data revision
- 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 EESE 2020 was not published.
- 17.2Data revision - practice
The data published are final data and it is not subject to revision.
- 17.1Data revision - policy
- 18Statistical processing
- 18.1Source data
Data collected for this statistical operation is conducted through two questionnaires:
A household questionnaire: It collects all household members and some basic sociodemographic variables of them all. Besides it collects information on sociodemographic characteristics of the household reference person (person who contributes most to the household budget).
An individual questionnaire: It collects information from the person of 15 years or more selected home
To meet the objectives of the survey to provide estimates with a specific degree of reliability on a national and autonomous community level, we selected a sample of 37,500 dwellings distributed in 2,500 census tracts. The number of dwellings selected in each census section is 15.
The method to collect the information was CAPI and CATI
- 18.2Frequency of data collection
The European Survey of Health is carried out every five years
- 18.3Data collection
The data collection method planned was computer-aided interview (CAPI). Due to the fact that the field work lasted 12 months ( from july 2019 to july 2020), the data collection method during the pandemia period ( march 2020-july 2020) changed to CATI
- 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.
- 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.
- 18.6Adjustment
No temporary adjustments carried out.
- 18.1Source data
- 19Comment
- 19.1Comment
Taking into account that EESE 2019 field period was from july 2019 to july 2020, It has been possible to calculate some indicators in two diferent periods, before the pandemia ( july 2019-february 2020) and during the pandemia ( march 2020-july 2020).
In the following link it is possible to consult these indicators:
- 19.1Comment