Australian Bureau of Statistics
4364.0 - National Health Survey: Summary of Results, 2001
Previous ISSUE Released at 11:30 AM (CANBERRA TIME) 25/10/2002
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To maximise the range of information collected, not all residents of the sampled dwellings were included: the survey enumerated one adult, one child aged 7 to 17 years, and all children aged less than 7 years in each dwelling.
This publication contains a cross-section of results from the survey for the main topics covered. Explanatory Notes provide information about the survey design and methodology, the quality and interpretation of results, and information about the range of publications and other data services available or planned. More detailed information about the survey will be contained in the 2001 National Health Survey: Users' Guide, which will be released on this site in December 2002.
An additional health survey of Aboriginal and Torres Strait Islander people was conducted in association with the 2001 NHS. Information about that survey, and summary results will be separately published on 15 November 2002 in National Health Survey 2001: Aboriginal and Torres Strait Islander Results, Australia (cat. no. 4715.0).
EFFECTS OF ROUNDING
Where estimates have been rounded, discrepancies may occur between sums of the component items and total.
ABS publications draw extensively on information provided freely by individuals, businesses, governments and other organisations. Their continued cooperation is very much appreciated; without it, the wide range of statistics published by the ABS would not be available. Information received by the ABS is treated in strict confidence as required by the Census and Statistics Act 1905.
For further information about these and related statitsics, contact the National Information and Referral Service on 1300 135 070 or Darren Evans on Canberra 02 6252 6415.
SUMMARY OF FINDINGS
SUMMARY HEALTH INDICATORS
The majority of Australians consider themselves to be in good health. Results of the 2001 National Health Survey (NHS) showed that 82% of people aged 15 years and over considered their overall health to be good, very good or excellent. Similar proportions were reported by males and females and in the previous NHS conducted in 1995. The proportion of people reporting fair or poor health increased with age, from 9% of those aged 15-24 years to 39% of those aged 75 years and over (table 3) .
Most people aged 15 years and over considered that their health was better (21%) or about the same (66%) as one year ago, with less than 2% reporting their health was much worse. A higher proportion of females reported that their health was much, or somewhat, better than one year ago (23%) than males (19%) (table 4).
LONG TERM MEDICAL CONDITIONS
Although most people reported they were in good health, 87% of those aged 15 years and over and 78% of the total population reported that they had one or more long term medical conditions up from 83% and 76% respectively in 1995. It should be noted that the survey results exclude persons in hospitals, nursing homes and other non-private dwellings.
The most commonly reported long term conditions were problems with eyesight, including long sightedness, short sightedness and presbyopia (22%, 21%, 9% respectively) and back and disc problems (21%). Other commonly reported conditions were hayfever and allergic rhinitis (16%), arthritis (14%), asthma (12%), complete or partial hearing loss (11%) and hypertensive disease (10%) (table 5).
The prevalence of most conditions increased with age, to the extent that at least one long term condition was reported for almost all (99%) persons aged 75 years and over compared with less than a third (27%) of children aged less than 5 years. The types of conditions most commonly reported also differed markedly across age groups.
Among children and young adults, respiratory conditions were the most commonly reported conditions, with asthma being the most prevalent among children under 15 years, while hayfever was the most prevalent condition for young people aged 15-24 years.
Although respiratory conditions were common among older people (31% of those aged 55 years and over), other conditions were more prevalent in this age group. Sight conditions, arthritis, back and disc problems, hypertension and hearing loss were the most common long term conditions among those aged 55 years and over. Arthritis increased with age from one in three of those aged 55-64 years to just over half (52%) of those aged 75 years and over. In contrast long sightedness decreased from 55% of 55-64 years olds to 43% of those aged 75 years and over.
Although the 2001 NHS collected information on all long term conditions it had a particular focus on the national health priority area (NHPA) conditions of asthma, cancer, heart and circulatory conditions and diabetes. Survey findings for these conditions are discussed briefly below.
In 2001, there were approximately 2.2 million (12%) people in Australia with asthma as a current and long term condition (11% of males and 13% of females (table 5)), up from 8% in 1989-90 and 11% in 1995 based on estimates from National Health Surveys conducted in those years (table 7).
Of those with long term asthma, 60% reported taking some action for their asthma in the previous 2 weeks (table 10). The most common action was use of pharmaceutical medications; 8% of those with asthma took medication for prevention only, 17% for relief of symptoms only and 34% for both prevention and relief purposes. The use of medications differed markedly across certain age groups from a low of 49% of those aged 5-14 years to over 80% of those aged 75 years and over. Just over 1% of persons with asthma visited a hospital for their condition in the previous 2 weeks, but 9% consulted a doctor.
Conditions of the circulatory system
In 2001, approximately 17% of the population reported a long term condition of the circulatory system. The most common of these conditions was hypertensive disease (high blood pressure), reported by 10% of the population. This was similar to the prevalence of the condition in 1995 (table 7). Other circulatory conditions commonly reported in 2001 were angina and other heart disease, tachycardia, cardiac murmurs and sounds, and varicose veins, each with a prevalence of around 2% of the population (table 5).
Circulatory conditions in total were more common among females (19%) than males (15%), and this was the case for most individual conditions. However, males were more likely to have angina and ischaemic/other heart diseases than females, although the prevalence for both males and females was very low (2.4% and 1.8%).
Circulatory conditions were mostly experienced by people in middle and older age groups, particularly those aged 45 years and over. Almost one in four (23%) of those aged 45-54 years had a long term circulatory condition, rising progressively to 62% of those aged 75 years and over. As the most reported single condition, much of this increase was attributable to increases in the prevalence of hypertensive disease; from 14% in the 45-54 year age group to 42% of those aged 75 years and over.
In interpreting survey data about persons with cancer, it should be noted that the 2001 National Health Survey excluded persons in hospitals, nursing and convalescent homes and hospices. The exclusion of these groups is expected to have a greater effect on the survey data for cancer than for most other conditions.
From information reported in the 2001 NHS it is estimated that 311,300 persons (1.6% of the population) currently had a medically diagnosed neoplasm in 2001. Of these people, 84% reported a malignant neoplasm and 16% reported a benign neoplasm or neoplasm of uncertain nature. The most common types of cancer reported were skin cancer (36% of those reporting malignant neoplasm), cancer of the digestive organs (11%) and breast cancer (26% of females reporting a malignant neoplasm) (table 5).
More males than females reported malignant neoplasms for most cancer types which were not sex specific, but the age distribution of those with cancer was generally similar for males and females. Just over half (53%) of both males and females with skin cancer were aged less than 65 years. The number of females reporting cancer was highest in the 45-54 year age group possibly related to the peak in breast cancer prevalence in this age group. However for both males and females cancer was most prevalent in the 65-74 and 75 years and over age groups (3% of females and 8% of males in these age groups).
An estimated 554,200 persons (2.9% of the population) in 2001 had been diagnosed with diabetes mellitus and considered themselves to still have the condition. This compares with an estimated 355,000 (2.4%) persons with long term diabetes in 1995 (table 2). The majority of people with diabetes reported they had Type 2 (adult onset) diabetes (78%), 17% reported Type 1 (sometimes referred to as insulin dependent diabetes) while 5% reported diabetes but did not know which type. A further 61,000 people reported they currently had high sugar levels in the blood or urine, but had not been diagnosed with diabetes.
The proportions of males and females with diabetes mellitus were similar at around 3%. As shown below the age profiles of Type 1 and Type 2 diabetes differed markedly.
Almost all (93%) persons with diabetes or high sugar levels reported that they took some action for the condition in the previous 2 weeks (table 11). Some 19% used insulin and 56% used other pharmaceutical medications. Consistent with the high proportion of Type 2 diabetes, lifestyle changes were also common. In particular, 80% of people with diabetes or high sugar levels reported they were following changed eating patterns/diet due to their diabetes. Some 30% of those with diabetes or high sugar levels reported they had exercised most days in the last 2 weeks, and 17% reported they were losing weight. Males were much more likely to exercise for diabetes (37%) than females (24%).
Almost one in ten people reported in the survey that they had a long term mental or behavioural problem (table 5). The most commonly reported problems were classified to two groups, anxiety related problems and mood (affective) problems (each reported by approximately 3% of males and 6% of females). However, unlike the NHPAs already discussed, respondents in the survey were not specifically asked whether they had been diagnosed with any mental disorders so that the information provided by the respondents could be based on self-diagnosis rather than diagnosis by a health professional. Hence, self-reported survey data on mental and behavioural problems are considered to be less reliable than other self-reported condition data.
To complement the data on long term conditions, additional information on mental health was collected from adult respondents using Kessler 10 Scale (K10), a 10 item scale of current psychological distress. The K10 asks about negative emotional states in the four weeks prior to interview. The results from the K10 are grouped into four categories: low (indicating little or no psychological distress); moderate; high; and very high levels of psychological distress. Based on research from other population studies, a very high level of psychological distress, as shown by the K10, may indicate a need for professional help.
Almost two-thirds (64%) of adults were classified to low levels of psychological distress, 23% to moderate levels, 9% to high levels and 3.6% to very high levels (table 12). Proportionally fewer males than females, across most age groups, reported high to very high levels of distress; of those who had very high levels of distress, 63% were female.
Compared to K10 results from the 1997 Survey of Mental Health and Wellbeing, relatively more people experienced moderate or higher levels of psychological distress in 2001 (36%) than in 1997 (26%). In 1997, almost one in five adults were classified as experiencing moderate (18%) psychological distress with a further 6% experiencing a high level and 2.2% a very high level of psychological distress.
One in five (18%) adults reported that in the previous 2 weeks they had used some medication for their mental wellbeing (table 13). Of those who had used medication, 53% had used pharmaceutical medications, 43% had used vitamin and mineral supplements and 30% had used other natural or herbal treatments. The most common pharmaceutical medications used were antidepressants (26% of those using medications), sleeping tablets (23%) and medications for anxiety or nerves (11%). Use of medications was higher among females than males overall (22% and 14% respectively), for all medication types and across most age groups. Use of medications was generally higher in older age groups. For example, 10% of males and 16% of females aged 75 years and over used sleeping medications compared with 3% and 5% respectively for the whole adult population.
Respondents to the survey were asked about events in the previous 4 weeks which resulted in injury for which they had sought medical treatment or taken some other action (see Glossary).
Some 12% of persons (13% of males and 11% of females) reported sustaining an injury in the previous 4 weeks (table 14). The types of events most commonly resulting in injury were low falls (less than 1 metre) which accounted for 33% of persons reporting a recent injury (31% for males, 36% for females); hitting or being hit by something (24% for males, 17% for females); and bites/stings requiring some treatment (8% for males and 13% for females).
Overall the proportion of people who had a recent injury event decreased with age from a peak of almost one in five (19%) children aged 5-14 years to less than one in twenty (4.8%) people aged 65-74 years. There was a slight increase in the proportion of people aged 75 years and over who reported sustaining an injury in the previous 4 weeks (7%).
HEALTH RELATED ACTIONS
Consultations with health professionals
Information was collected in the survey about actions people had recently taken for their health. Nearly one quarter of Australians (24%) consulted a general practitioner or specialist in the previous two weeks, up slightly from 23% in 1995 and 20% in 1989-90 (table 17). Other health professionals most commonly consulted were dentists (6%), chemists (4%), physiotherapists (2%) and chiropractors (2%) (table 20). Approximately 4% of the population had used a service at a hospital (inpatient, outpatient or emergency service) and 2% had visited a day clinic in the previous 2 weeks (table 15).
Females were more likely to consult most types of health professional than males. For example, 21% of males had consulted a doctor in the previous two weeks, compared with 27% of females. Although the overall proportions of the male and female populations consulting other health professionals are generally small, the numbers of females consulting were higher than males for most types of practitioner, and for some types such as chiropodist/podiatrist and naturopath they were 2 to 3 times higher (table 20).
Use of hospital services and consultations with doctors were strongly age-related. One in four (25%) children aged less than 5 years had consulted a doctor in the previous 2 weeks. The proportion consulting a doctor was lowest for children aged 5-14 years (15%) then rose across older age groups to 46% of persons aged 75 years and over (table15). The overall patterns of use across age groups were similar for males and females but as shown below consultations with doctors increased in older age groups whereas consultations with other health professionals showed little change.
(a) Other health professionals: see Glossary.
Days away from work
Some 14% of employed persons aged 15-64 years reported that they had one or more days away from work in the previous 2 weeks due to their own illness or injury (11%) or to care for another who was ill (4%). These absences from work accounted for around 3.7 million days lost from work (table 21). Although the proportion of females taking days away from work was higher than that for males (16% and 13% respectively), more male days were lost (2.0 million) than female days (1.8 million).
Days out of role
In addition to days away from work, information was obtained about days away from school/study and other days on which people cut down on their usual activities due to illness or injury. In this publication all these days are collectively referred to as days out of role (table 22). Some 17% of persons aged 5 years and over had one or more days out of role in the previous 2 weeks. Among those persons who had days out of role, the average number of days in the previous 2 weeks rose across age groups from 3 days in the 5-14 year age group (mostly schooldays) to 11 days for those aged 75 and over (mostly reduced activity).
Private health insurance/health cards
Results of the survey showed that 51% of the population aged 15 years and over had private health insurance (table 23) in 2001. Of these, 73% had both hospital and ancillary cover, 21% had hospital cover only and 6% had ancillary only cover. The level and type of cover differed across age groups, with highest overall coverage in the 45-54 year age group (65%) and the lowest among those aged 75 years and over (38%).
However, persons in the older age groups were more likely to have a government card which provided cardholders with access to selected health services free of charge or at concessional rates. More than 90% of persons aged 65 years and over were covered by such a card (table 26).
The 2001 National Health Survey collected information on a number of lifestyle behaviours and related characteristics which have been established as risks to health. The risk factors covered were smoking, alcohol consumption, exercise, being overweight and some dietary habits.
Compared with results from previous surveys in 1989-90 and 1995, the 2001 survey found that Australian adults are improving against the risk factors of smoking and exercise, but as shown in the following chart, the proportion of adults who are overweight continues to increase and risky and high risk alcohol use is unchanged since 1989-90.
(a) Risky and high alcohol risk.
(b) Sedentary exercise level.
(c) Overweight or obese body mass index (BMI).
Summary results for each of these risk factors are provided separately below.
One in four adults (24%) currently smoked in 2001; 22% were regular daily smokers and 2% smoked less often than once a day. Almost half of all adults (49%) reported that they had never smoked regularly, while the remaining 26% reported they were ex-smokers (table 27). More males than females were current smokers (28% and 21% respectively), and for both males and females the prevalence of smoking was higher in younger age groups than in older groups. Around 36% of males and 28% of females aged 18-34 years smoked compared with 7% of males and 5% of females aged 75 years and over.
(a) Includes daily and other current smoker.
The proportion of adults who smoked in 2001 (24%) was just over 1 percentage point lower than that in 1995 (25%) and 4 percentage points lower than in 1989-90 (28%) (table 31). Reductions in the number of adults smoking were primarily in older age groups. The proportions of males who smoked were similar in 2001 and 1995 up to 64 years, but for the 65-74 year olds, the proportion was 5% percentage points lower in 2001. Among females, changes between 1995 and 2001 in the proportions who smoked varied across age groups, from 4 percentage points lower in 2001 among females aged 18-24 years to almost 4 percentage points higher in 2001 for those aged 35-44 years.
The majority of adults (62%) had consumed alcohol in the previous week (71% of males and 52% of females) (table 27). However, 12% of males and 22% of females reported they had never consumed alcohol, or had last consumed alcohol 12 months or more ago.
Persons were classified to a health risk level (low risk, risky or high risk) based on their estimated average daily consumption of alcohol during the previous week. The majority of those who had consumed alcohol did so at a level which would pose a low risk to health (81% of males and 84% of females). The proportion of adults who had consumed alcohol at levels which would be risky or a high risk to their health if continued was 11% in 2001, the same as in 1989-90.
In 2001, 70% of adults had exercised for recreation, sport or fitness during the previous two weeks. Types of exercise covered in the survey were walking, moderate and vigorous exercise. Overall proportions of males and females who exercised were similar but females were more likely to walk for exercise than males (58% and 50% respectively), while males were more likely to undertake moderate (40%) and vigorous (20%) exercise than females (33% and 11% respectively) (table 35).
In terms of exercise level, derived from information on exercise types (walking, moderate and vigorous exercise) and the frequency and duration of exercise, the majority of both males and females were classified to sedentary (including no exercise) and low exercise levels; 65% of males and 74% of females were in these categories (table 27). Overall 9% of males and 4% of females were classified to the high exercise level, with males aged 18-24 years being most likely to be classified to this high exercise level(21%).
Comparing results from the 2001 NHS with those from previous surveys indicates that relatively more people are exercising than in 1995 and 1989-90, although differences are small (table 33). For example, the proportion of people exercising at low levels increased from 33% in 1989-90 to 38% in 2001 while those recording a sedentary exercise level fell from 37% in 1989-90 to 32% in 2001. Proportions exercising at moderate to high levels showed little change (at around 30%).
In the 2001 NHS, adults were asked whether they considered themselves to be overweight, of acceptable weight or underweight. Body mass index (BMI) was also calculated from self-reported height and weight information. Some 6% of men and 10% of women declined to provide their height and/or weight (table 27), and are excluded from the calculations of percentages in BMI categories discussed below.
In 2001, the majority of adults considered themselves to be of acceptable weight (64% of males and 58% of females), while 30% of males and 38% of females considered themselves to be overweight (table 39). However, males tended to perceive their weight as being in the acceptable range when it was not. Whereas 30% of males assessed themselves as overweight, 58% were classified as overweight (42%) or obese (16%) based on BMI. In contrast, the proportions of women classified to overweight and obese categories based on BMI (25% and 17% respectively) were similar in total to the proportion who assessed themselves as being overweight (38%) (table 27).
For both males and females the proportion classified as overweight or obese based on BMI was highest in the age groups from 45-74 years (e.g. 68% of males and 59% of females aged 55-64 years). Among females aged 18-24 years 13% were classified as being underweight.
Comparing results of the 2001 NHS with those from previous surveys shows the proportions of adults classified as overweight or obese has increased significantly. Excluding those for whom BMI could not be derived, the proportion of males classified as overweight or obese rose from 46% in 1989-90 to 52% in 1995 and to 58% in 2001; a 26% increase in prevalence. A higher increase was recorded for females: 32% to 37% to 42% giving an overall increase in prevalence of 31% (table 36). For both males and females, increases were recorded in both the overweight and obese groups, and were recorded across all age groups.
(a) Overweight or obese BMI based on self reported height and weight.
(a) Overweight and obese BMI based on self reported height and weight.
Combined health risk factors
While it is useful to consider the health risk factors of smoking, high alcohol consumption, low exercise and overweight/obese BMI separately, many people have two or more of these risk factors in combination (table 28). Over half (54%) of adult males and 45% of adult females reported two or more of these risk factors. For example, almost half (49%) of male smokers and a third (33%) of female smokers were classified as overweight or obese (with or without other risk factors).
Overall, 11% of adult males and 13% of adult females had none of these four risk factors.
Information was collected in the survey about usual intake of fruit and vegetables, about adding salt after cooking, and about type of milk consumed (as an indicator of fat intake). Results of the survey showed that in 2001 females were more likely to adopt healthier dietary behaviours than males (table 40).
Females were more likely to consume higher levels of fruit and vegetables than males. Four in five (81%) females aged 12 years and over reported that they usually consumed 2 or more serves of vegetables every day, and 58% usually consumed 2 serves or more serves of fruit. Proportions for males were 74% and 47% respectively.
Females were more likely to consume low fat or skim milk (49%) while males were more likely to consume whole milk (56%). Some 60% of females never or rarely added salt after cooking and 18% added salt sometimes; for males, 49% never or rarely added salt and 21% added salt sometimes.
Although the overall proportions of people consuming vegetables and fruit were higher for females than males, the pattern across age groups was similar with the highest proportions usually having 2 or more serves per day being the above 55 years age groups. In contrast these were the age groups where around 40% of males usually added salt to food after cooking.
Research has indicated that consumption of folate by women who are pregnant or trying to become pregnant reduces the risk of neural tube defects in babies. Women aged 18-49 years were asked about their deliberate consumption of folate enriched foods and beverages, and vitamins and minerals containing folate in the 2 weeks prior to interview.
Overall, 11% of women in this age group and, in particular, 19% of women aged 30-34 years reported that they had consumed these products because they contained folate (table 47).
Results of the survey showed that most children aged 0-6 years in 2001 were fully immunised against each of the diseases in the NHMRC's recommended Childhood Immunisation Schedule. Fully immunised means the children had received all vaccinations recommended for their age under the schedule. The recommended schedule is updated periodically. In this publication, immunisation status refers to the level of immunisation received relative to the requirements of the schedule current at the time at which the children started, or should have started, their immunisation program.
As shown below, the immunisation levels against the diseases covered by the Schedule have risen since the previous survey in 1995 (table 42).
(a) Received all recommemded vaccinations appropriate to their age.
(b) Introduced to recommended schedule in April 1993.
The proportion of children who were fully immunised against each of these diseases declined with age from very high levels at ages 0-12 months to moderate levels among children aged 5-6 years. For example, 95% of children less than 6 months of age were fully immunised against diphtheria and tetanus, falling to a reported 60% of children aged 5-6 years.
(a) Fully immunised against recommended schedule for the childs age.
(b) Haemophilus influenzae type b.
(c) Measles, mumps and rubella. The first MMR vaccination is scheduled at 12 months.
Of those children aged 0-3 years at the time of the interview in 2001, 87% had been breastfed for some period in their lives. Three quarters (76%) of infants aged less than 3 months were being breastfed (64% were fully breastfed and 12% were being breastfed in addition to receiving other foods), 16% had been but were no longer being breastfed, and 8% had not been breastfed (table 41). The proportions still being breastfed declined as expected in progressively older age groups (e.g. 55% of infants aged 3-5 months were being fully, partially or complementary breastfed, but this reduced to 13% of infants 12-17 months old).
Conversely, the proportion of children who had never been breastfed increased in older age groups, possibly indicating a rise in the breastfeeding rate in very recent years. For example, 11% of children aged 12-23 months had never been breastfed, rising to 16% of children aged 2 to less than 4 years.
SUPPLEMENTARY WOMEN'S HEALTH TOPICS
Women aged 18 years and over were invited to complete an additional questionnaire covering supplementary health issues including screening for breast and cervical cancer, breastfeeding and contraceptive practices. Overall more than 90% of women completed the questionnaire, although responses to individual questions varied. The following analysis includes only those women for whom information was obtained.
Of those women who provided the information, 22% reported they did not have regular breast examinations of any type, 30% had regular mammograms (with or without other types of examinations) and 47% had regular examinations by a doctor and/or undertook self-examinations only (table 43). The type of examination varied by age, with self-examinations most common in younger age groups, examinations by a doctor most common in middle age groups and mammograms most common in older age groups.
The proportion of women who did not have any regular breast examinations was highest in younger age groups (44% of those aged 18-29 years) and lowest in the age groups 50-59 years (7%) and 60-69 years (9%).
Some 60% of women indicated that they had regular Pap smear tests (table 44), and 97% of those reported they had tests at least every 2 years. The proportion having regular tests was highest in the 30-39 year age group (82%) and lowest in the 70 years and over group (18%).
Of those women who provided the information, 15% had had a hysterectomy. Of these, 47% reported this had been before they were 40 years of age.
Hormone replacement therapy (HRT)
Information was obtained in the 2001 NHS about women using HRT which had been prescribed by a doctor, and the time they had used HRT. Some 19% of women aged 40 years and over who responded were currently using HRT (table 44). Over half (56%) of those women reported using HRT for 5 years or more, and one third (34%) for 10 years or more.
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