Lisa Calderwood and Alison Park
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SUMMARY
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This chapter is divided into eight sections which cover a wide range of health topics: self-assessed health (11.2), psychosocial health (11.3), use of health services (11.4), prescribed medicines (11.5), dental health (11.6), bladder problems (11.7), gastroenteritis due to food poisoning (11.8) and children's blood lead levels (11.9).
The 1999 White Paper Towards a Healthier Scotland sets specific targets for improvement in dental health and identifies mental health as a key area of concern. However, the overarching aim of the White Paper is to tackle inequalities in health, including access to health care services. Regional and social class inequalities in self-assessed health status and use of services are discussed in this chapter.
11.2.1 Introduction
This section covers self-assessed general health, longstanding illness and acute sickness. Variations and trends in self-assessed health are also explored. All informants were asked about their general health and whether or not they had a longstanding illness, disability or infirmity. Informants reporting a longstanding illness were then asked about the nature of their condition, including its affect upon their activities. All informants were also asked about acute sickness in the previous two weeks. This series of questions is identical to those asked in the 1995 Scottish Health Survey and currently used in the Health Survey for England.
These measures provide important indicators of the general health of the population as a whole and the prevalence of longstanding illness and acute sickness. Self-reported health and illness may also be useful in anticipating future, and estimating latent, demand for health services and for subsequent planning and policy development.
As the results presented in this section are based on the informant's self-assessment of their own health, it should be noted that subjective perceptions of health in general and interpretations of key terms such as 'longstanding illness' may vary between informants. Self-reported assessments of health status and definitions of illnesses may not necessarily correspond to medical diagnoses. As well as variations in perceptions and interpretations, informants may differ in their willingness to report illness and ill health and in their knowledge about their own health conditions.1
11.2.2 Self-assessed general health
Informants were asked to classify their health in general as 'very good', 'good', 'fair', 'bad' or 'very bad'. More than three-quarters of men and women (77%) perceived their health to be either 'very good' or 'good'. Just under a fifth of men (18%) and women (17%) reported their health as 'fair' and only one in twenty adults (6%) felt that their health was 'bad or 'very bad'. Women were slightly more likely than men to report 'very good' health (38% compared with 35%) but overall adult's self-assessed health status was not significantly related to sex.
Adults' self-assessed general health was found to be strongly related to age. Over four-fifths of men and women under the age of 45 reported good health, but among the 65-74 age group this proportion fell to three in five (58% of men and 60% of women). In particular, the percentage of men and women reporting good health fell sharply from 77% and 74% in the 45-54 age group to 61% and 64% among those aged 55-64.
Children were significantly more likely than adults to report 'very good' or 'good' health. Ninety-four percent of both boys and girls were within these two categories, including 60% whose health was perceived as 'very good'. Only 6% of boys' and 5% of girls' health was viewed as 'fair' and only 1% of children were perceived to have 'bad' or 'very bad' health. The overall distribution of responses was almost identical for boys and girls and children's self-assessed general health varied little with age.
11.2.3 Longstanding illness
Prevalence of longstanding illness and limiting illness among adults and children, by age and sex
Longstanding illness is defined as an illness, disability or infirmity which has affected or is likely to affect the informant over a period of time. Informants with one or more longstanding illness were asked whether each of these illnesses limits their activities, in order to obtain a measure of limiting longstanding illness.
Adults' prevalence of longstanding and limiting illness varied little with sex. Three-fifths of men and women (60%) did not have a longstanding illness, over a fifth of men (22%) and women (25%) had a limiting longstanding illness and under a fifth of men (17%) and women (16%) had a non-limiting illness.
Adults' prevalence of longstanding illness was significantly related to age. While under a third of adults aged 16-34 had a longstanding illness, this proportion increased to nearly half of men (45%) and women (46%) in the 45-54 age group and nearly two thirds of men (65%) and women (62%) in the 65-74 age group. Adults between 55 and 74 were more likely than not to have a longstanding illness. Overall, adults with a longstanding illness were slightly more likely to have a limiting illness than a non-limiting illness but prevalence of limiting longstanding illness was also related to age. Informants with a longstanding illness in the 16-24 age group were more likely to have a non-limiting illness, while informants with a longstanding illness in the 55-64 and 65-74 age groups were twice as likely to have a limiting illness as a non-limiting illness. Six percent of men and 9% of women aged 16-24 had a limiting illness compared with 16% of men and 15% of women who reported a non-limiting illness, while in the 65-74 age group 43% of men and women had a limiting illness and 22% of men and 19% of women reported a non-limiting illness.
Around 80% of boys and girls did not have a longstanding illness although boys were more likely to than girls (22% compared with 18%). Boys prevalence of longstanding illness was related to age but prevalence among girls varied little with age. Among boys aged 2-5, 18% had a longstanding illness; this figure increases to 22%-24% of boys aged 6-13 and 28% of boys in the 14-15 age group. In contrast the percentage of girls with a longstanding illness varied between 15% and 19% across the age groups. In general, children were more likely to have a non-limiting than a limiting longstanding illness.
Number of illnesses
Among adults, number of longstanding illnesses varied little with sex. Just over a quarter of men (28%) and women (27%) had only one longstanding illness and 12% of men and 13% of women had two or more longstanding illnesses. Among those with a longstanding illness, the mean number of illnesses was similar for men (1.4) and women (1.5). Number of illnesses was related to age in the same way as prevalence. Among adults in the 25-34 age group, only 6% of men and 5% of women had two or more longstanding illnesses, but this figure increased to 30% of men and 29% of women in the 65-74 age group. Women were slightly more likely than men to have two of more longstanding illnesses in the 45-54 age group (16% compared with 14%) and the 55-64 age group (26% compared with 22%), although these differences were not statistically significant.
Among children, number of longstanding illnesses varied little with sex. Only 3% of both boys and girls had two or more longstanding illnesses and among children with a longstanding illness the mean number of illnesses was identical for boys and girls (1.2). Boys were slightly more likely than girls to have one longstanding illness (19% compared with 15%). As reported above, age was positively related to overall prevalence of longstanding illness among boys, but there was no clear relationship for boys or girls between age and the proportions reporting two or more longstanding illnesses.
Types of longstanding illness
Informants with a longstanding illness were asked about the nature of their condition. These illnesses were first coded by broad category and then aggregated into groups corresponding to the International Classification of Diseases.2 This classification is mostly used to code health conditions and diseases based on their cause. In the Scottish Health Survey informants with a longstanding illness are asked to state what is the matter with them. Classification of illnesses is based solely upon these definitions and self-reported symptoms. As a result the classification of illness may not always correspond to a classification based on a medical diagnosis, although informants may have been told the name of their illness by their GP.
Among men and women musculoskeletal problems were the most common type of illness; the rate per 1000 was 144 for men and 163 for women. The next most common types of illness were heart and circulatory system conditions (96 per 1000 for men and 85 per 1000 for women) and respiratory problems (85 per 1000 for men and 88 per 1000 for women). The prevalence of most types of longstanding illnesses increased with age with the exception of skin complaints which decreased with age. The rate per 1000 adults reporting mental disorders or problems of the nervous system peaked in the 45-64 age group. Among men but not women the rate per 1000 reporting illnesses of the genito-urinary system increased with age.
Among boys and girls respiratory problems were by far the most common type of illness (138 and 111 per 1000). Among boys the rate per 1000 reporting respiratory problems increased with age but among girls no clear age trend was revealed. Skin complaints were the next most common type of illness reported by children (22 and 28 per 1000 for boys and girls respectively). This type of illness was most common among boys aged 2-6 (34 per 1000) and girls aged 2-10 (35 per 1000 for 2-6 year olds and 36 per 1000 for 7-10 year olds). For boys and girls aged 11-15 problems of the nervous system were the second most common type of illness (25 and 31 per 1000).
11.2.4 Acute Sickness
Informants who had cut down on anything usually done about the house, at school/work or in their free time due to illness or injury, in the two weeks preceding the interview, were defined as having had acute sickness. In order to measure severity, informants reporting acute sickness were asked on how many days in the last fortnight their usual activities had been affected in this way.
Women were more likely than men to report acute sickness in the past two weeks (18% compared with 13%) and the mean number of days acute sickness in the last two weeks was higher for women than men (1.4 compared with 1.0). Among adults' who had suffered from acute sickness, the mean number of days acute sickness was almost identical for men (7.9) and women (7.8) and a similar pattern of severity is observed for both sexes, with the majority of informants reporting acute sickness for either very few days or every day. Of the 13% of men who reported acute sickness, 4% had suffered on 1-3 days and 5% had been affected every day in the past two weeks. Similarly, among the 18% of women who reported acute sickness 5% had suffered on 1-3 days and 6% had been affected every day in the past two weeks.
Adults' acute sickness was strongly related to age. There seemed to be an age threshold above which informants of both sexes were much more likely to report acute sickness. Older informants were also more likely to have been affected every day in the past two weeks and consequently had a higher mean number of days acute sickness. However, the age threshold was lower for women (45 years) than men (55 years). Although women were more likely than men to report acute sickness in all age groups, this disparity was particularly large in the 45-54 age group (21% of women compared with only 11% of men).
Of boys and girls, 91% did not suffer from acute sickness in the past two weeks. Among those children who did report acute sickness, around two-thirds had been affected for only 1-3 days. The mean number of days acute sickness was identical for boys and girls (0.4). Among children reporting acute sickness, the mean number of days was 4.0 for boys and 3.9 for girls (not shown in table). Acute sickness was not found to be related to age for boys or girls.
11.2.5 Variations in self-assessed health
Variations by social class
All of the age-standardised self-assessed health measures reported in this section were related to social class. In general, informants in Social Classes I and II were more likely to report good health and less likely to report longstanding illness or acute sickness than informants in Social Classes IV and V. The strength of this relationship varied between the different measures. Self-assessed general health was very strongly related to social class among both men and women; 90% of men and 94% of women in Social Class I reported good health compared with only 57% of men and 62% of women in Social Class V. Prevalence of longstanding illness also varied significantly with social class; only 38% of men and 35% of women in Social Class I reported a longstanding illness compared with 54% of men and 47% of women in Social Class V. There were also significant variations in acute sickness between social classes. The pattern among women is similar to that reported for general health and longstanding illness; 13% of women in Social Class I and 23% of women in Social Class V reported acute sickness in the past two weeks. However, the proportion of men reporting acute sickness was higher in Social Class I (19%) than in all other social classes, including Social Class V (16%).
Table 11.11, Figure 11A
Figure 11A Adults' self-assessed general health by social class and sex
Variations by region
All of the age-standardised self-assessed general health measures reported in this section varied with region. Men in Grampian and Tayside were more likely to report good health (84%) and less likely to report longstanding illness (32%) than men in all other regions. The prevalence of bad health was higher among men (10%) and women (11%) in Greater Glasgow than among men and women in all other regions. The lowest levels of good health were also reported by men (70%) and women (71%) in Greater Glasgow, although among men (72%) and women (75%) in Lanarkshire, Ayrshire and Arran the prevalence of good health was also lower than in most other regions. Men in Lanarkshire, Ayrshire and Arran were more likely to report longstanding illness (47%) than men in all other regions. For women, the highest prevalence of longstanding illness was in Lothian and Fife (44%), Greater Glasgow (43%) and Lanarkshire, Ayrshire and Arran (42%). Women in Greater Glasgow were more likely to report acute sickness (22%) than women in most other regions. For men, the highest prevalence of acute sickness was in Greater Glasgow (16%) and Lanarkshire, Ayrshire and Arran (15%).
11.2.6 Trends in adults' self-assessed health since 1995
Men and women aged 16-64 were more likely to report good health in 1998 than in 1995 (79% and 80% compared with 77%). Men of most age groups and women of all age groups were more or equally likely to report good health in 1998 than 1995. This trend is particularly marked among younger men (16-24) and women (16-34) and older men (45-64). The proportion of men aged 16-64 reporting longstanding illness increased from 34% in 1995 to 37% in 1998. The increase in the prevalence of longstanding illness was concentrated among men in the 25-34 and 35-44 age groups (25%/30% in 1995 compared with 30%/34% in 1998). Men in these age groups were also slightly (but not significantly) less likely to report good health in 1998 than 1995. There was no significant change in the prevalence of longstanding illness among women or in the prevalence of acute sickness among men and women aged 16-64 between 1995 and 1998.
11.2.7 Comparison of adults' self-assessed health between Scotland and England
In general, self-assessed health among men and women aged 16-74 in Scotland was better than the self-assessed health of men and women in England as a whole and in Northern England. However the strength and significance of this relationship varied between the different health measures.
Overall men in Scotland were less likely to report longstanding illness than men in England (40% compared with 42%) but there was no significant difference between the self-assessed general health of men in Scotland and England. Within age groups there were no significant differences between men in England and Scotland in self-assessed general health or in the prevalence of longstanding illness. Among women there were no significant differences between Scotland and England in either self-assessed general health or the prevalence of longstanding illness. However, within the 16-24 age group, women in Scotland were more likely to report good health than women in England (89% compared with 82%).
Both men and women in Scotland were more likely than men and women in Northern England to report good general health (77% compared with 73%) and less likely to have a longstanding illness (40% compared with 45% and 44%). The gap between Scotland and Northern England in the proportion who reported good self-assessed general health was greatest among men aged 45-54 (77% in Scotland compared with 71% in Northern England) and women aged 16-24 (89% in Scotland compared with 80% in Northern England). The gap between Scotland and Northern England in the prevalence of longstanding illness was greatest in the 65-74 age group: 65% of men and 62% of women aged 65-74 in Scotland reported a longstanding illness compared with 72% of men and 69% of women aged 65-74 in Northern England.
The prevalence of acute sickness did not vary significantly either overall or within age groups between men or women in Scotland, England and Northern England.
11.2.8 Comparison of children's self-assessed health between Scotland and England
The self-assessed health of boys in Scotland was better than the self-assessed health of boys in England and Northern England, on all of the health measures. The general health status of 94% of boys in Scotland was reported as good compared with 92% of boys in England and 91% of boys in Northern England. The prevalence of longstanding illness and acute sickness was also lower among boys in Scotland: 22% compared with 26% (England and Northern England) for longstanding illness and 9% compared with 13% (England) and 12% (Northern England) for acute sickness (although the difference between Scotland and Northern England was not statistically significant for longstanding illness). However, the only difference for the self-assessed general health of girls in Scotland, England and Northern England was in the prevalence of acute sickness which was lower among girls in Scotland than girls in England and Northern England (9% compared with 12%).
Although there were differences within age groups between children in Scotland, England and Northern England on all of the health measures, these need to be interpreted cautiously due to modest bases. Nevertheless there was an unusually large gap between the prevalence of longstanding illness among children aged 2-3 in Scotland and Northern England. Only 18% of boys and 15% of girls in this age group in Scotland reported a longstanding illness compared with 29% of those in Northern England. There was also a big difference between the prevalence of longstanding illness among boys aged 4-5 in Scotland and England (18% compared with 30%), but not among girls in this age group.
11.3.1 Introduction
Mental health is identified by the 1999 White Paper Towards a Healthier Scotland as a priority for the NHS in Scotland. The 1998 Scottish Health Survey used the General Health Questionnaire (GHQ12) in order to assess the psychosocial health of informants. The GHQ12 was designed to detect possible psychiatric morbidity in the general population and is comprised of 12 questions about general levels of happiness, anxiety, depression, stress and sleep disturbance over 'the past few weeks' immediately prior to the interview. Due to the potentially sensitive nature of these questions, they were asked in the form of a self-completion booklet which informants completed at the end of the main interview. The questions were asked of all adult informants and children aged 13-15.
As the GHQ12 asks about changes from normal functioning in the past few weeks, any possible psychiatric disorders which are detected in this way may vary greatly in their duration. As a result, the GHQ12 can only be used to estimate prevalence of possible psychiatric morbidity at a particular point in time and is most useful for comparing sub-groups within the population.
Informants score one unit (or point) each time they report having experienced a particular feeling or type of behaviour 'more than usual' or 'much more than usual' in the past few weeks. An overall GHQ12 score of between zero and twelve can then be calculated. A threshold score of four or more (referred to as a 'high' GHQ12 score) has been used to identify informants with a potential psychiatric disorder.3
11.3.2 Adults' GHQ12 scores
Women were more likely than men to have a high GHQ12 score (18% compared with 13%). This was true of all age groups, except those aged 55-64 among whom there was no real difference between men and women. The prevalence of a high GHQ12 score varied with age for both men and women although there was greater variation among men. The lowest prevalence of a high GHQ12 score was in the 16-24 age group for men (9%) and the 65-74 age group for women (15%). Men aged 55-64 were significantly more likely than average to have a high GHQ12 score (20%).
11.3.3 Trends in adults' GHQ12 scores since 1995
Overall there has been no real change since 1995 in the proportions of men and women aged 16-64 with a high GHQ12 score. Within certain age groups there has been a significant change in the prevalence of a high GHQ12 score. However no clear age trend was revealed for men or women.
11.3.4 Children's GHQ12 scores
Among children aged 13-15, 5% of boys and 8% of girls had a high GHQ12 score. Although this gender difference is not statistically significant, it reflects the pattern demonstrated by adults. Moreover, girls were significantly less likely than boys to have a GHQ12 score of zero (45% compared with 53%).
11.3.5 Logistic regression of high GHQ12 scores among adults
Logistic regression can be used to explore a range of complex associations between different independent variables, such as age, socio-economic group and marital status, and a dependent variable which in this case is a high GHQ12 score. Using this type of analysis, it is possible to determine whether each of the independent variables is a good or poor predictor of a high GHQ12 score whilst controlling for all of the other independent variables in the model. As it has been shown that a high GHQ12 score is strongly related to sex, separate logistic regressions were run for men and women. The independent variables chosen were age, social class, region, economic activity status, marital status and three measures of self-assessed health: self-reported general health, limiting illness and acute sickness. Odds ratios shown in Table 11.19 and discussed below are all relative to average.
For both men and women, all of the independent variables were strong predictors of a high GHQ12 score.
Among women the odds ratio of a high GHQ12 score decreased with age, from 1.59 in the youngest age group to 0.42 in the oldest age group. Overall, women under 45 had higher than average odds of having a high GHQ12 score and women aged 55-74 had lower than average odds of having a high GHQ12 score. Among men, there was a non-linear relationship between the odds of a high score and age: men aged 25-34 and 35-44 had the highest odds ratios (1.48 and 1.67 respectively), while younger men (16-24) had the lowest odds ratio (0.64).
Economic activity status was a good predictor of a high GHQ12 score for men and women. Among men, a clear relationship was observed; men in employment and retired men had lower than average odds ratios (0.61 and 0.63 respectively) and unemployed men and men who were classed as 'other' economically inactive had higher than average odds ratios (1.46 and 1.79 respectively). The odds of having a high GHQ12 score was almost two and a half times as high for unemployed men and about twice as high for unemployed women when compared with their employed counterparts.
Marital status is a good predictor of a high GHQ12 score for both men and women although different relationships were found. Married men and single women had the lowest odds ratios (0.62 and 0.72 respectively) and widowed men and separated women had the highest odds ratios (1.84 and 1.31 respectively).
A few social classes and regions had notably high or low odds ratios, but no clear patterns were apparent.
All three of the self-assessed health measures were strong predictors of a high GHQ12 score for both men and women. However, these findings are to be expected as it is likely that there will be a high correlation between self-assessed general health and self-reported psychosocial health as measured by GHQ12.4 The odds of having a high GHQ12 score were seven times as high for men with bad self-reported general health than for men with good self-reported general health (2.52 compared with 0.38) and five times as high for women with bad self-reported general health than for women with good self-reported health (2.17 compared with 0.43). The pattern for limiting illness was slightly different for men and women. Both men and women with a limiting longstanding illness had the highest odds ratios of having a high GHQ12 score (1.56 and 1.52 respectively). As might be expected, among women those with no longstanding illness had the lowest odds ratio (0.78) but among men, those with a non-limiting illness had the lowest odds ratio (0.74). Finally, acute sickness was a strong predictor of a high GHQ12 score for men and women. Those who had experienced acute sickness in the last two weeks had higher than average odds ratios (1.28 for men and 1.40 for women) and those who had not experienced acute sickness had lower than average odds ratios (0.78 for men and 0.71 for women).
11.3.6 Comparison of adults' GHQ12 scores between Scotland and England
Overall, women in Scotland were slightly less likely than women in Northern England (18% compared with 20%) and equally likely as women in England as a whole to have a high GHQ12 score. The prevalence of a high GHQ12 score among men in Scotland was not significantly different from men in England or Northern England. Within age groups, the prevalence of a high GHQ12 score did not vary significantly between men or women in Scotland and Northern England. However, among men and women aged 55-64 there was a higher prevalence of a high GHQ12 score in Scotland than England (20% and 19% compared with 13% and 14%).
11.3.7 Comparison of children's GHQ12 scores between Scotland and England
A lower proportion of both boys and girls aged 13-15 in Scotland had a high GHQ12 score than boys and girls of this age group in both England and Northern England. The difference between girls in Scotland (8%) and England (13%) was statistically significant.
11.4.1 Introduction
This section covers use of GP and hospital services. Variations in the use of health services by social class and region are also explored. All informants were asked whether or not they had consulted a doctor on their own behalf in the past two weeks and if so, how many times. Informants who had not consulted a doctor in the previous two weeks were asked when they had last consulted a doctor. All informants were also asked about their hospital attendance in the last 12 months (both outpatient and inpatient visits) and blood pressure and cholesterol monitoring. Informants with a cardiovascular (CVD) condition were also asked if any of their GP consultations and visits to hospital were about their CVD condition. Consultation rates and admissions to hospital provide valuable measures of primary and secondary health service usage that have an important role in health care planning.
11.4.2 GP consultations
The proportion of informants having consulted a doctor in the previous two weeks is referred to below as the 'consultation rate'. Evidently the number of consultations will be higher than the consultation rate as some informants will have had more than one consultation in the two-week reference period. The number of consultations in this two-week period is multiplied by 26 to give an estimate of the number of GP consultations over a 12 month period. The estimated mean number of GP consultations per year was then calculated.
GP consultations by adults and children in the past two weeks
Overall the GP consultation rate in the past two weeks was significantly higher for women (21%) than men (12%) and children (11% of girls and boys). This was also true of the estimated mean number of GP consultations per year; the figures are 6.6 for women, 3.9 for men, 3.5 for girls and 3.4 for boys. In addition, both the consultation rate and estimated mean number of consultations per year were higher for women than men in all age groups, the gaps being particularly large among the younger age groups.
Amongst men, both the GP consultation rate and estimated mean number of GP consultations per year increased with age. Only 8% of 16-24 year old men had consulted their GP in the past two weeks and their estimated mean number of consultations per year was 2.5. This contrasts with a consultation rate of 20% of men in the 65-74 age group and an estimated mean of 6.1 consultations per year. Amongst women, both the consultation rate and estimated mean number of consultations per year did not vary significantly with age. However both of these figures were highest among women aged 25-34 and 45-54 which may reflect child-bearing in the younger group and the menopause in the older group.
Overall there was no difference between boys and girls in their GP consultation rate and no significant difference in their estimated mean number of consultations per year. Amongst children there was no clear relationship between age and consultation rates/mean number of consultations per year but both were highest for boys aged 2-3 and girls aged 2-3 and 4-5. The difference in consultation rate and estimated mean number of consultations per year between boys aged 2-3 (17% and 5.5) and boys of all age groups (11% and 3.4) is statistically significant.
The vast majority of both adults and children in all age groups who had consulted a GP in the past two weeks had done so only once.
Variations in GP consultations by self-assessed health
Age-standardised GP consultation rates and estimated mean number of GP consultations per year varied significantly with all of the self-assessed health measures. As may be expected, acute sickness in the past two weeks was very strongly related to rates of GP consultation in the past two weeks -34% of men and 45% of women reporting acute sickness had consulted their GP in the past two weeks compared with 9% of men and 15% of women who had not reported acute sickness. Men and women with good self-reported general health had relatively low consultation rates (10% for men and 16% for women) and estimated mean consultations per year (3.1 for men and 5.0 for women). Men and women with fair or bad self-reported health had significantly higher consultation rates and estimated mean number of consultations per year (16%/5.3 for men with fair health, 29%/11.2 for men with bad health, 31%/10.3 of women with fair health and 56%/19.9 for women with bad health). Longstanding illness was significantly but less strongly related to GP consultations than the other two measures; the figures for those with longstanding illness were similar to those for informants with fair self-reported health.
Overall, for men the highest consultation rates and estimated mean number of consultations per year were reported amongst those with acute sickness in the last two weeks and for women among those with bad self-reported health. Women's consultation rates and estimated mean number of consultations per year were significantly higher than men's on all of the age standardised self-assessed health measures.
11.4.3 Use of hospital services
Outpatient visits
Outpatient visits included visits to casualty and day-patient treatments. Among adults, use of hospital outpatient services was strongly related to whether or not the informant had a cardiovascular (CVD) condition, was not significantly related to sex and had no clear relationship with age. About a third of men (30%) and women (34%) without a cardiovascular condition had visited hospital as an outpatient in the past 12 months compared with half of men (50%) and women (49%) with a cardiovascular condition. Use of outpatient services by men and women with a cardiovascular condition did not vary significantly with age. Among men and women without a CVD condition use of outpatient services did vary significantly with age although different patterns were observed. For men, the highest usage was by younger and older informants and among women, the highest usage was in the 25-34 age group.
Among children boys were more likely than girls (29% compared with 26%) to have attended hospital as an outpatient in the last 12 months. There was no clear relationship between the use of outpatient services and age for boys or girls. Usage was highest among boys aged 2-3 and 14-15 and girls aged 2-5.
Inpatient stays
An inpatient stay was defined as a stay in hospital for one or more nights. Adults' rate of inpatient stays in hospital was strongly related to whether or not the informant had a cardiovascular condition. Among all adults and adults without a cardiovascular condition the rate of inpatient stays was also related to sex. Men and women with a cardiovascular condition were much more likely than those without such a condition to have stayed in hospital as an inpatient in the last 12 months (17% compared with 7% and 11%). Women were more likely than men to have stayed in hospital as an inpatient in the past 12 months (13% compared with 9%). There was no clear relationship between inpatient stays and age (except that women aged 25-34 were most likely to have been inpatients, presumably due to pregnancy and childbirth).
Children's use of hospital inpatient services did not vary significantly with sex. About one in twenty boys (6%) and girls (5%) had stayed in hospital overnight or longer in the past 12 months. Younger boys (aged 2-7) had slightly higher usage of inpatient services than older boys. Among girls use of inpatient services did not vary with age.
11.4.4 Blood pressure monitoring
Adults' reported blood pressure monitoring was strongly related to whether or not the informant had a cardiovascular condition and, among all adults (and those without a cardiovascular condition), it was also related to sex. Both men and women with a cardiovascular condition were much more likely than men and women without such a condition to have had their blood pressure monitored in the past 12 months (78% and 82% compared with 37% and 59%). Women were much more likely than men to have had their blood pressure monitored in the last 12 months (64% compared with 47%). Although this was true of all age groups except those aged 65-74, the gender difference was particularly wide for adults aged 16-24 (65% for women compared with 29% for men). This may be expected as some women in this age group will have their blood pressure monitored due to pregnancy/contraceptive pill use and very few men in this age group are likely to have their blood pressure monitored due to a CVD condition.
There was a positive relationship between recent blood pressure monitoring and age for men, irrespective of CVD status -as men got older they were more likely to have had their blood pressure monitored in the past 12 months. Among all women and women with a cardiovascular condition, there was no clear relationship between blood pressure monitoring and age; among women without a cardiovascular condition there was an inverse relationship between recent blood pressure monitoring and age due to the impact of monitoring during pregnancy due to pill use.
11.4.5 Variations in use of health services
Variations by social class
Age-standardised use of hospital services did not vary significantly by social class for men or women. However social class was related to both the age-standardised GP consultation rate and the age-standardised estimated mean number of consultations per year, although the nature of the relationship was different for the sexes. Men in Social Classes I, II and IIINM had lower consultation rates than men in Social Classes IV and V (10%/11% compared with 15%). The same pattern was observed for estimated mean number of consultations. Women in Social Class I were much less likely than women in all other social classes to have consulted their GP in the past two weeks (13% compared with a range from 20% to 26% in other social classes) and had a much lower estimated mean number of consultations per year (3.5 compared with a range from 6.4 to 8.5 in other social classes).
Table 11.28, Figure 11B
Figure 11B Adults' GP consultations in past two weeks by social class and sex
Variations by region
Age-standardised GP consultation rates varied slightly by region for women but not for men. Women in Borders, Dumfries & Galloway had a lower than average consultation rate and estimated mean number of consultations per year (15% and 5.7). Men's use of outpatient services was significantly higher in Lanarkshire, Ayrshire and Arran (38%) than Borders, Dumfries and Galloway (31%). Women in Greater Glasgow were more likely than women in other regions to have attended hospital as an outpatient in the last 12 months (44% compared with a range from 34% to 39% in other regions). Men (11%) and women (15%) in Greater Glasgow were more likely than men (7%) and women (11%) in Borders, Dumfries and Galloway to have attended hospital as an inpatient in the last 12 months.
11.5.1 Introduction
This section reports on the number and types of prescribed medicines taken by adult and child informants, and outlines the use of oral contraceptives and hormone replacement therapy (HRT) among adult women.
Information on prescribed medicines was collected by nurses, who asked whether informants were 'taking or using any medicines, pills, syrups, ointments, puffers or injections prescribed for you by a doctor'. Where possible, nurses used medicine containers to record the name of each medication. Medicine classification was based on the British National Formulary (BNF).5 Although contraceptive pills were recorded by nurses when mentioned as part of this interview, they have been excluded from the analyses of prevalence and type of medication. Detailed information about oral contraceptive and HRT use among women was gathered within the self-completion part of the interview.
11.5.2 Medicines taken: number and category
Medicine taking by adults and children
A higher proportion of women than men were taking medicines at the time of interview (48% and 37% respectively). Most were taking one or two medicines (24% of men and 30% of women), but around one in ten were taking four or more medicines (8% of men and 12% of women). However, the mean number of medicines used by medicine takers did not vary between men and women (2.6).
Use of prescribed medicines was strongly related to age. Over seven in ten men aged 16-44 were taking no medicine at all, falling to four in ten among those aged 55-64, and a quarter of those aged 65-74. A similar pattern was evident among women. Whereas 71% of women aged 16-24 were not taking any medicines, this applied to only 39% in the 45-54 age group, and 22% in the 65-74 age group.
The number of medicines taken is also strongly related to the age of the informant, with older informants taking the highest number of medicines. Among women aged 65-74, for instance, the mean number of medicines per medicine taker was 3.6, compared with a mean of 2.0 or fewer among those aged under 45.
Around eight in ten children were taking no prescribed medicines at all at the time of interview, and around one in ten was taking one medicine. There was no difference between boys and girls in this respect nor was there much variation by age. The one exception to this relates to older boys and girls (aged 14-15) who were the most likely to be taking one or more medicines: 30% of boys and 34% of girls in this age group.
Medicines taken were classified into 41 pharmacological groups based on the BNF. However, analysis of types or categories of medicine is based on 13 broad groupings. Cardiovascular medicines were being taken by around one in seven men and women, respiratory medicines by around one in ten, and gastrointestinal medicines by around one in twelve. In most respects patterns of use among women and men were similar, though women were more likely than men to be using central nervous system medicines (18% and 11% respectively) or endocrine medicines (15% and 3%).
Use of most types of medicine increased with age. Around half of men and women aged 65-74 were using cardiovascular medicines compared with fewer than one in twenty of those aged under 45. Use of central nervous system medicines also increased markedly with age, particularly among women. A third of women aged 65-74 used this form of medicine, compared with around a quarter of women aged 45-54 and one in ten women in the 25-34 age group. Use of respiratory medicines was highest among adults aged 16-24 and 45-74.
Among children by far the most commonly taken prescribed medicines were those for respiratory problems. The proportion of children (12% of boys and girls) who were taking these types of medicines was similar to the proportion of adults doing so. Medicines for skin problems were next most common, with four per cent of children taking these. Boys and girls did not differ much in their use of particular types of prescribed medicine nor did use vary markedly between different age groups.
11.5.3 Use of contraceptive pills and injections
In the self-completion questionnaire women who were still menstruating were asked whether they were 'taking the contraceptive pill or having a contraceptive injection'.
Around four in ten women aged under 35 were taking the pill (45% in the 16-24 age group and 36% in the 25-34 age group). Use among women aged 35-44 was limited (15%), although the majority of this group were still menstruating. Most women who used the pill took a combined pill (used by 37% of those aged 16-24), with a much smaller proportion using a mini-pill, injection or implant (used by 7% of this age group).
11.5.4 Use of hormone replacement therapy
In the self-completion questionnaire, women were asked whether they were currently, or had been, on hormone replacement therapy (HRT). Overall 11% of women aged 25-74 were using HRT at the time of the interview, and a further 6% had been in the past. Not surprisingly use of HRT was much greater among older women, with around a quarter (27%) of those aged 45-54 and a fifth of those aged 55-64 using HRT at the time of interview. An additional 10% of women aged 45-54 and 16% of those aged 55-64 had used HRT previously.
11.6.1 Introduction
The 1999 White Paper, Towards a Healthier Scotland, identifies dental and oral health as a key health topic. Despite recent improvements in dental health, Scotland continues to have a poor record. Sugar in foods and drinks are identified as the leading cause, although regular toothbrushing and increased fluoridation of the water supply are also cited as means of improving dental health among children. The White Paper sets two dental health targets for the period 1995-2010: a 'headline target' concerning dental health among children and a 'second rank' target concerning dental health among adults. The target for children is 60% of 5 year olds to have no experience of dental disease and the target for adults is less than five percent of 45-54 year olds to have no natural teeth.
11.6.2 Dental health of adults
Prevalence of false teeth
Two-thirds of men and women (68% and 63% respectively) had all their own teeth, and a further one in five had some false and some natural teeth; 12% of men and 17% of women had all false teeth6
Nearly all informants under the age of 35 had some or all of their own teeth and, among the 35-44 age group, only one in twenty men and one in thirty women did not. After the age of 44, however, there is a sharp rise in the prevalence of false teeth, particularly among women. Consequently, there is a substantial gap between the target of less than five percent for 45-54 year olds set by the 1999 White Paper and the proportion of men and women in 1998 in this age group who had no natural teeth (12% and 17% respectively). Forty-six percent of men and 61% of women aged 65-74 had none of their own teeth.
Table 11.36, Figure 11C
Figure 11C Adults' prevalence of false teeth by age and sex
Frequency of brushing teeth
The majority of informants with some or all of their own teeth brushed their teeth at least once a day, although women were more likely to do so than men. Eighty-three per cent of women and 62% of men brushed more than once a day. One in twelve men (8%), compared with one in a hundred women, brushed their teeth less than once a day.
There were few age differences in the frequency with which people brushed their teeth, although the proportion of men and women who brushed their teeth more than once a day did fall from the age of 45 onwards.
Type of toothpaste
The vast majority of informants with some or all of their own teeth used a toothpaste containing fluoride. However, the proportion who did so was slightly lower among men and women aged 45 and over. Among the 55-64 age group, for instance, 8% of men and 12% of women said they used a non-fluoride toothpaste.
Few informants did not use toothpaste at all. The group among which this was most common was older men, with one in twenty of those aged 65-74 not using any toothpaste.
Frequency of visiting a dentist
Informants with some or all of their own teeth were asked how often they went to a dentist for a routine check-up. Almost three-quarters of men (72%) and nearly nine in ten women (85%) attended a dentist at least once every 2 years. Just over a half of men (52%) and over two-thirds of women (69%) attended a dentist at least once every six months. Among men a further 14% attended at least once a year and one in five less frequently than that. One in eight men (13%) said they never visited a dentist, double the comparable figure among women (6%).
Among women attendance at the dentist declined with age. A quarter (25%) of women aged 65-74 never go to a dentist, or do so less than every two years, compared with 13% of women aged 16-24. Among men there was no clear age pattern.
11.6.3 Trends in adults' dental health since 1995
Prevalence of false teeth
The proportion of men and women aged 16-64 with all their own teeth (that is, no false teeth) increased between 1995 and 1998, up four percentage points among both men and women. Conversely, the proportion with all false teeth fell. However, the question used in the 1998 survey was slightly different from that used in 1995 as it instructed informants to include caps and crowns as their own teeth. For this reason data from the two surveys are not perfectly comparable. Table 11.38
Frequency of brushing teeth and type of toothpaste
The proportion of men with their own teeth brushing more than once a day increased from 60% in 1995 to 63% in 1998. Among women, there has been no change since 1995. There also appeared to be some increase among men and women aged 45-54 and among men aged 55-64 in the proportion brushing their teeth more than once a day.
Use of fluoride toothpaste increased between 1995 and 1998, up three percentage points among both men and women. Increased use of fluoride toothpaste was particularly noticeable among older age groups _ and was most marked among men aged 55-64 whose use increased from 77% to 87%.
Frequency of visiting a dentist
The proportion of men and women who never visit a dentist fell slightly between 1995 and 1998, down three percentage points among men and two points among women. The proportion of women who visit a dentist at least once every six months increased by four percentage points, but there was no similar trend among men.
11.6.4 Dental health of children
This section reports on the dental health of children, based upon the responses of informants aged 13-15 (who were asked about their own dental health), and parents of 2-12 year olds (who were asked about the dental health of their children).
The dental health of children is a key concern in the 1999 White Paper Towards a Healthier Scotland, with action measures including increased fluoridation of water and a 'prevention from birth' programme (involving registration with a dentist, dental education for new parents, toothbrushing with a fluoride toothpaste for infants, and advice on dietary changes). As mentioned, one of the White Paper's headline targets is an increase in the proportion of children aged 5 with no experience of dental disease to 60% by 2010.
Children's attendance at a dentist
The average age at which children first attended a dentist was two and a half for both boys and girls. By the age of six, the vast majority (90% plus) of children had visited a dentist at least once, with no difference between boys and girls in this respect.
The most common reason given for a child's first visit was 'to get used to going to the dentist'. This applied to 62% of boys and 63% of girls and was more common still among the youngest children in the survey (2-3 year olds). A quarter (27% of boys and 25% of girls) first went to the dentist 'for a check up' and around one in twelve (8% of boys and 9% of girls) first went because they were actually having trouble with their teeth.
Children's dental treatment
Among children who had attended a dentist over half had fillings and/or teeth removed, including a fifth who had had both of these types of treatment. Around a third had undergone treatment to their teeth to stop decay (such as painting or sealing), and 11% of boys and 14% of girls had had orthodontic work. There was little difference overall between boys and girls in terms of dental treatment. Older girls were more likely than older boys to have had orthodontic treatment (30% of girls and 21% of boys aged 12-13; 39% and 33% respectively of those aged 14-15). Inevitably, reported dental treatment increased with age. Boys aged 14-15 were about five times more likely than those aged 4-5 to have had fillings, and were twice as likely to have had teeth removed because of decay. The age gradient was less steep among girls as they reported a higher incidence of this sort of treatment at a younger age. The prevalence of orthodontic treatment increased sharply in older age groups with over a third of those aged 14-15 reporting experience of orthodontic treatment.
The Health Survey is not intended to provide an accurate measure of dental disease as it is based solely on informant's (or their parent's) responses rather than medical records. However, the parents of around seven in ten children aged 5 years (71% of boys and 68% of girls) reported that their children had had no fillings or teeth removed due to decay (table not shown).
Children's assessment of dental health
The vast majority of children who had attended a dentist but had never had any treatment for decay thought they had (or were thought to have) 'perfectly healthy' teeth. This applied to 93% of boys and 95% of girls. Of those who had undergone treatment for decay (either in the form of fillings or teeth removal) around two-thirds were thought to have perfectly healthy teeth, and a third to have 'some decay'. There were no marked differences between boys and girls in this respect nor between children in different age groups.
11.7.1 Introduction
All informants aged 13 and over were asked about bladder problems. Due to the sensitive nature of this topic, questions were asked within the self-completion booklet completed after the main interview. It is possible that the prevalence of bladder problems will be under-reported due to informants' reluctance to reveal this information. Informants were provided with the following definition of bladder problems: 'accidentally having wet pants, leaking urine, needing to go to the toilet frequently or urgently, sometimes not making it to the toilet in time, or using aids and appliances to manage incontinence or bladder problems'. A general question established whether or not informants suffered from any problems with their bladder. Informants reporting bladder problems were asked how often they had such problems, whether they used any aids to help manage their problem and whether they had consulted a health professional in relation to their bladder problem.
11.7.2 Prevalence and frequency of bladder problems among adults
Women were more likely than men to report having a problem with their bladder (9% compared with 5%). However, among adults with bladder problems men were more likely than women to report having problems at least once a week (75% compared with 64%). For both men and women the prevalence and frequency of bladder problems increased with age. Men over 65 and women over 45 were much more likely than their younger counterparts to experience problems with bladder control.
11.7.3 Aids used by adults with a bladder problem
Over half of women (54%) with a bladder problem used some form of aid to help control their problem compared with a quarter of men (23%). Sanitary towels/panty liners were used by 34% of women with bladder problems and were by far the most commonly used aid in this group. Men who used aids were most likely to select the non-specific category 'other aid'.
11.7.4 Health professionals consulted by adults about bladder problem
About half of men (52%) and over half of women (62%) with bladder problems had consulted their GP about their problem and over a third of men (38%) and women (36%) had spoken to a hospital doctor or specialist. Overall 59% of men and 69% of women had consulted a health professional about their bladder problem. Men and women who experienced bladder problems at least once a week were more likely to use incontinence aids and to have consulted a health professional than those who experienced bladder problems less often.
11.7.5 Bladder problems reported by children
Children aged 13-15 were extremely unlikely to report bladder problems, although girls were three times as likely as boys to do so (3% compared with 1%).
11.8 GASTROENTERITIS DUE TO FOOD POISONING
11.8.1 Introduction
As part of the Health Survey, informants were asked by nurses about symptoms of gastroenteritis associated with food poisoning _ that is, diarrhoea or vomiting three or more times within a 24 hour period which lasted no more than two weeks. Adults were also asked whether they consulted a doctor and whether they had any time off paid work due to the illness.7
Food poisoning (whether proven or suspect) is statutorily notifiable in Scotland8 and the 1999 White Paper Towards a Healthier Scotland emphasises that food safety is a key factor in public health. However, because many patients with mild food poisoning may not require medical treatment, it is possible that many cases will not be notified to designated medical officers of the Health Board. Results from the Health Survey, therefore, may provide a more accurate estimate of the prevalence of food poisoning among the Scottish population than that derived from medical records. It should be noted that foodborne diseases that do not present with gastroenteritis were not covered. On the other hand cases of gastroenteritis due to non-infectious causes may be included in these estimates (although exclusion of cases lasting longer than two weeks was intended to minimise this problem).
Prevalence among adults and children
One in fourteen men (7%) and one in twenty women (5%) reported having suffered from this type of illness in the six months preceding their interview. Prevalence was highest among younger age groups, with 11% of men and 8% of women aged 25-34 reporting having been affected. A lower prevalence of 3% was recorded for children (both boys and girls), with no trend according to age.
Most of those who had suffered from diarrhoea and/or vomiting that they thought might have been due to food poisoning did not consult a doctor. Women were more likely than men to have done so (25% and 13% respectively). A quarter of men and women who had suffered from this type of illness took time off work as a result (a further 36% of men and 30% of women affected were in work but did not take time off). (Table not shown).
11.9 CHILDREN'S BLOOD LEAD LEVELS
11.9.1 Introduction
During the nurse visit, a blood sample was taken from children aged 11-15. Children's blood samples were analysed for lead levels. Lead may be present in blood due, primarily, to exposure to fumes from leaded petrol or from lead in water pipes. There is some evidence that very high lead levels in the blood of infants and very young children may lead to impaired cognitive development and lower IQ scores.9 The recommended safe level for blood lead is 10mg/dl.10
11.9.2 Children's blood lead levels
Overall, the blood lead levels of children aged 11-15 were well below the recommended level. Only 2% of boys and 1% of girls had blood lead levels of over 5mg/dl and none of the children in the sample had a blood lead level greater than 10mg/dl. A higher percentage of girls than boys had very low blood lead levels (89% compared with 79%). However, this difference between boys and girls may be explained by the fact that blood lead is bound to haemoglobin which is naturally lower in females than males.