Scottish Health Survey 2013 - volume 1: main report
Presents results for the 2013 Scottish Health Survey, providing information on the health and factors relating to health of people living in Scotland.
9 Multiple risks and vulnerabilities
Catherine Bromley
SUMMARY
Constructing a risk index
- A risk index for poor health in adults was created, based on 21 measures of risks and vulnerabilities included in the survey in 2012 and 2013. These spanned current chronic disease risk factors, family or historic risks, current morbidities, low wellbeing, and socio-economic disadvantage.
- Index scores were grouped to identify those with the least (0-3) and most (8 or more) risks.
- Based on their combinations of risks, six distinct groups of people were identified. Groups differed in average age, the extent of socio-economic disadvantage, and whether members had multiple long-term conditions (multimorbidity) or not.
Risks profile
- The overall distribution of scores ranged from 0 to 18, where a score of 0 indicated that someone had none of the risks included in the index.
- The median number of risks (risk score) for adults aged 16 and over in 2012/2013 was 5.
- Around a third (32%) of adults had between 0 and 3 of the selected risks in 2012/2013, while 19% had 8 or more.
- Overall, risk scores for men and women were almost identical, however young men (aged 16-24) were significantly more likely than young women to be in the lowest risk group (62% and 49%, respectively).
- The presence of multiple risks increased with age: just 3% of those aged 16-24 were in the highest risk group compared with 40% of those aged 75 and over.
- People living in areas with high levels of multiple deprivation were most likely to have a high number of individual risks. Among the 45-64 age group, 48% of those living in the 20% most deprived areas of Scotland had 8 or more risks, compared with 9% of those living in the least deprived SIMD quintile.
Risk groups
- Multimorbidity, poor self-reported health, low wellbeing and below average life-satisfaction were more likely to co-exist if people were also very socio-economically disadvantaged.
- Younger, deprived multimorbid people were more likely to drink heavily and smoke, whereas older deprived multimorbid people were more likely to be overweight/obese and physically inactive.
- The younger group of deprived people who did not have multimorbidity had high levels of psychosocial distress and low wellbeing, along with other notable risks such as very poor diets and high smoking rates.
Risk groups and self-reported general health
- Those risk groups with high levels of multimorbidity were most likely to report fair to very bad health in general.
- Those with multimorbidity, high levels of socio-economic disadvantage and low wellbeing (groups 5 and 6) had much worse self-rated general health than those who were multimorbid but not deprived (group 2).
Risk groups and recent health service use
- Recent health service use was greatest among multimorbid and deprived groups (groups 5 and 6).
- While 36% of group 4 (younger, high risk, not morbid) had at least one psychosocial risk (low wellbeing and/or psychological distress), prevalence of poor self-reported general health was low and health service usage was similar to group 1 (young, low risk).
- The wellbeing and disease risk profile of group 4, notably their high smoking prevalence and low fruit and vegetable consumption, suggest that they are a group with many risks that could be amenable to interventions, but low contact with primary care services make them potentially difficult to reach.
9.1 INTRODUCTION
The 2010 Scottish Health Survey (SHeS) annual report explored the prevalence of multiple risks for poor health among adults in Scotland,[1] focussing on the following five risks: smoking, hazardous or harmful alcohol consumption, overweight and obesity, low fruit and vegetable consumption and low physical activity levels. All these factors impact negatively on individual and population health and all feature among the top ten risks that have been estimated to contribute most to disease across the globe.[2]
Concern about multiple risks has parallels with another relatively new field now attracting significant attention from health policy makers and practitioners: multimorbidity - the concurrent existence of multiple health conditions in the same individual. The clinical consequences of multimorbidity on outcomes for people and for health and care systems are widely acknowledged, for example, the challenges associated with delivering effective, safe and person-centred treatment, care and support in the context of health and care systems and guidelines that are largely structured around single diseases.[3],[4] The population health implications of multiple overlaying risks are similarly challenging, given that many of the individual risks are themselves part of a complex web of causation (for example, obesity), and the policy interventions available are themselves multi-faceted, and at times controversial (for example, policies to reduce harmful alcohol consumption).
Many, but by no means all, interventions to improve health and wellbeing that focus primarily on individual risk factors treat them as single entities rather than adopting a more holistic approach. In part, this is due to the complexity of delivering such interventions, and the lack of evidence for their efficacy, for example in reducing heart disease mortality.[5] In contrast, greater evidence exists about the efficacy of delivering interventions for specific risks, for example smoking cessation.[6] Furthermore, the balance of evidence favours population-level approaches, rather than those solely targeting individual behavioural risk factors, especially where the aim is to improve health without widening health inequalities.[7],[8],[9]
Although numerous definitions of multimorbidity have been used over time, and debates still persist,[10],[11] a number of validated indices have been developed to assist with estimates of its impact on outcomes such as health care costs and mortality.[12],[13] In contrast, while the importance of acknowledging the contribution of other risks beyond health conditions is recognised,[12] and theoretical models have been developed to help shape how this topic might be approached,[14],[15] comparatively fewer attempts have been made to develop validated complexity measures for use in population health research.[16]
9.1.1 Reporting on multiple risks in the Scottish Health Survey (SHeS)
The analysis presented in this chapter is designed to help illustrate the myriad ways in which risks and vulnerabilities occur in the population, identify which are more commonly found to co-exist, and how they are distributed between men and women, across different age groups and through the deprivation spectrum. Rather than simply update the 2010 analysis (which itself partially replicated analysis of the 2003 survey)[17], this chapter has extended the approach to include a wider range of measures, spanning a number of domains, in order to provide a more detailed picture of the range, nature and burden of risk and vulnerabilities in the adult population in Scotland.
9.2.1 Index construction and selection criteria
SHeS contains a large range of measures of individual risk factors and other vulnerabilities, so a selection process was necessary to identify suitable items for use in a risk index. The Scottish Index of Multiple Deprivation (SIMD), which uses data on 38 indicators across 7 domains, was developed to capture the social complexity of geographic areas (See Glossary for a detailed description of the SIMD). A similar approach, of identifying domains, and selecting indicators to populate them, was also adopted for the analysis presented in this chapter.
A number of existing frameworks helped to guide the choice of measures used in the index, including theoretical models of health and disease causation that emphasize multiple pathways (such as Krieger's eco-social model);[15] life-course models of risk acquisition;[18] the social determinants of health literature;[19] and evidence relating to the well-established chronic disease risk-factors that feature prominently in most public health policy (each of which has been demonstrated to have negative associations with a range of health outcomes). Although the analysis presented in this chapter focuses on risks and vulnerabilities experienced by individuals, this is a function of the available data and should not be taken to imply that the more fundamental causes that underlie the social distribution of these risks have been ignored.[20]
The index was not designed with the intention of predicting outcomes (such as health status or mortality). Instead, its function is to identify risks within the population, such as smoking, as well as broader factors that make people vulnerable, such as chronic conditions and psychological distress. An index designed for predictive purposes would also use weighting, both within and across individual domains, to reflect the relative contributions of its components to the outcome of interest. In contrast, this index is intended to simply identify the presence of risks (they either exist or they do not), for a selection of available indicators, and does not attach greater significance to any individual component. A final point to note is that the index was created after the data were collected, the survey was not designed with the specific purpose of analysing multiple risks in this way. The selection of items for use in the index was therefore necessarily limited by the questions and measures included in the survey.
9.2.2 Items included in the risk index
The percentage of adults aged 16 and over in each of the categories making up the index is shown in the table below for the years 2012 and 2013 combined. The overall risk score was calculated by summing the total number of risks a person had (each individual risk was scored 1 if present, 0 if not). While the maximum possible score was 20, the highest score that anyone had in these years was in fact 18. Note that due to the exclusion of any cases with missing data on an item, these figures are not the true total population estimates for these measures, and should not be cited as such. They are shown for illustrative purposes only.
| Risk index items |
% adults with risk factor 2012/2013 combined |
|---|---|
| Current chronic disease risk-factors |
|
| Eats fewer than 5 portions of fruit or vegetables per day |
78 |
| BMI of 25 kg/m2 or above (overweight or obese) |
67 |
| Does not meet physical activity guideline on aerobic activity |
33 |
| Weekly and/or daily alcohol consumption outwith sensible drinking guidelines |
43 |
| Current cigarette smoker |
22 |
| Historic / familial chronic disease risk-factors |
|
| Ex-cigarette smoker |
25 |
| Mother/father/both died of CVD condition |
30 |
| Mother/father/sibling developed CVD condition before age of 60 |
27 |
| Current morbidity[21] |
|
| Number of long-term conditions (each condition contributes to index) 1 condition 2 conditions 3 conditions 4 conditions 5 conditions 6 conditions |
23 12 6 2 1 0 |
| Daily activities limited by a long-term condition[22] |
29 |
| Psycho-social distress / low wellbeing |
|
| GHQ12 score greater than or equal to 4 |
14 |
| WEMWBS score more than 1 SD below the mean |
14 |
| Socio-economic vulnerability |
|
| No educational qualifications |
16 |
| Unemployed |
4 |
| Routine or manual occupation NS-SEC category |
15 |
| In lowest equivalised household income quintile |
17 |
| Unweighted sample size |
6601 |
9.2.3 Classification of risk groups
To make the presentation of results more meaningful, two methods to summarise the data were applied. The first was a simple grouping of the index into approximate quartiles. Exact quartiles could not be created as the data were not normally distributed, with a larger proportion at the lower end of the index than the top. Grouping the risks in this way helps to distinguish between groups with relatively lower and higher risk profiles: those in the lowest quartile had 0-3 risks, while those in the highest had 8 or more.
The second method of summarising the data was more complex. Latent Class Analysis (LCA) was used to identify typologies of risk profiles, to help identify patterns within the data that would not otherwise be apparent. This statistical approach categorises individuals into different groups, or 'latent classes,' based on their responses to a series of questions, or in this case, the risk factors presented above. LCA operates by identifying the number of classes or groups that best fit the data and generating probabilities of membership of each group for every eligible participant. Once this is complete, a participant is assigned to the class for which they have the highest probability of membership. The first step is to identify how many different classes or groups best fit the data. To test this, a number of models, each containing a pre-specified number of classes, were produced. Results from each model were compared and the most appropriate solution selected. Once the latent classes were identified,[23] information about the age and deprivation profile of each class was used to help complete their description.
A six class model was selected for use in the analysis presented in this chapter; the classes identified are listed in the table below along with the percentage of adults falling into each risk group:
| Risk Group |
% adults in risk group |
|---|---|
| Younger, low risks, no morbidity |
48 |
| Older, average risks, multimorbid |
18 |
| Older, high risks, low morbidity |
13 |
| Younger, average / high risks, no morbidity |
9 |
| Older, multiple high risks, multimorbid |
8 |
| Younger, multiple high risks, multimorbid |
5 |
9.3 Risks index analysis
9.3.1 Risks in 2012/2013 combined, by age and sex
This section focuses on the risk index and quartile groups described above in Section 9.2. Scores ranged from 0 to 18, with a score of 0 indicating that none of the risks included in the scale were present. While the highest theoretically possible score was 20 in 2012/2013, no participants had more than 18 of the identified risks.
In 2012/2013, just 1% of adults had a risk score of 0, indicating that they didn't have any of the 21 risks included in the index. At the other end of the index, 1% had a score of 14 or more (data not shown). As Figure 9A illustrates, the index was not normally distributed, with a higher concentration of scores at the lower end. For this reason, the discussion in this section focuses on the median risks and risk quartiles, rather than means. Figure 9A
The mean and median number of risks for men, women and all adults, is presented by age group in Table 9.1. The median number of risks for adults in 2012/2013 was 5 and men and women had the same median number of risks. The median number of risks increased with age for both men and women, from 3 risks for those aged 16-24 to 7 risks for those in the oldest age group (aged 75 and above).
One in three (32%) adults were in the lowest risk group with between 0 and 3 risks, while 19% had 8 or more risks and fell in the highest risk group. Similar to the pattern observed for median risks, there were pronounced linear associations with age. Over half (56%) of those aged 16-24 were in the lowest risk group, decreasing steadily to 11% of those aged 75 and over. In contrast, four in ten (40%) of those aged 75 and over were in the highest group, compared with just 3% of the youngest age group.
While the risk profiles of men and women did not vary significantly overall, there was a pronounced difference in the profiles of young men and women (aged 16-24): 62% of young men were in the lowest risk group compared with 49% of young women (the largest difference between the sexes across all of the age groups). This difference appears to be partly due to young women being much less likely than young men to meet the physical activity guideline on aerobic activity (see Chapter 6). Very few of those aged 16-24 were in the highest risk group (2% of men and 5% of women). Figure 9B, Figure 9C, Table 9.1
9.3.2 Risks by Scottish Index of Multiple Deprivation (SIMD), age and sex in 2012/2013 combined
In Table 9.2 risk scores are presented by area deprivation, grouped by sex and age group. Area deprivation is measured using the Scottish Index of Multiple Deprivation (SIMD). This differs from the usual approach adopted in analysis presented in SHeS annual reports which is to present age-standardised figures for area deprivation. (See Glossary for a detailed description of SIMD and age-standardisation). This alternative approach was adopted to illustrate any interactions between these factors (sex, age and SIMD).
Risk distributions are presented by SIMD quintile in Figure 9D, without any adjustment for age. The chart illustrates that the percentage of adults in the highest risk group increases, in a fairly linear fashion, with increased deprivation, for both sexes.
Table 9.2 indicates that the association with deprivation was evident within each of the age groups examined. For example, 3-5% of adults aged 16-44 living in the three least deprived quintiles (SIMD quintiles 3, 4 and 5) were in the highest risk group, compared with 18% of 16-44 year olds living in the most deprived quintile (SIMD quintile 1). This pattern of increasing risks in line with increased deprivation was even more pronounced for older age groups. Among the 45-64 age group, 9% of those in the least deprived quintile were in the highest risk group, compared with 48% of those living in the most deprived areas. The proportion of those aged 65 and over in the highest risk group more than doubled between those in the least and most deprived quintiles (22% and 56%, respectively).
These results illustrate that the association between risks and age group, shown in Table 9.1, is strongly mediated by area deprivation. While the sample sizes for men and women separately were somewhat smaller and the estimates were therefore less robust, the same overall patterns were evident. It is notable, for example, that even among the youngest men (the group most likely to have the lowest risk score), the proportion with 0-3 risks halves between the least and most deprived quintiles (from 66% to 33%).
The largest analysis of chronic condition multimorbidity conducted in Scotland to-date found that people living in the most deprived areas of the country were typically multimorbid 10-15 years before their less deprived counterparts.[24] Similarly, Table 9.2 shows that the risk profiles of young and middle-aged adults living in the most deprived areas more closely resemble the profiles of less deprived older age groups, than of their counterparts of the same age. For example, 32% of adults aged 16-44 living in the most deprived areas were in the lowest risk group, 30% in the next lowest, 20% in the second highest risk group and 18% in the highest group, a profile very similar to that of adults aged 45-64 living in the second least deprived quintile (SIMD quintile 2). Figure 9D, Table 9.2
9.4 Risk groups analysis
9.4.1 Risk group profiles in 2012/2013 combined
The remaining discussion focuses on the results of the Latent Class Analysis (LCA), which as noted in Section 9.2.3, identified the following six groups within the adult population, based on their risk profiles:
| Risk group |
% |
|---|---|
| Younger, low risks, no morbidity |
48 |
| Older, average risks, multimorbid |
18 |
| Older, high risks, low morbidity |
13 |
| Younger, average / high risks, no morbidity |
9 |
| Older, multiple high risks, multimorbid |
8 |
| Younger, multiple high risks, multimorbid |
5 |
The key features that distinguish these groups or classes are, broadly, the age, socio-economic status and morbidity status of their members. Comprehensive details of the risk profile for each of the groups are presented in Table 9.3. The individual prevalence for each of the risks included in the index across the six risk groups are presented.[25] These details are provided largely for reference purposes, to help the reader understand more about how the groups are comprised.
A more detailed description of the six groups, drawing on the information presented in Table 9.3, and the age and sex information presented in Table 9.4 follows:
Group 1 - Younger, below average risks, no morbidity
| Median age |
41 |
| Male (%) Female (%) |
50 50 |
| Median number of risks |
3 |
This group comprised 48% of adults. The key risk for the group is excess alcohol consumption (53% of group members drank outwith the government's daily and/or weekly sensible drinking guidelines). For the remaining risks, levels for group members were below average, or at worst, roughly average (though note that below average can still mean a highly prevalent risk, for example 60% were overweight or obese, 72% ate fewer than 5 portions of fruit or vegetables per day). This group was also notable for its low levels of socio-economic disadvantage, across all of the measures included.
Group 2 - Older, average risks, multimorbid
| Median age |
56 |
| Male (%) Female (%) |
46 54 |
| Median number of risks |
7 |
The second group comprised 18% of adults. Like group 1, most members had favourable socio-economic circumstances. This group had a higher number of risks than group 1 overall. With the exception of familial risk factors, which were somewhat above average, group members were at, or just below, average for most risks. The key distinguishing feature of this group was their multimorbidity, with almost all group members reporting that they had a limiting long-term condition (a mean of 1.9 conditions).
Group 3 - Older, high risks, low morbidity
| Median age |
60 |
| Male (%) Female (%) |
55 45 |
| Median number of risks |
6 |
Reflecting their older age, prevalence of family and historic disease risks were higher than average for the third group (which comprised 13% of adults). Forty-two percent had at least one parent who died of a CVD condition and a close relative with CVD onset before the age of 60. Forty-four percent were ex cigarette smokers. While over a third (37%) had no educational qualifications, the group was not notably disadvantaged on any of the other socio-economic measures included in the index. Prevalence of chronic disease risks was generally high, the most notable being the prevalence of overweight or obesity (91%), though alcohol consumption and smoking rates were below average. Despite their older age and other risk profile, this group was notable for having, on average, less than one chronic condition, and no limiting long-standing conditions.
Group 4 - younger, average / high risks, no morbidity
| Median age |
38 |
| Male (%) Female (%) |
50 50 |
| Median number of risks |
5 |
With a median age of 38, the fourth group (9% of adults) had a similar age profile to group 1, but with higher prevalence of some key chronic disease risks, the most notable being their very low fruit and vegetable consumption (96% ate fewer than 5 portions per day), and very high smoking prevalence (66% were current cigarette smokers). The group had high levels of socio-economic disadvantage on all measures: 24% were unemployed, 28% had no educational qualifications and 59% were in the lowest equivalised household income quintile. The group reported very few chronic and/or limiting conditions, but wellbeing/psychological distress prevalence was higher than average (36% had at least one psychosocial risk factor). One positive risk factor was apparent: only 50% were overweight or obese, compared with an average of 67%. However, the group was almost twice as likely as the other group of equivalent age (group 1) to be physically inactive.
Group 5 - Older, multiple high risks, multimorbid
| Median age |
66 |
| Male (%) Female (%) |
37 63 |
| Median number of risks |
10 |
Almost two-thirds of the fifth group were women and this group also had the oldest age profile. This group comprised 8% of adults. They were multiply burdened by risks across all domains, with particularly high levels of socio-economic disadvantage and an average of 2.7 long-term conditions. Like group 2, almost all in the group were limited by their long-term conditions on a day to day basis. Unlike group 2, however, levels of poor mental wellbeing were very high (25% had both a low WEMWBS score and a high GHQ12 score). Their poor health status was also reflected in their notably low activity levels (87% did not meet the aerobic activity guideline). The only factor for which they stood out as being at comparatively low risk was alcohol consumption (just 9% drank outwith the recommended weekly and/or daily limits), but based on other evidence about poor health and alcohol, this may be due to some giving up drinking for health reasons, and the low prevalence of drinking among older women, rather than low alcohol consumption being deleterious for health.
Group 6 - Younger, multiple high risks, multimorbid
| Median age |
46 |
| Male (%) Female (%) |
45 55 |
| Median number of risks |
9 |
The final group, comprising 5% of adults, had many parallels with group 5 (older and multimorbid) and group 4 (younger, but not morbid). For example, they had an average of 1.9 long-term conditions, almost half (48%) drank outwith the government guidelines on sensible drinking, and the majority (85%) smoked cigarettes. Overweight or obesity prevalence, however, was much lower than average (52%). Low wellbeing was most prevalent among this group (61% had at least one psychosocial risk), and members had some of the highest levels of socio-economic disadvantage (26% were unemployed, 68% were in the lowest equivalised household income quintile). Table 9.3, Table 9.4
9.4.2 Risk groups and selected outcomes in 2012/2013 combined
Some further contextual information on the self-reported general health and life-satisfaction of each of the six risk groups is presented in Table 9.5 and Figure 9E. Table 9.5 also provides the SIMD profile of the risk groups. In part, this information is presented to help provide confirmatory support for the results of the LCA analysis - if the measures shown had followed unexpected patterns it would suggest that the LCA lacked substantive validity. It is also presented to help illustrate the interplay between risks, area deprivation and health and wellbeing outcomes in the population.
Following the patterns evident for the indicators of socio-economic disadvantage in Table 9.3, the majority of those in group 4 (Younger, average / high risks, no morbidity) and group 6 (Younger, multiple high risks, multimorbid) lived in the two most deprived SIMD quintiles (SIMD quintiles 1 and 2). In contrast, the younger, low risk group (group 1), and the older, average risk group (group 2), had the most favourable SIMD profiles, with just 11-12% living in the most deprived quintile, and around half living in the two least deprived quintiles (SIMD quintiles 4 and 5).
Unsurprisingly, those groups with high levels of multimorbidity were most likely to report fair to very bad health in general. However, people in groups 5 and 6, who had multimorbidity, high levels of socio-economic disadvantage and low wellbeing had much worse self-rated general health than those in group 2, who were multimorbid but not deprived. Similarly, although below average life-satisfaction was more prevalent among those in group 2 than among the other two largely non-deprived groups (group 1 and group 3), low life satisfaction was higher still among the groups comprised of people with multimorbidity and high levels of socio-economic disadvantage, or high deprivation without multimorbidity. Figure 9E, Table 9.5
9.4.3 Risk groups and recent health service use in 2012/2013
Recent health service use, measured by whether a person had spoken to a GP on their own behalf in the previous two weeks or had received outpatient treatment at a hospital in the past year, is presented for each of the six risk groups in Figure 9F[26]. Health service use was greatest among groups 5 and 6 - multimorbid and multiple high risks. Interestingly, although 36% of group 4 (younger, high risk, not morbid) had at least one psychosocial risk (low wellbeing and/or psychological distress), prevalence of poor self-reported general health was low (Figure 9E) and health service usage was similar to group 1 (young, low risk). The wellbeing and disease risk profile of group 4, notably their high smoking prevalence and low fruit and vegetable consumption, suggest that they are a group with many risks that could be amenable to interventions, but their low contact with primary care services might make them potentially difficult to reach. Figure 9F
Table list
Table 9.1 Average number of risks, and percentage in each quartile, 2012/2013 combined, by age and sex
Table 9.2 Average number of risks, and percentage in each quartile, 2012/2013 combined, by Scottish Index of Multiple Deprivation, age and sex
Table 9.3 Individual risks by risk group membership, 2012/2013 combined
Table 9.4 Age, sex and risk profile by risk group membership, 2012/2013 combined
Table 9.5 Risk group membership, 2012/2013 combined, by Scottish Index of Multiple Deprivation, general health and life-satisfaction
Table 9.1 Average number of risks, and percentage in each quartile, 2012/2013 combined, by age and sex
| Aged 16 and over |
|
2012/2013 combined | ||||||
| Number of risksa |
Age |
Total |
||||||
| 16-24 |
25-34 |
35-44 |
45-54 |
55-64 |
65-74 |
75+ |
||
| % |
% |
% |
% |
% |
% |
% |
% |
|
| Men |
||||||||
| Median risks |
3 |
4 |
4 |
5 |
6 |
7 |
7 |
5 |
| Mean risks |
3.1 |
4.0 |
4.3 |
5.3 |
6.1 |
6.6 |
6.8 |
5.1 |
| SE of mean |
0.16 |
0.12 |
0.12 |
0.13 |
0.14 |
0.14 |
0.18 |
0.07 |
| Lowest quartile (0-3 risks) |
62 |
48 |
38 |
29 |
18 |
13 |
11 |
32 |
| 2nd quartile (4-5 risks) |
30 |
32 |
40 |
32 |
31 |
21 |
24 |
31 |
| 3rd quartile (6-7 risks) |
6 |
14 |
13 |
19 |
23 |
31 |
30 |
19 |
| Highest quartile (8 or more risks) |
2 |
6 |
9 |
20 |
28 |
34 |
36 |
18 |
| Women |
||||||||
| Median risks |
4 |
4 |
4 |
5 |
6 |
6 |
7 |
5 |
| Mean risks |
3.8 |
3.9 |
4.4 |
5.3 |
6.1 |
6.6 |
7.0 |
5.2 |
| SE of mean |
0.15 |
0.11 |
0.11 |
0.13 |
0.14 |
0.16 |
0.19 |
0.06 |
| Lowest quartile (0-3 risks) |
49 |
50 |
39 |
34 |
21 |
13 |
12 |
32 |
| 2nd quartile (4-5 risks) |
34 |
29 |
33 |
27 |
27 |
25 |
22 |
28 |
| 3rd quartile (6-7 risks) |
12 |
13 |
16 |
19 |
25 |
25 |
24 |
19 |
| Highest quartile (8 or more risks) |
5 |
8 |
13 |
21 |
28 |
37 |
42 |
21 |
| All adults |
||||||||
| Median risks |
3 |
4 |
4 |
5 |
6 |
6 |
7 |
5 |
| Mean risks |
3.4 |
4.0 |
4.4 |
5.3 |
6.1 |
6.6 |
6.9 |
5.1 |
| SE of mean |
0.11 |
0.08 |
0.09 |
0.10 |
0.11 |
0.11 |
0.14 |
0.05 |
| Lowest quartile (0-3 risks) |
56 |
49 |
38 |
31 |
19 |
13 |
11 |
32 |
| 2nd quartile (4-5 risks) |
32 |
30 |
36 |
29 |
29 |
23 |
22 |
30 |
| 3rd quartile (6-7 risks) |
9 |
13 |
14 |
19 |
24 |
28 |
27 |
19 |
| Highest quartile (8 or more risks) |
3 |
7 |
11 |
20 |
28 |
36 |
40 |
19 |
| Bases (weighted): |
||||||||
| Men |
310 |
486 |
566 |
635 |
526 |
358 |
204 |
3085 |
| Women |
304 |
516 |
595 |
649 |
540 |
374 |
265 |
3244 |
| All adults |
614 |
1003 |
1161 |
1284 |
1066 |
732 |
469 |
6329 |
| Bases (unweighted): |
||||||||
| Men |
183 |
381 |
521 |
609 |
524 |
485 |
259 |
2962 |
| Women |
233 |
523 |
678 |
763 |
636 |
486 |
320 |
3639 |
| All adults |
416 |
904 |
1199 |
1372 |
1160 |
971 |
579 |
6601 |
a See Section 9.2 for further details on the risk index
Table 9.2 Average number of risks, and percentage in each quartile, 2012/2013 combined, by Scottish Index of Multiple Deprivation, age and sex
| Aged 16 and over |
|
2012/2013 combined | |||
| Number of risksa |
Scottish Index of Multiple Deprivation |
||||
| 5th (least deprived) |
4th |
3rd |
2nd |
1st (most deprived) |
|
| % |
% |
% |
% |
% |
|
| Men |
|||||
| Age 16-44 |
|||||
| Median risks |
3 |
4 |
4 |
4 |
4 |
| Mean risks |
3.2 |
3.7 |
3.8 |
4.2 |
4.8 |
| SE of mean |
0.13 |
0.14 |
0.14 |
0.17 |
0.25 |
| Lowest quartile (0-3 risks) |
66 |
49 |
50 |
36 |
33 |
| 2nd quartile (4-5 risks) |
27 |
35 |
33 |
43 |
34 |
| 3rd quartile (6-7 risks) |
4 |
12 |
14 |
13 |
18 |
| Highest quartile (8 or more risks) |
3 |
3 |
4 |
7 |
15 |
| Age 45-64 |
|||||
| Median risks |
4 |
5 |
5 |
6 |
7 |
| Mean risks |
4.4 |
5.2 |
5.8 |
6.0 |
7.6 |
| SE of mean |
0.13 |
0.18 |
0.20 |
0.20 |
0.33 |
| Lowest quartile (0-3 risks) |
35 |
28 |
24 |
18 |
9 |
| 2nd quartile (4-5 risks) |
42 |
32 |
30 |
28 |
21 |
| 3rd quartile (6-7 risks) |
15 |
21 |
21 |
25 |
23 |
| Highest quartile (8 or more risks) |
8 |
19 |
25 |
29 |
47 |
| Age 65+ |
|||||
| Median risks |
6 |
6 |
7 |
7 |
8 |
| Mean risks |
5.8 |
6.0 |
6.9 |
7.5 |
7.8 |
| SE of mean |
0.19 |
0.19 |
0.26 |
0.29 |
0.29 |
| Lowest quartile (0-3 risks) |
21 |
14 |
13 |
8 |
2 |
| 2nd quartile (4-5 risks) |
22 |
29 |
23 |
16 |
18 |
| 3rd quartile (6-7 risks) |
36 |
32 |
24 |
31 |
28 |
| Highest quartile (8 or more risks) |
22 |
24 |
40 |
45 |
52 |
| Women |
|||||
| Age 16-44 |
|||||
| Median risks |
3 |
3 |
4 |
4 |
5 |
| Mean risks |
3.4 |
3.4 |
3.8 |
4.6 |
5.2 |
| SE of mean |
0.14 |
0.13 |
0.15 |
0.15 |
0.21 |
| Lowest quartile (0-3 risks) |
60 |
54 |
47 |
34 |
31 |
| 2nd quartile (4-5 risks) |
25 |
33 |
35 |
39 |
26 |
| 3rd quartile (6-7 risks) |
12 |
9 |
11 |
16 |
22 |
| Highest quartile (8 or more risks) |
3 |
4 |
7 |
12 |
20 |
| Age 45-64 |
|||||
| Median risks |
4 |
4 |
5 |
6 |
7 |
| Mean risks |
4.4 |
4.8 |
5.8 |
6.5 |
7.5 |
| SE of mean |
0.17 |
0.15 |
0.20 |
0.20 |
0.26 |
| Lowest quartile (0-3 risks) |
38 |
35 |
29 |
18 |
12 |
| 2nd quartile (4-5 risks) |
36 |
30 |
25 |
20 |
19 |
| 3rd quartile (6-7 risks) |
16 |
23 |
18 |
31 |
21 |
| Highest quartile (8 or more risks) |
10 |
12 |
28 |
32 |
48 |
| Age 65+ |
|||||
| Median risks |
5 |
6 |
7 |
7 |
8 |
| Mean risks |
5.4 |
6.3 |
6.7 |
7.4 |
8.5 |
| SE of mean |
0.20 |
0.21 |
0.23 |
0.29 |
0.31 |
| Lowest quartile (0-3 risks) |
25 |
13 |
12 |
8 |
4 |
| 2nd quartile (4-5 risks) |
29 |
32 |
23 |
21 |
11 |
| 3rd quartile (6-7 risks) |
25 |
23 |
24 |
25 |
26 |
| Highest quartile (8 or more risks) |
21 |
33 |
41 |
46 |
59 |
| All adults |
|||||
| Age 16-44 |
|||||
| Median risks |
3 |
3 |
4 |
4 |
5 |
| Mean risks |
3.3 |
3.6 |
3.8 |
4.4 |
5.0 |
| SE of mean |
0.11 |
0.11 |
0.10 |
0.12 |
0.18 |
| Lowest quartile (0-3 risks) |
63 |
51 |
49 |
35 |
32 |
| 2nd quartile (4-5 risks) |
26 |
34 |
34 |
41 |
30 |
| 3rd quartile (6-7 risks) |
8 |
11 |
12 |
14 |
20 |
| Highest quartile (8 or more risks) |
3 |
4 |
5 |
10 |
18 |
| Age 45-64 |
|||||
| Median risks |
4 |
5 |
5 |
6 |
7 |
| Mean risks |
4.4 |
5.0 |
5.8 |
6.3 |
7.6 |
| SE of mean |
0.12 |
0.12 |
0.16 |
0.15 |
0.23 |
| Lowest quartile (0-3 risks) |
36 |
32 |
26 |
18 |
11 |
| 2nd quartile (4-5 risks) |
39 |
31 |
27 |
24 |
20 |
| 3rd quartile (6-7 risks) |
16 |
22 |
20 |
28 |
22 |
| Highest quartile (8 or more risks) |
9 |
15 |
27 |
30 |
48 |
| Age 65+ |
|||||
| Median risks |
6 |
6 |
7 |
7 |
8 |
| Mean risks |
5.6 |
6.2 |
6.8 |
7.4 |
8.2 |
| SE of mean |
0.16 |
0.15 |
0.19 |
0.23 |
0.23 |
| Lowest quartile (0-3 risks) |
23 |
13 |
12 |
8 |
3 |
| 2nd quartile (4-5 risks) |
26 |
30 |
23 |
19 |
14 |
| 3rd quartile (6-7 risks) |
30 |
28 |
24 |
28 |
27 |
| Highest quartile (8 or more risks) |
22 |
29 |
40 |
46 |
56 |
| Bases (weighted): |
|||||
| Men 16-44 |
271 |
312 |
265 |
291 |
223 |
| Men 45-64 |
291 |
223 |
243 |
221 |
182 |
| Men 65+ |
127 |
132 |
111 |
108 |
83 |
| Women 16-44 |
261 |
281 |
288 |
295 |
289 |
| Women 45-64 |
277 |
264 |
242 |
218 |
189 |
| Women 65+ |
138 |
141 |
120 |
130 |
110 |
| All adults 16-44 |
532 |
593 |
553 |
587 |
512 |
| All adults 45-64 |
568 |
488 |
485 |
439 |
371 |
| All adults 65+ |
265 |
273 |
231 |
238 |
194 |
| Bases (unweighted): |
|||||
| Men 16-44 |
209 |
272 |
225 |
222 |
157 |
| Men 45-64 |
254 |
237 |
274 |
210 |
158 |
| Men 65+ |
156 |
182 |
172 |
139 |
95 |
| Women 16-44 |
251 |
318 |
303 |
296 |
266 |
| Women 45-64 |
298 |
331 |
339 |
245 |
186 |
| Women 65+ |
159 |
197 |
180 |
156 |
114 |
| All adults 16-44 |
460 |
590 |
528 |
518 |
423 |
| All adults 45-64 |
552 |
568 |
613 |
455 |
344 |
| All adults 65+ |
315 |
379 |
352 |
295 |
209 |
a See Section 9.2 for further details on the risk index
Table 9.3 Individual risks by risk group membership, 2012/2013 combined
| Aged 16 and over |
|
2012/2013 combined | |||||
| Individual risks |
Risk group typea |
All |
|||||
| Younger, below average risks, non-morbid, non-deprived |
Older, low to average risks, multi-morbid, non-deprived |
Older, high disease/ family risks, non-morbid, low to average deprivation |
Younger, average to high risks, non-morbid, high deprivation |
Older, high risks, multi-morbid, high deprivation |
Younger, high risks, multi-morbid, high deprivation |
||
| % |
% |
% |
% |
% |
% |
% |
|
| Individual risks |
|||||||
| Eats <5 fruit/vegetables a day |
72 |
72 |
85 |
96 |
87 |
95 |
78 |
| Overweight or obese |
60 |
74 |
91 |
50 |
84 |
52 |
67 |
| Does not meet activity recommendations |
19 |
36 |
37 |
37 |
87 |
53 |
33 |
| Drinks outwith recommended limits |
53 |
37 |
39 |
40 |
9 |
48 |
43 |
| Current cigarette smoker |
12 |
13 |
17 |
66 |
31 |
85 |
22 |
| Ex-smoker |
20 |
30 |
44 |
8 |
39 |
2 |
25 |
| Parent died of CVD and relative CVD <60 |
5 |
19 |
42 |
6 |
39 |
14 |
15 |
| Parent died of CVD (but no relative CVD <60) |
10 |
21 |
30 |
6 |
28 |
4 |
15 |
| Mother, father or sibling CVD <60 (but no parent died of CVD) |
11 |
12 |
4 |
23 |
6 |
23 |
12 |
| Mean number of conditions |
.2 |
1.9 |
.7 |
.1 |
2.7 |
1.9 |
.8 |
| Standard error |
.01 |
.04 |
.03 |
.01 |
.07 |
.06 |
.02 |
| Daily activities limited by LTC |
- |
97 |
- |
- |
98 |
97 |
29 |
| GHQ12 >=4 and low wellbeing (WEMWBS) |
3 |
6 |
2 |
12 |
25 |
35 |
7 |
| Low wellbeing (WEMWBS) (but GHQ12 <4) |
2 |
6 |
6 |
14 |
13 |
19 |
6 |
| GHQ12 >=4 (but not low wellbeing) |
5 |
10 |
1 |
10 |
10 |
7 |
7 |
| No qualifications |
- |
7 |
37 |
28 |
78 |
28 |
16 |
| Unemployed |
1 |
0 |
1 |
24 |
- |
26 |
4 |
| Routine or manual NS-SEC |
4 |
8 |
29 |
43 |
41 |
32 |
15 |
| Lowest household income quintile |
3 |
6 |
13 |
59 |
50 |
68 |
17 |
| Grouped risks |
|||||||
| Median risks |
3 |
7 |
6 |
5 |
10 |
9 |
5 |
| Mean risks |
3.1 |
6.7 |
5.9 |
5.5 |
10.6 |
9.3 |
5.1 |
| SE of mean |
.03 |
.07 |
.06 |
.07 |
.12 |
.12 |
.05 |
| Total group size |
48 |
18 |
13 |
9 |
8 |
5 |
100 |
| Bases (weighted): |
3061 |
1138 |
789 |
563 |
481 |
297 |
6329 |
| Bases (unweighted): |
2996 |
1268 |
905 |
544 |
557 |
331 |
6601 |
a See Section 9.2.3 for further details on the risk groups classification
Table 9.4 Age, sex and risk profile by risk group membership, 2012/2013 combined
| Aged 16 and over |
|
2012/2013 combined | ||||
| Age and sex |
Risk group typea |
|||||
| Younger, below average risks, non-morbid, non-deprived |
Older, low to average risks, multi-morbid, non-deprived |
Older, high disease/ family risks, non-morbid, low to average deprivation |
Younger, average to high risks, non-morbid, high deprivation |
Older, high risks, multi-morbid, high deprivation |
Younger, high risks, multi-morbid, high deprivation |
|
| % |
% |
% |
% |
% |
% |
|
| Risk numbers |
||||||
| Median risks |
3 |
7 |
6 |
5 |
10 |
9 |
| Mean risks |
3.1 |
6.7 |
5.9 |
5.5 |
10.6 |
9.3 |
| SE of mean |
.03 |
.07 |
.06 |
.07 |
.12 |
.12 |
| Sex |
||||||
| Men |
50 |
46 |
55 |
50 |
37 |
45 |
| Women |
50 |
54 |
45 |
50 |
63 |
55 |
| Men |
||||||
| 16-24 |
15 |
4 |
0 |
18 |
- |
6 |
| 25-34 |
21 |
9 |
3 |
26 |
1 |
15 |
| 35-44 |
24 |
12 |
10 |
24 |
5 |
18 |
| 45-54 |
21 |
18 |
27 |
14 |
17 |
31 |
| 55-64 |
12 |
24 |
27 |
10 |
23 |
19 |
| 65-75 |
5 |
21 |
22 |
6 |
29 |
7 |
| 75 and over |
2 |
12 |
11 |
2 |
25 |
4 |
| Women |
||||||
| 16-24 |
12 |
5 |
4 |
19 |
0 |
9 |
| 25-34 |
22 |
12 |
4 |
22 |
2 |
17 |
| 35-44 |
24 |
14 |
8 |
23 |
5 |
23 |
| 45-54 |
22 |
20 |
19 |
14 |
15 |
24 |
| 55-64 |
13 |
21 |
25 |
10 |
23 |
17 |
| 65-75 |
6 |
16 |
26 |
4 |
24 |
7 |
| 75 and over |
2 |
10 |
14 |
7 |
29 |
3 |
| All adults |
||||||
| 16-24 |
14 |
5 |
2 |
19 |
0 |
7 |
| 25-34 |
22 |
10 |
4 |
24 |
2 |
16 |
| 35-44 |
24 |
13 |
9 |
24 |
5 |
20 |
| 45-54 |
21 |
19 |
23 |
14 |
16 |
27 |
| 55-64 |
12 |
23 |
26 |
10 |
23 |
18 |
| 65-75 |
5 |
19 |
24 |
5 |
26 |
7 |
| 75 and over |
2 |
11 |
13 |
4 |
28 |
4 |
| Total group size |
48 |
18 |
13 |
9 |
8 |
5 |
| Bases (weighted): |
||||||
| Men |
1529 |
525 |
435 |
281 |
180 |
135 |
| Women |
1533 |
613 |
354 |
281 |
301 |
162 |
| All |
3061 |
1138 |
789 |
563 |
481 |
297 |
| Bases (unweighted): |
||||||
| Men |
1335 |
543 |
472 |
255 |
215 |
142 |
| Women |
1661 |
725 |
433 |
289 |
342 |
189 |
| All |
2996 |
1268 |
905 |
544 |
557 |
331 |
a See Section 9.2.3 for further details on the risk groups classification
Table 9.5 Risk group membership, 2012/2013 combined, by Scottish Index of Multiple Deprivation, general health and life-satisfaction
| Aged 16 and over |
|
2012/2013 combined | ||||
| Area deprivation (SIMD), general health, life satisfaction |
Risk group type |
|||||
| Younger, below average risks, non-morbid, non-deprived |
Older, low to average risks, multi-morbid, non-deprived |
Older, high disease/ family risks, non-morbid, low to average deprivation |
Younger, average to high risks, non-morbid, high deprivation |
Older, high risks, multi-morbid, high deprivation |
Younger, high risks, multi-morbid, high deprivation |
|
| % |
% |
% |
% |
% |
% |
|
| SIMD |
||||||
| 5th (least deprived) |
29 |
22 |
18 |
7 |
8 |
5 |
| 4th |
24 |
25 |
21 |
16 |
12 |
8 |
| 3rd |
20 |
21 |
21 |
19 |
19 |
13 |
| 2nd |
16 |
20 |
23 |
28 |
27 |
27 |
| 1st (most deprived) |
11 |
12 |
18 |
29 |
34 |
46 |
| General health |
||||||
| Very good |
53 |
12 |
33 |
35 |
3 |
6 |
| Good |
42 |
42 |
51 |
48 |
15 |
21 |
| Fair |
4 |
33 |
15 |
15 |
42 |
42 |
| Bad |
0 |
10 |
0 |
1 |
31 |
26 |
| Very bad |
0 |
2 |
0 |
0 |
10 |
6 |
| Life satisfaction |
||||||
| Below average |
25 |
38 |
24 |
49 |
60 |
73 |
| Average |
36 |
33 |
35 |
21 |
23 |
15 |
| Above average |
39 |
29 |
41 |
30 |
17 |
12 |
| Bases (weighted): |
3060 |
1136 |
789 |
562 |
480 |
296 |
| Bases (unweighted): |
2995 |
1266 |
904 |
543 |
556 |
329 |
a See Section 9.2.3 for further details on the risk groups classification
Contact
Email: Julie Landsberg
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