the scottish health survey: multiple risk factors in adults aged 16+ years catherine bromley,...

The Scottish Health Survey: multiple risk factors in adults aged 16+ yearsCatherine Bromley, ScotCen

Faculty of Public Health Conference

Aviemore 10 November 2011

• Research questions• What is the prevalence of multiple risks in the adult

population?

• What common combinations exist?

• How do risks relate to outcomes?

• Who is at greatest risk?

• Data source• 2010 Scottish Health Survey

• Chapter 10 “Multiple Risks” in 2010 report (published September 2011)

• Plus some new analysis using combined 08-10 data

Presentation outline

• ISD’s analysis of multiple risks in 2003 survey1

• 90% of the disease burden in high income countries is accounted for by:2

• Excess alcohol consumption

• Smoking

• Low fruit and vegetable consumption

• Physical inactivity

• Obesity

1Lawder R et al (2010) Is the Scottish population living dangerously? Prevalence of multiple risk factors: the Scottish Health Survey 2003;

2Ezzati M et al (2006) Comparative quantification of mortality and burden of disease attributable to selected risk factors, in: Lopez AD et al (eds)

Global Burden of Disease and Risk Factors, OUP

Background

• Public health interventions often focus on single risk factors – but are increasingly more integrated

• But, risk factors do not operate in isolation• E.g. risk of liver disease is greater in people who drink excess

alcohol and are obese1

• Risk factors do not exist in isolation

1Hart C et al (2010) Effect of body mass index and alcohol consumption on liver disease: analysis of data from two prospective cohort studies,

BMJ, 340:c1240

Background

Smokescigarettes:

26%

Drinks more than advised:

45%

Not active

enough: 58%

Over-weight:

66%

Fruit & veg <5/day:

78%

Individual risks

Scottish Health Survey 2010 (5,897 adults 16+)

Measures in the scale

Five: 4%

Four:20%

Three: 35%

Two: 28%

One: 11%

None: 2%

No. ofrisks

Multiple risk scale


Fruit & veg <5/day

OverweightNot

active enough

12%

7%3%

Risk combinations


Fruit & veg <5/day

OverweightNot

active enough

18%14%

8%

12%

7%3%

Risk combinations


Fruit & veg <5/day

OverweightNot

active enough

33%

18%14%

8%

12%

7%3%

=96% of adult population

Risk combinations


0

5

10

15

20

25

30

35

0 1 2 3 4 5

Number of risks

% a

du

lts

16+

year

s

Doctor-diagnosed diabetes

GHQ 4+

Limiting long-term condition

Scottish Health Survey 2008/09/10 (17,478 adults 16+)

Risk and health outcomes

0

10

20

30

40

50

60

70

0-1 2 3 4-5

Number of risks

% a

du

lts

16+

year

s

Pre-diabetes

Undiagnosed diabetes

Cholesterol >=5mmol/l

Risk and health outcomes

Scottish Health Survey 2008/09/10 (2,342 adults 16+)

0

10

20

30

40

50

60

70

80

16-24 25-34 35-44 45-54 55-64 65-74 75+

Age group (years)

% w

ith

3 o

r m

ore

ris

ks

Men

Women


3+ risks by age and sex

0

10

20

30

40

50

60

70

80

16-24 25-34 35-44 45-54 55-64 65-74 75+

Age group (years)

% w

ith

4 o

r 5

risk

s

Men

Women

4 or 5 risks by age and sex


0

10

20

30

40

5th (leastdeprived)

4th 3rd 2nd 1st (mostdeprived)

SIMD quintile

% w

ith

4 o

r 5

risk

s

Men

Women

4 or 5 risks by SIMD quintile and sex


Number of risks higher if:

Ordinal model

Linear model

Logistic model (4/5 risks)

Aged 35-64 (versus 16-24)

Permanently unable to work (versus employed)

Looking for work (versus employed)

Higher grades (Vs degree/HE)

Standard grades (Vs degree/HE)

Other school level (Vs degree/HE)

No qualifications (Vs degree/HE)

Cohabiting (versus married/civil partner)

Separated (versus married/civil partner)

Factors associated with multiple risks: men

Number of risks higher (*lower) if:

Ordinal model

Linear model

Logistic model (4/5 risks)

*Aged 75+ years (versus 16-24)

SIMD 2nd most deprived quintile (v least) SIMD most deprived quintile (v least)

Intermediate NS-SEC (v professional) Semi-routine/routine NS-SEC (v professional) Semi-routine/routine NS-SEC in childhood (v professional)

Permanently unable to work (v employed) Higher grades (Vs degree/HE)

Standard grades (Vs degree/HE) Other school level (Vs degree/HE) No qualifications (Vs degree/HE)

Factors associated with multiple risks: women

• Other research questions• Has the profile of multiple risks changed over time?

• Do multiple risks help predict mortality, CVD events or cancer diagnoses?

• Is similar analysis of children useful?

• Public health policy and/or practice implications• Does understanding more about multiple risks help policy

makers / practitioners – or does it just make life more complicated?

Discussion points

Thank youFor more details about the Scottish Health Survey: www.scotland.gov.uk/scottishhealthsurvey

Email survey queries to: [email protected]

Queries about these presentations:[email protected]

the scottish health survey: multiple risk factors in adults aged 16+ years catherine bromley,...

Documents