The Scottish Health Survey Past, present and future Catherine Bromley Scottish Centre for Social Research

Aims of the Scottish Health Survey Scottish Government’s stated aims for the survey: To estimate the prevalence of particular health conditions in Scotland To estimate the prevalence of certain risk factors associated with these health conditions and to document the pattern of related health behaviours To look at differences between regions and between subgroups of the population in the extent of their having these particular health conditions or risk factors, and to make comparisons with other national statistics for Scotland and internationally To monitor trends in the population’s health over time To make a major contribution to monitoring progress towards health targets

Examples of uses of the Survey Scottish Government annual reports & web tables Reports on most of the survey’s aims (national estimates, trends, differences between groups, etc) Scottish Government topic reports UK comparisons, Glasgow effect, obesity, older people (29/11/11) Journal articles / conference papers Prospective analysis of: CVD episodes, alcohol-related hospital admissions, psychiatric admissions, mortality Trend analysis of: socio-economic patterning of CVD risk factors, diabetes prevalence and risk factors International comparisons of: self-reported health, diabetes management Regional differences within Scotland Estimates of screening burden for CVD or diabetes risk

Methods and design General population, multi-stage PAF sample All adults in selected households & up to 2 children Two stage design ( ) Main interview with height & weight measurement Follow-up visit from a nurse Topics Main focus: cardiovascular disease and its risk factors Key data on: smoking, alcohol, phys activity, diet, BMI Plus general health and wellbeing, respiratory conditions, accidents, dental health Consent to SMR and mortality record linkage sought Originally based on 1994 Health Survey for England, still has lots of topics in common (not always identical measures) Contractors: Scottish Centre for Social Research (95-15) with UCL (95-11), MRC/CSO Social and Public Health Sciences Unit (03-15), U of Edinburgh ( ), U of Aberdeen ( )

History of the Scottish Health Survey ( ) adults aged also had a nurse visit and 6183 gave a blood sample adults aged children aged adult and 3211 child nurse visits 6178 adults and 466 children (11-15) gave a blood sample adults aged children aged adult and 2224 child nurse visits 4264 adults and 300 children (11-15) gave a blood sample

2005/6 Review recommendations Continuous survey from 2008 Core and modular structure From 2008, topics are either in every year, or alternating years 1 adult in sub-sample of households completes Health Scotland’s Knowledge, Attitudes and Motivations module Scotland level results annually NHS Board results by amalgamating years together Unclustered sample NHS Boards able to purchase boosts to enhance their samples Fife, Borders and Grampian have boosted samples Adult nurse visits in a sub-sample of households

History & future of the Survey ( ) ~7000 adults aged 16+ per year ~2000 children aged 0-15 per year Sub-sample of adult nurse visits ~ 1000 per year No nurse visits for children Major redesign as part of SG review of population surveys Clustered sample drawn by SG Harmonised core questionnaire common to all 3 Scottish population surveys KAM module discontinued SHeS still continuous, but smaller sample: ~4000 adults aged 16+ per year ~1800 children aged 0-15 per year No nurse visits Interviewer biomeasures instead

progress update Blood pressure Int Lung function  Waist/hip (16+) Int Cotinine blood saliva HDL cholesterol  ?? Total cholesterol  ?? Fibrinogen  C Reactive protein  ?? Glycated haemoglobin  ?? Urinary sodium/ potassium/creatinine  Int ECG  Biomeasures - adults

Datasets available in the Data Archive 1995, 1998 and and 2009 combined data Jan 2012: 2010 and 2008/2009/2010 combined data Jan 2013: 2011 and 2008/2009/2010/2011 combined data Jan 2013: trend analysis mini-dataset Note – the combined datasets are not a substitute for the annual datasets, their purpose is to increase n for questions included in multiple years. Analysis of a single year should be run on the relevant single year dataset.

Scottish Health Survey-SMR linked data File maintained by ISD Over 90% of participants consent to linkage linkage now available for each survey up to 2009 Consent wording from 2012 will increase scope of linkage Two versions of file Minimum SHeS-SMR free to research community: SMR01 (general/acute inpatient/day case inc. reasons for admission derived from SMR records) SMR04 (mental health inpatient/day case) SMR06 (cancer register) Causes of death Full dataset with individual SMR data, available by seeking permission from Privacy Advisory Committee Further info: Article in International Journal of Epidemiology (2010, 39: ) Leanne Hopkins at ISD

Negative implications of 2012 changes Wider confidence intervals for health board data Current minimum adult sample per HB=784, from 2012=500 More reliance on combined datasets for detailed sub-group analysis / fewer analyses stratified by gender CVD / diabetes risk analysis based on blood samples might not be possible Potential for interrupting time series (waist/BP) Continued need to use combined datasets for biomeasure analysis Additional uncertainty about sample sizes in early years until response rates are established

Positive implications of 2012 changes Increased ability to analyse trends Better estimates of future CVD & diabetes risk based on family history Potentially higher response to biomeasures Greater focus on respiratory health Ability to analyse smoking prevalence, long-term conditions and self-reported health using pooled sample from Health, Household and Crime surveys First time that Scottish data will exist for smaller populations such as minority ethnic groups

Scottish Health Survey: key contacts At Scottish Government: Queries: Main website: Includes all Scottish Govt survey publications and links to other work based on the survey Useful analysis site: health-survey/SHeSAnalystHelp Includes advice on analysis, variables in each report table, full SPSS syntax files and more At ScotCen: Queries: