close

Вход

Забыли?

вход по аккаунту

?

Building a picture of national psychiatric morbidity: a

код для вставкиСкачать
General measures of health for use in
Health Interview Surveys and Censuses:
the UK experience
Howard Meltzer
Social Survey Division, Office for National Statistics, London
Washington City Group meeting, Ottawa
9-10 January 2003
1
Typology of surveys in the UK which include
questions on health problems or disability
• Surveys which include a global measure of chronic ill
health or disability (2/3 questions on limiting
longstanding illness)
• Surveys which include a module of questions on
disability - look at relationship between disability and
particular topic of survey (employment, housing,
finances)
• Surveys which have disability as their primary
concern
2
Surveys in the UK which have included
general measures of disability
•
•
•
•
•
•
•
•
Health Survey for England (HSE)
General Household Survey (GHS)
Health and Lifestyle Survey
Health Education Monitoring Survey (HEMS)
Psychiatric Morbidity Surveys (PMS)
National Child Development Survey
Physical Health of Prisoners
Family Resources Survey (FRS)
• Censuses: 1991 and 2001
3
Surveys in the UK which have included a
module of questions on disability
• Labour Force Survey (LFS)
– Focuses on limitation in type and kind of work
– Opportunities for disabled people in labour market
– Monitors the Disability Discrimination Act, 1995
• National Travel Survey (NTS)
– Mobility, transport and travel
– Use of cars or buses
• English Housing Conditions Survey
– Mobility, Activities of Daily Living,
– Personal assistance, disability equipment,
adaptations to the home
4
Surveys in the UK dedicated to the topic of
disability
• The 1971 OPCS Survey of “Handicapped and
Impaired” in Great Britain
– Adults
– Private household and institutional population
• The 1985 OPCS Surveys of Disability in Great Britain
– Adults and children
– Private household and institutional population
• The 1996/7 follow up to the Family Resources Survey
– Repeated the 1985 assessment schedule
– Different methodology
5
Why are questions about general health
included in surveys?
• To control both the burden on respondents and the cost and
complexity of surveys. A single question providing an indicator
of general health is cheap and hopefully straightforward to
interpret.
• To derive a simple indicator (or small set of indicators) to
subsume the detail which emerges when a person is questioned
in depth about something as complex as his or her state of
health.
• To estimate the �burden of ill health’ in the population, where �ill
health’ is defined as �that which requires input from the health
services’.
6
Range of questions used in the UK
• GHS (since 1971); HSE (since 1991)
– Do you have any long-standing illness, disability or infirmity?
By long-standing I mean anything that has troubled you over
a period of time or that is likely to affect you over a period of
time?
• The GHS also asks a second question on
limitation
– Does this illness or disability (Do any of these illnesses or
disabilities) limit your activities in any way?
7
Supplementary questions
• Activities of Daily Living (OPCS, 1994)
• Checklist of symptoms (Health Promotion Trust,
1987)
• What is the matter with you? (GHS, 1988, 1989,
1994, 1996)
8
Census questions used in the UK
• The 1991 Census used the following question:
– Do you have any long-term illness, health problem or
handicap which limits your daily activities or the work you
can do? (Include problems which are due to old age)
• The 2001 Census used a slightly different
question:
– Do you have any long-term illness, heath problem or
disability which limits your daily activities or the work
you can do? (Include problems which are due to old age)
9
Effect of question wording, question order
and survey design (1)
• Surveys which attempt to measure both limiting and
non-limiting chronic illness with one question tend to
produce lower overall estimates of prevalence than
those which ask two separate questions.
• Asking whether respondents �have’ a long-standing
illness produces higher estimates than asking
whether they �suffer’ from an illness; some people
may answer �no’ to the latter on the grounds that they
are not actually suffering (Goddard, 1990).
10
Effect of question wording, question order
and survey design (2)
• Asking whether an illness limits activities compared with �people
of your age’ produces lower estimates than asking whether it
limits them �in any way’; it is believed that elderly people in
particular would say no because most of their contemporaries
were as limited in their activities as they were (OPCS, 1975).
• Using a checklist of symptoms stimulates reporting (Blaxter,
1987). It might produce overestimates of prevalence as
informants who are not sure whether they have a condition
might include themselves (Goddard, 1990).
11
Assessment of validity
• Comparisons with standardised mortality rates
– Higher rates among those with long term illness
• Results of clinical examinations or doctors’ reports
– Overall good agreement
• Discrepancies not necessarily due to inaccurate self report
– Problem may not have been brought to doctors’ attention
– Medical records could be incomplete or inaccurate
– Doctor may not have told patient of diagnosis
– Lay descriptions may differ from those given by doctors
12
Caveats from validity studies
• Elderly people regard limitations in their daily activities,
particularly difficulties with eyesight and hearing, as a normal
part of growing old, not as evidence of illness or disability
(Martin et al. 1988).
• Some people are more troubled by a certain kind of symptom
than others, and that the need to limit activities will depend on
what people usually do (Bennett et al. 1996)
• Informants may also vary in the amount of information they
choose to give or in their knowledge of the extent and nature of
their ill-health (Blaxter, 1990).
• Complaints most often missed are: anxiety and depression,
varicose veins, migraine, haemorrhoids and �back trouble’
13
Empirical considerations
• Identical questions do not produce identical estimates
– although any differences tend to be small.
• Differences can emerge for a number of reasons
– Different approach to taking proxy information
– Different non-response bias
– Context: general versus specific health survey
– Mode of administration (postal, face to face, telephone)
14
Longstanding illness by year (GHS)
16-44
45-64
65-74
75+
Percentage with longstanding illness
80
70
60
50
40
30
20
10
0
1981
15
1985
1991
1993
1995
1996
1998
2000
2001
Limiting longstanding illness by year (GHS)
Percentage with limiting longstanding illness
16-44
65-74
75+
60
50
40
30
20
10
0
1981
16
45-64
1985
1991
1993
1995
1996
1998
2000
2001
Percentage reporting longstanding illness:
GHS (1996) and HSE (1995) - Men
GHS (1996)
HSE (1995)
Percentage with longstanding illness
70
60
50
40
30
20
10
0
16-24
17
25-34
35-44
45-54
55-64
65-74
75+
Percentage reporting longstanding illness:
GHS (1996) and HSE (1995) - Women
GHS (1996)
HSE (1995)
Percentage with longstanding illness
80
70
60
50
40
30
20
10
0
16-24
18
25-34
35-44
45-54
55-64
65-74
75+
Percentage reporting limiting longstanding illness:
GHS (1996) and Omnibus (1995) - Men
Percentage with limiting longstanding illness
GHS (1996)
50
45
40
35
30
25
20
15
10
5
0
16-24
19
Omnibus (1996)
25-34
35-44
45-54
55-64
65-74
75+
Percentage reporting limiting longstanding illness:
GHS (1996) and Omnibus (1995) - Women
Percentage with limiting longstanding illness
GHS (1996)
60
50
40
30
20
10
0
16-24
20
Omnibus (1996)
25-34
35-44
45-54
55-64
65-74
75+
Percentage reporting limiting longstanding illness:
GHS (1991) and Census (1991) - Men
Percentage with limiting longstanding illness
GHS (1991)
50
45
40
35
30
25
20
15
10
5
0
16-44
21
Census (1991)
45-64
65-74
75+
Percentage reporting limiting longstanding illness:
GHS (1991) and Census (1991) - Women
Percentage with limiting longstanding illness
GHS (1991)
60
50
40
30
20
10
0
16-44
22
Census (1991)
45-64
65-74
75+
Implications of the UK experience on the
Minimum European Health Module (1)
• Do you have any longstanding illness or health
problem? (Yes/No)
– No comparable question in the UK surveys
– All UK surveys have the word “disability” or
“infirmity”
– The word “health problem” only occurs in the
census.
23
Implications of the UK experience on the
Minimum European Health Module (2)
• For at least, the past six months, have you been
limited in activities people usually do because of
a health problem? (Yes/No)
– Normally asked in reverse order, health than
limitation
– In population surveys, usually asked as two
questions
– The reference concept is always what the
respondent usually does and not what “people
usually do”.
24
Conclusions
• Data from general health questions need to take
account of differences in:
– question wording, question order and context
– mode of administration
– population surveys as distinct from censuses
– different responses by subgroups (age, gender,
and social class)
– how different conditions are rated (sight, hearing,
mental health, access treatment)
– reference group for assessing limitation
25
General measures of health for use in
Health Interview Surveys and Censuses:
the UK experience
Howard Meltzer
Social Survey Division, Office for National Statistics, London
Washington City Group meeting, Ottawa
9-10 January 2003
26
Документ
Категория
Презентации
Просмотров
3
Размер файла
149 Кб
Теги
1/--страниц
Пожаловаться на содержимое документа