National Health Survey methodology

Latest release
Reference period
2022

Overview

Scope

Includes:

  • all usual residents in Australia aged 0+ years living in private dwellings.
  • urban and rural areas in all states and territories, excluding very remote parts of Australia and discrete Aboriginal and Torres Strait Islander Communities.

Geography

The data available includes estimates for:

  • Australia
  • States and territories

Source

The National Health Survey conducted by the Australian Bureau of Statistics.

Medications data from the Pharmaceutical Benefits Scheme.

Collection method

Face-to-face interview with an Australian Bureau of Statistics Interviewer.

Linkage to the Person Level Integrated Data Asset.  

Concepts, sources and methods

Health conditions are presented using a classification which is based on the 10th revision of the International Classification of Diseases (ICD-10).

History of changes

Full history of changes.

About this survey

Overview

The 2022 National Health Survey (NHS) is a component of the wider Intergenerational Health and Mental Health Study (IHMHS) funded by the Australian Government Department of Health and Aged Care. 

The 2022 NHS was conducted from January 2022 to April 2023. Data was collected from approximately 13,100 households around Australia.

The survey focused on the health status of Australians and health-related aspects of their lifestyles. Information was collected about respondents' long-term health conditions and on lifestyle factors which may affect health, such as tobacco smoking and vaping, alcohol consumption, fruit and vegetable consumption, and physical activity. Self-reported health status, height, and weight were also collected. In addition to the self-reported measures, respondents could voluntarily provide blood pressure, height, weight and waist measurements.

Some topics were included for the first time in the 2022 NHS, including questions about gender and sexual orientation and use of over the counter medications. 

The survey also collected a standard set of information about respondents including age, sex, country of birth, main language, employment, education, and income.

The 2022 NHS is considered to be comparable with the 2017–18 NHS and previous cycles. The 2022 NHS will not be compared to the 2020–21 survey which was enumerated during the COVID-19 pandemic with significant changes to the data collection. The 2020–21 survey is considered a break in time series from previous NHS collections, to be used for point-in-time national analysis only.

Key changes to the survey in 2022 compared with the 2017–18 NHS are detailed in Summary of content changes. This includes updates to the classification of long-term health conditions (refer to Health conditions for more details). Changes to the 2022 NHS from the 2020–21 NHS are also included for completeness. 

How the data is collected

Scope

The scope of the survey included:

  • all usual residents in Australia aged 0 years and over living in private dwellings.
  • both urban and rural areas in all states and territories, except for very remote parts of Australia and discrete Aboriginal and Torres Strait Islander communities.
  • members of the Australian permanent defence forces living in private dwellings and any overseas visitors who have been working or studying in Australia for the last 12 months or more, or intend to do so.

The following people were excluded:

  • visitors to private dwellings.
  • overseas visitors who have not been working or studying in Australia for 12 months or more, or do not intend to do so.
  • members of non-Australian defence forces stationed in Australia and their dependants.
  • non-Australian diplomats, diplomatic staff and members of their households.
  • people who usually live in non-private dwellings, such as hotels, motels, hostels, hospitals, nursing homes and short-stay caravan parks (people in long-stay caravan parks, manufactured home estates and marinas are in scope).
  • people in Very Remote areas.
  • discrete Aboriginal and Torres Strait Islander communities.
  • households where all Usual Residents are less than 18 years of age.

Collection Method

Households could complete the first part of the survey, which collected basic demographic information about all usual residents of the household via an online form, telephone interview or face-to-face interview with an ABS Interviewer. The individual questionnaires were completed via face-to-face interview only.

Sample design

Households were randomly selected to participate in the survey. One adult aged 18 years and over and one child aged 0–17 years were randomly selected to complete individual questionnaires.

If the randomly selected child was aged 0–14 years a parent/guardian answered the questions on the child’s behalf.

If the randomly selected child was aged 15–17 years, parental/guardian consent was sought for the selected child to answer the questions. Where consent was not given a parent/guardian answered the questions on the selected person’s behalf. 

Proxy interviews were accepted for selected adults who were unable to answer for themselves due to language difficulties, significant long term illness or disability.

Response rates

There were 13,095 fully responding households in the survey, a response rate of 56.7%. The following table summarises the response rates achieved for the sample approached across Australia.

Response rates, Australia
 Total households approached (no.)Total households responded (no.)Response rate(a) (%)
NSW5,3592,73851.1%
VIC3,3151,80454.4%
QLD2,6111,62962.4%
SA2,3361,47663.2%
WA2,7131,73363.9%
TAS2,5001,47158.8%
NT1,85183945.3%
ACT2,4191,40558.1%
AUSTRALIA23,10413,09556.7%
  1. Rate of response is calculated out of total sample approached.

Content

The survey collected the following content:

  • Demographics – Age, Sex, Gender and Sexual orientation, Country of Birth, Main language spoken, Marital status
  • Household details – Type, Size, Household composition, Tenure, SEIFA, Geography
  • Labour force status
  • Educational attainment
  • Personal and Household Income
  • Migrant and Visa status
  • Self-assessed health status
  • Self-reported height and weight
  • Long-term health conditions such as arthritis, asthma, cancer, diabetes, hypertension, kidney disease etc
  • Risk factors such as tobacco smoking, e-cigarettes/vaping, alcohol consumption, fruit and vegetable consumption, and physical activity
  • Bodily pain
  • Psychological distress
  • Physical Measures – blood pressure, height, weight, and waist

The 2022 NHS uses the Standard for Sex, Gender, Variations of Sex Characteristics and Sexual Orientation Variables, 2020. Data in this publication are presented using the Sex at birth variable. When a small number of responses are recorded in any output category, outputs may be suppressed or combined into other categories due to confidentiality and statistical issues. A small number of people in the study reported having a term other than male or female recorded as their sex at birth. Estimates for people whose sex at birth is neither male or female are not able to be output as a separate category but they are included in the estimates for total Persons. 

See the Data Item List for full details of content collected in the 2022 NHS.

How the data is processed

Estimation methods

As only a sample of people in Australia were surveyed, results needed to be converted into estimates for the whole population. This was done through a process called weighting:

  • Each person or household is given a number (known as a weight) to reflect how many people or households they represent in the whole population.
  • A person or household’s initial weight is based on their probability of being selected in the sample. For example, if the probability of being selected in the survey was one in 45, then the person would have an initial weight of 45 (that is, they would represent 45 people).

The person and household level weights are then calibrated to align with independent estimates of the in-scope population, referred to as ‘benchmarks’. The benchmarks use additional information about the population to ensure that:

  • people or households in the sample represent people or households that are similar to them.
  • the survey estimates reflect the distribution of the whole population, not the sample.

Benchmarks align to the estimated resident population (ERP) at September 2022 which was 10,029,883 households and 25,433,341 people (after exclusion of people living in non-private dwellings, very remote areas of Australia and discrete Aboriginal and Torres Strait Islander communities).

Sample counts and weighted estimates are presented in the table below. 

Sample counts and weighted estimates, Australia
 PERSONS IN SAMPLEWEIGHTED ESTIMATE
Age group (years)Males (no.)Females (no.)Persons (no.)Males ('000)Females ('000)Persons ('000)
0–4552.0541.01094.0770.6741.71512.8
5–9533.0509.01042.0816.2734.71551.0
10–14576.0546.01122.0835.4807.91643.3
15–19514.0450.0964.0841.1798.11639.2
20–24327.0291.0620.0745.9703.61451.1
25–29459.0415.0874.0897.4785.01682.4
30–34550.0576.01127.0934.91065.22000.2
35–39548.0660.01208.0827.6927.01754.6
40–44615.0607.01223.0922.9879.51802.7
45–49514.0541.01056.0819.7807.91630.1
50–54450.0490.0940.0763.0830.51593.4
55–59463.0545.01008.0761.6732.11493.7
60–64495.0602.01097.0688.2794.21482.4
65–69520.0608.01128.0600.7691.21291.9
70–74464.0517.0981.0552.0559.61111.6
75–79357.0436.0793.0432.7461.2893.9
80–84188.0251.0439.0266.9252.6519.5
85 years and over127.0230.0357.0134.9244.6379.5
Total all ages8252.08815.017073.012611.612816.625433.3

Accuracy

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How the data is released

Release strategy

This release presents national health estimates for 2022. Commentary presents analysis by age groups, sex, state and selected population characteristics.

Data Cubes (spreadsheets) in this release present tables of estimates, proportions and their associated measures of error. A data item list is also available.

Detailed microdata is also available on DataLab for users who want to undertake interactive (real time) complex analysis of microdata in the secure ABS environment.

Confidentiality

The Census and Statistics Act 1905 authorises the ABS to collect statistical information and requires that information is not published in a way that could identify a particular person or organisation. The ABS must make sure that information about individual respondents cannot be derived from published data.

To minimise the risk of identifying individuals in aggregate statistics, a technique called perturbation is used to randomly adjust cell values. Perturbation involves small random adjustment of the statistics which have a negligible impact on the underlying pattern. This is considered the most satisfactory technique for avoiding the release of identifiable data while maximising the range of information that can be released. After perturbation, a given published cell value will be consistent across all tables. However, adding up cell values in Data Cubes to derive a total may give a slightly different result to the published totals. The introduction of perturbation in publications ensures that these statistics are consistent with statistics released via services such as TableBuilder.

Summary of content changes

The following table summarises content changes applied in the 2022 NHS. For full details of data items refer to the Data Item List.

The 2022 NHS is considered to be comparable to the 2017-18 NHS and previous cycles. The 2020–21 NHS data should be considered a break in time series from previous NHS collections and used for point-in-time national analysis only. The survey was collected during the COVID-19 pandemic which significantly changed the data collection. Changes to the 2022 NHS from the 2020–21 NHS are included here for completeness. 

2022 NHS Content Changes Summary (changes between current cycle and 2017–18 NHS)
TOPICCHANGES
Overall
  • Instrument design and layout changes introduced in 2020–21 NHS to improve usability and make it more suitable for both online reporting (in 2020–21 only) and interviewer enumeration.
Gender and sexual orientation
Visa Status
  • New question module and associated outputs.
Country of Birth of Parents
Education
  • Minor question and sequencing updates to improve comparability across other household surveys.
Employment
  • Minor question and sequencing updates to improve comparability across other household surveys.
Defence Force Service
  • Wording update to 'inclusions' description to exclude Australian Defence Force Cadets.
Mental Wellbeing
  • Change to population to include 15 years and over when answering for self. In 2017–18 NHS these questions were only asked of people aged 18 years and over.
Physical Activity
  • Major updates to question module to improve respondent experience and accuracy of reporting.
  • Amount of time spent on physical activity collected for each individual day of the last week, rather than just the total amount last week.
  • New physical activity day level (output data level), with daily timing data for types of physical activity each day.
Breastfeeding
  • New question and output item for reasons child started having any food or drink other than breast milk.
  • Minor changes to question wording and sequencing to improve data quality. 
Diet
  • Changes to fruit and vegetable visual aids for serving sizes.
  • Question updates to fruit and vegetable number of serves to allow more accurate reporting against guidelines.
  • Sweetened and diet beverages consumption questions removed.
Smoking
  • New questions and outputs on use of e-cigarettes and vaping.
  • Removed question and output item for smoking level compared to 12 months ago.
Alcohol Consumption
  • Alcohol consumption module updated to report consumption of common alcohol drink types instead of specific alcohol brands.
  • Redesigned daily consumption questions into a matrix style to capture volume and number of drinks by alcohol type.
  • 12 month alcohol consumption questions re-ordered to reduce respondent burden.
  • Outputs updated to include new 2020 Alcohol Guidelines along side 2009 Alcohol Guidelines.
  • Improved collection of type and size of alcoholic drinks, including new visual aids.
  • Addition of beer size description (e.g. pint, pot, schooner, etc) based on terms used in the respondent's State or Territory of residence, to aid in improved identification of drink size.
Health Conditions
  • Minor changes to question wording and sequencing across all condition modules to improve user experience and data quality.
  • Conditions coder updated.
  • Conditions output classification updated in 2020–21 to improve use of conditions data. Further updates to include codes for COVID-19 added in 2022.
Asthma
  • New questions to collect data on frequency of use of over the counter medication.
Cardiovascular
  • Update to terminology within questions to exclusively use 'cardiovascular' instead of 'heart'.
Diabetes and High Sugar Levels
Sight and Hearing
  • Minor question wording changes.
Other Long Term Conditions
  • Update to the Conditions Coder and minor changes to condition names and examples.
Medications
Over the Counter medications
  • New module to collect data on frequency of use of over the counter paracetamol and ibuprofen; and triptans for those diagnosed with migraine.
Physical Measurements (height, weight, waist and blood pressure)
  • Due to COVID-19, the procedures for collecting physical measurements have been adapted to account for increased hygiene and social distancing measures, including a move to collection via self measurements only (rather than via ABS Interviewers) and use of single use waist measurement tape
  • Removal of output and imputation of measurements for persons who self reported pregnancy.
Opt in to National Health Measures Survey (NHMS)
  • New module to collect whether respondent would like to participate in the National Health Measures Survey (NHMS) and Australian Health Biobank (AHB).
  • NHS respondents aged 12 years and over were invited to voluntarily provide blood and/or urine samples (urine samples only for children aged 5–11) by visiting their local pathology collection centre.  Results will feed into the NHMS, which will be a separate release expected in late 2024.
  • Respondents aged 18 years and over were invited to participate in the AHB. 
Consent to Follow Up (Contact Details)
  • Not collected in 2022 National Health Survey.
Phones
  • Not collected in 2022 National Health Survey.
2022 NHS Content Changes Summary (changes between current cycle and 2020–21 NHS)
TOPICCHANGES
Gender and sexual orientation 
Country of Birth of Parents
Education
  • Minor change to sequencing in Current Study module to improve comparability across other household surveys.
Defence Force Service
  • Wording update to 'inclusions' description to exclude Australian Defence Force Cadets.
Mental Wellbeing 
  • Change to population to include 15 years and over when answering for self. In 2020–21 these questions were only asked of people aged 18 years and over.
Physical Activity
  • Minor wording change to 'inclusions' description.
Diet
  • Sweetened and diet beverages consumption questions removed.
Smoking
  • Minor changes to questions to remove data collected around smoking level compared with 12 months ago, and to include collection of monthly e-cigarette use.
Alcohol consumption
  • Improved collection of type and size of alcoholic drinks.
  • New visual aids for identifying type and size of alcoholic drinks.
  • Addition of beer size description (e.g. pint, pot, schooner, etc) based on terms used in respondent's State or Territory of residence, to aid in improved identification of drink size.
Asthma
  • New questions to collect data on frequency of use of over the counter medication.
  • Removal of purchase of inhaler over the counter question.
Cardiovascular
  • Update to terminology within questions to exclusively use 'cardiovascular' instead of 'heart and circulatory'.
Diabetes and High Sugar Levels
Sight and Hearing
  • Minor question wording changes.
Other Long Term Conditions 
  • Update to the Conditions Coder and minor wording changes to condition names and examples
Over the counter medications
  • New module to collect data on frequency of use of over the counter paracetamol and ibuprofen; and triptans for those diagnosed with migraine.
Personal and Household income
  • Modules shortened to reduce respondent burden.
  • Question module is aligned with the 2017–18 NHS.
Physical Measurements (height, weight, waist and blood pressure)
  • Resumed collection in 2022 National Health Survey (see changes between current cycle and and 2017 NHS).
Opt in to National Health Measures Survey (NHMS)
  • New module to collect whether respondent would like to participate in the National Health Measures Survey (NHMS) and Australian Health Biobank.
  • NHS respondents aged 12 years and over were invited to voluntarily provide blood and/or urine samples (urine samples only for children aged 5–11) by visiting their local pathology collection centre. 
  • Results will feed into the NHMS, which will be a separate release expected in late 2024.
Health Service Use
  • Not collected in 2022 National Health Survey.
Carer identification
  • Not collected in 2022 National Health Survey.
Food security
  • Not collected in 2022 National Health Survey.
Stressors
  • Not collected in 2022 National Health Survey.
Consent to Follow Up (Contact Details)
  • Not collected in 2022 National Health Survey.

 

Health conditions

A long-term health condition was defined as a medical condition (illness, injury or disability) which was current at the time of interview and had lasted, or was expected to last, 6 months or more.

Some reported conditions were assumed to be long-term, including asthma, arthritis, cancer, osteoporosis, diabetes, sight problems, rheumatic heart disease, heart attack, angina, heart failure and stroke. Diabetes, rheumatic heart disease, heart attack, angina, heart failure and stroke were also assumed to be current. Respondents could report multiple health conditions.

Any reported health conditions that did not meet this definition were excluded from estimates, e.g. a person may have been told that they had a health condition in the past but it is no longer current or expected to last 6 months or more.  Conditions that were not considered to be current and long term can be analysed using the data item Condition Status (CONDSTAT) on the survey microdata.

The classification hierarchy is based on the 10th revision of the International Classification of Diseases (ICD). The classification was updated for the previous cycle, 2020–21 NHS, to improve use of the conditions data.

New COVID-19 codes have been included in the classification for the 2022 NHS, in line with the World Health Organisation's adaptation of the ICD.

See the Data Item List for full details of the conditions classification used in the 2022 NHS. 

A concordance for the current classification to the previous version used in the 2017–18 NHS is available on request.

Alcohol consumption

Alcohol consumption risk levels have been assessed using guidelines from the National Health and Medical Research Council (NHMRC) released from 2009 and updated in 2020.

Analysis in the commentary of the 2022 NHS has focussed on assessing alcohol consumption against the updated 2020 guideline. However, data has been provided in the Data Cubes to assess against the 2009 guidelines to provide a closure of this analysis. Analysis of the updated 2020 guidelines cannot be directly compared to the 2009 guidelines and therefore represents a break in time series.

Current 2020 guidelines

The most recent Australian Adult Alcohol Guideline, released by NHMRC in December 2020, is based on Guideline 1 of the Australian Guidelines to Reduce Health Risks From Drinking Alcohol. Guideline 1 recommends that ‘to reduce the risk of harm from alcohol-related disease or injury, healthy men and women should drink no more than 10 standard drinks a week and no more than 4 standard drinks on any one day. The less you drink, the lower your risk of harm from alcohol’. Persons aged 18 years and over who exceeded the Guideline have been interpreted as those who either consumed more than 10 standard drinks per week, or more than 4 standard drinks on a single day, or both components (i.e. groups A, B or C) (see the table below). The guidelines aim to reduce the risk of dying from alcohol-related disease and injury. Adults who drink within the Guideline recommendation have a less than 1 in 100 chance of dying from an alcohol-related condition (i.e. group D).

Additional advice was received that consuming more than 4 standard drinks on any day at least monthly in the last year was an appropriate measure in line with NHMRC recommendations. This means that those who consumed more than 4 standard drinks on any day at least monthly are considered to have exceeded the 1 in 100 chance of dying from an alcohol-related condition. This survey measures monthly consumption as consuming 5 or more drinks at least 12 or more times in the last 12 months. This measure is not directly comparable to single occasion risk interpreted from the NHMRC 2009 Guideline 2.

Guideline 1 Summary of Exceeded Alcohol Consumption Groups
 More than 4 standard drinks on any one day at least 12 times (monthly) in the last year4 or less standard drinks on any one day
More than 10 standard drinks per weekAB
10 or less standard drinks per weekCD

Guideline 2 recommends that ‘to reduce the risk of injury and other harms to health, children and young people under 18 years of age should not drink alcohol’. That is, not consuming alcohol is the safest option. However, this population group has been assessed in the NHS against the Australian Adult Alcohol Guideline. This allows for assessment of the levels of risky drinking for this age group. Data presented for people aged 15–17 years in this release does not reflect guideline 2.

For more detailed information, see Australian guidelines to reduce health risks from drinking alcohol.

Previous 2009 Alcohol guidelines

The 2009 lifetime risk guideline (guideline 1) recommended no more than 2 standard drinks per day (equivalent of 14 standard drinks per week). This guideline was assessed using average daily consumption of alcohol for persons aged 15 years and over, derived from the type, number and serving sizes of beverages consumed on the three most recent days of the week prior to interview, in conjunction with the total number of days alcohol was consumed in the week prior to interview.

The 2009 single occasion risk guideline (guideline 2) recommended no more than 4 standard drinks on a single occasion. This guideline was assessed using questions on the number of times in the last 12 months a person's consumption exceeded specified levels.

Physical activity

Physical activity refers to a combination of exercise and workplace activity. Exercise includes walking, running and bike riding for transport or fitness; sport or recreation; moderate exercise and/or vigorous exercise undertaken in the last week. Workplace activity is physical activity undertaken in the workplace which includes moderate and/or vigorous activity undertaken on a typical workday.

Australia’s Physical Activity and Sedentary Behaviour Guidelines 2014, are assessed against the respective age group for NHS data.

The 2014 Guidelines recommend that:

  • Children and young people (5–17 years) accumulate at least 60 minutes of moderate to vigorous physical activity every day, from a variety of activities including some vigorous, and do muscle strengthening activities on at least three days each week 
  • Adults (18–64 years) should be active most days of the week, accumulate 150 to 300 minutes of moderate intensity physical activity or 75 to 150 minutes of vigorous intensity physical activity (or an equivalent combination each week), and do muscle strengthening activities on at least two days each week
  • Older Australians (65 years and over) should accumulate at least 30 minutes of moderate intensity physical activity on most, preferably all, days.

Minutes undertook physical activity is based on respondents meeting the recommended guideline of at least 150 minutes of physical activity a week. Minutes spent on vigorous activity is multiplied by a factor of two.

For more information, see Australia's Physical Activity and Sedentary Behaviour Guidelines.

Diet

A balanced diet, including sufficient fruit and vegetables, reduces a person's risk of developing conditions such as heart disease and diabetes. The National Health and Medical Research Council's (NHMRC) 2013 Australian Dietary Guidelines recommend a minimum number of serves of fruit and vegetables each day, depending on a person's age and sex, to ensure good nutrition and health. Adequacy of intake (consumption) is based on whether a respondent's reported usual daily intake in serves of fruit or vegetables meets or exceeds each recommendation.

Usual daily intake of fruit refers to the number of serves of fruit (excluding drinks and beverages) usually consumed each day, as reported by the respondent. A serve is approximately 150 grams of fresh fruit or 50 grams of dried fruit. Adequate daily fruit intake refers to whether the respondent met the minimum number of serves as recommended in the NHMRC 2013 Australian Dietary Guidelines. 

Usual daily intake of vegetables refers to the number of serves of vegetables (excluding drinks and beverages) usually consumed each day, as reported by the respondent. A serve is approximately half a cup of cooked vegetables (including legumes) or one cup of salad vegetables – equivalent to approximately 75 grams. Adequate daily vegetable intake refers to whether the respondent met the minimum number of serves as recommended in the NHMRC 2013 Australian Dietary Guidelines. Tomatoes were included as vegetables while juices were excluded.

2013 NHMRC Australian Dietary Guidelines
 Recommended serves per day
 Age group (years)
 2–34–89–1112–1314–1819–5051–7070 years and over
Fruit 
 Males11.5222222
 Females11.5222222
Vegetables 
 Males2.54.555.55.565.5(a)5
 Females2.54.5555555
  1. Rounded up to 6 serves in published data.

    Source: Australian Bureau of Statistics, National Health Survey: First Results methodology 2017–18 financial year

Physical measures

In the 2022 National Health Survey (NHS), voluntary measurements of height, weight and waist circumference were collected from respondents aged two years and over (respondents who advised that they were pregnant were not measured), whilst voluntary blood pressure measurements were also collected from adult respondents (aged 18 years and over). These measurements provide information on overweight and obesity (using Body Mass Index (BMI)), risk of developing chronic disease, and high blood pressure amongst the Australian population.

Body Mass Index (BMI)

Body Mass Index (BMI) is a simple index of weight-for-height that is commonly used to classify underweight, normal weight, overweight and obesity. It is calculated from height and weight information, using the formula weight (kg) divided by the square of height (m):

\(BMI = {kg \over m^2}\)

To produce a measure of the prevalence of underweight, normal weight, overweight or obesity in adults, people aged 18 years and over were classified as underweight, normal weight, overweight or obese based on their BMI score as recommended by the World Health Organization’s BMI Classification. The BMI categories for children take into account the age and sex of the child. For a detailed list of the cut-offs see Appendix 4 in the National Health Survey: Users’ Guide, 2017–18 (cat. no. 4363.0).

Non-response rates

Physical measurements have a relatively high rate of non-response due to their voluntary and sensitive nature. To correct for the high rate of non-response, imputation of values for those that did not have measurements collected was used to achieve estimates of physical measurements for the whole population.

Non-response rates for physical measurements were higher in 2022 than in the 2017–18 NHS (which in turn were higher than the 2014–15 NHS). The non-response for BMI for adults in 2022 was 40.8%, compared with 33.8% in 2017–18 and 26.8% in 2014–15. The non-response for BMI for children 2022 was 56.8%, compared with 43.9% in 2017–18 and 37.7% in 2014–15.

The non-response for waist measurements in 2022 was 39.4% for adults and 57.6% for children. The non-response for Blood Pressure measurements (taken for adults only) in 2022 was 39.0%.

The higher non-response rates in 2022 could in part be due to the trend of declining participation in physical measures, however the COVID-19 pandemic would also have had an effect. The procedures for collecting physical measurements in the 2022 NHS were adapted to include increased hygiene and social distancing measures, and respondents were required to take their own measurements (rather than ABS Interviewers taking measurements).

Self-reported height and weight

In addition to the voluntary measured items, respondents in the 2022 NHS were also asked to self report their height and weight measurements (respondents who advised that they were pregnant were not asked to self-report as they are not applicable to the BMI population for analysis). This provides valuable information about height and weight that can be used in assisting in the imputation for those with missing values.

How imputation works

In the 2022, 2017–18 and 2014–15 NHS, missing values were imputed using the 'hot decking' imputation method. In this method, a record with a missing response (the 'recipient') receives the response of another similar record (the 'donor'). A number of characteristics with which to match recipients to donors were used. For adults they were:

  • age group
  • sex
  • part of state (capital city and balance of state)
  • self-perceived body mass (underweight, acceptable, or overweight)
  • level of exercise (sedentary, low, moderate, or high)
  • whether or not has high cholesterol (as a long-term health condition)
  • self-reported BMI category (calculated from self-reported height and weight)

For example, a female recipient aged 35–39 years who lives in a capital city, has a self-reported BMI category of overweight (calculated using self-reported height and weight), has a self perceived body mass of healthy, has high cholesterol and lives a sedentary lifestyle will match to a donor record who has the same profile (female, 35–39, self-reports as overweight, etc).

For BMI, around 85% of imputed records with self-reported BMI used all seven variables to match to a donor record. The remaining 15% could not be matched using all seven variables and were therefore matched using fewer variables.

For children 2–14 years, single year of age, sex, self reported BMI and part of state were used as imputation variables, while for 15–17 year olds, level of exercise and self-perceived body mass (only if a person answered for themselves) were also used as imputation variables, due to the other variables not being collected for children aged 2–17 years. Single year of age was used in the imputation method for children in the 2022 NHS, which differs from the 2017–18 NHS. This change to the methodology was made for the 2018–19 National Aboriginal and Torres Strait Islander Health Survey (NATSIHS) and retained for NHS22, as children's height and weight can change rapidly within a short period of time and, to avoid over or under estimating BMI, donors that were of the same age as the recipient were used. 

Sex was not used as a variable to match recipients to donors for people with a Transgender and Gender Diverse experience. People with a Transgender and Gender Diverse experience did not act as donors during the imputation process. Imputation was not performed for people who self-reported pregnancy as they are not applicable to the BMI population for analysis.  

Physical measurement data (BMI, waist circumference and blood pressure) that includes imputed values are of suitable quality for comparisons to 2017–18 and 2014–15 NHS. For comparisons to earlier years, the Australian Bureau of Statistics (ABS) recommends using proportion comparisons only as imputation was not used on the physical measurement data prior to 2014–15 NHS.

PBS Medications

For the 2022 NHS, medications data was sourced from the Pharmaceutical Benefits Scheme (PBS) instead of being collected directly from survey respondents. To enable this, the 2022 NHS sample was linked to the ABS’ Person Level Integrated Data Asset to source the PBS administrative data including Repatriation PBS (RPBS) data, with appropriate permissions. The PBS and RPBS administrative data was then used to create new medications data items which are added to the 2022 NHS dataset for this release.  

For more information on the PLIDA, refer to Person Level Integrated Data Asset (PLIDA)

Pharmaceutical Benefits Scheme (PBS)

The PBS is an Australian Government program that subsidises medications listed on the PBS Schedule for all Australian residents who hold a current Medicare card. In addition, some overseas visitors are eligible for some PBS medications through reciprocal health care agreements. The PBS subsidises medications for most medical conditions, and most PBS and RPBS subsidised prescriptions are dispensed by pharmacists and used by patients at home. Patients pay a “co-payment” towards the cost of PBS subsidised medications, and many PBS medicines cost significantly more that the co-payment amount.

There are programs operating under Section 100 of the National Health Act 1953 particularly in remote and very remote areas, such as the Aboriginal Medical Services, which receive access to free and subsidised medicines, at times on a bulk supply basis, that are not captured through the PBS data when distributed to patients. Noting that the NHS sample design excludes very remote areas.

PBS subsidised prescriptions do not include over-the-counter medications, private prescriptions, dietary supplements, or medications supplied to most public hospital in-patients. Non-prescription medications and products are generally available in pharmacies, supermarkets, health food stores and other retailers and are typically used for mild health problems. There are also prescription medicines that are not listed on the PBS, referred to as non-PBS prescriptions. These medications, products and non-PBS prescriptions are not represented in the NHS-PBS linked data.

The PBS Safety Net scheme is intended to protect patients from large out of pocket costs when they require a number of medicines within a calendar year. There are two Safety Net thresholds – one for concession card holders and one for all other patients. Individuals and families who spend an amount equal to their Safety Net threshold on co-payments in a calendar year receive further prescriptions for that year for free (if they are concession card holders) or for the concessional co-payment rate (if they are general patients) applicable to that year. 

For further information on the PBS, refer to Pharmaceutical Benefits Scheme (PBS).

NHS-PBS linked data

The NHS-PBS linked data has been used to create data items for use with the 2022 NHS dataset. These include:

  • number of medications dispensed per NHS respondent
  • medication types as classified using the Anatomical Therapeutic Chemical (ATC) Classification
  • the method for dispensing PBS medication or ‘pharmacy type’
  • concessions or entitlements per prescription or ‘patient entitlement status’.

This last group includes different Safety Net categories eg. General Safety Net prescription, Concessional Safety Net prescription, or Repatriation (Department of Veterans' Affairs - DVA) Safety Net prescription.

Data items created from the NHS-PBS linked data can be analysed with demographics, long-term health conditions and health risk behaviours collected from NHS respondents. A full list of the PBS medications data items created for this NHS release can be found in the Data Item List.

The PBS data provides the date of prescription and the date of supply. The timeframe used for analysis of PBS-NHS data in this release is based on date of supply, and spans from 180 days (6 months) before the NHS interview up to 180 days (6 months) after the date of the NHS interview (ie. a total time period of 12 months).

PLIDA linkage results have defined three (3) population groups for the NHS-PBS linked data. These are: NHS records that have been linked to PLIDA  and have PBS data; NHS records that have been linked to PLIDA but do not have any PBS data (the ‘No PBS medications’ population); and NHS records that were unable to be linked to PLIDA  (unknown PBS data). This last group accounts for approximately 7.0% of all 2022 NHS respondents. 

It should be noted that PBS data tells us when a subsidised medication is prescribed and dispensed, but not whether the patients consumed the medication. It is also possible to have multiple prescriptions per medication type, and multiple medication types per person.

Anatomical Therapeutic Chemical (ATC) Classification

PBS medication types are classified using the 2023 Anatomical Therapeutic Chemical (ATC) classification system which is maintained by the World Health Organisation (WHO) and widely used internationally.

Under the ATC, medications are classified into different groups based on the main active ingredient, the organ or system on which they act, and their therapeutic, pharmacological and chemical properties. Drugs are classified in a hierarchy with five different levels.

  • The ATC first or main level has fourteen main anatomical or pharmacological groups comprising: Alimentary tract and metabolism; Blood and blood forming organs; Cardiovascular system; Dermatologicals; Genito urinary system and sex hormones; Systemic hormonal preparations, excluding sex hormones and insulins; Anti-infectives for systemic use; Antineoplastic and immunomodulating agents; Musculo-skeletal system; Nervous system; Antiparasitic products, insecticides and repellents; Respiratory system; Sensory organs; and Various.
  • The ATC second level divides each main group into either Pharmacological or Therapeutic subgroups.
  • The ATC third and fourth levels are Chemical, Pharmacological or Therapeutic subgroups.
  • The ATC fifth level is the chemical substance.

Within this 2022 release, medications were classified down to the fourth ATC level ie. this is the lowest level of detail supported by the NHS-PBS data linkage. The count of medication types has been defined as the total count of unique ATC codes at the fourth ATC level.

The first or main ATC level has been used in the datacubes. The list below includes examples of common uses and treatments for the fourteen main anatomical or pharmacological groups:

     A. Alimentary tract and metabolism – reflux, ulcer, anti-nausea and diabetic medications

     B. Blood and blood forming organs – blood thinners, vitamin K, anti-anemic preparations (e.g. iron, B12, folic acid)

     C. Cardiovascular system – cholesterol-lowering, blood pressure and heart failure medication

     D. Dermatologicals – topical corticosteroids for skin conditions (e.g. dermatitis, eczema)

     G. Genito urinary system and sex hormones – contraceptives, menopausal and gynaecological medications

     H. Systemic hormonal preparations, excluding sex hormones and insulins – anti-inflammatory medications for autoimmune disorders (e.g. rheumatoid arthritis) and thyroid issues

     J. Antiinfectives for systemic use – bacterial antibiotics and antivirals

     L. Antineoplastic and immunomodulating agents – immunosuppressants and anti-cancer medications

     M. Musculo-skeletal system – non-steroid based anti-inflammatory medications

     N. Nervous system – pain relief and medications used for mental health

     P. Antiparasitic products, insecticides and repellents – medications used for infestations, parasitic worms and insect pests

     R. Respiratory system – asthma and Chronic Obstructive Pulmonary Disease (COPD) medications

     S. Sensory organs – anti-inflammatory and antibiotic medications used for the ear and eyes

     V. Various – nutrients, treatment for high potassium/phosphate and other therapeutic medications.

 

For further information on the ATC, refer to WHOCC - Structure and principles.

The 2022 release has implemented the ATC according to the PBS body system classification. For further information on the implementations of the ATC classification for PBS medications, refer to the PBS Body System.

Age standardisation

Age standardisation is a way of allowing comparisons between two or more populations with different age structures, in order to remove age as a factor when examining relationships between variables. For example, the age structure of the population of Australia is changing over time. As the prevalence of a particular health condition (for example, arthritis) may be related to age, any increase in the proportion of people with that health condition over time may be due to real increases in prevalence or to changes in the age structure of the population over time or to both. Age standardising removes the effect of age in assessing change over time or between different populations.

Proportions quoted in commentary in this publication are not age standardised, however, proportions presented in Tables 1 and 2 include age standardised rates. Data are age standardised to the 2001 Australian population.

Other scales and measures

Kessler Psychological Distress Scale Plus (K10+)

The Kessler Psychological Distress Scale (K10) is a widely used indicator, which gives a simple measure of psychological distress. It is not a diagnostic tool but is an indicator of psychological distress.

The K10 is based on a person's emotional state during the 4 weeks prior to the survey interview. People were asked a series of 10 questions, about how often they felt:

  1. tired for no good reason
  2. nervous
  3. so nervous nothing could calm them down
  4. hopeless
  5. restless or fidgety
  6. so restless that they could not sit still
  7. depressed
  8. that everything was an effort
  9. so sad that nothing could cheer them up; and
  10. worthless.

For each question, an answer was provided using a five-level response scale, based on the amount of time a person reported experiencing the problem. The response scale corresponded to the following:

  • none of the time
  • a little of the time
  • some of the time
  • most of the time
  • all of the time.

If a person selected 'none of the time' for questions 2 or 5 they were not asked the follow-on questions at 3 or 6 but were skipped to subsequent questions at 4 or 7 respectively.

Scores for the 10 questions were put together, with a minimum possible score of 10 and a maximum possible score of 50. Low scores indicate low levels of psychological distress, and high scores indicate high levels of psychological distress.  In this publication, scores are grouped as follows:

  • Low levels of distress (10–15);
  • Moderate levels of distress (16–21);
  • High levels of distress (22–29); and
  • Very high levels of distress (30–50).

Four ‘plus’ questions are used to assess functioning and how often the feelings were caused by physical health problems.

Comparing ABS long-term health conditions data sources

The Australian Bureau of Statistics (ABS) has several sources of long-term health conditions data which provide data to inform health policy and assist with health service planning.  For more information see 'Comparing ABS long-term health conditions data sources'.

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