ABOUT NSI

The National Statistical Institute (NSI) is a state institution in Bulgaria that collects, processes and disseminates official statistical information on social, economic and demographic processes in the country. The NSI's activities are aimed at providing objective and reliable data that support informed decision-making by the state, business and society. The Institute works in accordance with international statistical standards and is an active participant in the European Statistical System.

(02) 9857 111 ИЛИ [email protected]

Final data

Final data

  • Data
    
    SELF-PERCEIVED HEALTH, BY SEX
    (%)
      Total Male Female
    Very good 23.5 27.4 20.2
    Good 43.1 42.9 43.3
    Fair 22.3 20.9 23.4
    Bad 8.3 6.7 9.7
    Very bad 2.8 2.1 3.4
    SELF-PERCEIVED HEALTH, BY AGE
    (%)
      Total Age (in completed years)
    15 - 24 25 - 44 45 - 64 65 +
    Very good 23.5 72.3 37.9 10.4 1.5
    Good 43.1 25.2 53.5 51.9 24.5
    Fair 22.3 .. 6.5 27.2 45.5
    Bad 8.3 .. (1.8) u 8.4 20.4
    Very bad 2.8 .. (0.3) u (2.2) u 8.1
    PEOPLE HAVING A LONG-STANDING ILLNESS OR HEALTH PROBLEM, BY SEX
    (%)
      Total Male Female
    Yes 44.6 40.3 48.5
    No 55.4 59.7 51.5
    PEOPLE HAVING A LONG-STANDING ILLNESS OR HEALTH PROBLEM, BY AGE
    (%)
    Age (in completed years) Yes No
    Total 44.6 55.4
    15 - 24 9.3 90.7
    25 - 44 17.6 82.4
    45 - 64 54.7 45.3
    65 + 86.5 13.5
    SELF-REPORTED PREVALENCE OF CHRONIC DISEASES, BY DISEASES AND SEX
    (%)
    Disease Total Male Female
    Arthrosis 7.5 4.5 10.2
    Low back disorder or other chronic back defect 10.1 7.9 12.1
    Neck disorder or other chronic neck defect 5.3 3.5 6.9
    Asthma 2.7 2.1 3.3
    Chronic lower respiratory diseases (excluding asthma) 4.6 4.1 5.1
    Heart attack or chronic consequences of heart attack 2.2 2.7 1.7
    Coronary heart disease or angina pectoris 9.1 7.9 10.2
    High blood pressure 29.6 26.0 33
    Stroke or chronic consequences of stroke 2.7 2.8 2.6
    Cirrhosis of the liver (0.3) u (0.4) u (0.3) u
    Urinary incontinence, problems in controlling the bladder 2.8 3.1 2.6
    Kidney problems 5.8 4.9 6.7
    Diabetes 6.4 5.4 7.3
    Allergy 4.4 2.9 5.7
    Chronic depression 3.2 2.1 4.2
    .. - confidential data
    u - due to a small sample size figures in brackets are not reliable.
    ADMISSION AS AN INPATIENT IN A HOSPITAL IN THE PAST 12 MONTHS, BY SEX
    (%)
      Total Male Female
    Yes 10.0 9.0 10.8
    No 90.0 91.0 89.2
    ADMISSION AS AN DAY PATIENT IN A HOSPITAL IN THE PAST 12 MONTHS, BY SEX
    (%)
      Total Male Female
    Yes 8.5 8.3 8.7
    No 91.5 91.7 91.3
    LAST TIME OF VISIT TO A DENTIST OR ORTHODONTIST, BY SEX
    (%)
      Total Male Female
    Less than 6 months 22.0 20.3 23.6
    6 to less than 12 months 22.4 22.0 22.9
    12 months or longer 50.8 52.9 48.8
    Never 4.8 4.8 4.7
    LAST TIME OF VISIT TO A DENTIST OR ORTHODONTIST, BY AGE
    (%)
      Total Age (in completed years)
    15 - 24 25 - 44 45 - 64 65 +
    Less than 6 months 22.0 25.5 25.6 23.5 12.9
    6 to less than 12 months 22.4 26.8 25.7 23.6 13.8
    12 months or longer 50.8 39.3 43.3 49.7 69.1
    Never 4.8 8.3 5.4 3.3 4.2
    LAST TIME OF CONSULTATION OF A GENERAL PRACTITIONER, BY SEX
    (%)
      Total Male Female
    Less than 12 months ago 71.2 64.3 77.7
    12 months ago or longer 26.8 33.0 21.0
    Never 2.0 2.7 (1.4) u
    LAST TIME OF CONSULTATION OF A GENERAL PRACTITIONER, BY AGE
    (%)
      Total Age (in completed years)
    15 - 24 25 - 44 45 - 64 65 +
    Less than 12 months ago 71.2 52.6 60.4 76.5 88.5
    12 months ago or longer 26.8 43.4 37.1 21.9 10.7
    Never 2.0 (4.0) u 2.5 (1.6) u (0.8) u
    LAST TIME OF CONSULTATION OF A MEDICAL OR SURGICAL SPECIALIST, BY SEX
    (%)
      Total Male Female
    Less than 12 months ago 30.9 23.1 38.1
    12 months ago or longer 52.8 57.8 48.2
    Never 16.3 19.1 13.7
    LAST TIME OF CONSULTATION OF A MEDICAL OR SURGICAL SPECIALIST, BY AGE
    (%)
      Total Age (in completed years)
    15 - 24 25 - 44 45 - 64 65 +
    Less than 12 months ago 30.9 19.2 31.7 33.4 32.1
    12 months ago or longer 52.8 46.0 50.1 54.5 57.7
    Never 16.3 34.8 18.2 12.2 10.2
    BLOOD PRESSURE MEASUREMENT BY A HEALTH PROFESSIONAL, BY SEX
    (%)
      Total Male Female
    Within the past 12 months 64.4 58.2 69.9
    1 to less than 3 years 21.3 24.3 18.6
    3 to less than 5 years 3.5 4.1 2.9
    5 years or more 2.9 3.6 2.3
    Never 7.9 9.8 6.2
    BLOOD PRESSURE MEASUREMENT BY A HEALTH PROFESSIONAL, BY AGE
    (%)
      Total Age (in completed years)
    15 - 24 25 - 44 45 - 64 65 +
    Within the past 12 months 64.4 30.8 49.9 72.0 87.3
    1 to less than 3 years 21.3 28.9 30.0 18.8 9.8
    3 to less than 5 years 3.5 (4.3) u 5.1 3.2 (1.2) u
    5 years or more 2.9 (3.3) u 4.0 3.1 ..
    Never 7.9 32.7 11.0 2.9 ..
    BLOOD CHOLESTEROL MEASUREMENT, BY SEX
    (%)
      Total Male Female
    Within the past 12 months 51.1 45.4 56.0
    1 to less than 3 years 22.9 24.9 21.2
    3 to less than 5 years 3.9 3.9 3.9
    5 years or more 3.8 4.1 3.6
    Never 18.3 21.8 15.3
    BLOOD CHOLESTEROL MEASUREMENT, BY AGE
    (%)
      Total Age (in completed years)
    15 - 24 25 - 44 45 - 64 65 +
    Within the past 12 months 51.1 21.7 36.8 59.9 69.9
    1 to less than 3 years 22.9 18.8 27.8 22.5 18.6
    3 to less than 5 years 3.9 .. 4.9 4.1 (2.8) u
    5 years or more 3.8 .. 3.4 4.1 4.5
    Never 18.3 54.2 27.0 9.4 4.2
    BLOOD SUGAR MEASUREMENT, BY SEX
    (%)
      Total Male Female
    Within the past 12 months 51.7 46.3 56.4
    1 to less than 3 years 23.0 24.3 21.9
    3 to less than 5 years 4.3 4.9 3.8
    5 years or more 4.1 4.2 4.0
    Never 16.9 20.4 13.9
    BLOOD SUGAR MEASUREMENT, BY AGE
    (%)
      Total Age (in completed years)
    15 - 24 25 - 44 45 - 64 65 +
    Within the past 12 months 51.7 22.7 37.5 59.7 71.2
    1 to less than 3 years 23.0 21.1 27.9 22.5 18.0
    3 to less than 5 years 4.3 .. 5.5 4.5 (2.7) u
    5 years or more 4.1 .. 3.9 4.2 4.9
    Never 16.9 50.1 25.2 9.1 3.2
    .. - confidential data
    u - due to a small sample size figures in brackets are not reliable.
    BODDY MASS INDEX OF PERSONS AGED 18 AND OVER, BY SEX
    (%)
    Boddy mass index Total Male Female
    Underweight (<18.5) 2.2 (0.5) u 3.6
    Normal (18.5 - 24.99) 43.8 37.3 49.6
    Overweigth (25.00 - 29.99) 39.2 46.7 32.6
    Obese (30.00+) 14.8 15.5 14.2
    BODDY MASS INDEX OF PERSONS AGED 18 AND OVER, BY AGE
    (%)
    Boddy mass index Total Age (in completed years)
    15 - 24 25 - 44 45 - 64 65 +
    Underweight (<18.5) 2.2 (5.9) u (3.4) u (0.8) u (1.2) u
    Normal (18.5 - 24.99) 43.8 73.3 53.0 34.6 34.4
    Overweigth (25.00 - 29.99) 39.2 16.3 34.1 44.9 45.8
    Obese (30.00+) 14.8 (4.6) u 9.5 19.7 18.6
    CONSUMPTION OF FRUITS BY FREQUENCY, BY SEX
    (%)
      Total Male Female
    Once or more a day 35.4 32.0 38.4
    4 to 6 times a week 24.3 23.3 25.2
    1 to 3 times a week 26.9 29.9 24.3
    Less than once a week 12.7 14.0 11.5
    Never (0.7) u (0.8) u (0.6) u
    CONSUMPTION OF VEGETABLES BY FREQUENCY, BY SEX
    (%)
      Total Male Female
    Once or more a day 38.4 36.2 40.4
    4 to 6 times a week 27.7 28.6 26.9
    1 to 3 times a week 24.5 26.0 23.3
    Less than once a week 8.8 8.7 8.9
    Never (0.5) u (0.5) u (0.5) u
    SMOKING BEHAVIOUR, BY SEX
    (%)
    Do you smoke? Total Male Female
    Yes, dayli 28.2 36.4 20.7
    Yes, occasionally 6.5 7.0 6.2
    Not at all 65.2 56.7 73.2
    SMOKING BEHAVIOUR, BY AGE
    (%)
    Do you smoke? Total Age (in completed years)
    15 - 24 25 - 44 45 - 64 65 +
    Yes, dayli 28.2 21.5 40.5 32.7 7.7
    Yes, occasionally 6.5 8.1 8.9 6.5 (2.5) u
    Not at all 65.2 70.4 50.6 60.8 89.8
    FREQUENCY OF ALCOHOL CONSUMPTION IN THE PAST 12 MONTHS, BY SEX
    (%)
      Total Male Female
    Every day or almost every day 8.9 14.9 3.6
    5 - 6 days a week 3.3 5.5 1.3
    3 - 4 days a week 7.3 11.9 3.3
    1 - 2 days a week 9.0 11.8 6.6
    2 - 3 days in a month 13.2 15.0 11.6
    Once a month 12.1 11.3 12.8
    Less than once a month 12.3 8.1 15.9
    Not in the past 12 months, as I no longer drink alcohol 10.7 9.7 11.5
    Never, or only a few sips or trials, in my whole life 23.3 11.7 33.4
    .. - confidential data
    u - due to a small sample size figures in brackets are not reliable.
    04.06.2025
  • Time series

    Zdr_7.2.1_EHIS_EN.xlsx

  • Metadata
    

    Euro-SDMX Metadata Structure (ESMS)

    European health interview survey
    Contact
    Contact organisation

    National Statistical Institute

    Contact organisation unit

    "Health and Justice Statistics" Department

    Contact name

    Evelin Yordanova

    Contact person function

    Head of department

    Contact mail address

    2, P. Volov Str.; 1038 Sofia, Bulgaria

    Contact email address

    [email protected]

    Contact phone number

    +359 2 9857 459

    Contact fax number
    Metadata update
    Metadata last certified08 July 2021
    Metadata last posted08 July 2021
    Metadata last update08 July 2021
    Statistical presentation
    Data description

    The survey is a part of the European Health Survey System in the framework of the European Statistical System. The EHIS aims at measuring on a harmonised basis and with a high degree of comparability among EU Member States, the health status, life style (health determinants) and health care services use of the EU citizens.

    EHIS wave 1

    The survey was carried out by NSI based on harmonized instruments in 2008. The questionnaire for the first round of the EHIS (2007 - 2008) was adopted on 22 November 2006 by the Eurostat Working Group on Public Health Statistics.

    The topics included in the questionnaire are developed in order to meet main needs as for the management of health care systems, as well as in science. Within these needs, EHIS questions are aimed at meeting the basic needs of information at EU level. They do not cover all detailed aspects of health which can better be carried out via specific surveys at national level.

    The questionnaire consists of four modules.

    • Health status;
    • Health care;
    • Health determinants (life style);
    • Background module.

    In addition, in order to meet the information needs of the European Commission`s DGs "Health and Consumers" (SANCO) and "Employment, Social Affairs and Inclusion (EMPL), 26 indicators which cover the three topics - Health status, Health care and Health determinants are calculated. Indicators are calculated using respondent`s answers during the interview. No documents are required, proving the correctness of answers and no measurements are done. All the indicators are calculated for the population aged 15 and over, except in case a specific age is indicated.

    EHIS wave 2

    In 2014 BNSI participated in the EHIS wave 2 in accordance with the Commission Regulation (EU) No 141/2013 implementing Regulation (EC) No 1338/2008 requrements. The survey was carried out by using the harmonized questionnaire proposed by Eurostat.

    EHIS wave 3

    In 2019 all Member States participated in the EHIS wave 3 in accordance with the Commission Regulation (EU) No. 2018/255 as the BNSI carried out the survey in the period October 2019 - January 2020.

    The questionnaire consists of the same four modules  for all the EHIS waves. In order to reduce the responce burden and to satisfy the specific users’ needs the questionnaire is  changed.

     

    EHIS includes the following topics:

    Health status
    This topic includes different dimensions of health status and health-related activity limitations:

    • General health status (Minimum European health module): self-perceived health, chronic morbidity and activity limitation
    • Disease-specific morbidity
    • Accidents and injuries
    • Health-related absenteeism from work
    • Physical and sensory functional limitations
    • Difficulties in personal care activities / activities of daily living (such as eating and washing) and help received/needed
    • Household activities / Instrumental activities of daily living (such as preparing meals and shopping) and help received/needed
    • Pain
    • Aspect of mental health (psychological distress and mental well-being in the first wave, depressive symptoms in the second wave).

    Health care

    • Hospitalisation (in-patient and day care)
    • Consultations with doctors and dentists
    • Visits to specific health professionals (such as physiotherapists or psychologists)
    • Use of home care and home help services
    • Use of medicines (prescribed and non-prescribed)
    • Healthcare preventive actions (such as influenza vaccination, breast examination, cervical smear test and blood tests)
    • Unmet needs for health care.

    Health determinants

    • Height and weight
    • Physical activity
    • Consumption of fruits, vegetables and juice
    • Smoking behaviour and exposure to tobacco smoke
    • Alcohol consumption
    • Social support.

    Background variables on demography and socio-economic status.

    Classification system

    EHIS - wave 1

    • National Classification of Occupations and Duties-2005 (NCOD-2005) - consistent with the International Standard Classification of Occupations ISCO-88 (COM);
    • Classification of Economic Activities (CEA-2008, for international use NACE.BG -2008) - consistent with the European classification NACE Rev. 2;
    • Classification of Territorial Units for Statistical Purposes in Bulgaria (NUTS);
    • International Standard Classification of Education, 1997 revision (ISCED 1997).

    EHIS - wave 2 and 3

    • National Classification of Occupations and Duties-2011 - consistent with the International Standard Classification of Occupations ISCO-08;
    • Classification of Economic Activities (CEA-2008, for international use NACE.BG -2008) - consistent with the European classification NACE Rev. 2;
    • Classification of Territorial Units for Statistical Purposes in Bulgaria (NUTS);
    • International Standard Classification of Education, 2011 revision (ISCED 2011).
    Sector coverage

    All persons aged 15 and over living within the selected non-institutionalised households are covered.

    In accordance with the EHIS methodology people living in institutionalized households as residencies for students or workers, medical or social institutions, prisons are excluded from the target population.

    Statistical concepts and definitions

    Diseases - self-reported prevalence:

    EHIS - wave 1

    Percentage of persons reporting:

    • to have the selected disease,
    • the disease was diagnosed by a medical doctor,
    • the disease occurred during the past 12 months.

    The indicator is calculated for five diseases: diabetes, chronic depression, chronic bronchitis, chronic obstructive pulmonary disease, emphysema, asthma, incl. allergic and high blood pressure (hypertensive diseases).

    EHIS - wave 2

    Proportion of the population reporting a chronic condition in the past 12 months. Statistics on 15 diseases or chronic conditions are presented:

    A. Asthma (allergic asthma included)

    B. Chronic bronchitis, chronic obstructive pulmonary disease, emphysema

    C. Myocardial infarction (heart attack) or chronic consequences of myocardial infarction

    D. Coronary heart disease or angina pectoris

    E. High blood pressure (hypertension)

    F. Stroke (cerebral haemorrhage, cerebral thrombosis) or chronic consequences of stroke

    G. Arthrosis (arthritis excluded)

    H. Low back disorder or other chronic back defect

    I. Neck disorder or other chronic neck defect

    J. Diabetes

    K. Allergy, such as rhinitis, hay fever, eye inflammation, dermatitis, food allergy or other allergy (allergic asthma excluded)

    L. Cirrhosis of the liver

    M. Urinary incontinence, problems in controlling the bladder

    N. Kidney problems

    O. Depression

    Injury by accident - at home, school or leisure accident, road traffic accident. Percentage of persons reporting to have had an accident during the past 12 months, which resulted in injury.

    Self-reported visits to general practitioner, dentist or orthodontist, medical specialist - Percentage of persons having consulted a doctor during the last 4 weeks.

    Medicine use

    EHIS - wave 1

    Percentage of persons reporting to take medication prescribed by a physician for a specific disease during the past 2 weeks for diabetes; chronic depression; chronic bronchitis, chronic obstructive pulmonary disease, emphysema; asthma, incl. allergic and high blood pressure.

    EHIS - wave 2

    Self-reported use of prescribed and non-prescribed medicines: Proportion of the population who used medicines prescribed and non-prescribed by a doctor in the past 2 weeks.

     

    Breast cancer screening - Percentage of women aged 50-69 years, who have undergone a mammography.

    Cervical cancer screening - Percentage of women aged 20-69 years, reporting to have undergone a cervical cancer screening test.

     

    Body Mass Index (BMI): Percentage of persons aged 18 and over with specific BMI. The indicator is calculated as ratio of weight (kg) and the square of height (m) - kg/m2. The following subdivision is used:

    • underweight (less than 18.5 kg/m2)
    • normal weight (between 18.5 and less than 24.99 kg/m2 )
    • overweight (between 25.00 and less than 29.99 kg/m2)
    • obese (equal or greater than 30.00 kg/m2)

     

    Daily cigarettes smokers: Percentage of persons reporting to smoke cigarettes (manufactured and hand-rolled) daily. 

    Hazardous alcohol consumption (EHIS - wave 1) - Percentage of persons who drink 6 and more alcohol drinks for one occasion, during the past 12 months, by frequency of use.

    Statistical unit

    Persons aged 15 and over living in non-institutionalised households.

    Statistical population

    All persons aged 15 and over living in non-institutionalised households are covered.

    In accordance with the EHIS methodology people that live in institutionalised households as residencies for students or workers, medical or social institutions, prisons are excluded from the target population.

    Reference area

    The territory of the Republic of Bulgaria.

    Time coverage

    EHIS wave 1 - 2008

    EHIS wave 2 - 2014

    EHIS wave 3 - 2019

    Base period

    Not applicable.

    Unit of measure

    Relative share

    Reference period

    EHIS wave 1

    The survey was carried out in October and November 2008.

    EHIS wave 2

    The survey was carried out in the period October 2014 - January 2015.

    EHIS wave 3

    The survey was carried out in the period October 2019 - January 2020.

     

    According to the character of the questions the reference period is two or four weeks, six or twelve months, weekdays or weekend.

    Institutional mandate
    Legal acts and other agreements

    EHIS wave 1

    • Regulation (EC) No 1338/2008 of the European Parliament and of Council of 16 December 2008 on Community statistics on public health and health and safety at work;
    • Law on Statistics.

    EHIS wave 2

    • Regulation (EC) No 1338/2008 of the European Parliament and of Council of 16 December 2008 on Community statistics on public health and health and safety at work;
    • Commission Regulation (EU) No 141/2013 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);
    • Law on Statistics.

    EHIS wave 3

    Regulation (EC) No 1338/2008 of the European Parliament and of Council of 16 December 2008 on Community statistics on public health and health and safety at work;

    Commission Regulation (EU) No 2018/255 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);

    Law on Statistics;

    Personal Data Protection Act.

    Data sharing
    Confidentiality
    Confidentiality - policy
    • Law on Statistics;
    • Regulation (EC) No 223/2009 on European statistics (recital 24 and Article 20(4)) of 11 March 2009 (OJ L 87, p. 164), 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.
    Confidentiality - data treatment

    Individual data are not published in accordance with article 25 of the Law on Statistics. The publishing of individual data can be performed only in accordance with article 26 of the same law.

    For the purposes of dissemination of aggregated data the following rules are applied:

    • An estimate should not be published if it is based on fewer than 20 sample observations or if the non-response for the item concerned exceeds 50%.
    • An estimate should be published with a flag "low reliability" if it is based on 20 to 49 sample observations or if non-response for the item concerned exceeds 20% and is lower or equal to 50%.
    • An estimate shall be published in the normal way when based on 50 or more sample observations and the item's non-response does not exceed 20%.
    Release policy
    Release calendar

    The date of the statistical information release is shown in the Release Calendar presenting the results of the statistical surveys carried out by the National Statistical Institute.

    Release calendar access

    The calendar is available on the NSI website: http://www.nsi.bg/en/node/480

    User access

    Data on European health interview survey is published on the NSI website, section Health in accordance with the Law on Statistics and the European Statistics Code of Practice respecting the professional independence and aimed at objectivity, transparency and equal treatment of all consumers.

    Frequency of dissemination

    The final data are disseminated after the finalization of the data validation procedure.

    Accessibility and clarity
    News release

    Press release.

    Publications

    EHIS - wave 1

    Bulgaria - Statistical Panorama

    On-line database

    Data on European health interview survey are available to all users of the NSI website under the heading Health - Health interview survey: http://www.nsi.bg/en/node/5630

    Eurostat online database 

     

    Micro-data access

    Anonymised individual data can be provide for scientific and research purposes by individual request, according to the Rules for the provision of anonymised individual data for scientific and research purposes.

    Other

    Information service on request, according to the Rules for the dissemination of statistical products and services in NSI.

    Documentation on methodology

    EHIS wave 1

    • European Health Interview Survey questionnaire (2007-2009);
    • Conceptual translation cards and guidelines;
    • Quality Categories and Criteria for Delivery Data to EHIS;
    • European Health Interview survey methodological sampling guidelines (Task force III report);
    • Guidelines for the development and criteria for the adoption of Health Survey instruments.

    EHIS wave 2

    • European Health Interview Survey (EHIS wave 2), Methodological manual, Eurostat, 2013 edition;
    • EHIS wave 2 Validation rules; 
    • EHIS wave 2 Data delivery guidelines.

    EHIS wave 3

    • European Health Interview Survey (EHIS wave 3), Methodological manual, Eurostat, 2018 edition;
    • EHIS wave 3 Validation rules.
    Quality documentation

    EHIS wave 1

    Summary report on the application of criteria for quality assessment of the European Health Interview - Eurostat.

    EHIS wave 2 and 3

    Quality report

    Quality management
    Quality assurance

    There is a quality management system in the BNSI in accordance with the requirements of ISO 9001:2015. Since 2019, an extended scope of the system has been approved, including receiving, data collection, processing, storing, analyzing, providing and dissemination of statistical information.

    According to the Regulation 1338/2008 on Community statistics on public health and health and safety at work EHIS is to be conducted every five years. EHIS wave 2 and 3 were conducted according to the European legislation.

    EHIS aims at achieving an input standardisation. A model questionnaire (questions, answer categories, filters, etc.) as well as conceptual guidelines and rationales were prepared. Conceptual translation into all EU languages was requested. By using the Methodological manual 'European Health Interview Survey ' the harmonizad questionnaire a standard translation protocol as well as Conceptual translation cards and guidelines were applied.

    National data entry tool is elaborated according to the Validation rules and Data delivery guidelines proposed by Eurostat. Data validation tool is used in order to prevalidated the national microdata before sending them to Eurostat.

    Quality assessment

    The quality management system certified in accordance with ISO 9001:2015,  application of the uniform methodological documents, rules and procedures at all stages of the study ensure high quality of the data.

    Relevance
    User needs

    The produced information answers to needs as for the management of health care systems, as well as in science. In framework of these needs, EHIS questions are aimed at meeting the basic needs of information at EU level, as they do not cover all detailed aspects of health, which can better be carried out via specific surveys at national level.

    User satisfaction

    Not applicable.

    Completeness

    Persons aged 15 and over living in private households are covered. Persons up to 14 years of age as well as those living in institutionalized households, as residencies for students or workers, medical or social institutions, prisons are generally excluded from the target population.

    Accuracy and reliability
    Overall accuracy

    EHIS wave 2

    The minimum effective sample size as is set out in Annex II of the Commission Regulation (EU) No 141/2013 is achieved. The proxy interview rate is 11.1%. 

    EHIS wave 3

    The precision requirements set out in the Annex II of the Commission Regulation (EU) No 2018/255 are achieved.

    The proxy interview rate is 4.1%.

    Sampling error

    The standard error for 3 indicators was calculated.

    • Relative share of respondents in good or very good health;
    • Relative share of respondents with a longstanding illness or health problem;
    • Relative share of respondents that were severely limited in activities people usually do because of health problems for at least the past 6 months.

    Imputation techniques of missing values are not applied.

    Non-sampling error

    Coverage errors:

    A two stage stratified cluster sample on national and regional level is used. The sample is stratified by using the administrative regions in the country and persons' place of residence (town, village). As a result of the stratification 56 strata are designed. At the first stage clusters are selected with a probability proportional to their size, separately for 28 districts and for urban and village population. At the second stage, through a systematic selection households are identified. All persons aged 15 and over in selected households were interviewed. The survey applies the principle of the voluntary participation. A substitution is not allowed.

    EHIS wave 1

    By face to face interview (PAPI) 5 661 persons from 8 393 are interviewed. The response rate is 73.8%.

    EHIS wave 2

    By face to face interview (PAPI) 6 410 persons from 8 839 are interviewed. The response rate is 72.5%.

    EHIS wave 3

    By face to face interview (PAPI) 7 540 from 10 322 eligible persons are interviewed. The response rate is 73.0%.

     

    In order to provide maximum opportunities for  analysing the data additional information is available:

    • Original sample size (Eligible + Not eligible)
    • Interviewed respondents - fully or partially completed questionnaire;
    • Non-interviewed respondents - respondent was not found, refusal;
    • Not eligible - deceased, does not live at the address, non-existent address / building / dwelling.
    Timeliness and punctuality
    Timeliness

    T+11 months (preliminary data)

    Final data will be disseminated following the validation procedure.

    Punctuality

    Micro-data are provided to Eurostat according to the European legislation.

    The data for publishing statistical data is shown in the Release Calendar presenting the results of the statistical surveys carried out by the National Statistical Institute.

     

    Coherence and comparability
    Comparability - geographical

    Due to sample type of the survey, the data are representative at district level only for part of indicators.

    International comparison - EHIS aims at achieving an input standardisation (questions, answers, filters, etc.) through conceptual translation into all EU languages. Each of the questions and response categories are accompanied by a detailed description, so that their meaning is identical in all Member States. Should be taken into account that not all countries have fully implemented the questionnaire or some questions were modified.

    Comparability - over time

    Due to changing the EHIS questionnaire, some of the questions and indicators are partly or not comparable.

    Coherence - cross domain

    Not applicable.

    Coherence - internal

    Not applicable.

    Cost and burden

    Not applicable.

    Data revision
    Data revision - policy

    Not applicable.

    Data revision - practice

    Not applicable.

    Statistical processing
    Source data

    EHIS wave2

    Sampling frame

    The Census 2011 DataBase is used. The sampling frame is updated annualy based on current demographic statistics as of 31.12. 2014 data are used.

    Survey population

     

    A) Total coverage

     6204002

    B) Estimate (in %) of the resulting percentage of under-coverage (a proportion of units not accessible via the sampling frame that belong to the target population)

     0.5%

    C) Estimate (in %) of the resulting percentage of over-coverage (a proportion of units accessible via the sampling frame that do not belong to the target population)

     0.0%

    D) Population groups that may be excluded even though they belong to sampling frame (e.g. people with hearing problems in case of CATI)

     None.

    E) Non-target population -
         population (number of individuals) younger than 15 years 

     998 196 (as of 31.12.2014)

    Sampling design

    A two stage stratified cluster sample on national and regional level is used. The sample is stratified by using the administrative regions in the country and persons' place of residence (town, village). As a result of the stratification 56 strata are designed. At the first stage clusters are selected with a probability proportional to their size, separately for 28 districts and for urban and village population. At the second stage, through a systematic selection 6 households are identified. All persons aged 15 and over in selected households were interviewed.

     

    Summary table on participation and non-participation

    Number of households

    Number of individuals

    1

    Total released sample cases

    The number of sampling units initially selected from the sampling frame.

    ►   [1] = [2] + [3] + [6]

     4505

    9720 

    2

    Ineligible sample cases / out-of-scope units

    381 

    881 

    2.1

    Non-existent units

    (house/building not existing, no one living in the building/on the address)

    8 

    20 

    2.2

    Changes in status

    373 

    861 

    2.3

    Out of target units

    - 

    - 

    2.4

    Other ineligible

    - 

    - 

    3

    Eligible sample cases / in-scope units

    The unit belongs to the population of interest for the survey (both non-response and response cases).

    ►   [3] = [4] + [5]

    4124 

    8839 

    4

    Non-response cases / Non-participation

    1014

    2429 

    4.1

    Non-contact

    614 

    1376 

    4.2

    Refusal

    392 

    1043 

    4.3

    Inability to respond

    e.g. selected household or individual was unable to participate due to language barriers or cognitive or physical incapacity to respond (and no proxy interview was conducted).

    8 

    10 

    4.4

    Rejected interviews

    e.g. the selected household/individual did take part but the survey form cannot be used (poor quality - e.g. strong inconsistencies; unacceptable item-response – e.g. individual left most of the questions unanswered; survey form got lost and interview cannot be repeated; etc.).

    - 

    - 

    4.5

    Other non-response

    - 

    - 

    5

    Response cases / Participation

    3110 

    6410 

    5.1

    A fully completed interview

    All relevant questions answered by the respondent or by a proxy interview.

    (a) Variables not recommended to be completed by proxy respondents if the interview was conducted with a proxy respondent and (b) variables for which derogations were granted, are not taken into account when evaluating completeness.

    3110 

    6410 

    5.2

    A partly completed interview

    Not all relevant but at least some technical variables (PID, HHID, PRIMSTRAT, PSU, WGT, PROXY, REFYEAR, REFMONTH, INTMETHOD), sex and age and at least 50 % of all other variables (to be answered and) answered by the respondent or by a proxy interview.

    0 

    0 

    6

    Unknown eligibility

     -

    - 

     

    Number and structure of target and response population

    Target population

    Response

    Number

    %

    Number

    %

    Total

    6204002

    100.0 

    6410

    100.0

    Women

     3215275

    51.8 

     3344

    52.2

    Men

    2988727

    48.2 

     3066

    47.8

    Age (women)

     3215275

    100.0 

    3344

    100.0

    15-24

     348193

    10.8 

     285

    8.5

    25-34

     469599

    14.6 

     358

    10.7

    35-44

     520600

    16.2 

     514

    15.4

    45-54

    487664

    15.2 

     499

    14.9

    55-64

     531726

    16.5 

     620

    18.5

    65-74

     474797

    14.8 

     631

    18.9

    75-84

    300277

    9.3 

     342

    10.2

    85+

     82419

    2.6 

     95

    2.8

    Age (men)

     2988727

    100.0 

     3066

    100.0

    15-24

    370080

    12.4 

     364

    11.9

    25-34

     505290

    16.9 

     439

    14.3

    35-44

     554442

    18.6 

     487

    15.9

    45-54

     497724

    16.7 

     515

    16.8

    55-64

     478355

    16.0 

     553

    18.0

    65-74

     356601

    11.9 

     451

    14.7

    75-84

     183921

    6.2 

     213

    6.9

    85+

     42314

    1.4 

     44

    1.4

    Educational attainment level (ISCED 2011)

    6216600

    100.0 

     6409

    100.0

    ISCED 0-2

     1752900

    28.2 

    2194

    34.2

    ISCED 3-4

     3108900

    50.0 

     3016

    47.1

    ISCED 5-8

     1354800

    21.8 

     1199

    18.7

    Current labour status (self-declared)

     6216600

    100.0 

     6406

    100.0

    Employed

     2963100

    47.7 

     2636

    41.1

    Unemployed

     627900

    10.1 

     934

    14.6

    Retired

     1619700

    26.1 

     2066

    32.3

    Students

     462000

    7.4 

     408

    6.4

    Other inactive

     543900

    8.7 

     362

    5.7

    Data source on Target population by sex and age is Current demographic statistics as of 31.12.2014.

    Data source on Target population by Educational attainment level (ISCED 2011) and Current labour status (self-declared) is LFS 2014.

    EHIS wave3

    Sampling frame

    Population Census 2011 data base updated with deaths and births (annually) was used as sampling frame. In the list the information for households and household’s members is eligible. The list is updated annually based on current demographic statistics data as of 31 December.

     

     

    Survey population

     

    A) Total coverage

    5949224

    B) Estimate (in %) of the resulting percentage of under-coverage (a proportion of units not accessible via the sampling frame that belong to the target population)

    0.8%

    C) Estimate (in %) of the resulting percentage of over-coverage (a proportion of units accessible via the sampling frame that do not belong to the target population)

    0.0%

    D) Population groups that may be excluded even though they belong to sampling frame (e.g. people with hearing problems in case of CATI)

    None

    E) Non-target population -
         population (number of individuals) younger than 15 years 

    1.002 mln. (incl. living in institutions), data as of 31.12.2019

     

    Sampling design

    The sample was stratified by administrative-territorial districts in the country (NUTS3 level) and the household’s location. As a result 56 strata were formed (28 of urban and 28 of rural population).

    Taking into account the precision requirements laid down in the european legislation in the field, design effect and the planned response rate 11 629 persons aged 15 and over were initialy selected for the EHIS wave 3.

     

    The clusters on the first stage are chosen with probability proportional to population size (number of households) in the SUs. Systematic sampling of the secondary units (households) selected in each primary unit is applied. Each SU contains the same size - 8 households. All individuals aged 15 and over are selected in each sampled household.

     

     

     

    Summary table on participation and non-participation

    Number of households

    Number of individuals

    1

    Total released sample cases

    The number of sampling units initially selected from the sampling frame.

    ►   [1] = [2] + [3] + [6]

    5024

    11629

    2

    Ineligible sample cases / out-of-scope units

    565

    1307

    2.1

    Non-existent units

    (house/building not existing, no one living in the building/on the address)

    34

    75

    2.2

    Changes in status

    531

    1232

    2.3

    Out of target units

    -

    -

    2.4

    Other ineligible

    -

    -

    3

    Eligible sample cases / in-scope units

    The unit belongs to the population of interest for the survey (both non-response and response cases).

    ►   [3] = [4] + [5]

    4459

    10322

    4

    Non-response cases / Non-participation

    817

    2782

    4.1

    Non-contact

    510

    1736

    4.2

    Refusal

    304

    1035

    4.3

    Inability to respond

    e.g. selected household or individual was unable to participate due to language barriers or cognitive or physical incapacity to respond (and no proxy interview was conducted).

    3

    11

    4.4

    Rejected interviews

    e.g. the selected household/individual did take part but the survey form cannot be used (poor quality - e.g. strong inconsistencies; unacceptable item-response – e.g. individual left most of the questions unanswered; survey form got lost and interview cannot be repeated; etc.).

    -

    -

    4.5

    Other non-response

    -

    -

    5

    Response cases / Participation

    3642

    7540

    5.1

    A fully completed interview

    All relevant questions answered by the respondent or by a proxy interview.

    (a) Variables not recommended to be completed by proxy respondents if the interview was conducted with a proxy respondent and (b) variables for which derogations were granted, are not taken into account when evaluating completeness.

    3642

    7540

    5.2

    A partly completed interview

    Not all relevant but at least some technical variables (PID, HHID, PRIMSTRAT, PSU, WGT, PROXY, REFYEAR, REFMONTH, INTMETHOD), sex and age and at least 50 % of all other variables (to be answered and) answered by the respondent or by a proxy interview.

    0

    0

    6

    Unknown eligibility

    -

    -

     

    Number and structure of target and response population

    Target population

    Response

    Number

    %

    Number

    %

    Total

    5949224

    100.0

    7540

    100.0

    Women

    3094728

    52.0

    3477

    46.1

    Men

    2854496

    48.0

    4063

    53.9

    Age groups

    5949224

    100.0

    7540

    100.0

    15-24

    614613

    10.3

    682

    9.0

    25-34

    867066

    14.6

    746

    9.9

    35-44

    1012773

    17.0

    1041

    13.8

    45-54

    1002093

    16.8

    1284

    17.0

    55-64

    948591

    15.9

    1280

    17.0

    65-74

    881907

    14.8

    1394

    18.5

    75-84

    476431

    8.0

    849

    11.3

    85+

    145750

    2.4

    264

    3.5

    Educational attainment level (ISCED 2011)

    5966300

    100

    7540

    100

    ISCED 0-2

    1539400

    25.8

    2074

    27.5

    ISCED 3-4

    3066400

    51.4

    3857

    51.2

    ISCED 5-8

    1360500

    22.8

    1609

    21.3

    Current labour status (self-declared)

    5966300

    100.0

    7540

    100.0

    Employed

    3223000

    54.0

    3405

    45.2

    Unemployed

    237300

    4.0

    649

    8.6

    Retired

    1558800

    26.1

    2695

    35.7

    Unable to work due to longstanding health problem

    157300

    2.6

    185

    2.5

    Student, pupil

    428500

    7.2

    437

    5.8

    Fulfilling domestic tasks

    214600

    3.6

    152

    2.0

    Other

    146800

    2.5

    17

    0.2

    Household size (number of persons living in household)

    5995495

    100.0

    7540

    100.0

    1

    1004030

    16.7

    1228

    16.3

    2

    1554001

    25.9

    2286

    30.3

    3

    1288246

    21.5

    1536

    20.4

    4

    1267447

    21.1

    1247

    16.5

    5 and more

    881771

    14.7

    1243

    16.5


    Data source on Target population is as follow:

    - by sex and age and by degree of urbanisation - Current demographic statistics as of 31.12.2019;

    - by Educational attainment level (ISCED 2011) and Labour status - LFS 2019;

    - by Household size – SILC 2019.

     

    Frequency of data collection

    According to the European legislation - every 5 years.

    Data collection

    A face to face PAPI interview and self-administered part.

     

    Interviewers

    All interviewers are internal staff with experience in health/social surveys.

    Ratio interviews / interviewers – 53 (2014); 75 (2019)

     

    Interviewer training method and support 

    The training of trainers is conducted (representatives from Departments "Statistical Surveys" at the Regional Statistical Offices). They are experienced in conducting the household’s surveys. Some of them participated in the previous EHIS waves .

    The training programme included:

    • Aims and tasks of the survey. Background and explanation of the rationale of the EHIS;
    • General presentation as well as presentation in details of the survey modules. General concept of the questions, definitions, use of classifications, use of proxy interview, self-completion forms;
    • Work in groups with different examples, which described the difficulties and specific features of the instrument cases that may occur. Discussion of the results and the interviewer’s opinions. How to respond to Frequently Asked Questions;
    • Presentation and detailed discussion of the content of the template for interviewers notes, which are to be filled in by each interviewer after conducting the interview;
    • Organization of the survey.

    As a part of the training, the interviewers were provided with the detailed guideline manual for the fieldwork, containing all aspects necessary to execute the survey correctly, the questionnaire and the Self-completion forms as well as the Notes for the interviewers.

     

    Quality control during the fieldwork

    Method used for the prenotification or first contact of respondents - letter.

    Use of incentives - no.

    Theoretical minimal number of contacts with a respondent before declaring a nonparticipation (i.e. the number of attempts that an interviewer is asked to do for interviewing a respondent) - up to two visits for distant clusters and up to 4 visits in close clusters from the RSO location.

    Interview duration for the EHIS questions:

    EHIS wave 2

    • Average: 30 minutes 
    • Minimum: 5 minutes 
    • Maximum: 65 minutes        

    EHIS wave 3

    • Average: 32 minutes 
    • Minimum: 10 minutes 
    • Maximum: 75 minutes 

    Techniques used to control interviewer performance – There is a supervisor in each Department “Statistical Surveys” at RSO. A review of questionnaires and Interviewers’ notes was carried out by the supervisors in order to check whether the questionnaires were correctly filled in. Individual contacts were regularly established. Weekly reports on survey participations was provided in NSI by supervisors.

     

    Ratio interviewers / field supervisors - 4.

    Were (some of) the respondents contacted for quality control? - No.

    Were additional studies performed in relation to the nonparticipation? - No.

     

    Additional IT application for fieldwork monitoring was elaborated as well. The application allows referring for the visited, contacted and non-contacted households and persons in real time. Information on non-surveyed households and individuals as well as for the reasons for that was collected. The available information makes it possible to monitor the response rate and field work in general at the regional and national level.

     

    Questionnaire

    Development of the questionnaire

    The survey was carried out in Bulgarian lenguage. The translation protocol proposed by Eurostat is used.

    Were the modules pre-tested? EHIS wave 1 questionnaire was tested, EHIS wave 2 and 3 - no. 

    Design of the questionnaire

    The recommended order of modules and sub-modules is followed.

    Modified EHIS questions in comparison with the model questionnaire and conceptual guidelines - AC2, PL6, HO1, AM7, PA1, AL1, AL6. All questions are modified in accordance with the Eurostat Methodological manual - "European Health Interview Survey (EHIS wave 2)" requirements.   

    The content of alcohol in the “national standard” drink (in grams) used in AL sub-module = 14 g.

    Data validation

    EHIS wave 1

    The data are validated by Eurostat. Common rules for checking and consistency checks are applied.

    EHIS wave 2

    The proposed by Eurostat harmonized instrumentarium according to the "EHIS wave 2 Methodological manual" is used. Conceptual guidelines and translation protocol is also applied. Common rules for checking and consistency checks in accordance with the requirements of the Commission Regulation (EU) No 141/2013 implementing Regulation (EC) No 1338/2008 are applied. Proposed by Eurostat EDIT validation tool is used before sending the microdata file. 

    EHIS wave 3

    The proposed by Eurostat harmonized instrumentarium according to the „European Health Interview Survey Manual“ is used. Conceptual guidelines and translation protocol is also applied. Common rules for checking and consistency checks in accordance with the requirements of the Commission Regulation (EU) No 255/2018 implementing Regulation (EC) No 1338/2008 are applied. Proposed by Eurostat validation tool is used before sending the microdata file. 

    Data compilation

    Data checking, cleaning and editing is done in accordance with the EHIS Methodological manual, EHIS Validation rules as well as EHIS Data delivery guidelines. 

    Imputation, adjustment for non-response and calibration is not applied (EHIS wave 2).

    EHIS wave 3 – calibration is used.

    The current demographic data for the total population is used for weighting.

    Adjustment

    EHIS wave 2

    The current demographic data as of 31 December 2014 for the total population is used for weighting.

    Information on the variability of final weights

    average divided by minimum = 2.71
    maximum divided by average = 2.55
    coefficient of variation = 0.32

     

    EHIS wave 3

    The procedure for weighting was applied in three steps as follows:

    • Calculation of sample’s weights, which represent the inverse of inclusion probabilities of the sample units. All sampling units receive these sampling weights;
    • Non-response adjustment - the sample weights were adjusted with the survey’s results by the coefficient of responsibility;
    • Calibration - data on population as of 31.12.2019 from Information System ‘Demography’ was used. Following categories were used for calibration.

     

    Following categories were used for calibration:

     

    • Population by administrative-territorial districts in the country (NUTS3 level) and the household’s location (56 groups - 28 of urban and 28 of rural areas);
    • Population by the household’s location and sex (112 groups – 56 groups of men by urban and rural areas and 56 groups of women by urban and rural areas);
    • Population by age groups and sex – men and women divided into 13 age groups: 15-19, 20-24, 25-29, 30-34, 35-39, 40-44, 45-49, 50-54, 55-59, 60-64, 65-69, 70-74, 75+ (26 groups).
    Comment
    Download in SDMX 2.1 file format: European health interview survey
    Metadata Structure Definition in SDMX 2.1: ESMS_MSD+BNSI+2.0+SDMX.2.1.xml
    Download in SDMX 2.0 file format: European health interview survey
    Metadata Structure Definition in SDMX 2.0: ESMS_MSD+BNSI+2.0+SDMX.2.0.xml
  • Quality reports
    

    ESS Standard for Quality Reports Structure (ESQRS)

    European health interview survey
    Contact
    Contact organisation

    National Statistical Institute

    Contact organisation unit

    "Health and Justice Statistics" Department

    Contact name

    Evelin Yordanova

    Contact person function

    Head of department

    Contact mail address

    2, P. Volov Str.; 1038 Sofia, Bulgaria

    Contact email address

    [email protected]

    Contact phone number

    +359 2 9857 459

    Contact fax number
    Statistical presentation
    Data description

    The survey is a part of the European Health Survey System in the framework of the European Statistical System. The EHIS aims at measuring on a harmonised basis and with a high degree of comparability among EU Member States, the health status, life style (health determinants) and health care services use of the EU citizens.

    EHIS wave 1

    The survey was carried out by NSI based on harmonized instruments in 2008. The questionnaire for the first round of the EHIS (2007 - 2008) was adopted on 22 November 2006 by the Eurostat Working Group on Public Health Statistics.

    The topics included in the questionnaire are developed in order to meet main needs as for the management of health care systems, as well as in science. Within these needs, EHIS questions are aimed at meeting the basic needs of information at EU level. They do not cover all detailed aspects of health which can better be carried out via specific surveys at national level.

    The questionnaire consists of four modules.

    • Health status;
    • Health care;
    • Health determinants (life style);
    • Background module.

    In addition, in order to meet the information needs of the European Commission`s DGs "Health and Consumers" (SANCO) and "Employment, Social Affairs and Inclusion (EMPL), 26 indicators which cover the three topics - Health status, Health care and Health determinants are calculated. Indicators are calculated using respondent`s answers during the interview. No documents are required, proving the correctness of answers and no measurements are done. All the indicators are calculated for the population aged 15 and over, except in case a specific age is indicated.

    EHIS wave 2

    In 2014 BNSI participated in the EHIS wave 2 in accordance with the Commission Regulation (EU) No 141/2013 implementing Regulation (EC) No 1338/2008 requrements. The survey was carried out by using the harmonized questionnaire proposed by Eurostat.

    EHIS wave 3

    In 2019 all Member States participated in the EHIS wave 3 in accordance with the Commission Regulation (EU) No. 2018/255 as the BNSI carried out the survey in the period October 2019 - January 2020.

    The questionnaire consists of the same four modules  for all the EHIS waves. In order to reduce the responce burden and to satisfy the specific users’ needs the questionnaire is  changed.

     

    EHIS includes the following topics:

    Health status
    This topic includes different dimensions of health status and health-related activity limitations:

    • General health status (Minimum European health module): self-perceived health, chronic morbidity and activity limitation
    • Disease-specific morbidity
    • Accidents and injuries
    • Health-related absenteeism from work
    • Physical and sensory functional limitations
    • Difficulties in personal care activities / activities of daily living (such as eating and washing) and help received/needed
    • Household activities / Instrumental activities of daily living (such as preparing meals and shopping) and help received/needed
    • Pain
    • Aspect of mental health (psychological distress and mental well-being in the first wave, depressive symptoms in the second wave).

    Health care

    • Hospitalisation (in-patient and day care)
    • Consultations with doctors and dentists
    • Visits to specific health professionals (such as physiotherapists or psychologists)
    • Use of home care and home help services
    • Use of medicines (prescribed and non-prescribed)
    • Healthcare preventive actions (such as influenza vaccination, breast examination, cervical smear test and blood tests)
    • Unmet needs for health care.

    Health determinants

    • Height and weight
    • Physical activity
    • Consumption of fruits, vegetables and juice
    • Smoking behaviour and exposure to tobacco smoke
    • Alcohol consumption
    • Social support.

    Background variables on demography and socio-economic status.

    Classification system

    EHIS - wave 1

    • National Classification of Occupations and Duties-2005 (NCOD-2005) - consistent with the International Standard Classification of Occupations ISCO-88 (COM);
    • Classification of Economic Activities (CEA-2008, for international use NACE.BG -2008) - consistent with the European classification NACE Rev. 2;
    • Classification of Territorial Units for Statistical Purposes in Bulgaria (NUTS);
    • International Standard Classification of Education, 1997 revision (ISCED 1997).

    EHIS - wave 2 and 3

    • National Classification of Occupations and Duties-2011 - consistent with the International Standard Classification of Occupations ISCO-08;
    • Classification of Economic Activities (CEA-2008, for international use NACE.BG -2008) - consistent with the European classification NACE Rev. 2;
    • Classification of Territorial Units for Statistical Purposes in Bulgaria (NUTS);
    • International Standard Classification of Education, 2011 revision (ISCED 2011).
    Sector coverage

    All persons aged 15 and over living within the selected non-institutionalised households are covered.

    In accordance with the EHIS methodology people living in institutionalized households as residencies for students or workers, medical or social institutions, prisons are excluded from the target population.

    Statistical concepts and definitions

    Diseases - self-reported prevalence:

    EHIS - wave 1

    Percentage of persons reporting:

    • to have the selected disease,
    • the disease was diagnosed by a medical doctor,
    • the disease occurred during the past 12 months.

    The indicator is calculated for five diseases: diabetes, chronic depression, chronic bronchitis, chronic obstructive pulmonary disease, emphysema, asthma, incl. allergic and high blood pressure (hypertensive diseases).

    EHIS - wave 2

    Proportion of the population reporting a chronic condition in the past 12 months. Statistics on 15 diseases or chronic conditions are presented:

    A. Asthma (allergic asthma included)

    B. Chronic bronchitis, chronic obstructive pulmonary disease, emphysema

    C. Myocardial infarction (heart attack) or chronic consequences of myocardial infarction

    D. Coronary heart disease or angina pectoris

    E. High blood pressure (hypertension)

    F. Stroke (cerebral haemorrhage, cerebral thrombosis) or chronic consequences of stroke

    G. Arthrosis (arthritis excluded)

    H. Low back disorder or other chronic back defect

    I. Neck disorder or other chronic neck defect

    J. Diabetes

    K. Allergy, such as rhinitis, hay fever, eye inflammation, dermatitis, food allergy or other allergy (allergic asthma excluded)

    L. Cirrhosis of the liver

    M. Urinary incontinence, problems in controlling the bladder

    N. Kidney problems

    O. Depression

    Injury by accident - at home, school or leisure accident, road traffic accident. Percentage of persons reporting to have had an accident during the past 12 months, which resulted in injury.

    Self-reported visits to general practitioner, dentist or orthodontist, medical specialist - Percentage of persons having consulted a doctor during the last 4 weeks.

    Medicine use

    EHIS - wave 1

    Percentage of persons reporting to take medication prescribed by a physician for a specific disease during the past 2 weeks for diabetes; chronic depression; chronic bronchitis, chronic obstructive pulmonary disease, emphysema; asthma, incl. allergic and high blood pressure.

    EHIS - wave 2

    Self-reported use of prescribed and non-prescribed medicines: Proportion of the population who used medicines prescribed and non-prescribed by a doctor in the past 2 weeks.

     

    Breast cancer screening - Percentage of women aged 50-69 years, who have undergone a mammography.

    Cervical cancer screening - Percentage of women aged 20-69 years, reporting to have undergone a cervical cancer screening test.

     

    Body Mass Index (BMI): Percentage of persons aged 18 and over with specific BMI. The indicator is calculated as ratio of weight (kg) and the square of height (m) - kg/m2. The following subdivision is used:

    • underweight (less than 18.5 kg/m2)
    • normal weight (between 18.5 and less than 24.99 kg/m2 )
    • overweight (between 25.00 and less than 29.99 kg/m2)
    • obese (equal or greater than 30.00 kg/m2)

     

    Daily cigarettes smokers: Percentage of persons reporting to smoke cigarettes (manufactured and hand-rolled) daily. 

    Hazardous alcohol consumption (EHIS - wave 1) - Percentage of persons who drink 6 and more alcohol drinks for one occasion, during the past 12 months, by frequency of use.

    Statistical unit

    Persons aged 15 and over living in non-institutionalised households.

    Statistical population

    All persons aged 15 and over living in non-institutionalised households are covered.

    In accordance with the EHIS methodology people that live in institutionalised households as residencies for students or workers, medical or social institutions, prisons are excluded from the target population.

    Reference area

    The territory of the Republic of Bulgaria.

    Time coverage

    EHIS wave 1 - 2008

    EHIS wave 2 - 2014

    EHIS wave 3 - 2019

    Base period

    Not applicable.

    Statistical processing
    Source data

    EHIS wave2

    Sampling frame

    The Census 2011 DataBase is used. The sampling frame is updated annualy based on current demographic statistics as of 31.12. 2014 data are used.

    Survey population

     

    A) Total coverage

     6204002

    B) Estimate (in %) of the resulting percentage of under-coverage (a proportion of units not accessible via the sampling frame that belong to the target population)

     0.5%

    C) Estimate (in %) of the resulting percentage of over-coverage (a proportion of units accessible via the sampling frame that do not belong to the target population)

     0.0%

    D) Population groups that may be excluded even though they belong to sampling frame (e.g. people with hearing problems in case of CATI)

     None.

    E) Non-target population -
         population (number of individuals) younger than 15 years 

     998 196 (as of 31.12.2014)

    Sampling design

    A two stage stratified cluster sample on national and regional level is used. The sample is stratified by using the administrative regions in the country and persons' place of residence (town, village). As a result of the stratification 56 strata are designed. At the first stage clusters are selected with a probability proportional to their size, separately for 28 districts and for urban and village population. At the second stage, through a systematic selection 6 households are identified. All persons aged 15 and over in selected households were interviewed.

     

    Summary table on participation and non-participation

    Number of households

    Number of individuals

    1

    Total released sample cases

    The number of sampling units initially selected from the sampling frame.

    ►   [1] = [2] + [3] + [6]

     4505

    9720 

    2

    Ineligible sample cases / out-of-scope units

    381 

    881 

    2.1

    Non-existent units

    (house/building not existing, no one living in the building/on the address)

    8 

    20 

    2.2

    Changes in status

    373 

    861 

    2.3

    Out of target units

    - 

    - 

    2.4

    Other ineligible

    - 

    - 

    3

    Eligible sample cases / in-scope units

    The unit belongs to the population of interest for the survey (both non-response and response cases).

    ►   [3] = [4] + [5]

    4124 

    8839 

    4

    Non-response cases / Non-participation

    1014

    2429 

    4.1

    Non-contact

    614 

    1376 

    4.2

    Refusal

    392 

    1043 

    4.3

    Inability to respond

    e.g. selected household or individual was unable to participate due to language barriers or cognitive or physical incapacity to respond (and no proxy interview was conducted).

    8 

    10 

    4.4

    Rejected interviews

    e.g. the selected household/individual did take part but the survey form cannot be used (poor quality - e.g. strong inconsistencies; unacceptable item-response – e.g. individual left most of the questions unanswered; survey form got lost and interview cannot be repeated; etc.).

    - 

    - 

    4.5

    Other non-response

    - 

    - 

    5

    Response cases / Participation

    3110 

    6410 

    5.1

    A fully completed interview

    All relevant questions answered by the respondent or by a proxy interview.

    (a) Variables not recommended to be completed by proxy respondents if the interview was conducted with a proxy respondent and (b) variables for which derogations were granted, are not taken into account when evaluating completeness.

    3110 

    6410 

    5.2

    A partly completed interview

    Not all relevant but at least some technical variables (PID, HHID, PRIMSTRAT, PSU, WGT, PROXY, REFYEAR, REFMONTH, INTMETHOD), sex and age and at least 50 % of all other variables (to be answered and) answered by the respondent or by a proxy interview.

    0 

    0 

    6

    Unknown eligibility

     -

    - 

     

    Number and structure of target and response population

    Target population

    Response

    Number

    %

    Number

    %

    Total

    6204002

    100.0 

    6410

    100.0

    Women

     3215275

    51.8 

     3344

    52.2

    Men

    2988727

    48.2 

     3066

    47.8

    Age (women)

     3215275

    100.0 

    3344

    100.0

    15-24

     348193

    10.8 

     285

    8.5

    25-34

     469599

    14.6 

     358

    10.7

    35-44

     520600

    16.2 

     514

    15.4

    45-54

    487664

    15.2 

     499

    14.9

    55-64

     531726

    16.5 

     620

    18.5

    65-74

     474797

    14.8 

     631

    18.9

    75-84

    300277

    9.3 

     342

    10.2

    85+

     82419

    2.6 

     95

    2.8

    Age (men)

     2988727

    100.0 

     3066

    100.0

    15-24

    370080

    12.4 

     364

    11.9

    25-34

     505290

    16.9 

     439

    14.3

    35-44

     554442

    18.6 

     487

    15.9

    45-54

     497724

    16.7 

     515

    16.8

    55-64

     478355

    16.0 

     553

    18.0

    65-74

     356601

    11.9 

     451

    14.7

    75-84

     183921

    6.2 

     213

    6.9

    85+

     42314

    1.4 

     44

    1.4

    Educational attainment level (ISCED 2011)

    6216600

    100.0 

     6409

    100.0

    ISCED 0-2

     1752900

    28.2 

    2194

    34.2

    ISCED 3-4

     3108900

    50.0 

     3016

    47.1

    ISCED 5-8

     1354800

    21.8 

     1199

    18.7

    Current labour status (self-declared)

     6216600

    100.0 

     6406

    100.0

    Employed

     2963100

    47.7 

     2636

    41.1

    Unemployed

     627900

    10.1 

     934

    14.6

    Retired

     1619700

    26.1 

     2066

    32.3

    Students

     462000

    7.4 

     408

    6.4

    Other inactive

     543900

    8.7 

     362

    5.7

    Data source on Target population by sex and age is Current demographic statistics as of 31.12.2014.

    Data source on Target population by Educational attainment level (ISCED 2011) and Current labour status (self-declared) is LFS 2014.

    EHIS wave3

    Sampling frame

    Population Census 2011 data base updated with deaths and births (annually) was used as sampling frame. In the list the information for households and household’s members is eligible. The list is updated annually based on current demographic statistics data as of 31 December.

     

     

    Survey population

     

    A) Total coverage

    5949224

    B) Estimate (in %) of the resulting percentage of under-coverage (a proportion of units not accessible via the sampling frame that belong to the target population)

    0.8%

    C) Estimate (in %) of the resulting percentage of over-coverage (a proportion of units accessible via the sampling frame that do not belong to the target population)

    0.0%

    D) Population groups that may be excluded even though they belong to sampling frame (e.g. people with hearing problems in case of CATI)

    None

    E) Non-target population -
         population (number of individuals) younger than 15 years 

    1.002 mln. (incl. living in institutions), data as of 31.12.2019

     

    Sampling design

    The sample was stratified by administrative-territorial districts in the country (NUTS3 level) and the household’s location. As a result 56 strata were formed (28 of urban and 28 of rural population).

    Taking into account the precision requirements laid down in the european legislation in the field, design effect and the planned response rate 11 629 persons aged 15 and over were initialy selected for the EHIS wave 3.

     

    The clusters on the first stage are chosen with probability proportional to population size (number of households) in the SUs. Systematic sampling of the secondary units (households) selected in each primary unit is applied. Each SU contains the same size - 8 households. All individuals aged 15 and over are selected in each sampled household.

     

     

     

    Summary table on participation and non-participation

    Number of households

    Number of individuals

    1

    Total released sample cases

    The number of sampling units initially selected from the sampling frame.

    ►   [1] = [2] + [3] + [6]

    5024

    11629

    2

    Ineligible sample cases / out-of-scope units

    565

    1307

    2.1

    Non-existent units

    (house/building not existing, no one living in the building/on the address)

    34

    75

    2.2

    Changes in status

    531

    1232

    2.3

    Out of target units

    -

    -

    2.4

    Other ineligible

    -

    -

    3

    Eligible sample cases / in-scope units

    The unit belongs to the population of interest for the survey (both non-response and response cases).

    ►   [3] = [4] + [5]

    4459

    10322

    4

    Non-response cases / Non-participation

    817

    2782

    4.1

    Non-contact

    510

    1736

    4.2

    Refusal

    304

    1035

    4.3

    Inability to respond

    e.g. selected household or individual was unable to participate due to language barriers or cognitive or physical incapacity to respond (and no proxy interview was conducted).

    3

    11

    4.4

    Rejected interviews

    e.g. the selected household/individual did take part but the survey form cannot be used (poor quality - e.g. strong inconsistencies; unacceptable item-response – e.g. individual left most of the questions unanswered; survey form got lost and interview cannot be repeated; etc.).

    -

    -

    4.5

    Other non-response

    -

    -

    5

    Response cases / Participation

    3642

    7540

    5.1

    A fully completed interview

    All relevant questions answered by the respondent or by a proxy interview.

    (a) Variables not recommended to be completed by proxy respondents if the interview was conducted with a proxy respondent and (b) variables for which derogations were granted, are not taken into account when evaluating completeness.

    3642

    7540

    5.2

    A partly completed interview

    Not all relevant but at least some technical variables (PID, HHID, PRIMSTRAT, PSU, WGT, PROXY, REFYEAR, REFMONTH, INTMETHOD), sex and age and at least 50 % of all other variables (to be answered and) answered by the respondent or by a proxy interview.

    0

    0

    6

    Unknown eligibility

    -

    -

     

    Number and structure of target and response population

    Target population

    Response

    Number

    %

    Number

    %

    Total

    5949224

    100.0

    7540

    100.0

    Women

    3094728

    52.0

    3477

    46.1

    Men

    2854496

    48.0

    4063

    53.9

    Age groups

    5949224

    100.0

    7540

    100.0

    15-24

    614613

    10.3

    682

    9.0

    25-34

    867066

    14.6

    746

    9.9

    35-44

    1012773

    17.0

    1041

    13.8

    45-54

    1002093

    16.8

    1284

    17.0

    55-64

    948591

    15.9

    1280

    17.0

    65-74

    881907

    14.8

    1394

    18.5

    75-84

    476431

    8.0

    849

    11.3

    85+

    145750

    2.4

    264

    3.5

    Educational attainment level (ISCED 2011)

    5966300

    100

    7540

    100

    ISCED 0-2

    1539400

    25.8

    2074

    27.5

    ISCED 3-4

    3066400

    51.4

    3857

    51.2

    ISCED 5-8

    1360500

    22.8

    1609

    21.3

    Current labour status (self-declared)

    5966300

    100.0

    7540

    100.0

    Employed

    3223000

    54.0

    3405

    45.2

    Unemployed

    237300

    4.0

    649

    8.6

    Retired

    1558800

    26.1

    2695

    35.7

    Unable to work due to longstanding health problem

    157300

    2.6

    185

    2.5

    Student, pupil

    428500

    7.2

    437

    5.8

    Fulfilling domestic tasks

    214600

    3.6

    152

    2.0

    Other

    146800

    2.5

    17

    0.2

    Household size (number of persons living in household)

    5995495

    100.0

    7540

    100.0

    1

    1004030

    16.7

    1228

    16.3

    2

    1554001

    25.9

    2286

    30.3

    3

    1288246

    21.5

    1536

    20.4

    4

    1267447

    21.1

    1247

    16.5

    5 and more

    881771

    14.7

    1243

    16.5


    Data source on Target population is as follow:

    - by sex and age and by degree of urbanisation - Current demographic statistics as of 31.12.2019;

    - by Educational attainment level (ISCED 2011) and Labour status - LFS 2019;

    - by Household size – SILC 2019.

     

    Frequency of data collection

    According to the European legislation - every 5 years.

    Data collection

    A face to face PAPI interview and self-administered part.

     

    Interviewers

    All interviewers are internal staff with experience in health/social surveys.

    Ratio interviews / interviewers – 53 (2014); 75 (2019)

     

    Interviewer training method and support 

    The training of trainers is conducted (representatives from Departments "Statistical Surveys" at the Regional Statistical Offices). They are experienced in conducting the household’s surveys. Some of them participated in the previous EHIS waves .

    The training programme included:

    • Aims and tasks of the survey. Background and explanation of the rationale of the EHIS;
    • General presentation as well as presentation in details of the survey modules. General concept of the questions, definitions, use of classifications, use of proxy interview, self-completion forms;
    • Work in groups with different examples, which described the difficulties and specific features of the instrument cases that may occur. Discussion of the results and the interviewer’s opinions. How to respond to Frequently Asked Questions;
    • Presentation and detailed discussion of the content of the template for interviewers notes, which are to be filled in by each interviewer after conducting the interview;
    • Organization of the survey.

    As a part of the training, the interviewers were provided with the detailed guideline manual for the fieldwork, containing all aspects necessary to execute the survey correctly, the questionnaire and the Self-completion forms as well as the Notes for the interviewers.

     

    Quality control during the fieldwork

    Method used for the prenotification or first contact of respondents - letter.

    Use of incentives - no.

    Theoretical minimal number of contacts with a respondent before declaring a nonparticipation (i.e. the number of attempts that an interviewer is asked to do for interviewing a respondent) - up to two visits for distant clusters and up to 4 visits in close clusters from the RSO location.

    Interview duration for the EHIS questions:

    EHIS wave 2

    • Average: 30 minutes 
    • Minimum: 5 minutes 
    • Maximum: 65 minutes        

    EHIS wave 3

    • Average: 32 minutes 
    • Minimum: 10 minutes 
    • Maximum: 75 minutes 

    Techniques used to control interviewer performance – There is a supervisor in each Department “Statistical Surveys” at RSO. A review of questionnaires and Interviewers’ notes was carried out by the supervisors in order to check whether the questionnaires were correctly filled in. Individual contacts were regularly established. Weekly reports on survey participations was provided in NSI by supervisors.

     

    Ratio interviewers / field supervisors - 4.

    Were (some of) the respondents contacted for quality control? - No.

    Were additional studies performed in relation to the nonparticipation? - No.

     

    Additional IT application for fieldwork monitoring was elaborated as well. The application allows referring for the visited, contacted and non-contacted households and persons in real time. Information on non-surveyed households and individuals as well as for the reasons for that was collected. The available information makes it possible to monitor the response rate and field work in general at the regional and national level.

     

    Questionnaire

    Development of the questionnaire

    The survey was carried out in Bulgarian lenguage. The translation protocol proposed by Eurostat is used.

    Were the modules pre-tested? EHIS wave 1 questionnaire was tested, EHIS wave 2 and 3 - no. 

    Design of the questionnaire

    The recommended order of modules and sub-modules is followed.

    Modified EHIS questions in comparison with the model questionnaire and conceptual guidelines - AC2, PL6, HO1, AM7, PA1, AL1, AL6. All questions are modified in accordance with the Eurostat Methodological manual - "European Health Interview Survey (EHIS wave 2)" requirements.   

    The content of alcohol in the “national standard” drink (in grams) used in AL sub-module = 14 g.

    Data validation

    EHIS wave 1

    The data are validated by Eurostat. Common rules for checking and consistency checks are applied.

    EHIS wave 2

    The proposed by Eurostat harmonized instrumentarium according to the "EHIS wave 2 Methodological manual" is used. Conceptual guidelines and translation protocol is also applied. Common rules for checking and consistency checks in accordance with the requirements of the Commission Regulation (EU) No 141/2013 implementing Regulation (EC) No 1338/2008 are applied. Proposed by Eurostat EDIT validation tool is used before sending the microdata file. 

    EHIS wave 3

    The proposed by Eurostat harmonized instrumentarium according to the „European Health Interview Survey Manual“ is used. Conceptual guidelines and translation protocol is also applied. Common rules for checking and consistency checks in accordance with the requirements of the Commission Regulation (EU) No 255/2018 implementing Regulation (EC) No 1338/2008 are applied. Proposed by Eurostat validation tool is used before sending the microdata file. 

    Data compilation

    Data checking, cleaning and editing is done in accordance with the EHIS Methodological manual, EHIS Validation rules as well as EHIS Data delivery guidelines. 

    Imputation, adjustment for non-response and calibration is not applied (EHIS wave 2).

    EHIS wave 3 – calibration is used.

    The current demographic data for the total population is used for weighting.

    Adjustment

    EHIS wave 2

    The current demographic data as of 31 December 2014 for the total population is used for weighting.

    Information on the variability of final weights

    average divided by minimum = 2.71
    maximum divided by average = 2.55
    coefficient of variation = 0.32

     

    EHIS wave 3

    The procedure for weighting was applied in three steps as follows:

    • Calculation of sample’s weights, which represent the inverse of inclusion probabilities of the sample units. All sampling units receive these sampling weights;
    • Non-response adjustment - the sample weights were adjusted with the survey’s results by the coefficient of responsibility;
    • Calibration - data on population as of 31.12.2019 from Information System ‘Demography’ was used. Following categories were used for calibration.

     

    Following categories were used for calibration:

     

    • Population by administrative-territorial districts in the country (NUTS3 level) and the household’s location (56 groups - 28 of urban and 28 of rural areas);
    • Population by the household’s location and sex (112 groups – 56 groups of men by urban and rural areas and 56 groups of women by urban and rural areas);
    • Population by age groups and sex – men and women divided into 13 age groups: 15-19, 20-24, 25-29, 30-34, 35-39, 40-44, 45-49, 50-54, 55-59, 60-64, 65-69, 70-74, 75+ (26 groups).
    Quality management
    Quality assurance

    There is a quality management system in the BNSI in accordance with the requirements of ISO 9001:2015. Since 2019, an extended scope of the system has been approved, including receiving, data collection, processing, storing, analyzing, providing and dissemination of statistical information.

    According to the Regulation 1338/2008 on Community statistics on public health and health and safety at work EHIS is to be conducted every five years. EHIS wave 2 and 3 were conducted according to the European legislation.

    EHIS aims at achieving an input standardisation. A model questionnaire (questions, answer categories, filters, etc.) as well as conceptual guidelines and rationales were prepared. Conceptual translation into all EU languages was requested. By using the Methodological manual 'European Health Interview Survey ' the harmonizad questionnaire a standard translation protocol as well as Conceptual translation cards and guidelines were applied.

    National data entry tool is elaborated according to the Validation rules and Data delivery guidelines proposed by Eurostat. Data validation tool is used in order to prevalidated the national microdata before sending them to Eurostat.

    Quality assessment

    The quality management system certified in accordance with ISO 9001:2015,  application of the uniform methodological documents, rules and procedures at all stages of the study ensure high quality of the data.

    Relevance
    User needs

    The produced information answers to needs as for the management of health care systems, as well as in science. In framework of these needs, EHIS questions are aimed at meeting the basic needs of information at EU level, as they do not cover all detailed aspects of health, which can better be carried out via specific surveys at national level.

    User satisfaction

    Not applicable.

    Completeness

    Persons aged 15 and over living in private households are covered. Persons up to 14 years of age as well as those living in institutionalized households, as residencies for students or workers, medical or social institutions, prisons are generally excluded from the target population.

    Data completeness - rate

    Not applicable.

    Accuracy and reliability
    Overall accuracy

    EHIS wave 2

    The minimum effective sample size as is set out in Annex II of the Commission Regulation (EU) No 141/2013 is achieved. The proxy interview rate is 11.1%. 

    EHIS wave 3

    The precision requirements set out in the Annex II of the Commission Regulation (EU) No 2018/255 are achieved.

    The proxy interview rate is 4.1%.

    Sampling error

    The standard error for 3 indicators was calculated.

    • Relative share of respondents in good or very good health;
    • Relative share of respondents with a longstanding illness or health problem;
    • Relative share of respondents that were severely limited in activities people usually do because of health problems for at least the past 6 months.

    Imputation techniques of missing values are not applied.

    Sampling errors - indicators

    EHIS wave 2

    Standard errors of key indicators

    Indicator/sub-indicator (variable(s) from which the indicator is derived)

    Number of respondents - n (unweighted)

    Estimated proportion - p (weighted)

    Standard error - SE

    Confidence interval

    95% lower limit,

    in %

    95% upper limit, 

    in %

    Respondents aged 15 years or over in good or very good health (HS1)

    Total

    3568

    66.6

    0.8

    65.1

    68.2

    Male

    1760

    70.2

    0.9

    68.4

    72.1

    Female

    1808

    63.5

    1.0

    61.5

    65.5

    Respondents aged 15 years or over with a longstanding illness or health problem (HS2)

    Total

    3110

    44.6

    0.8

    42.8

    46.3

    Male

    1337

    40.3

    0.4

    38.2

    42.3

    Female

    1773

    48.5

    1.0

    46.4

    50.5

    Respondents aged 15 years or over that were severely limited in activities people usually do because of health problems for at least the past 6 months (HS3)

    Total

    466

    6.4

    0.3

    5.7

    7.1

    Male

    194

    5.9

    0.4

    4.9

    6.8

    Female

    272

    7.0

    0.4

    6.1

    7.8

    Respondents aged 15 years or over declaring having been hospitalized in the past 12 months (HO1) (men and women)

    701

    10.0

    0.4

    9.1

    10.7

    Respondents aged 18 years or over who are obese (BMI>=30, where BMI = BM2 in kg/(BM1 in m* BM1 in m) (men and women)

    836

    14.8

    0.6

    13.6

    15.9

     

     

    EHIS wave 3

    Indicator/ sub-indicator (variable(s) from which the indicator is derived)

    Number of respondents - n
    (unweighted)

    Estimated proportion - p 
    (weighted)

    Standard error - SE
     

    95% confidence interval:

    lower | upper border

    Design effect deff
     

    Respondents aged 15+ in good or very good health (HS1)

    All

    4587

    69.9

    0.7

    68.6 | 71.4

    1.748

    Women

    2383

    67.2

    0.4

    65.5 | 68.8

    1.213

    Men

    2204

    73.1

    0.9

    71.4 | 74.8

    1.328

    Respondents aged 15+ with longstanding illness or health problem (HS2)

    All

    1448

    40.2

    0.8

    38.7 | 41.7

    1.818

    Women

    2048

    44.1

    0.9

    42.3 | 45.9

    1.293

    Men

    1448

    36.0

    0.9

    34.1 | 37.8

    1.399

    Respondents aged 15+ that were severely limited in activities people usually do because of health problems for at least past 6 months (HS3)

    All

    527

    5.8

    0.3

    5.2 | 6.5

    1.434

    Women

    309

    6.1

    0.4

    5.4 | 6.9

    1.024

    Men

    218

    5.5

    0.4

    4.7 | 6.4

    1.341

    Respondents aged 15+ having been hospitalized in the past 12 months (HO1)

    All

    764

    8.8

    0.4

    8.1 | 9.6

    1.298

    Women

    431

    9.5

    0.5

    8.5 | 10.4

    1.144

    Men

    333

    8.2

    0.5

    7.2 | 9.1

    1.117

    Respondents aged 18+ who are obese (BMI > = 30, where BMI = BM2 in kg / (BM1 in m * BM1 in m)

    All

    1004

    13.2

    0.5

    12.3 | 14.2

    1.505

    Women

    498

    11.5

    0.6

    10.5 | 12.6

    1.151

    Men

    506

    15.1

    0.7

    13.7 | 16.5

    1.336

     

    Non-sampling error

    Coverage errors:

    A two stage stratified cluster sample on national and regional level is used. The sample is stratified by using the administrative regions in the country and persons' place of residence (town, village). As a result of the stratification 56 strata are designed. At the first stage clusters are selected with a probability proportional to their size, separately for 28 districts and for urban and village population. At the second stage, through a systematic selection households are identified. All persons aged 15 and over in selected households were interviewed. The survey applies the principle of the voluntary participation. A substitution is not allowed.

    EHIS wave 1

    By face to face interview (PAPI) 5 661 persons from 8 393 are interviewed. The response rate is 73.8%.

    EHIS wave 2

    By face to face interview (PAPI) 6 410 persons from 8 839 are interviewed. The response rate is 72.5%.

    EHIS wave 3

    By face to face interview (PAPI) 7 540 from 10 322 eligible persons are interviewed. The response rate is 73.0%.

     

    In order to provide maximum opportunities for  analysing the data additional information is available:

    • Original sample size (Eligible + Not eligible)
    • Interviewed respondents - fully or partially completed questionnaire;
    • Non-interviewed respondents - respondent was not found, refusal;
    • Not eligible - deceased, does not live at the address, non-existent address / building / dwelling.
    Coverage error

    Population Census 2011 data base updated with deaths and births (annually) was used as sampling frame. In the list the information for households and household’s members is eligible. The list is updated annually based on current demographic statistics data as of 31 December. Although the population frame was updated with the latest results, there still were some shortcomings.

    Over-coverage - rate

    Not applicable.

    Common units - proportion

    Not applicable.

    Measurement error

    These are errors in the interview stage of collection of data, understanding of the issues by the respondents, sometimes wrong answers, and errors in data codification. The data entry program has been designed as to guarantee correctness and consistency of the data (logical controls, acceptable value, etc.), to be minimize this type of error. The program performs further checks for data accuracy with SPSS scripts.

    In accordance with the methodological recommendations proxy interview is allowed only due to health problems of the respondent. There are two possibilities: either the respondent is unable to complete the interview due to physical or mental problems or when the person is hospitalized. Proxy interview was allowed limited to the questions specified in the Eurostat guidelines.

    Non response error

    Methods used for reducing unit non-response 

    1. The respondents’ address information was sent to the Regional Statistical Offices for checking after the sample selection.

    2.Household invitation letter was prepared and signed by the President of the NSI. In this letter we explain the aim of the survey and how the sample was drawn. The importance to participate is stressed. The households were informed that the interviewers are staff of the Regional statistical offices and will identify himself (herself) by an identity card. We assure the persons that their answers will remain confidential.

    3.Additional visits to the households - there were allowed second visits for the distant clusters and up to 4 visits in close clusters from the RSO location. 

    Substitution is not allowed.

     

    Unit non-response - rate

    Non-response rate -  27.5%.

    Item non-response - rate

    Item non-response - rate

    EHIS – wave 2

     

    A) Item non-response rate across the health variables (un-weighted and before imputation)

    Min: 0.00%

    Max: 15.62% (MH1F)

    Average: 6.3%

     

    B) Total item non-response (un-weighted)

    (number of completed values / expected values over all variables of all respondents taking into account filtering and derogations granted)
    (link to data completeness rate / substitution rate)

     8.82% - total item non-response rate (proxy are excluded)

    C) For which variables the item response (i.e. before imputation) was below 90 %?

     

    AL1         87.22%

    AL2         88.17%

    AL3         88.63%

    AL4         88.17%

    AL5         88.64%

    AL6         87.41%

    AW2        88.80%

    BM1        87.08%

    BM2        85.99%

    FV1         88.30%

    FV2         88.00%

    FV3         88.28%

    FV4         87.93%

    HA3        88.64%

    HS1         88.85%

    IC1          88.44%

    IC2          88.78%

    IC3          87.71%

    MD1        88.83%

    MD2        88.72%

    MH1A     85.88%

    MH1B     86.32%

    MH1C     87.21%

    MH1D     87.43%

    MH1E     86.54%

    MH1F     84.38%

    MH1G    85.46%

    MH1H    84.96%

    PA1        87.78%

    PA2        87.49%

    PA3        85.62%

    PA4        85.66%

    PA5        87.50%

    PA6        87.43%

    PA7        87.66%

    PA8        86.4%

    PC3        88.77%

    PE1        88.25%

    PE2        86.68%

    PE3        88.1%

    PE4        88.47%

    PE5        88.78%

    PE6        88.56%

    PE7        88.69%

    PE8        88.44%

    PN1       88.56%

    PN2       88.44%

    SK4       85.6%

    SS1        88.16%

    SS2        87.46%

    SS3        86.02%

    UN1A    88.47%

    UN1B    88.60%

    UN2A    88.49%

    UN2B    88.38%

    UN2C    88.46%

    UN2D    88.14%

    For all of them proxy is not allowed.

      EHIS wave 3

     

    Item non-response

    Answers

    A) Item non-response rates (average – minimum – maximum) across the health variables.

     

    Min – 0%

    Max – 36.7% (AW2)

    Average – 3.9%

    B) Total item non-response (un-weighted; number of completed values divided by expected values over all variables of all respondents; taking into account filtering and derogations).

    3.07%

    C) Variables for which the item response (i.e. before imputation) was below 90%. Indication of the codes of variables, including common variables.

    AW2 - 63.3%

    PC3 – 86.0%

    PE5 – 31.1%

    PE7 – 69.5%

    PE9 – 88.9%

    AL2 – 87.4%

    AL3 – 86.7%

    AL4 – 88.2%

    AL5 – 88.1%

    IC2 – 75.8%

    IC3 – 73.9%

     

    Processing error

    Data checking, cleaning and editing were done in accordance with the proposed by Eurostat guidelines and documents. Errors caused by the interviewers as well as errors introduced during data-entry were cleaned and edited. Many consistency checks are implemented in the data entry software, which are corrected simultaneously. Additional checks for logical consistence are carried out over the aggregated files. Data processing was performed with SPSS. 

    Imputation - rate

    Imputation techniques are not applied.

    Model assumption error

    Not applicable.

    Seasonal adjustment

    Not applicable.

    Data revision - policy

    Not applicable.

    Data revision - practice

    Not applicable.

    Data revision - average size

    Not applicable.

    Timeliness and punctuality
    Timeliness

    T+11 months (preliminary data)

    Final data will be disseminated following the validation procedure.

    Time lag - first results

    Preliminary data are available 11 months after the field work.

    Time lag - final results

    The final data are disseminated after finalization of data validation procedure by Eurostat. 

    Punctuality

    Micro-data are provided to Eurostat according to the European legislation.

    The data for publishing statistical data is shown in the Release Calendar presenting the results of the statistical surveys carried out by the National Statistical Institute.

     

    Punctuality - delivery and publication
    Coherence and comparability
    Comparability - geographical

    Due to sample type of the survey, the data are representative at district level only for part of indicators.

    International comparison - EHIS aims at achieving an input standardisation (questions, answers, filters, etc.) through conceptual translation into all EU languages. Each of the questions and response categories are accompanied by a detailed description, so that their meaning is identical in all Member States. Should be taken into account that not all countries have fully implemented the questionnaire or some questions were modified.

    Asymmetry for mirror flows statistics - coefficient

    Not applicable.

    Comparability - over time

    Due to changing the EHIS questionnaire, some of the questions and indicators are partly or not comparable.

    Length of comparable time series

    Not applicable.

    Coherence - cross domain

    Not applicable.

    Coherence - sub annual and annual statistics

    The coherence of the survey data and other official data sources was analysed as follow:

    • morbidity - for selected diseases;
    • discharges by diagnoses;
    • mortality by causes;
    • Health module applied in the Survey on Income and Living Conditions (SILC).

     

    EHIS wave 3

    SILC 2019

     

    Total

    Males

    Females

    Total

    Males

    Females

    HS1

     

     

     

     

     

     

    Very good or good

    69.9

    73.1

    67.2

    67.2

    71.5

    63.2

    Fair

    20.9

    19.2

    22.4

    23.6

    20.5

    26.5

    Bad or very bad

    9.2

    7.7

    10.4

    9.2

    8.1

    10.3

    HS2

     

     

     

     

     

     

    People having a long-standing illness or health problem

    40.2

    36.0

    44.1

    21.6

    19.1

    23.9

    HS3

     

     

     

     

     

     

    Some

    15.3

    13.3

    17.1

    12.9

    10.9

    14.8

    Severe

    5.8

    5.5

    6.1

    3.2

    3.0

    3.3

    None

    78.9

    81.2

    76.8

    83.9

    86.1

    81.8

     

    Coherence - National Accounts

    Not applicable.

    Coherence - internal

    Not applicable.

    Accessibility and clarity
    News release

    Press release.

    Publications

    EHIS - wave 1

    Bulgaria - Statistical Panorama

    On-line database

    Data on European health interview survey are available to all users of the NSI website under the heading Health - Health interview survey: http://www.nsi.bg/en/node/5630

    Eurostat online database 

     

    Data tables - consultations

    Not applicable.

    Micro-data access

    Anonymised individual data can be provide for scientific and research purposes by individual request, according to the Rules for the provision of anonymised individual data for scientific and research purposes.

    Other

    Information service on request, according to the Rules for the dissemination of statistical products and services in NSI.

    Metadata - consultations

    Not applicable.

    Documentation on methodology

    EHIS wave 1

    • European Health Interview Survey questionnaire (2007-2009);
    • Conceptual translation cards and guidelines;
    • Quality Categories and Criteria for Delivery Data to EHIS;
    • European Health Interview survey methodological sampling guidelines (Task force III report);
    • Guidelines for the development and criteria for the adoption of Health Survey instruments.

    EHIS wave 2

    • European Health Interview Survey (EHIS wave 2), Methodological manual, Eurostat, 2013 edition;
    • EHIS wave 2 Validation rules; 
    • EHIS wave 2 Data delivery guidelines.

    EHIS wave 3

    • European Health Interview Survey (EHIS wave 3), Methodological manual, Eurostat, 2018 edition;
    • EHIS wave 3 Validation rules.
    Metadata completeness – rate

    100%

    Quality documentation

    EHIS wave 1

    Summary report on the application of criteria for quality assessment of the European Health Interview - Eurostat.

    EHIS wave 2 and 3

    Quality report

    Cost and burden

    Not applicable.

    Confidentiality
    Confidentiality - policy
    • Law on Statistics;
    • Regulation (EC) No 223/2009 on European statistics (recital 24 and Article 20(4)) of 11 March 2009 (OJ L 87, p. 164), 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.
    Confidentiality – data treatment

    Individual data are not published in accordance with article 25 of the Law on Statistics. The publishing of individual data can be performed only in accordance with article 26 of the same law.

    For the purposes of dissemination of aggregated data the following rules are applied:

    • An estimate should not be published if it is based on fewer than 20 sample observations or if the non-response for the item concerned exceeds 50%.
    • An estimate should be published with a flag "low reliability" if it is based on 20 to 49 sample observations or if non-response for the item concerned exceeds 20% and is lower or equal to 50%.
    • An estimate shall be published in the normal way when based on 50 or more sample observations and the item's non-response does not exceed 20%.
    Comment
    Download in SDMX 2.1 file format: European health interview survey
    Metadata Structure Definition in SDMX 2.1: ESQRS_MSD+BNSI+2.0+SDMX.2.1.xml
    Download in SDMX 2.0 file format: European health interview survey
    Metadata Structure Definition in SDMX 2.0: ESQRS_MSD+BNSI+2.0+SDMX.2.0.xml
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The National Statistical Institute (NSI) is a state institution in Bulgaria that collects, processes and disseminates official statistical information on social, economic and demographic processes in the country. The NSI's activities are aimed at providing objective and reliable data that support informed decision-making by the state, business and society. The Institute works in accordance with international statistical standards and is an active participant in the European Statistical System.

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