The HealthSurvey for England (HSE) comprises a series of annual surveys beginning in1991. The series is part of an overall programme of surveys commissioned by theDepartment of Health and designed to provide regular information on variousaspects of the nation's health. All surveys have covered the adult populationaged 16 and over living in private households in England. Children aged 2-15were included in the survey for the first time in 1995 and have beeninterviewed every year since.
Each survey in the series consists of a core set ofquestions and measurements (such as anthropometric and blood pressuremeasurements and analysis of blood samples), plus modules of questions onspecific issues that change periodically. On average, about 16,000 adults and4,000 children resident in 9,000 households are interviewed each year.
This section presents key indicators of generalhealth, prevalence of risk factors and morbidity patterns at Health Authority(HA) level using HSE data combined over the period 1994 to 1996.
Variable Definitions
Generalhealth, Chronic and Acute Illness
Proportion withself-assessed fair, poor or bad health.
Definition:Observed percentage and age-standardised rate of adults rating their generalhealth as "fair", "bad" or "very bad" on a fivepoint scale ranging from "very good" to "very bad".
Prevalence of longstandingillness.
Definition:Observed percentage and age-standardised rate of self-reported prevalence ofone or more chronic conditions among adults. Informants were asked whether theyhad any longstanding illness, disability or infirmity that had troubled themover a period of time or was likely to affect them over a period of time.
Prevalence of acutesickness.
Definition:Observed percentage and age-standardised rate of self-reported acute sicknessamong adults in the two weeks preceding the interview. Acute sickness wasdefined as having had to cut down on usual activities at home, work or leisure,because of an illness or injury.
Indicator: Proportion ofadults on prescribed medication
Definition:Observed percentage and age-standardised rate of adults currently taking atleast one prescribed medicine. Contraceptives are not included as prescribedmedicines.
PhysicalMeasurements: Blood Pressure, BMI, height and weight
Indicator: Mean systolicblood pressure.
Definition:Observed and age-standardised mean systolic blood pressure (SBP) of adults.
Comments:Adults with a valid blood pressure reading were included in the calculation ofthis variable. The nurse protocol required three readings to be taken and validcases were defined as those for whom all three readings were successfullyobtained and who had not eaten, drunk alcohol or smoked in the 30 minutes priorto the measurement. Blood pressure for valid cases was calculated as the meanof the second and third readings.
Indicator: Mean diastolicblood pressure.
Definition:Observed and age-standardised mean diastolic blood pressure (DBP) of adults.
Comments:Adults with a valid blood pressure reading were included in the calculation ofthis variable. The nurse protocol required three readings to be taken and validcases were defined as those for whom all three readings were successfullyobtained and who had not eaten, drunk alcohol or smoked in the 30 minutes priorto the measurement. Blood pressure for valid cases was calculated as the meanof the second and third readings.
Indicator: Proportion withhigh blood pressure.
Definition:Observedpercentage prevalence and age-standardised rate of high blood pressure amongadults.
Comments:The term "high blood pressure" is used to refer to those who arehypertensive, i.e. with a SBP ³ 160 and/or a DBP ³ 95, whether or not currentlyon antihypertensive drugs (hypertensive treated and hypertensive untreated); aswell as those with a SBP < 160 and DBP < 95 who are currently onantihypertensive drugs (normotensive treated). The counts include all adultswith a valid blood pressure reading (cf. SBP, DBP above) and data onmedication.
Indicator: Mean height ofadults (cm).
Definition:Observed and age-standardised mean height of adults.
Comments:The height of informants who were chair-bound, unsteady or could not standstraight was not measured. Data for those who were considered by theinterviewer to have unreliable measurements (e.g. wig, turban) were excludedfrom the analysis.
Indicator: Mean weight ofadults (kg).
Definition:Observed and age-standardised mean weight of adults.
Comments:The weight of informants who were pregnant, chair-bound, unsteady or could notstand was not measured. Those who weighed more than 130 kg. were asked fortheir ‘estimated weight’ because the scales were unreliable above this level.These have been included in the analysis.
Indicator: Mean Body MassIndex (BMI) of adults.
Definition:Observed and age-standardised mean BMI of adults.
Comments:BMI, defined as weight (kg) divided by height squared (m
2
), wascalculated for all informants who had a valid height and weight measurement(cf. mean height and mean weight above).
Indicator: Proportion ofadults who are overweight.
Definition:Observed percentage and age-standardised rate per 100 of persons with a BMI> 25 to 30 kg/m
2
.
Comments:BMI, defined as weight (kg) divided by height squared (m
2
), wascalculated for all informants who had a valid height and weight measurement(cf. mean height and mean weight above).
Indicator: Proportion ofadults who are obese.
Definition:Observed percentage and age-standardised rate per 100 of persons with a BMIgreater than 30 kg/m
2
.
Comments:BMI, defined as weight (kg) divided by height squared (m
2
), wascalculated for all informants who had a valid height and weight measurement(cf. mean height and mean weight above).
Smoking
Indicator: Proportion ofadults who currently smoke cigarettes, pipes or cigars.
Definition:Observed percentage prevalence and age-standardised rate of self-reportedcurrent smokers.
Indicator: Proportion ofadults who currently smoke cigarettes.
Definition:Observed percentage prevalence and age-standardised rate of self-reportedcurrent cigarette smokers.
Indicator: Proportion ofadults with a serum cotinine level of 20ng/ml or over.
Definition:Observed percentage and age-standardised rate per 100 of adults with a serumcotinine level of 20ng/ml or above.
Comments:Blood samples taken from adult Health Survey respondents were analysed toestimate serum cotinine levels, providing an objective cross-check onself-reported smoking status. Levels of 20 nanograms per millilitre or highersuggest strongly that the informant is a smoker. Persons using nicotinereplacement products were excluded from the analysis.
Indicator: Mean per capitanumber of cigarettes smoked
Definition:Observed mean and age-standardised mean number of cigarettes smoked per day(base all adults, smokers and non-smokers).
Drinking
Indicator: Proportion ofMales drinking over 21 units/week and Females drinking over 14 units/week .
Definition:Observed percentage and age-standardised rate of males drinking more than 21units of alcohol per week and females drinking more than 14 units of alcoholper week.
Comments:Weekly consumption was estimated from responses to questions on how often fivetypes of alcoholic drinks (shandy, beer/lager/cider, spirits/liqueurs,fortified wine and wine) were consumed over the past 12 months; and how muchthey had usually drunk on any one day. Low alcohol drinks were excluded andAlcopops were included with beer.
Indicator: Proportion ofMales drinking over 50 units/week and Females drinking over 35 units/week.
Definition:Observed percentage and age-standardised rate of males drinking more than 50units of alcohol per week and females drinking more than 35 units of alcoholper week.
Indicator: Mean weeklyalcohol consumption (base all adults)
Definition:Observed mean and age-standardised mean estimated usual weekly alcoholconsumption level (units per week) for adults.
Respiratory Conditions
Title: Proportion with wheeze ordoctor-diagnosed asthma
Definition:All adult informants who have ever had wheezing or whistling in the chest ordoctor-diagnosed asthma.
Comments:Wheezing is the most commonly used indicator of asthma in prevalence surveys.Overall, 33% of respondents had a history of wheezing and 11% of these werediagnosed asthmatics. A few respondents (1%) who were diagnosed as sufferingfrom asthma reported not to have a history of wheezing.
PsychiatricMorbidity
Title: Proportion of adultswith GHQ12 score of 4 and over
Definition:All adults with a score of 4 or over on the 12-item General HealthQuestionnaire (GHQ12). The self-completion questionnaire asks informants abouttheir general level of happiness, depression, anxiety and sleep disturbanceover the past four weeks. Scores were calculated only for those informants whohad answered all 12 questions.
Accidents
Title: Annual accident rateper 100 persons for major accidents
Definition:Observed mean and age-standardised mean major accident rate per 100 persons peryear. ‘Major’ non-fatal accidents are defined as those about which informantssaw a doctor or went to hospital. Informants were asked to recall how many suchmajor accidents they had had in the 6 months prior to interview. To enable comparisonsbetween sub-groups, annual rates per 100 persons were estimated.
Comments:The HSE accident rates will be slight underestimates of the true non-fatalaccident rate, specially for older people. This is because as it covers onlythe current private household population, it will not include accidents leadingto more than a six months’ stay at a hospital or institution.