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4363.0.55.001 - National Health Survey: Users' Guide - Electronic Publication, 2007-08  
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This document was added 09/17/2009.




CONTENTS

Introduction
Information about medical conditions
Asthma
Cancer
Heart and circulatory conditions
Diabetes mellitus
Arthritis
Osteoporosis
Mental health and wellbeing
Sight and hearing
Long-term conditions
Cause of conditions
Self-assessed health status
Healthy lifestyles
Disability
Personal stressors
Bodily pain


INTRODUCTION

The 2007-08 NHS collected information to describe various aspects of the health status of the Australian population, with a particular focus on asthma, cancer, heart and circulatory conditions, diabetes, mental health, arthritis and osteoporosis.

To enable the prevalence of current long-term conditions to be established, supplementary information was collected as part of the process of determining whether a reported condition was current and long-term.

Current long-term conditions are defined as medical conditions (illnesses, injuries or disabilities) which were current at the time of the survey and which had lasted at least six months, or which the respondent expected to last for six months or more, including:

  • long-term conditions from which only infrequent attacks may occur;
  • long-term conditions which may be under control, for example, through the continuing use of medication;
  • conditions which, although present, may not be generally considered ‘illness’ because they are not necessarily debilitating, e.g. reduced sight; and
  • long-term or permanent impairments or disabilities.

In addition to information about the medical conditions they had, respondents were asked to rate their overall health, and provide information about their disability status, selected personal stressors and levels of bodily pain.

The focus on long-term conditions in the 2007-08 survey is consistent with the 2001 and 2004-05 surveys. In 2007-08, more detailed information was collected on mental health. For each of the long-term conditions collected, a condition 'status' item has been derived. These items bring together the concepts of whether ever told (by a doctor or nurse) that they have the condition, whether the condition was current at the time of the interview, and whether the condition had lasted, or was expected to last, for six months or more, regardless of how and where in the questionnaire the condition was reported. Condition status classifies the condition for each respondent into the following categories:
      1. Ever told has condition, still current and long-term
      2. Ever told has condition, still current but not long-term
      3. Ever told has condition, not current
      4. Not known if ever told, but condition current and long-term
      5. Never told, not current or long-term

Counts of persons with a particular long-term condition will tally with the sum of current and long-term status categories (status categories 1 and 4) above. Some conditions are assumed to be current and/or long-term. This is discussed in more detail in the individual condition sections later in this chapter.

In some cases persons with a condition may not have reported the conditions in response to the specific questions for that condition, but may instead have reported the condition in response to subsequent, more general questions covering all conditions. Where this occurred, the condition was recorded and is counted in survey results as a current and long-term condition, but the supplementary information about actions taken or medication used is not available. Where these cases were identified by the survey instrument at the time of the interview, the respondent was asked whether they had ever been told by a doctor or nurse that they had the condition. This enabled most of these cases to be appropriately classified in condition status items which are derived for all conditions. Some conditions were not able to be identified in the instrument, therefore further information was not collected. The small number of cases not identified at the time of interview were allocated to condition status 4: Not known if ever told, but condition current and long-term.

The approach of screening respondents through 'ever told' questions for some conditions was adopted because people who were previously diagnosed with a condition, but no longer consider they have the condition, may be at special risk of developing chronic conditions, and were therefore a key group of interest to users of the data.

Conceptually, cases of mis-diagnosis are excluded. Where interviewers became aware of a condition which the respondent had been told they had/have, but that diagnosis later proved incorrect, the respondent was recorded as not ever told they have the condition. This approach retains the conceptual alignment between the 'ever told' and 'whether current' populations. However, respondents may not have made this known to interviewers, with the result those cases will appear in survey results as 'ever told' but 'not current'.

Although the overall approach was similar for most conditions, there are some differences in the conceptual basis of the conditions data available. These are summarised in the table below. As noted above, regardless of these differences, the scope of published results about long-term conditions is those conditions identified (by the respondent or assumed under the survey methodology) as current and long-term.

Long-term conditions

Type of condition
Ever had condition
Ever told by a doctor or nurse has condition
Currently has condition
Condition lasted or expected to last for 6 months or more

Asthma
X
(a)X
Assumed
Cancer
X
X
Assumed
Heart and circulatory condition
X
X
Assumed and X
Diabetes/high sugar levels
X
X
(b)Assumed and X
Arthritis
X
X
X
Assumed
Osteoporosis
X
X
Assumed
Mental health(c)
X
X
X
All other conditions(c)
X
X

(a) Must have had symptons of asthma or taken treatment for asthma in the last 12 months.
(b) Assumed for diabetes mellitus, asked for high sugar levels.
(c) In contrast to the other specified conditions, respondents must volunteer that they have a condition.


Despite the different methodologies used for obtaining information about medical conditions, all condition data from the survey are ultimately 'as reported' by respondents. While the survey questionnaire was designed to prompt respondents and give them an opportunity to report all long-term conditions they had, whether or not they chose to report a condition to the ABS interviewer, and how they chose to identify or describe that condition, was at the respondent's discretion.

The conditions recorded and classified in the survey were those currently experienced by the respondent at the time of the interview. The condition may not necessarily have been manifest in terms of current symptoms; for example, a person may suffer from hayfever or sinusitis but experience infrequent attacks.

The 2007-08 NHS questionnaire design enabled a theoretical maximum of almost 100 conditions per person to be reported.

As the NHS is a household survey, residents of hospitals, nursing or convalescent homes or similar accommodation were outside the scope of the survey, therefore prevalence data for conditions such as cancer are likely to be affected.


INFORMATION ABOUT MEDICAL CONDITIONS

Classification of conditions

Provision was made on the survey questionnaire for interviewers to record condition information in two ways;
  • record responses against predefined and specified condition type/name response categories, and
  • write in responses as reported by respondents for later office coding.

Information from both sources was combined and classified to a single list of approximately 1000 specific condition and condition group categories (referred to as the "1000 input code list" in this publication). This list covered the more common types of long-term conditions experienced in the Australian community. The list was initially developed by the Family Medicine Research Centre at the University of Sydney, in consultation with the ABS, for the 2001 NHS. A computer-based coding system was developed by the ABS based on this list, and all 'write in' condition information was office coded using this system. Predefined response categories in the questionnaire were allocated unique codes within the 1000 input code list.

An automated coding system was used to code medical conditions. The system allocated codes on the basis of an exact match between the condition description recorded by the interviewer, and the description contained in the auto-coder. The coder was successful in coding around 20% of conditions. Cases which were not auto-coded were manually coded using the computer-assisted system.

Results from the survey are generally not available classified to the most detailed condition level. As the data are from a sample survey, there are not enough observations to support reliable estimates at that level of detail. While some data at this level may be made available on request for more commonly occurring conditions, for general output purposes, long-term conditions are classified based on the 10th Revision of the International Classification of Diseases (ICD10).

The output classification was developed by the ABS based on mappings between the 1000 input code list and ICD10 provided by the Family Medicine Research Centre. The classification takes into account
  • the types of long-term conditions more commonly reported in a population based survey and for which reliable estimates could be produced;
  • the types of conditions or groups of conditions known to be of particular interest to data users; and
  • the variability of the descriptions of conditions provided by respondents.

Efforts were made to ensure that the description of each condition which was recorded at interview was as precise and informative as possible, to enable detailed, accurate and consistent coding of conditions. Copies of the standard classifications of medical conditions available from this survey are contained in Appendix 2 of this Users' Guide. The process of mapping the 1000 input codes to the ICD10 output classifications was complex, and in some cases the classification of the input codes was based on 'best fit' rather than 'exact match'.


Interpretation of conditions data

Any interpretation of conditions data should consider the fact that all data is self-reported, and the way that respondents report a condition may differ according to the type and form of the questions asked. Conditions which are specifically mentioned in questions or in prompt cards or other aids are expected to be better reported than conditions which are not. As it is not possible (or appropriate) to mention every condition in the survey interview, the relativity between conditions shown in survey results may in part reflect different methodologies used to collect the information. In the 2007-08 survey, respondents were specifically asked about key long-term conditions, eye and sight problems, and ear and hearing problems.

Other conditions specifically shown in prompt cards (in the order in which they were shown) were:
  • Astigmatism
  • Short-sightedness/Myopia/difficulty seeing objects in the distance
  • Macular degeneration
  • Other age related sight problems/Presbyopia
  • Long sightedness/Hyperopia/difficulty seeing objects close up
  • Hayfever
  • Sinusitis or sinus allergy
  • Other allergy
  • Anaemia
  • Bronchitis
  • Emphysema
  • Epilepsy
  • Fluid problems, fluid retention or oedema (exclude those due to a heart or circulatory condition)
  • Hernias
  • Kidney stones
  • Migraine
  • Psoriasis
  • Stomach ulcers or other gastrointestinal ulcers
  • Thyroid trouble or goitre
  • Depression
  • Feeling depressed
  • Back - slipped disc or other disc problem
  • Back pain or other back problems
  • Amputation or loss of limb (for example: arm, foot, finger)
  • Behavioural or emotional disorders
  • Deformity or disfigurement from birth (for example: club foot, cleft palate)
  • Other deformity or disfigurement (for example: effects of burns)
  • Dependence on drugs or alcohol
  • Difficulties in learning or understanding
  • Feeling anxious or nervous
  • Gallstones
  • Incontinence
  • Paraplegia or other paralysis
  • Speech impediment

The survey estimates show the reported prevalence of the condition (as a long-term condition) at any point of time during the survey period. The data do not refer to the incidence of conditions occurring in the survey period.

As noted previously, only those conditions which were current at the time of interview and which were long-term (i.e. of six months or more duration in the respondent's view) are included in estimates of the prevalence of persons with that long-term condition. However, for some conditions and purposes, estimates relating to whether persons have ever been told they have the condition may be considered a useful measure of the condition. This is particularly the case for conditions that can be successfully managed, such as diabetes mellitus. Respondents with successfully managed conditions may not feel they have a current condition, therefore would not report their condition as current, and the measure of prevalence consequently excludes them.

Results of the survey show numbers of people with particular conditions or combinations of conditions, as well as number of conditions per person. Some caution should be used in interpreting counts of the number of conditions per person, however, as this can be affected by the classification system used to compile the data. At those levels of the classifications which are fairly broad, the effect may be to undercount conditions (because several different conditions may be classified to a single category and appear in output as a single condition), while at more detailed classification levels the effect would be reduced. For example, a person could have 3 conditions at the detailed level (angina, oedema and hypertensive disease), but only one condition at the broad level (circulatory condition).


ASTHMA

Definition

This topic refers to those ever told by a doctor or a nurse that they have asthma, whose asthma may be considered as a current condition. For asthma to be identified as current, the respondent must have been told by a doctor or nurse that they have asthma, and have had symptoms or taken treatment for asthma in the 12 months prior to interview.


Methodology

All respondents were asked whether they had ever been told by a doctor or nurse that they have asthma, whether symptoms were present or they had taken treatment in the 12 months prior to interview, and whether they still had asthma. Those who answered yes to these questions were asked questions about written asthma action plans, use of medications for asthma in the two weeks prior to interview, frequency of medication use, visits to general practitioners, specialists or other health professionals (see list, below), hospital visits, change in severity of asthma, and whether stayed away from work/study because of asthma.

Other health professionals include the following:
  • Accredited counsellor
  • Acupuncturist
  • Chemist (for advice only)
  • Chiropodist/Podiatrist
  • Chiropractor
  • Dietician/Nutritionist
  • Naturopath
  • Nurse
  • Occupational therapist
  • Optician/Optometrist
  • Osteopath
  • Physiotherapist/Hydrotherapist
  • Psychologist
  • Social worker/Welfare officer
  • Other

Persons sequenced around the asthma questions may have reported current long-term asthma in response to later general questions about medical conditions. These are included in and contribute to estimates of the prevalence of asthma, but the information about written action plans, medication use, consultations, hospital visits and days away was not collected in these cases.

Respondents were encouraged to refer to their medication packets, bottles, etc when answering questions about medications used for asthma. The brand or generic names of the medications reported by respondents as used for asthma in the last two weeks were recorded by interviewers, and office coded during processing (refer to Chapter 2: Survey Design and Operation.) Provision was made to record the names of up to three medications. If more than three medications were reported, only the three which the respondent considered were their main asthma medications were recorded.


Population

Information was obtained for all persons.


Data items

The data items and related output categories for this topic are available in Excel spreadsheet format from the downloads tabs of the National Health Survey: Users' Guide, 2007-08 (cat. no. 4363.0.55.001) and the National Health Survey Data Reference Package, 2007-08 (cat. no. 4363.0.55.002).


Interpretation

Points to be considered in interpreting data for this topic include the following:
  • Almost all current asthma cases identified are those which the respondent reported as being medically diagnosed, however cases are essentially self-reported, and hence may not agree with data from other sources using different approaches to the definition of asthma and the collection of data.
  • Medications recorded were those reported by respondents as used for asthma. In some cases respondents may have failed to report a medication, because they forgot they used the medication in the previous two weeks, were not aware the medication was for asthma, or did not wish to report they used it. As a result, the use of medications for asthma may be undercounted. Also, to the extent that asthma medication may be used for other conditions for which medications data were not recorded in the survey (e.g. hayfever, sinusitis), the data do not represent total use of asthma medication.
  • Respondents may have mistakenly reported other medications they were using as medications for asthma. All medications reported were coded, and data can be refined for use on the basis of medication type.


Comparability with 2004-05

The methodology used in the 2007-08 NHS was similar to that used in the 2004-05 survey. The 2007-08 NHS used additional criteria to determine whether the reported asthma was current, using symptoms and medications data. Remaining data for this topic which are common to both surveys are considered comparable. (see Chapter 7: Data quality and interpretation of results).


CANCER

Definition

This topic refers primarily to those ever told by a doctor or nurse they have cancer, who consider they currently have cancer (including cancer in remission).

For the purposes of this survey, all cancer reported as current was regarded as being a long-term condition. Given the potential sensitivity of the topic, this was considered the most appropriate approach, although it was recognised that some cases of cancer may not meet the six months threshold (e.g. a person diagnosed for skin cancer who has had surgery to remove it, all within a six month period).


Methodology

Respondents were asked if they had ever been told by a doctor or nurse that they had cancer, and the type of cancer (including type of skin cancer) they had.

Predefined 'type of cancer' categories were included on the questionnaire, with provision for interviewers to record one additional type of cancer if required. The categories used were:
  • Skin (including melanoma, basal cell carcinoma, squamous cell carcinoma)
  • Colon/rectum/bowel
  • Breast
  • Prostate
  • Lung (including trachea, pleura, bronchus)
  • Cervical cancer
  • Other female reproductive organs (including, uterus, ovary)
  • Bladder/Kidney
  • Stomach
  • Leukaemia
  • Non-Hodgkin lymphoma
  • Other type of lymphoma
  • Cancer of unknown primary site
  • Other (specified)

The use of these types in the questionnaire effectively established this list as the most detailed level of information on type of cancer available from the survey, although very limited further detail may also be available for types of cancer recorded in the 'Other - specify' category.

Respondents were then asked if they currently had cancer and the type of cancer (including type of skin cancer). For the purposes of this survey, persons in remission were regarded as still having cancer, irrespective of the period of remission. This was specifically mentioned in the question regarding currency (i.e. "including cancer which is in remission, do you currently have cancer?").

Those who answered yes to these questions were asked questions about use of natural or herbal medications or vitamin/mineral supplements for cancer in the two weeks prior to interview, frequency of visits to general practitioners, specialists or other health professionals, and whether stayed away from work/study because of asthma.

As noted in the introduction to this chapter, persons sequenced around these questions may have reported current long-term cancer in response to later general questions about medical conditions. These are included in and contribute to estimates of the prevalence of cancer.


Population

Information was obtained for all persons.


Data items

The data items and related output categories for this topic are available in Excel spreadsheet format from the downloads tabs of the National Health Survey: Users' Guide, 2007-08 (cat. no. 4363.0.55.001) and the National Health Survey Data Reference Package, 2007-08 (cat. no. 4363.0.55.002).


Interpretation

Points to be considered in interpreting data for this topic include the following:
  • Cases of cancer reported through the general questions about long-term conditions (rather than the specific cancer questions) have not necessarily been medically diagnosed, and may instead be other conditions. In particular, self-diagnosed skin cancer may be subject to misreporting.
  • As noted above, current cancers were assumed to be long-term (of six months or more duration), whether or not this was actually the case.
  • Because this is a household-based survey, people with cancer who are residents in hospitals, nursing or convalescent homes or similar accommodation are outside the scope of this survey.


Comparability with 2004-05

The methodology used in the 2007-08 NHS was the same as that used in the 2004-05 survey. Additional type of cancer categories were added at the input level so that key cancers (e.g. cervical cancer) can be identified. The categories included in 2007-08 aggregate to 2004-05 categories.


HEART AND CIRCULATORY CONDITIONS

Definition

This topic refers to those persons ever told by a doctor or nurse that they have one or more heart or circulatory conditions, who consider they currently have one or more such conditions.

The scope of this topic differs according to the particular data aspect being considered.

For data collection purposes, and for data output relating to heart and circulatory conditions as a group of conditions, heart and circulatory conditions were defined broadly to include a range of heart, vascular and related conditions.

For output as long-term conditions classified to the standard ICD based classifications, some conditions such as high cholesterol were classified to other (i.e. non-circulatory) disease or condition groups as appropriate.

Some care should be taken in using the data to ensure the scope of the topic is appropriate to the data use intended.

For the purposes of this survey, rheumatic heart disease, heart attack, heart failure, stroke and angina were assumed to be current long-term conditions (i.e. of six months or more duration), if the respondent reported that they have ever been told by a doctor or nurse that they had been diagnosed with the condition. This reflects the likelihood of ongoing effects/consequences of those conditions. Although unlikely, it is possible that other heart and circulatory conditions could have been reported by the respondent as current conditions, but in the respondent's perception not be of six months or more duration, hence not be defined as long-term conditions in this survey.


Methodology

Respondents were asked if they had ever been told by a doctor or nurse that they had a heart or circulatory condition. A prompt card showing examples of conditions was provided to respondents. The following predefined condition categories were included on the questionnaire, with provision for interviewers to record three additional conditions if required:
  • Rheumatic heart disease
  • Heart attack
  • Heart failure
  • Stroke (including after effects of stroke)
  • Angina
  • High blood pressure or hypertension
  • Low blood pressure or hypotension
  • Hardening of the arteries, atherosclerosis or arteriosclerosis
  • Fluid problems, fluid retention or oedema
  • High cholesterol
  • Rapid or irregular heartbeats, tachycardia or palpitations
  • Heart murmur or heart valve disorder
  • Haemorrhoids
  • Varicose veins
  • Other (up to three conditions could be recorded)

The use of these categories in the questionnaire effectively established this as the most detailed level of information on those conditions available from the survey, although very limited further detail may also be available for those conditions recorded in the 'other specify' category.

Respondents were then asked if they currently had any heart or circulatory conditions, including conditions currently controlled by medications, and whether any/which of these conditions had lasted or were expected to last for six months or more. The list of predefined conditions was again used for these questions, with provision for interviewers to record up to three additional conditions if required.

Respondents who reported their rheumatic heart disease, heart attack, heart failure, stroke or angina as no longer current were sequenced past the following questions until the question related to blood pressure. These respondents were later included among those with a current long-term condition as it was considered the effects of these conditions would be long-term. When analysing the data, respondents with these conditions who were excluded from the following questions are included in the 'not stated' category.

Respondents were asked how often they usually consulted their GP about their condition, and then how often they usually consulted a specialist about their condition. They were then asked if they had consulted any other health professionals in the last 12 months. A list of other health professionals was provided to the respondent to identify particular professionals (see Asthma).

All respondents aged 45 years or over, and respondents aged 18-44 who specified that they had a current heart or circulatory condition, were asked whether their cholesterol had been checked in the last 5 years, and if so, whether their cholesterol had been checked in the last 12 months.

Respondents aged 18 years or over were asked whether their blood pressure had been checked in the last two years, and if so, whether it had been checked in the last 12 months, and who had performed the check (GP, specialist, other health professional, somebody else (e.g. family member), and/or the respondent themself).

Information was then obtained about medication use for up to three current and long-term heart and circulatory conditions reported. Respondents were asked whether they had taken vitamins/minerals, natural/herbal medicines or other medications (pharmaceuticals) for these heart and circulatory heart conditions in the last two weeks, and if they knew for which condition they were taking each medication. Respondents were encouraged to refer to their medication packets, bottles, etc. when answering questions about medications used for heart and circulatory conditions. The brand or generic names of the medications reported by respondents were recorded by interviewers, and office coded during processing - refer to Chapter 2: Survey Design and Operation. Provision was made to record the names of up to three medications each for up to three heart and circulatory conditions. If more than three medications were reported, only the three which the respondent considered were the main medications they used for each condition were recorded.

Testing had shown that in some cases, people who had several heart and circulatory conditions were unable to link a particular medication they had used with a particular condition. Provision was made to record up to three additional medication names in these cases so that they could be included as being used for a heart or circulatory condition.

Only those medications specifically used for particular heart or circulatory conditions are conceptually included. Other medications, used, for example, to treat symptoms or side effects of treatment, were excluded where the purpose for use was identified.

Respondents who reported they had taken medication in the last two weeks were also asked whether they took aspirin on a daily basis, and whether this had been on the advice of a doctor. Respondents may or may not have had room to record aspirin as one of their three medications per condition, therefore response rates for aspirin as a medication for circulatory conditions and daily use of aspirin for circulatory conditions do not necessarily tally.

Respondents were then asked if their heart or circulatory condition had caused them to take more than half a day away from work/study/ school in the last 12 months, and if so, the number of days involved.

Persons sequenced around these questions because they reported they had never been told by a doctor or nurse that they had a heart or circulatory condition may have reported a current and long-term heart or circulatory condition in response to later general questions about medical conditions. These cases are included in, and contribute to, estimates of the prevalence of heart and circulatory conditions, but information about associated medication use was not collected.


Population

Information was obtained for all persons, with certain questions only asked of specific groups, as identified above.


Data items

The data items and related output categories for this topic are available in Excel spreadsheet format from the downloads tabs of the National Health Survey: Users' Guide, 2007-08 (cat. no. 4363.0.55.001) and the National Health Survey Data Reference Package, 2007-08 (cat. no. 4363.0.55.002).


Interpretation

Points to be considered in interpreting data for this topic include the following:
  • As this is a household based survey, people with heart or circulatory conditions who are resident in hospitals, nursing or convalescent homes, or similar accommodation are outside the scope of this survey. As a result, the survey will under-represent those with more severe conditions.
  • In this survey, persons who reported they had been told they had rheumatic heart disease, a heart attack, heart failure, angina or stroke are counted as having a current and long-term condition. Even though these conditions are usually short-term events, they often result in some form of residual damage or effects, and have been treated in this survey as current long-term conditions on that basis.
  • The conditions recorded are as reported by respondents. In some cases it could be expected that some conditions reported may be symptoms of other heart or circulatory conditions, or other conditions. For example, oedema may be a symptom of a heart valve disorder. Respondents were not asked to associate conditions in this way, such that both symptoms and underlying conditions may have been reported in some cases, or symptom or condition only in other cases. As a result, in looking at the prevalence of certain conditions, data users should consider how related or associated conditions should be treated.
  • Medications recorded were those reported by respondents as used for heart and circulatory conditions. In some cases respondents may have not reported a medication because they forgot they used the medication in the previous two weeks, were not aware the medication was for a heart or circulatory condition, or did not wish to report they used it. In other cases medications taken for conditions or symptoms associated with a heart or circulatory condition but not for the condition itself may have been reported, when conceptually they were excluded. Also, to the extent that heart or circulatory medications may be used for other conditions for which medications data were not recorded in the survey, the data do not represent total use of these medication types.
  • Respondents may have mistakenly reported other medications they were using as medications for a heart or circulatory condition. All medications reported were coded, and data can be refined for use on the basis of medication type.
  • As the number of heart and circulatory conditions and medications for which data can be collected is restricted, some conditions and/or medication information may be under-represented.


Comparability with 2004-05

The questions for this survey were the same in 2007-08 as in the 2004-05 NHS, however, the following should be noted:
  • Heart failure was added to the prompt card and main condition picklist in the 2007-08 NHS. This may have led to a higher level of reporting of that condition than in previous surveys.
  • Due to the change in the methodology of deriving rheumatic heart disease, heart attack, heart failure, stroke and angina as current long-term conditions, the prevalence of these conditions has increased. Consequently the prevalence of ischaemic heart diseases (angina and other ischaemic heart diseases), other heart diseases, and cerebrovascular diseases has also increased.


DIABETES MELLITUS

Definition

This topic refers primarily to those ever told by a doctor or nurse they have diabetes mellitus or high sugar levels in their blood or urine, and who consider they currently have this condition.

All types reported were recorded for the item 'whether ever told by a doctor or nurse'.
  • Diabetes; Type 1
  • Diabetes; Type 2
  • Diabetes; Gestational
  • Diabetes; Type unknown
  • High sugar levels


Methodology

Respondents were asked if they had ever been told by a doctor or nurse that they had diabetes and/or high sugar levels in blood or urine, and those aged 50 years and over were asked if they had been screened for diabetes in the last three years. Those who reported they had been told they had diabetes or high sugar levels were asked the age at which they were told they had diabetes/high sugar levels, and the type of diabetes they were told they had. Persons were then asked whether the diabetes or high sugar level was still current. Those reporting only diabetes insipidus were sequenced out of further diabetes questions at this point and recorded elsewhere as a current, long-term condition. From this point on in the User Guide, any references to diabetes refer to diabetes mellitus.

Where the respondent had reported they currently had Type 1 or Type 2 diabetes those conditions were assumed to be of six months or more duration. If the respondent reported they currently had diabetes but didn't know the type, or currently had high sugar levels, they were asked if their condition had lasted, or was expected to last, for six months or more.

Additional information outlined below was obtained only for those people reporting conditions determined or assumed to be both current and long-term.

Information was obtained about whether the respondent consulted their GP or specialist about their condition, the frequency of the consultations, and whether they had taken place in the last 12 months. Respondents were then asked whether they had consulted other health professionals, including diabetes educators, and whether this had taken place in the last 12 months. They were then asked how often in the last 12 months their blood glucose levels had been tested, and how often their feet had been checked. Respondents were also asked if their diabetes or high sugar levels had caused them to take more than half a day off work, study or school in the last 12 months, and if so, the number of days taken; as well as whether it had interfered with other daily activities in the last 12 months.

Respondents were asked if they had daily insulin, and if so, the age they started. The use of other pharmaceutical medications for diabetes/high sugar levels in the last two weeks was then recorded. Although the question on these other medications specifically excluded insulin, approximately 8% of 'other medication' recorded was insulin.

Respondents were encouraged to gather up and refer to their medication packets, bottles, etc when answering questions about medications used for diabetes. The brand or generic names of the medications reported by respondents were recorded by interviewers, and office coded during processing - see Chapter 2: Survey Design and Operation. Provision was made to record the names of up to three medications. If more than three medications were used, only the three which the respondent considered were the main medications they used for diabetes or high sugar levels were recorded. Use of vitamins/minerals and natural/herbal medications was identified through questions about other recent actions (see below). Only those medications specifically used for diabetes or high sugar levels were conceptually included. Other medications, used, for example, to treat symptoms or side effects of treatment, were excluded where the purpose for use was identified.

Respondents who reported they had current and long-term diabetes or high sugar levels were also asked about changes to their eating pattern or diet. Actions taken to manage their condition in the last two weeks, such as losing weight, exercising most days, taking vitamin/mineral supplements or natural/herbal treatments were also recorded. Further information was obtained about whether these people had a diabetes/high sugar levels-related sight problem, the type of sight problem, and the time since they had last consulted an eye specialist or optometrist.

Respondents sequenced around these questions because they reported they had never been told by a doctor or nurse that they had diabetes or high sugar levels may have reported these conditions in response to later general questions about long-term medical conditions. These cases are included in and contribute to estimates of the prevalence of diabetes mellitus and high blood sugar as appropriate, but associated information about medication use, recent actions and eye/sight problems was not collected.


Population

Information was obtained for all persons.


Data items

The data items and related output categories for this topic are available in Excel spreadsheet format from the downloads tabs of the National Health Survey: Users' Guide, 2007-08 (cat. no. 4363.0.55.001) and the National Health Survey Data Reference Package, 2007-08 (cat. no. 4363.0.55.002).


Interpretation

Points to be considered in interpreting data for this topic include the following:
  • Those cases of diabetes or high sugar levels reported through the general questions about long-term conditions (rather than the specific questions about diabetes and high sugar levels) have not necessarily been medically diagnosed.
  • Because this is a household-based survey, those people with diabetes resident in hospitals, nursing or convalescent homes, or similar accommodation are outside the scope of this survey. As a result, the survey will under-represent those with more severe complications of the condition.
  • Medications recorded were those reported by respondents as used for diabetes or high sugar levels. In some cases respondents may have not reported a medication, because they forgot they used the medication in the previous two weeks, or were not aware the medication was for diabetes or high sugar levels, or did not wish to report they used it. In other cases medications taken for conditions or symptoms associated with diabetes but not for the condition itself may have been reported, when conceptually they were excluded. Also, to the extent that medications for diabetes/high sugar levels may be used for other conditions for which medications data were not recorded in the survey, the data do not represent total use of these medication types.
  • Gestational diabetes is not considered a long-term condition.


Comparability with 2004-05

The methodology used in the 2007-08 NHS was similar to that used in the 2004-05 survey, and therefore data for most items are considered directly comparable between surveys.


ARTHRITIS

Definition

This topic refers primarily to those who consider they currently have arthritis (whether or not they had been told by a doctor or nurse that they had the condition - see Intrepretation of results for this topic). Information about gout and rheumatism is also covered.


Methodology

Respondents were asked whether they have, or had ever had gout, rheumatism or arthritis. Those who reported arthritis were asked the type of arthritis - osteoarthritis, rheumatoid arthritis, and/or other type (specified). Respondents were then asked whether they currently had any of these conditions, and for gout and rheumatism were asked whether the condition had lasted, or was expected to last, for six months or more. All cases of current arthritis were assumed to be long-term conditions. All respondents who reported they had ever had arthritis (of any type) were asked whether they had been told by a doctor or nurse, and the age they were first told.

Information was then obtained about medications used for arthritis in the last two weeks, including vitamin and mineral supplements, natural and herbal products and pharmaceutical medicines. Respondents were encouraged to refer to their medication packets, bottles, etc when answering questions about medications used for arthritis. The brand or generic names of the pharmaceutical medications reported by respondents were recorded by interviewers, and office coded during processing - see Chapter 2: Survey Design and Operation. Provision was made to record the names of up to three pharmaceutical medications. If more than three were reported, only the three which the respondent considered were the main medications they used for arthritis were recorded. Only those medications specifically used for arthritis were conceptually included. Other medications, used, for example, to treat symptoms or side effects of treatment, were excluded where the purpose for use was identified.

Respondents were also asked about their use of specific dietary supplements such as vitamin D, calcium, glucosamine and various marine-based products, natural or herbal treatments. The names or brands of vitamin D supplements, calcium supplements and other vitamin/mineral supplements or other natural/herbal treatments were recorded.

Information relating to respondents with arthritis who visited GPs, specialists and other health professionals because of their arthritis was collected in conjunction with persons who reported having osteoporosis and osteopenia. They were also asked (as a group) whether they had taken the following actions for their condition in the last two weeks:
  • Did weight/strength/resistance training
  • Obtained and/or used physical aids (used at home or work)
  • Water therapy
  • Massage
  • Changed eating pattern/diet
  • Losing weight
  • Exercised most days
  • Other action taken

Respondents sequenced around these questions because they reported they had not ever had arthritis may have reported the condition in response to later general questions about long-term medical conditions. These cases are included in and contribute to estimates of the prevalence of arthritis as appropriate, but the associated information about medication use and recent actions was not collected.


Population

Information was obtained for all persons.


Data items

The data items and related output categories for this topic are available in Excel spreadsheet format from the downloads tabs of the National Health Survey: Users' Guide, 2007-08 (cat. no. 4363.0.55.001) and the National Health Survey Data Reference Package, 2007-08 (cat. no. 4363.0.55.002).


Interpretation

Points to be considered in interpreting data for this topic include the following:
  • Whereas the 2007-08 NHS methodology used for other long-term conditions commenced with the 'ever told' question so that all further questions were asked only of that population medically diagnosed, questions on arthritis commence with 'have or ever had' such that the 'ever told' population is a subset, not the defining population for the topic. This methodology recognises the large numbers of people in the community who consider themselves to have arthritis, but who have not necessarily been diagnosed with the condition. Most of these cases would not be recorded under the methodology used for the other long-term conditions. For output the different approach means that:
      • although 'status' items are derived for arthritis in the same way as for other long-term conditions, the data are conceptually different; and
      • for the purpose of contributing to long-term condition data, it is those cases of current arthritis which are counted (as it is assumed all current cases are long-term), not those cases ever told and current (which is the case for most other long-term conditions).
  • The distinction between arthritis, rheumatism and some other joint disorders may not be clear to respondents, particularly those whose condition has not been medically diagnosed. As the data collected in the survey are self-reported by respondents, there is a likelihood of some leakage to and from similar conditions. Unfortunately, information is not available from this survey regarding the extent to which this is likely to have occurred, but users of the data should consider taking account of similar conditions when, for example, looking at the prevalence of arthritis.
  • Because this is a household-based survey, those people with arthritis resident in hospitals, nursing or convalescent homes or similar accommodation are outside the scope of this survey. As a result the survey will under-represent those with more severe complications of the condition, and the elderly.
  • Medications recorded were those reported by respondents as used for arthritis. In some cases respondents may not have reported a medication, because they forgot they used the medication in the previous two weeks, or were not aware the medication was for arthritis, or did not wish to report they used it. In other cases medications taken for conditions or symptoms associated with arthritis but not for the condition itself may have been reported, when conceptually they were excluded. Also, to the extent that medication for arthritis may be used for other conditions for which medications data were not recorded in the survey, the data do not represent total use of these medication types.
  • Information relating to respondents with arthritis who visited GPs, specialists and other health professionals, or who undertook specified actions because of their arthritis, was collected in conjunction with persons who reported having osteoporosis or osteopenia. It is not possible to identify whether the respondent made the visits or took the actions because of their arthritis unless the respondents did not report having osteoporosis or osteopenia.


Comparability with 2004-05

Results from the 2007-08 survey are comparable the 2004-05 survey.


OSTEOPOROSIS

Definition

This topic refers primarily to those ever told by a doctor or nurse they have osteoporosis or osteopenia (a mild loss of bone mass density that may progress to osteoporosis). The methodology is similar to that used for most long-term conditions in this survey.


Methodology

Respondents aged 15 years and over, and younger respondents who reported having gout, rheumatism or arthritis, were asked whether they had ever been told by a doctor or nurse that they had osteoporosis, osteopenia or both, and if so, the age they were first told. All cases reported were assumed to be still current and long-term. Information was obtained about medications used for the conditions in the last two weeks, including vitamin and mineral supplements, natural and herbal products and pharmaceutical medicines. Respondents were encouraged to refer to their medication packets, bottles, etc when answering questions about medications used for their osteoporosis or osteopenia.

The brand or generic names of the pharmaceutical medications reported by respondents were recorded by interviewers, and office coded during processing - see Chapter 2: Survey Design and Operation. Provision was made to record the names of up to three pharmaceutical medications. If more than three were reported, only the three which the respondent considered were the main medications they had used for their osteoporosis or osteopenia were recorded. Only those medications specifically used for osteoporosis or osteopenia were conceptually included. Other medications, used, for example, to treat symptoms or side effects of treatment, were excluded where the purpose for use was identified.

Respondents were also asked about their use of specific dietary supplements such as vitamin D, calcium, glucosamine and various marine-based products. The names or brands of vitamin D supplements, calcium supplements and other vitamin/mineral supplements or natural/herbal treatments were recorded.

Information was obtained on whether respondents had visited their GP or specialist about their osteoporosis or osteopenia, the frequency of the visits, and whether they had consulted specific health professionals in the last 12 months. Respondents were asked whether they had taken certain actions for their osteoporosis or osteopenia in the last two weeks, and the types of action taken; as well as whether they had taken more than half a day away from work, study or school in the last 12 months for their osteoporosis or osteopenia, and if so, how many days.

Finally, respondents were asked whether they had ever had their bone density tested, and if so, whether it had been tested in the last 2 years.

Respondents sequenced around these questions because they reported they had never been told they had osteoporosis or osteopenia may have reported the condition in response to later general questions about long-term medical conditions. These cases are included in and contribute to estimates of the prevalence of the conditions as appropriate, but the associated information about medication use and recent actions was not collected.


Population

Information was obtained for all persons.


Data items

The data items and related output categories for this topic are available in Excel spreadsheet format from the downloads tabs of the National Health Survey: Users' Guide, 2007-08 (cat. no. 4363.0.55.001) and the National Health Survey Data Reference Package, 2007-08 (cat. no. 4363.0.55.002).


Interpretation

Points to be considered in interpreting data for this topic include the following:
  • The population for this topic was respondents aged 15 years and over, and those aged less than 15 who had gout, rheumatism or arthritis who had also been told by a doctor or nurse that they had the condition. Limiting the population to this group makes virtually no difference to the prevalence of the condition.
  • The currency and long-term nature of the condition were assumed. While this is appropriate for the nature of this condition, it differs conceptually from the approach used for most other conditions covered in the survey. Presence of the condition is often not known or even suspected until medical diagnosis. Results from this survey therefore expect to significantly underestimate the true prevalence of the condition throughout the community.
  • Because this is a household based survey, those people with osteoporosis or osteopenia resident in hospitals, nursing or convalescent homes or similar accommodation are outside the scope of this survey. As a result, the survey will under-represent those with more severe complications of the condition, and the elderly.
  • Medications recorded were those reported by respondents as used for osteoporosis or osteopenia. In some cases respondents may have not reported a medication because they forgot they used the medication in the previous two weeks, or were not aware the medication was for osteoporosis or osteopenia, or did not wish to report they used it. In other cases, medications taken for conditions or symptoms associated with osteoporosis or osteopenia but not for the condition itself may have been reported, when conceptually they were excluded. Also, to the extent that medications for osteoporosis or osteopenia may be used for other conditions for which medications data were not recorded in the survey, the data do not represent total use of these medication types.
  • As stated in the section above, information relating to respondents with arthritis who visited GPs, specialists and other health professionals, or who undertook specified actions because of their arthritis, was collected in conjunction with persons who reported having osteoporosis or osteopenia. It is not possible to identify whether the respondent made the visits or took the actions because of their arthritis unless the respondents did not report having osteoporosis or osteopenia.


Comparability with 2004-05

Despite the change in the population answering these questions, the prevalence of osteoporosis and medication use is considered to be comparable with 2004-05. Most of the data items collected for this topic in the 2007-08 survey were available for 2004-05.


MENTAL HEALTH AND WELLBEING

Definition

Mental health and wellbeing relates to emotions, thoughts and behaviours. A person with good mental health is generally able to handle day-to-day events and obstacles, work towards important goals, and function effectively in society. However, even minor mental health problems may affect everyday activities to the extent that individuals cannot function as they would wish, or are expected to, within their family and community. Consultation with a health professional may lead to the diagnosis of a mental disorder.

In the 2007-08 survey, information was collected on mental health and wellbeing via:
  • The Kessler Psychological Distress Scale-10 (K10) questionnaire;
  • Self-reported long-term mental and behavioural problems; and
  • Information on medication use for mental health and wellbeing.

Information collected later in the survey on personal stressors included items related to mental health.


Kessler Psychological Distress Scale-10

The Kessler Psychological Distress Scale-10 (K10) is a scale of non-specific psychological distress. It was developed by Professors Ron Kessler and Dan Mroczek, as a short dimensional measure of non-specific psychological distress in the anxiety-depression spectrum, for use in the US National Health Interview Survey. It was asked of adults aged 18 years and over in the 2007-08 NHS.

The 10 item questionnaire yields a measure of psychological distress based on questions about negative emotional states (with different degrees of severity) experienced in the 4 weeks prior to interview. For each question, there is a five-level response scale based on the amount of time that a respondent experienced the particular problem. The response options are:
  • None of the time
  • A little of the time
  • Some of the time
  • Most of the time
  • All of the time.

Each of the items are scored from 1 for 'none', to 5 for 'all of the time'. Scores for the ten items are summed, yielding a minimum possible score of 10 and a maximum possible score of 50, with low scores indicating low levels of psychological distress and high scores indicating high levels of psychological distress.

K10 results are commonly grouped for output. Results from the 2007-08 NHS are usually grouped into the following four levels of psychological distress:
  • low (scores of 10-15, indicating little or no psychological distress)
  • moderate (scores of 16-21)
  • high (scores of 22-29)
  • very high (scores of 30-50)

Based on research from other population studies, a very high level of psychological distress shown by the K10 may indicate a need for professional help.

In Australia, national level information on psychological distress using the K10 was first collected in the Survey of Mental Health and Wellbeing (SMHWB) conducted by the ABS in 1997 and later in 2007. The SMHWB was an initiative of, and funded by, the (then) Commonwealth Department of Health and Family Services as part of the National Mental Health Strategy. The K10 was included in both the 2001, 2004-05 and 2007-08 NHS as it proved to be a better predictor of depression and anxiety disorders than the other short, general measures used in the 1997 SMHWB. For further information about ABS use of the instrument, refer to Use of the Kessler Psychological Distress Scale in ABS surveys (cat. no. 4817.0.55.001).


Long-term mental and behavioural problems

Information on long-term conditions (conditions that had lasted or were expected to last for six months or more) was collected in the 2007-08 NHS for people of all ages. Mental health and behavioural problems were identified through self-reported information on long-term conditions. When respondents reported a long-term mental or behavioural problem, the conditions were treated in a similar manner to other long-term conditions such as diabetes and asthma. Up to six long-term mental and behavioural problems could be recorded.

Conditions such as behavioural or emotional disorders, dependence on drugs or alcohol, feeling anxious or nervous, depression, and feeling depressed were identified on prompt cards with more general questions about long-term conditions. Other mental health conditions were collected when respondents were asked to identify any other long-term conditions they had. These conditions were identified by a mental health conditions coding list in the instrument.

For each mental health and behavioural problem reported, respondents were asked whether a doctor, nurse or other health professional had told them they had the condition, and if so, how old they were when they were told. Data was then collected on the frequency of consultations with a GP and psychiatrist about the condition(s), and consultations with the following health professionals in the last 12 months:
  • Psychologist
  • Alcohol and drug worker
  • Accredited counsellor
  • Acupuncturist
  • Chemist (for advice only)
  • Chiropodist/Podiatrist
  • Chiropractor
  • Dietitian/Nutritionist
  • Naturopath
  • Nurse
  • Occupational therapist
  • Optician/Optometrist
  • Osteopath
  • Physiotherapist/Hydrotherapist
  • Social worker/Welfare officer
  • Other

After information on medication was collected (see below), respondents were asked whether they had taken more than half a day off work or study in the last 12 months due to their condition, and if so, how many days.


Interpretation

There are issues around whether or not mental health conditions are reported by respondents, impacting on the quality of the data. This is partly to do with the nature of these conditions, which respondents may see as very personal or sensitive, particularly as other household members may be present at the interview.


Type of medication used for mental health and wellbeing

Information was collected on whether respondents had taken any vitamin or mineral supplements and herbal or natural medicines for their condition in the two weeks prior to interview. Respondents were then asked whether they had taken any sleeping tablets or capsules, tablets or capsules for anxiety or nerves, tranquillisers, antidepressants, mood stabilisers or other medications for mental health in the last two weeks. This information was also collected from persons aged 18 years and over with respect to mental wellbeing in conjunction with the K10 questions.

The brand or generic names of the pharmaceutical medications reported by respondents were recorded by interviewers, and office coded during processing - see Chapter 2: Survey Design and Operation. Provision was made to record the names of up to three pharmaceutical medications for long-term mental and behavioural problems. If more than three were reported, only the three which the respondent considered were the main medications they had used for their long-term mental and behavioural problems were recorded. Up to five medications were recorded for mental wellbeing.

For each pharmaceutical medication recorded, information was collected on the duration and frequency of use.


Other mental health related problems

Information was also collected on whether mental illness or drug-related problems had been a problem for the respondent or anyone close to them (see Personal Stressors).


Population

Information was collected for all persons for long-term mental and behavioural problems. This information was provided by a proxy for all persons under 15 years of age, and for some persons aged 15 to 17 years - see Chapter 2: Survey Design and Operation.

Information relating to mental wellbeing (the K10 levels of psychological distress) was collected for persons aged 18 years and over.

Information relating to personal stressors was collected from persons aged 15 years and over.


Data items

The data items and related output categories for this topic are available in Excel spreadsheet format from the downloads tabs of the National Health Survey: Users' Guide, 2007-08 (cat. no. 4363.0.55.001) and the National Health Survey Data Reference Package, 2007-08 (cat. no. 4363.0.55.002).


Comparability with 2004-05

Prevalence information about long-term mental health problems is not considered directly comparable between surveys as additional conditions were added to the prompt cards. Changes in community perceptions of mental illness/problems, together with changes in the identification of illness and the treatment of conditions (e.g. institutional versus community care), may have affected the degree to which certain conditions were identified in the survey.

The K10 was included in the 2001, 2004-05 and 2007-08 NHS, and the data are considered directly comparable. Users should note that the version of K10 used in the NHS is slightly different to that used in the Survey of Mental Health and Wellbeing (see Kessler Psychological Distress Scale, in Other Scales and Measures, National Survey of Mental Health and Wellbeing: Users' Guide, 2007 (cat. no. 4327.0)).

Medications data for mental and behavioural problems was collected for the first time in 2007-08.


SIGHT AND HEARING

Definition

This topic covers detailed information about sight and hearing, including conditions that can be corrected (for instance by glasses) through to total blindness or deafness.


Methodology

Respondents were asked a number of questions relating to eyesight. After ascertaining whether the respondent was colour blind (not conceptually considered to be a long term condition), respondents were asked whether they wore glasses or contact lenses to correct or partially correct their eyesight. Persons who did so were shown the following prompt card listing a number of sight conditions which are currently corrected or partially corrected by glasses or contact lenses, and asked to select any conditions they may have had.
  • Astigmatism
  • Short sightedness/Myopia/difficulty seeing objects in the distance
  • Macular degeneration
  • Other age related sight problems/Presbyopia
  • Long sightedness/Hyperopia/difficulty seeing objects close up
  • Other. (One other eye sight problem could be recorded.)

All persons were then asked whether they had any other sight problems. A list of conditions was provided to interviewers to make it easier to record the information, however this may have led to some conditions being recorded in categories that were not entirely appropriate. The listed categories were:
  • Astigmatism
  • Short sightedness/Myopia/difficulty seeing objects in the distance
  • Macular degeneration
  • Other age related sight problems/Presbyopia
  • Long sightedness/Hyperopia/difficulty seeing objects close up
  • Totally blind in both eyes
  • Totally blind in one eye
  • Partially blind in both eyes
  • Partially blind in on eye
  • Glaucoma
  • Cataracts
  • Trachoma
  • Lazy eye/Strabismus
  • Retinopathy
  • Other (One other eye sight problem could be recorded.)

Whether any recorded conditions were caused by diabetes or high sugar levels was determined, as well as the time since they consulted an eye specialist or optometrist.

Respondent were asked whether they had any hearing problems or problems with their ears which had lasted, or was expected to last for six months or more. As with eye sight problems, a list of conditions was provided to interviewers to make it easier to record the information. Again, this may have led to some conditions being recorded in categories that were not entirely appropriate. The listed categories were:
  • Total deafness
  • Deaf in one ear
  • Hearing loss/partially deaf
  • Tinnitus
  • Meniere's Disease
  • Otitis Media
  • Other (One other hearing or ear problem could be recorded.)


Population

Information was collected in respect of all persons in scope of the survey.


Data items

The data items and related output categories for this topic are available in Excel spreadsheet format from the downloads tabs of the National Health Survey: Users' Guide, 2007-08 (cat. no. 4363.0.55.001) and the National Health Survey Data Reference Package, 2007-08 (cat. no. 4363.0.55.002).


LONG-TERM CONDITIONS: TYPE OF CONDITION

Definition

In the 2007-08 NHS, long-term condition data is drawn from two conceptually different sets of data:
  • conditions that are specifically asked about, including asthma, cancer, heart and circulatory conditions, diabetes mellitus, mental and behavioural problems, arthritis and osteoporosis, and sight and hearing. As noted in previous sections, these data primarily refer to conditions which have been medically diagnosed, and reported as (or assumed to be) current and of six months or more duration; and
  • conditions reported in response to the question on whether they had any other long-term health conditions which had lasted, or were expected to last, for six months or more.

Data from these two groups are combined for output relating to long-term conditions or persons with long-term conditions.


Methodology

Information about the collection of data for the specific long-term conditions noted above appears in previous sections of this publication. Initial data for other long-term conditions was collected via a prompt card showing the following conditions:
  • Hayfever
  • Sinusitis or sinus allergy
  • Other allergy
  • Anaemia
  • Bronchitis
  • Emphysema
  • Epilepsy
  • Fluid problems/fluid retention/Oedema (excluding those due to heart or circulatory conditions)
  • Hernias
  • Kidney stones
  • Migraine
  • Psoriasis
  • Stomach/other gastrointestinal ulcers
  • Thyroid trouble/goitre
  • Depression
  • Feeling depressed
  • Back - slipped disc or other disc problems
  • Back pain or other problems

Respondents were asked to report any conditions they might have from this list, which had lasted, or were expected to last, for six months or more. Additional information was collected about back pain or problems to help determine the long-term nature of the problem. Respondents were then asked to report any long-term conditions they might have that did not appear on that list, including:
  • Conditions that recur from time to time;
  • Conditions that have lasted for a long time and that may have been adjusted to; and
  • Conditions which are under control because of long term treatment or taking medication.

There was capacity to report up to six other conditions.

Finally, respondents were asked whether they had any other long-term conditions such as the following:
  • Amputation or loss of limbs, e.g. arm, foot, finger
  • Behavioural or emotional disorders
  • Deformity or disfigurement from birth, e.g. club foot, cleft palate
  • Other deformity or disfigurement, e.g. effects of burns
  • Dependence on drugs or alcohol
  • Difficulties in learning or understanding
  • Feeling anxious or nervous
  • Gallstones
  • Incontinence
  • Paraplegia or other paralysis
  • Speech impediment

Information was collected on how long each condition had lasted and whether the respondent was told they had the condition by a doctor or nurse.


Interpretation

Points to be borne in mind in interpreting data from the survey relating to long-term conditions include the following:
  • As noted previously, the data relate to conditions 'as reported' by respondents and hence do not necessarily represent conditions as medically diagnosed, except in the case of those conditions which respondents reported having been advised that they had by a doctor or nurse. However, as the data relate to conditions which had lasted or were expected to last for six months or more, there is considered to be a reasonable likelihood that medical diagnoses would have been made in most cases. The degree to which conditions have been medically diagnosed is likely to differ across condition types.
  • Even where conditions have been medically diagnosed, respondents may have used different terminology when reporting the condition, such that it has been classified to a different group.
  • While the methodology was aimed at maximising the identification of long-term conditions, some under-reporting may have occurred, particularly in respect of those conditions which are controlled by treatment (such as epilepsy) or recur infrequently, or those to which respondents have become accustomed and no longer consider an illness.
  • Where asthma, cancer, heart and circulatory conditions, diabetes mellitus, mental and behavioural problems, arthritis or osteoporosis are reported later in the survey (rather than the specified section), the prevalence of that condition is still recorded appropriately. However, as the questions asked within the condition module will not have been answered, a 'not known' response will be recorded for condition-related data.
  • It is expected that conditions which were specifically mentioned in questions or (to a lesser extent) shown on prompt cards would have been better reported than conditions for which response relied entirely on respondent judgement and willingness to report them. Data are not available from this survey to enable the magnitude of this effect to be quantified, but it is likely to differ across condition types and for different groups in the population.
  • Although long-term/permanent disabilities were within the scope of long-term conditions, data from this section on long-term conditions should not be interpreted as indicating the disabled population. In some cases, long-term/permanent impairment/disability could be evident from the condition categories, e.g. blindness (complete or partial), while for others some degree of impairment/disability could be inferred from the nature of the condition, e.g. arthritis, back problems. However, these data should, at best, be considered as proxy indicators of disability only. See Disability, in this Chapter, for more information.


Comparability with 2004-05
  • The methodologies used for the majority of long-term conditions are the same or similar to those used in the 2004-05 NHS. Most data should be directly comparable, however readers are advised to note the comments on comparability contained in each of the separate condition sections. There were some small differences (e.g. in the coverage of particular conditions in the survey prompt cards) which may have reduced comparability.
  • Information collected about mental health or behavioural problems was collected in more detail in the 2007-08 NHS, so data is not directly comparable.
  • Changes in community perceptions of illness and disability, together with changes in the identification and treatment of conditions (e.g. institutional versus community care) may have affected the degree to which certain conditions were identified in the survey.
  • The prevalence of most long-term illness increases with age. In drawing comparisons of prevalence between the surveys, account should be taken of the shift in the age profile of the population during the period between surveys.
  • Data classified to the International Classification of Primary Care (I.C.P.C.) is not available in 2007-08.


CONDITIONS CAUSED BY INJURY

Definition

This topic determines whether any current long-term conditions reported by the respondent resulted from an injury.


Methodology

Respondents who had reported one or more current long-term conditions (or conditions which were assumed to be current and long-term) were asked whether that/any of the condition(s) was the result of an injury.

Respondents who reported that one or more conditions were due to an injury were asked, in respect of each condition, whether the injury occurred at work, school, study, in a motor vehicle accident, during exercise or sport, at home or somewhere else. For each condition reported to have been caused by injury, respondents were asked how old they were when the injury occurred.


Population

Information was collected in respect of all persons for whom one or more current long-term conditions (or conditions which were assumed to be current and long-term) had been reported.


Data items

The data items and related output categories for this topic are available in Excel spreadsheet format from the downloads tabs of the National Health Survey: Users' Guide, 2007-08 (cat. no. 4363.0.55.001) and the National Health Survey Data Reference Package, 2007-08 (cat. no. 4363.0.55.002).


Interpretation

Points to be borne in mind in interpreting data from the survey relating to the reported cause of long-term conditions include the following:
  • The data are self-reported, and reflect the respondent's view of causality and responsibility. Conditions identified as due to an injury at work are not necessarily consistent with those which might be deemed to be work related for workers' compensation purposes.
  • The questions were asked only in respect of conditions which had previously been reported during the survey interview. To the extent that respondents had failed to previously report a condition, the origin of the injury could not be established. As a result, some conditions resulting from an injury may not be identified in the survey.
  • Injuries that did not cause long-term conditions are not reported in the survey.


Comparability with 2004-05

In the 2007-08 NHS, the questions and general methodology for this topic were similar to those of the 2004-05 survey, with the exception of the collection of work-related injuries. As a result, the data are considered broadly comparable between the surveys. However, the following points should be borne in mind in making comparisons:
  • This topic is directly dependent on the conditions previously reported in the survey, so that any change in methodology affecting the likelihood of conditions being reported will impact on comparability. While the overall approach to collecting conditions data was the same in both surveys, changes to the approach for some heart and circulatory conditions and mental health and behavioural problems, as well as changes to population groups and condition prompt cards, will have had some impact on data for this topic.
  • In the 2004-05 survey, questions on conditions caused by an injury were asked following a question on whether any conditions were work-related. In the 2007-08 survey, the question of whether any conditions were work-related was not asked, but place of injury questions are directly comparable.


SELF-ASSESSED HEALTH STATUS

Definition

This is a single question about how respondents rate their health overall.


Methodology

Before any more specific health questions are asked, respondents are asked whether in general they feel their health is excellent, very good, good, fair or poor.


Population

Information was obtained for all persons aged 15 years and over.


Data items

The data items and related output categories for this topic are available in Excel spreadsheet format from the downloads tabs of the National Health Survey: Users' Guide, 2007-08 (cat. no. 4363.0.55.001) and the National Health Survey Data Reference Package, 2007-08 (cat. no. 4363.0.55.002).


Interpretation

Points to be considered in interpreting this data item include the following:
  • This is a subjective data item. Perceptions may be influenced by any number of factors which may be unrelated to health, or which may reflect momentary or short term feelings or circumstances (rather than usual feelings or circumstances). Responses may have been influenced by factors involved in the interview itself such as the presence of another family member.
  • Analysis of similar data from previous NHSs showed some correlation between self-assessed health status and health status as indicated by more objective measures such as recent and/or long-term illness. However, self-assessed health status should not be used as an alternative to those measures without analysis of correlations in the particular use of the item proposed.
  • Information recorded for persons aged 15 to 17 may have been reported by an adult within the household, usually a parent. Data for this age group, therefore, may not be conceptually 'self-assessed' as responses may have been different if the children had responded for themselves.


Comparability with 2004-05

Self-assessed health status is considered directly comparable between the 2004-05 and 2007-08 surveys


HEALTHY LIFESTYLES

Definition

This topic covers check-ups and healthy lifestyle discussions with a GP or other health professional.


Methodology

Respondents were asked if they had check-ups with their GP, and if so, how frequent the check-ups usually were. Response categories for frequency were:
  • At least once a month
  • Every three months
  • Every six months
  • Annually
  • Less frequently
  • Not regularly
  • Other

Respondents were then asked if they had discussed any of the following lifestyle issues with their GP in the 12 months prior to interview:
  • Reducing or quitting smoking
  • Drinking alcohol in moderation
  • Reaching a healthy weight
  • Increasing physical activity
  • Eating healthy food or improving their diet

They were also asked if they had consulted, or discussed their lifestyle issues, with any of the following other health professionals:
  • Specialist doctor
  • Accredited counsellor
  • Acupuncturist
  • Chemist (for advice only)
  • Chiropodist/Podiatrist
  • Chiropractor
  • Diabetes educator
  • Dietitian/Nutritionist
  • Naturopath
  • Nurse
  • Occupational therapist
  • Optician/Optometrist
  • Osteopath
  • Physiotherapist/Hydrotherapist
  • Psychologist
  • Social worker/Welfare officer
  • Other


Population

Information was obtained from persons aged 15 years and over.


Data items

The data items and related output categories for this topic are available in Excel spreadsheet format from the downloads tabs of the National Health Survey: Users' Guide, 2007-08 (cat. no. 4363.0.55.001) and the National Health Survey Data Reference Package, 2007-08 (cat. no. 4363.0.55.002).


Interpretation

When interpreting data for this topic, it should be noted that the interpretation of what constituted a 'check-up' was up to the respondent. If a respondent asked for clarification, the definition provided by the Department of Health and Ageing Medicare 'health check' was used. This indicates that when a GP conducts a 'regular check-up', it may include the following:
  • collection of family, medical and lifestyle history;
  • physical examinations such as blood pressure, height and weight;
  • tests such as pap smears, blood test, urine test and cancer screening; and
  • giving advice on how to improve the patient's health, such as actions to take and referrals to other professionals.


Comparability with 2004-05

This topic was not collected in 2004-05, therefore no comparison can be made.


DISABILITY

Definition

A disability or restrictive long-term health condition exists if a limitation, restriction, impairment, disease or disorder has lasted, or is expected to last for six months or more, which restricts everyday activities.

A disability or restrictive long-term health condition is classified by whether or not a person has a specific limitation or restriction. The specific limitation or restriction is further classified by whether the limitation or restriction is a limitation in core activities, or a schooling/employment restriction only.

There are four levels of core activity limitation (profound, severe, moderate and mild). These are based on whether, and how often, a person needs help, has difficulty, or uses aids or equipment with any core activities (self care, mobility or communication). A person's overall level of core activity limitation is determined by their highest level of limitation in any of these activities.


Methodology

Respondents were asked if they had any of the following conditions which had lasted, or were likely to last for six months or more:
  • Sight problems not corrected by glasses or contact lenses;
  • Hearing problems;
  • Speech problems;
  • Blackouts, fits or loss of consciousness;
  • Difficulty learning or understanding things;
  • Limited use of arms or fingers;
  • Difficulty gripping things;
  • Limited use of legs or feet;
  • Any condition that restricts physical activity or physical work (e.g. back problems, migraines);
  • Any disfigurement or deformity; or
  • Any mental illness for which help or supervision is required.

They were also asked if their everyday activities were restricted due to:
  • Shortness of breath, or difficulty breathing;
  • Chronic or recurring pain;
  • A nervous or emotional condition;
  • Long term effects as a result of a head injury, stroke or other brain damage;
  • Any other long-term condition that requires treatment or medication; or
  • Any other long-term condition such as arthritis, asthma, heart disease, Alzheimer's disease or dementia.

Respondents were then asked whether they needed help or supervision with, had difficulty with, or used aids or equipment for any core activities, education or employment due to their condition or conditions. If respondents had more than one condition, and had reported that they needed help or supervision with, had difficulty with, or used aids or equipment for any core activities, education or employment, they were asked to nominate which condition caused the most problems.


Population

Information on type of condition, type of restriction, and level of core activity limitation was obtained for all persons. Schooling restriction questions were asked of persons aged 5-64 years, and employment questions were asked of persons aged 15-64 years.


Data items

The data items and related output categories for this topic are available in Excel spreadsheet format from the downloads tabs of the National Health Survey: Users' Guide, 2007-08 (cat. no. 4363.0.55.001) and the National Health Survey Data Reference Package, 2007-08 (cat. no. 4363.0.55.002).


Interpretation

Points to be considered in interpreting data for this topic include the following:
  • ABS analysis has shown that some of the people in the population with a 'disability or restrictive long-term health condition' have conditions that do not restrict them in everyday activities. As a result, estimates of population size or the prevalence of people with a 'disability or restrictive long-term health condition' are overstated. The best use of this population is for comparison of the health characteristics of people with a 'disability or restrictive long-term health condition' against people who do not have a 'disability or restrictive long-term health condition'.
  • Conditions are 'as reported' by respondents and do not necessarily represent conditions as medically diagnosed. However, as the data relate to conditions which had lasted, or are expected to last, for six months or more there is considered to be a reasonable likelihood that medical diagnoses would have been made in most cases. The degree to which conditions have been medically diagnosed is likely to differ across condition types.
  • 'Restricted in everyday activities' means less able, or unable, to engage in the everyday activities that a healthy individual of the same age would be able to. Respondents can perceive themselves to be restricted in everyday activities by causes other than the specific conditions listed.
  • Aids needed for any condition lasting less than six months (i.e. broken leg) were not included. Examples of aids are hearing aids, wheelchairs for long-term use, special cutlery and changes to floors/steps/paths.
  • Difficulties with education relate to situations such as being unable to attend a particular educational institution, needing time off from regular classes, or requiring special tuition. Only current difficulties with education were collected. Any difficulties a respondent may have previously experienced with education were excluded.
  • Difficulties with employment relate to respondents who could not work or were restricted in the type of work they could do, regularly needed time off work, were restricted in the number of hours they could work, or required an employer to make special arrangements for them. Only current difficulties with employment were collected. Any difficulties a respondent may have previously experienced with employment were excluded.


Comparability with 2004-05

This topic was not collected in 2004-05, therefore no comparison can be made.

The disability module used in the 2007-08 survey is the same short module used in other ABS household surveys, with an additional question asking the respondent which disability (at the broad level) they consider to be their main disability. For the NHS, the insertion of the term 'restrictive' into the data item description 'disability or long-term health condition' was to identify that the long-term health conditions included did not necessarily include all long-term health conditions reported, only those which restrict activities.


PERSONAL STRESSORS

Definition

Personal stressors were defined as life events that may have been a problem for the respondent or anyone close to them in the 12 months prior to interview. These life events include:
  • serious illness
  • serious accident
  • death of family member or close friend
  • mental illness
  • serious disability
  • divorce or separation
  • not able to get a job
  • involuntary job loss
  • alcohol or drug related problems
  • witness to violence
  • abuse or violent crime
  • trouble with the police
  • gambling problem
  • other (specified)


Methodology

Respondents were asked whether they or a family member or friend had experienced any of the events listed above, and if so, which ones. If a respondent had experienced a stressful event that was not listed, they were able to specify the event. If more than one unlisted stressful event was experienced, the respondent was asked to indicate the main event.


Population

Information was obtained for persons aged 15 years and over.


Data items

The data items and related output categories for this topic are available in Excel spreadsheet format from the downloads tabs of the National Health Survey: Users' Guide, 2007-08 (cat. no. 4363.0.55.001) and the National Health Survey Data Reference Package, 2007-08 (cat. no. 4363.0.55.002).


Interpretation

Points to be considered in interpreting data for this topic include:
  • 'Anyone close to you' could refer to a family member, a friend or anyone else the respondent felt was close to them.
  • The effects of the event should have been felt by the respondent themselves, either directly or through a family member or friend who was experiencing the problem.
  • The effects of the problem must have been felt in the 12 months prior to interview, even if the problem occurred more than 12 months ago.
  • The interest was in the respondent's perception of whether the stressors had been a problem for them or not.


Comparability with 2004-05

This topic was not collected in 2004-05, therefore no comparison can be made.


BODILY PAIN

Definition

This topic refers to the severity of bodily or physical pain experienced by the respondent, and the extent to which it interfered with normal work (both outside the home and housework).


Methodology

Based on SF36 questions, respondents were asked how much bodily pain they had experienced in the four weeks prior to interview. Response categories were:
  • None
  • Very mild
  • Mild
  • Moderate
  • Severe
  • Very severe

If the respondent had experienced any bodily pain, they were then asked if pain had interfered with their normal work, including work outside the home and housework. Response categories were:
  • Not at all
  • A little bit
  • Moderately
  • Quite a bit
  • Extremely


Population

Information was obtained for all persons aged 15 years and over.


Data items

The data items and related output categories for this topic are available in Excel spreadsheet format from the downloads tabs of the National Health Survey: Users' Guide, 2007-08 (cat. no. 4363.0.55.001) and the National Health Survey Data Reference Package, 2007-08 (cat. no. 4363.0.55.002).


Interpretation

Points to be considered in interpreting data for this topic include the following:
  • Respondents were asked to indicate the severity of any bodily pain that they had experienced (from any and all causes) during the four weeks prior to interview.
  • Interference with normal work includes work or housework activities that the respondent did or would have done during the four weeks prior to interview.


Comparability with 2004-05

This topic was not collected in 2004-05, therefore no comparison can be made. Data is, however, comparable with that collected in the 1995 NHS.


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