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Scottish Health Survey 2012 - Volume 1 Main Report

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8 Long-Term Conditions

Linsay Gray and Alastair H Leyland

Summary

  • Adult long-term conditions prevalence increased from 41% in 2008 to 46% in 2012; the increase has been greater for women than men. The proportion of men and women with limiting long-term conditions also increased over this period.
  • Prevalence of both long-term conditions and limiting long-term conditions was generally higher for women than for men and increased with age for both genders.
  • Since 1998, the proportion of adults (aged 16 to 74) with doctor-diagnosed asthma has increased from 11% to 17% in 2012.
  • Similar proportions of men and women had asthma in 2012 (16% and 17% respectively). Asthma prevalence declined with age (28% among those aged 16-24 to 11% of those aged 75 and over).
  • In 2012, 13% of 2 to 15 year olds had doctor-diagnosed asthma, down from 18% in 1998. The drop in asthma levels was more pronounced among girls.
  • Asthma rates were higher among boys than girls in 2012 (15% compared with 9% for girls).
  • Since 1998, there has been little change in the proportion of adults with doctor-diagnosed COPD (3.8% in 2008 and 4.0% in 2012). COPD prevalence was at a similar level for men and women, and increased with age for both genders (from less than 0.5% of those aged 16 to 34 to one in ten (9.6%) of those aged 75 and above).
  • Between 1995 and 2012, there was a rise in the proportion of adults (aged 16 to 64) with cardio-vascular disease (CVD) (from 8.7% to 10.8%).
  • In 2012, one in six (16.2%) adults aged 16 and over had a CVD condition. CVD prevalence increased with age (from 4.6% among those aged 16-24 to 45.8% for those aged 75 and above).
  • The proportion of adults (aged 16 to 64) with doctor-diagnosed diabetes has increased from 1.5% in 1995 to 3.7% 2012. 5.5% of all adults (aged 16 and over) had diabetes in 2012.
  • IHD, stroke and IHD or stroke prevalence have not varied significantly since 1995.

8.1 Introduction

The significant personal, social and economic costs of long-term health conditions to Scottish society are well recognised[172]. The established links with deprivation and age are particularly significant in Scotland given its persistent health inequalities and ageing population. While numerous serious long-term conditions exist, diabetes, cardiovascular and respiratory diseases together represent a significant health burden in Scotland, and globally[173].

The Scottish Government's National Action Plan[172] relating to people with long-term conditions states that: 'Long term conditions are health conditions that last a year or longer, impact on a person's life, and may require ongoing care and support.' These include mental health problems and a wide range of physical conditions such as chronic pain, arthritis, inflammatory bowel disease. Prominent among the physical conditions are respiratory diseases and metabolic disorders including cardiovascular disease (CVD) and diabetes. Long-term conditions in Scotland account for 80% of all GP consultations; they also account for 60% of all deaths in Scotland[172].

Asthma and chronic obstructive pulmonary disease (COPD) are common long-term respiratory diseases. Asthma is characterised by variable and recurring symptoms of breathlessness, wheezing, coughing and chest tightness. COPD, another chronic lung condition, is caused by restricted airways that result in breathing difficulties, persistent coughing and abnormal sputum production[174]. In the past, COPD has also been referred to as chronic bronchitis or emphysema.

CVD is one of the leading contributors to the global disease burden. Its main components are ischaemic heart disease (IHD) (or coronary heart disease) and stroke, both of which have been identified as clinical priorities for the NHS in Scotland[175].

Diabetes is the most common metabolic disorder and its increasing prevalence is a major health issue for Scotland. Scotland has one of the highest levels of type 1 diabetes in Europe, but it is the rising levels of type 2 diabetes - linked to obesity, physical inactivity and ageing - which are driving the increased prevalence and causing concern[176].

Long-term respiratory conditions, CVD and diabetes all place significant demands on the NHS in Scotland. The breathing restrictions associated with COPD, for example, are a major cause of repeated hospital admissions in Scotland[177]. Estimates suggest the cost borne by NHS Scotland for treating COPD is around £100 million a year[177].

In terms of mortality, IHD and respiratory diseases are the second and third most common causes of death in Scotland after cancer, accounting for 14% and 13% of deaths, respectively, in 2012, with a further 8% caused by stroke[178]. Diabetes is a risk factor in premature mortality, although there have been improvements in recent years[176]. Early mortality from heart disease and stroke have also both improved in recent years (surpassing targets in both cases), but concern remains about continuing inequalities in relation to morbidity and mortality linked to these conditions[175].

Thus, the challenges presented by long-term conditions in general, and respiratory disease, CVD and diabetes specifically, are clear. In recognition of the challenges posed by long-term conditions - both for the individual as well as for health and care services - the Scottish Government, working with partners such as NHS Scotland, has pursued a range of actions and initiatives over recent years to help reduce the prevalence of these conditions and improve management and care of them.

At a strategic level, the Scottish Government's National Performance Framework includes a national outcome of 'We live longer, healthier lives'. In addition, a number of the NPF national indicators[179] are linked to key CVD and respiratory disease risk factors, most notably smoking[180], but also physical activity[181] and obesity[182] (as described in Chapters 4, 6 and 7 respectively). The refreshed NPF, published in December 2011[183], now also includes an indicator to 'reduce premature mortality' (deaths from all causes in those aged under 75)[184]. CVD is described as one of the key 'big killer' diseases around which action must be taken if this target is to be met. As the only major cause of death in Scotland which is increasing, effective COPD prevention and symptom management will also contribute to reducing premature mortality[177].177

The Scottish Government published an overarching strategy for long-term conditions in 2009: Improving the Health & Wellbeing of People with Long Term Conditions in Scotland: A National Action Plan (the Action Plan)[172]. The Action Plan delivered on a commitment made in the earlier Better Health, Better Care: Action Plan[185]. It recognises the need for system-wide action in response to the challenge presented by the increasing prevalence of long-terms conditions within the context of an ageing population, the links to health inequalities, and the particular challenges of multi-morbidity - the experience of two or more long-term conditions.

Following on from the Action Plan, there have been a range of more specific actions and initiatives addressing prevention, treatment and care in relation to long-term conditions, including:

  • The Scottish Government's Better Heart Disease and Stroke Care Action Plan[186], launched in June 2009, which built on the Coronary Heart Disease and Stroke Strategy for Scotland published in 2002, and updated in 2004[187].
  • The SIGN guidelines on cardiovascular health[188] published in 2007, which include a risk assessment tool (ASSIGN) to calculate a person's future risk of cardiovascular disease.
  • The revised SIGN guidelines on diabetes[189] published in March 2010.
  • The revised Diabetes Action Plan, published in August 2010[190].
  • The updated SIGN guidelines on asthma management for adults and children published in 2011, originally developed in conjunction with the British Thoracic Society[191].
  • The publication of NHS Quality Improvement Scotland (now Healthcare Improvement Scotland) clinical standards on COPD management[178]7 in 2010 which carries on from previous work on long-term conditions. The seven standards cover: service organisation and delivery, timely case identification, diagnostic accuracy and review, access to pulmonary rehabilitation and oxygen therapy, the provision of support at home, and access to palliative care.
  • The Quality and Outcomes Framework[192] and initiatives such as the Keep Well programme[193].
  • The roll-out of the Life begins at 40 programme which invites all those turning 40 to participate in a health assessment delivered by NHS 24 via telephone or online[194].

At an operational level, NHS Scotland's HEAT performance management system[195] is based around a series of targets against which the performance of individual Health Boards is measured. The Scottish Government's 2007 action plan Better Health, Better Care[196] set out how the HEAT system would feed into the Government's overarching objectives as set out in the NPF. A number of the HEAT targets are relevant to long-term conditions. For example, the quality of care in the immediate aftermath of a stroke is an important factor in a person's recovery rate and subsequent quality of life, and there was a HEAT target specifically aimed at improving performance in this area: by March 2013 90% of patients admitted with a stroke should be admitted to a specialist stroke unit within one day of admission[197]. In the quarter ending March 2013 80% of stroke patients were admitted to a specialist stroke unit within one day of their admission, up from 68% in 2010 and 78% in 2011. There was also a HEAT target for inequalities-targeted cardiovascular health checks; almost 50,000 checks were carried out in 2011/12, far in excess of the target of 26,682[198].

The Scottish Health Survey (SHeS) is an important source of information on the prevalence of long-term conditions in Scotland and the characteristics of people who have them. In previous reports, data on long-term conditions were presented in the chapter on general health and mental wellbeing. Here, for the first time, relevant findings on a wide-range of long-term conditions have been brought together in one chapter.

This chapter presents the prevalence of self-reported long-term conditions in Scotland, as well as adult prevalence of specific respiratory conditions (asthma and COPD), CVD, and diabetes. As with the four most recent SHeS reports, the combined prevalence of CVD and diabetes is also reported, reflecting the status of these two conditions as major health burdens for individuals and the NHS in Scotland. Prevalence of asthma and wheezing among children is also reported.

All of the topics presented in this chapter have time series data from 2008, while for some topics, the data extend back further to 1995 or 1998. This chapter focuses on updating trends and presenting prevalence data by age group and gender. Space constraints mean it is not possible to explore other sub-group differences, such as socio-economic status, or lifestyle risk factors. Future SHeS reports will return to these topics in more detail. Results of the various bio-markers relevant to long-term conditions included in the survey (such as blood pressure) will be included in future reports.

8.2 Methods And Definitions

8.2.1 Questions

Participants were asked about the presence of a series of conditions. In some cases questions sought responses based on a participant's own perceptions; in other cases, confirmation of doctor-diagnosis was sought.

All long-term conditions

All participants were asked if they had any physical or mental health condition or illness lasting - or likely to last - for twelve months or more. As this wording differs slightly from that used in the 2008 to 2011 surveys, time series data needs to be interpreted with caution[199]. Those who reported having such a condition were asked to provide more details about it. Answers were recorded verbatim and then coded in the office. Those reporting a condition were also asked if it limited their daily activities a lot, a little, or not at all. This enabled conditions to be classified as either 'limiting' or 'non-limiting'. Prior to 2012, participants were only asked to say whether or not their condition limited their activities; thus, to aid comparability with previous years, the categories 'a lot' and 'a little' have been combined in the tables presented here. These questions did not specify that conditions had to be doctor-diagnosed; responses were thus based on individuals' perceptions.

Asthma and COPD

Participants were asked if a doctor had ever told them they had asthma. Due to changes in the way that COPD has been described over time, participants were asked if they had ever had COPD, chronic bronchitis or emphysema, and if so, whether a doctor had told them they had one of these conditions. No direct measures were used to confirm these self-reported diagnoses.

CVD conditions

Participants were asked whether they had any of the following conditions: angina, heart attack, stroke, heart murmur, irregular heart rhythm, other heart trouble. Those who responded affirmatively were then asked whether a doctor had ever told them they had the condition. For the purposes of this report, participants are classified as having a particular condition if they reported that the diagnosis was confirmed by a doctor. Those who said they had a condition were asked if they had it during the last 12 months.

Diabetes

Participants were asked whether they had diabetes and, if so, whether they had ever been told by a doctor that they had the condition. Here, only those reporting that a doctor diagnosed them with condition were classified as having diabetes. Women whose diabetes occurred only during pregnancy were excluded from the classification. No distinction was made between type 1 and type 2 diabetes in the interview[200].

8.2.2 Summary measures

Responses to the individual questions were used to derive a number of summary measures.

Any CVD condition / Any CVD condition or diabetes

Participants were classified as having any CVD condition if they reported ever having any of the following conditions confirmed by a doctor: angina, heart attack, stroke, heart murmur, abnormal heart rhythm, or 'other heart trouble'[201]. A second category that includes diabetes as well as the above CVD conditions is also presented in the tables as 'any CVD condition or diabetes' so that the total combined prevalence of these conditions can be seen. The trend table reports the prevalence of both any CVD, and any CVD or diabetes from 1995 onwards.

Ischaemic heart disease (IHD)

Participants were classified as having IHD if they reported ever having angina or a heart attack, confirmed by a doctor.

Ischaemic heart disease or stroke

Participants were classified as having IHD or stroke if they reported ever having angina, a heart attack, or a stroke, confirmed by a doctor.

8.3 Long-Term Conditions

8.3.1 Trends in long-term conditions prevalence since 2008

The prevalence of long-term conditions in adults increased significantly between 2008 and 2012 (from 41% to 46%). While the wording of the question changed slightly in 2012[199], much of the increase took place between 2008 and 2011, with no significant change in prevalence between 2011 and 2012. Over the years, prevalence has been consistently higher among women than men. The increase in prevalence, since 2008, was also greater for women than for men. In 2008, 42% of women had a long-term condition, with this increasing to 49% by 2012; the equivalent figures for men were 38% and 42% respectively.

Trends in limiting long-term conditions have been similar to those for long-term conditions in general. Between 2008 and 2012 there was a 6 percentage point increase in the proportion of adults in Scotland reporting that they had a limiting long-term condition (from 26% to 32%). Prevalence increased steadily for both men and women over this period (from 23% to 28% for men and from 28% to 35% for women).

Prevalence of non-limiting long-term conditions has been more stable over the years. Each year, around one in seven adults (ranging between 14% and 16%) reported having a condition that did not limit their daily activities in any way. Male and female trends in prevalence of non-limiting conditions were very similar. Table 8.1

8.3.2 Long-term conditions, 2012, by age and sex

In 2012, 46% of adults in Scotland had a long-term condition with women significantly more likely than men to do so (49% compared with 42% of men). The gender disparity was most apparent among those aged under 45.

Prevalence increased progressively in line with age, with those in the youngest age group (16-24 year olds) least likely to report having a long-term condition (15% of men and 25% of women). At age 75 and over, 79% of men and 76% of women reported the presence of a long-term condition.

A third (32%) of adults in Scotland had a limiting long-term condition in 2012. In line with the pattern seen for all long-term conditions, prevalence varied both by gender and age. Over a third (35%) of women and 28% of men reported that they had a long-term condition that limited their daily activities. Limiting conditions were generally more prevalent among women than men. For example, women aged 16-24 were twice as likely as men of the same age to report having a limiting condition (16% compared with 8%). The exception was the oldest age group (aged 75 and over) where prevalence was similar for both sexes (63% and 62% respectively).

One in seven adults (14%) had a non-limiting long-term condition in 2012. Overall prevalence was the same for men and women but the age-related pattern was slightly different for both. Among men, prevalence rose steadily from 6% in the youngest age group to 23% among those aged 65-74, before dropping back to 15% for the oldest age group. For women, prevalence ranged from one in ten (9%) in the youngest group to two in ten (21%) in the 65-74 year age group but with no obvious pattern evident. Figure 8A, Table 8.2

Figure 8A Prevalence of long-term conditions, 2012, by age and sex

Figure 8A Prevalence of long-term conditions, 2012, by age and sex

The most commonly reported long-term conditions for men and women (aged 16 or above) in 2012 were: musculoskeletal conditions (18% prevalence), heart and circulatory conditions (including CVD conditions) (13%), endocrine and metabolic conditions (including diabetes) (9%), and conditions related to the respiratory system (including asthma and COPD) (8%) (Data not shown).

8.4 Asthma

8.4.1 Trends in asthma prevalence since 1998

Trends in the prevalence of both doctor-diagnosed asthma and wheezing are presented by age and sex in Table 8.3. Data for both adults and children are included for 2003 onwards; in addition, 1998 figures for those aged 2 to 15 and 16 to 74 are also presented.

Adults

Since 1998 there has been a steady increase in the prevalence of doctor-diagnosed asthma among 16 to 74 year olds from 11% to 13% in 2003, 14% in 2008/2010 and 17% in 2012. Levels have risen for both men and women, from 11% and 12% respectively in 1998 to 16% and 17% in 2012.

There was no clear pattern to the trend in wheezing prevalence for 16 to 74 year olds between 1998 and 2012. In 1998 and 2003, 16% reported the presence of wheezing in the last 12 months, the equivalent levels in 2008/2010 and 2012 were 15% and 18% respectively. As with asthma, trends in wheezing were similar for men and women, with little change observed for either gender since 2008.

The trends in both doctor-diagnosed asthma and wheezing in the last 12 months for all adults (aged 16 and over) were similar to those discussed above for 16 to 74 year olds.

Children

The proportion of children aged 2 to 15 with doctor-diagnosed asthma fell from 18% in both 1998 and 2003, to 13% in 2012. The decline was most pronounced for girls, falling from 16% in 1998 to 10% in 2012. For boys prevalence declined from 19% in 1998 to 17% in 2012 with some fluctuation observed in interim years.

Over this same period there was a similar, but less pronounced, decline in prevalence of wheezing among 2 to 15 year olds. In 1998, 16% of 2 to 15 year olds had experienced wheezing in the last 12 months by 2003 this had declined slightly to 13% where it has remained since. During this time, prevalence among boys remained steady (between 14% and 16%) whereas there has been a small drop in wheezing levels among girls (14% in 1998 to 11% in 2012).

Since 2003, prevalence of both doctor-diagnosed asthma and wheezing (in the last 12 months) among all children (aged 0 to 15) have been similar to levels discussed above for 2 to 15 year olds. Figure 8B, Table 8.3

Figure 8B Proportion of children aged 2-15 with doctor-diagnosed asthma, 1998-2012, by sex

Figure 8B Proportion of children aged 2-15 with doctor-diagnosed asthma, 1998-2012, by sex

8.4.2 Asthma prevalence, 2012, by age and sex

Adults

In 2012, one in six adults (aged 16 and over) reported having doctor-diagnosed asthma. While overall, prevalence was similar for men and women (16% and 17% respectively) this was not the case at all ages. The gender difference was particularly pronounced among the youngest age group (16-24 year olds), with 33% of men of this age reporting doctor-diagnosed asthma compared with 22% of women.

Asthma levels were highest among younger people with over a quarter (28%) of those aged 16-24 reporting, in 2012, that a doctor had diagnosed them with the condition. Prevalence declined with age with just one in ten (11%) of those aged 75 and over having the condition.

In 2012, 18% of adults reported wheezing in the previous 12 months. Prevalence was similar among men (17%) and women (18%) and there was no clear age-related pattern for either gender. Fifteen percent of 16-24 year olds reported wheezing, as did 17% of those aged 75 and over with levels among the intervening age groups ranging from 14% to 23%.

Children

Twelve percent of children aged 0 to 15 had doctor-diagnosed asthma in 2012. The level for boys was six percentage points higher than for girls (15% compared with 9%). The proportion of children reporting experience of wheezing in the previous 12 months was similar to the level with asthma (13%), with boys, again, more likely than girls to have experienced it (15% and 11% respectively). Table 8.4

8.5 COPD

8.5.1 Trends in COPD prevalence since 2008

Since 2008, there has been little change in the proportion of adults (aged 16 or above) in Scotland with doctor-diagnosed COPD. In 2008, 3.8% reported that a doctor had diagnosed them with the condition and the equivalent figure in 2012 was 4.0% with only slight, and insignificant, deviations in the intervening years (3.2% in 2009 and 4.5% in 2010). Male and female trends in COPD prevalence were similar with neither gender experiencing more than a one percentage point change between survey years. Table 8.5

8.5.2 COPD prevalence, 2012, by age and sex

As noted above, in 2012, 4.0% of adults reported that a doctor had diagnosed them with COPD (3.5% of men and 4.4% of women). The proportion diagnosed with the condition increased with age for both genders. Less than 0.5 percent of 16 to 34 year olds had doctor-diagnosed COPD compared with one in ten (9.6%) of those in the oldest age group (aged 75 and over). In 2012, 7.8% of men aged 75 and over and 10.7% of women of this age had doctor-diagnosed COPD. Table 8.6

8.6 Cardiovascular Conditions And Diabetes

This section examines trends, since 1995, in the prevalence of: any CVD; any CVD or diabetes; diabetes; IHD; stroke and IHD or stroke. Changes to the sample composition over the first three years of the survey mean that discussion of the trend between 1995 and 2012 is based on those aged 16 to 64, while from 2003 onwards the trend for all adults aged 16 and over is included and discussed.

8.6.1 Trends in any CVD, and CVD or diabetes prevalence since 1995

Any CVD

Since 1995, there has been a rise in the proportion of adults aged 16 to 64 with any CVD condition, from 8.7% to 10.8% in 2012 (varying between 8.4% and 10.3% in the intervening years). The observed increase in prevalence was evident for both men and women. In 1998, 8.4% of men (aged 16 to 64) and 8.9% of women of the same age had any CVD condition, the equivalent figures in 2012 were 10.3% and 11.3%

Prevalence among all adults (aged 16 and over) was higher than for 16 to 64 year olds only, reflecting the higher CVD prevalence at older ages. Among men, 14.9% had any CVD condition in 2003 rising to 16.6% in 2012. The corresponding figures for women were 14.5% and 15.9%, with some fluctuation in the interim years.

CVD or diabetes

Since 1995, there has been a more or less steady rise in any CVD or diabetes prevalence among adults aged 16 to 64, from 9.8% to 13.5% in 2012. The trend for men (aged 16 to 64) was similar to the trend for all adults of this age, with the proportion diagnosed with CVD or diabetes increasing from 9.4% in 1995 to 13.0% in 2012. While there has been more fluctuation in the level for women over the years, there has, overall, been a small increase in prevalence since 1995 (from 10.1% to 13.9% in 2012).

Since 2003, there has been an upward trend in any CVD or diabetes prevalence among all adults (aged 16 or above), rising from 16.6% to 19.7% in 2012. An increase has been observed for both men and women. In 2003 16.8% of men and 16.4% of women had CVD or diabetes; by 2012 the equivalent figures were 20.1% and 19.3% respectively. Table 8.7

8.6.2 Trends in doctor-diagnosed diabetes since 1995

Since 1995, doctor-diagnosed diabetes has become more common among adults aged 16 to 64. In 1995, 1.5% of adults this age had been told by a doctor that they had diabetes. By 2012, diabetes prevalence had increased more than two-fold to 3.7%. Increased prevalence of diabetes was true for both men and women of this age. Among men (aged 16 to 64), prevalence rose from 1.5% in 1995 to 4.7% in 2009, and has remained at or just above 4.0% since then (4.1% in 2012). For women, during this period, the level rose from 1.5% in 1995 to 3.4% in 2012.

In 2003, 3.7% of all adults (aged 16 or above) had doctor-diagnosed diabetes. By 2012, 5.5% of adults had the condition. Between 2003 and 2012 prevalence among men increased from 3.8% to 6.2%. There was a less pronounced increase for women over this same period (from 3.7% in 2003 to 4.9% in 2012). Figure 8C, Table 8.7

Figure 8C Proportion of adults (aged 16-64) with doctor-diagnosed diabetes, 1995-2012, by sex

Figure 8C Proportion of adults (aged 16-64) with doctor-diagnosed diabetes, 1995-2012, by sex

8.6.3 Trends in IHD, stroke, and IHD or stroke prevalence since 1995

IHD

Unlike any CVD and diabetes, IHD prevalence among 16 to 64 year olds has not changed significantly since 1995. Four percent of men had IHD in 1995, and in 2012 prevalence was 3.3%. The equivalent figures for women were 2.9% in 1995 and 2.3% in 2012, with levels as low as 1.8% in 2011.

The picture for all adults (aged 16 and over) since 2003 was similar. In 2003, 7.3% of adults in Scotland had IHD, and in 2012, 6.5% had been told they had the condition. Again, levels remained stable for both men and women. In 2003, 8.2% of men and 6.5% of women had IHD. The corresponding figures for 2012 were 7.3% and 5.7% respectively,

Stroke

Since 1995, the proportion of 16 to 64 years olds that have had a stroke has remained relatively stable. Among all adults of this age, there was a small increase in prevalence from 0.8% in 1995 to 1.3% in 2012. For men, in both 1995 and 2012, 1.0% reported having had a stroke, with the lowest level observed in 1998 (0.7%) and the highest in 2010 (1.8%). In 1995, 0.5% of women aged16 to 64 reported having a stroke and by 2012 this had risen to 1.5%, but with some fluctuation in the intervening period.

Stroke prevalence among all adults (aged 16 and over) increased by less than one percentage point between 2003 and 2012 (from 2.2% to 2.8%). In 2003, 2.4% of men and 2.1% of women reported that they had had a stroke. The corresponding figure in 2012 was 2.8% for both men and women.

IHD or stroke

There has been very little change in IHD or stroke prevalence among 16 to 64 year olds since 1995. In 1995, 3.9% (4.6% of men and 3.2% of women) reported that they had IHD or had a stroke. The corresponding figure in 2012 was 3.7% (4.0% of men and 3.5% of women).

The prevalence of IHD or stroke among all men aged 16 years and over was 9.6% in 2003 and 9.2% in 2012. The corresponding figures for women of this age were 8.0% and 7.7%. Table 8.7

8.6.4 Any CVD, CVD or diabetes, diabetes, IHD, stroke and IHD or stroke prevalence, 2012, by age and sex

The 2012 prevalence figures for each condition are shown by sex and age in Table 8.8 and are summarised below.

Any CVD Any CVD or diabetes Diabetes IHD Stroke IHD or stroke
Men (%) 16.6 20.1 6.2 7.3 2.8 9.2
Women (%) 15.9 19.3 4.9 5.7 2.8 7.7
All adults (%) 16.2 19.7 5.5 6.5 2.8 8.4

Any CVD

In 2012, one in six (16.2%) adults (aged 16 and over) had any CVD condition. Prevalence increased progressively in line with age, rising from 4.6% for those aged 16-24 to 45.8% for those in the oldest age group (75 and over). Overall CVD levels were similar for men (16.6%) and women (15.9%) with differentials at some ages; for example, among those aged 16-24, 2.2% of men had any CVD condition compared with 7.1% of women. Among those aged 65 and over, men were more likely than women to have been diagnosed with a CVD condition (55.8% of men age 75 and over had any CVD condition compared with 39.3% of women this age).

CVD or diabetes

One in five (19.7%) adults in 2012 reported having CVD or diabetes. Again, overall levels were similar for men (20.1%) and women (19.3%) and, as with any CVD, prevalence increased by age. Around one in twenty (6.1%) 16-24 year olds had either CVD or diabetes in 2012, compared with around half (52.4%) of those aged 75 and over.

Diabetes

In 2012, 5.5% of adults in Scotland had doctor-diagnosed diabetes (6.2% of men and 4.9% of women). Those in the youngest age group were least likely to have had a diagnosis (1.5%) with prevalence increasing progressively in line with age up to 13.5% in the 75 and over age group.

IHD

In 2012, 6.5% of adults had IHD (7.3% of men and 5.7% of women). No-one in the youngest age group had been diagnosed with IHD by a doctor. Prevalence was just 0.3% among 25-34 year olds and by age 75 and over had increased to 25.0%. Age-related patterns in IHD prevalence were similar for men and women although, as seen with CVD and diabetes, prevalence among older men was higher than for women (for example 30.7% of men aged 75 and over had IHD compared with 21.2% of women this age).

IHD or stroke

Joint prevalence of IHD or stroke for all adults in 2012 was 8.4% (9.2% of men and 7.7% of women). Again, prevalence was strongly related to age. Less than 1% of 16 to 34 year olds had IHD or stroke with the level increasing to 11.7% at age 55-64; 21.7% at age 65-74 and 33.6% at age 75 or above. Differences between men and women were particularly apparent among older people (for example, 41.9% of men aged 75 and over had either condition compared with 28.2% of women of this age).

Stroke

In 2012, 2.8% of adults reported having had a stroke at some point. Levels for men and women were identical (2.8%). The age-related pattern for stroke prevalence was very similar to that seen for all the other conditions discussed above: prevalence increased in line with age and gender differences were most apparent among older people. Less than 1% of those under the age of 45 reported having had a stroke, but by age 75 and over this had climbed to 12.9%. Among those aged 75 and over, prevalence was 7 percentage points higher for men than women. Table 8.8

Table list

Table 8.1 Prevalence of long-term conditions in adults, 2008 to 2012

Table 8.2 Prevalence of long-term conditions in adults, 2012, by age and sex

Table 8.3 Doctor-diagnosed asthma, 1998 to 2012, by age and sex

Table 8.4 Doctor-diagnosed asthma, 2012, by age and sex

Table 8.5 Doctor-diagnosed COPD, 2008 to 2012

Table 8.6 Doctor-diagnosed COPD, 2012, by age and sex

Table 8.7 Any CVD, any CVD or diabetes, doctor-diagnosed diabetes, IHD, stroke, IHD or stroke, 1995 to 2012

Table 8.8 Any CVD, any CVD or diabetes, doctor-diagnosed diabetes, IHD, stroke, IHD or stroke, 2012, by age and sex

Table 8.1 Prevalence of long-term conditions in adults, 2008 to 2012

Aged 16 and over 2008 to 2012
Long-term conditions and limiting long-term conditions 2008 2009 2010 2011 2012
% % % % %
Men
No long-term conditions 62 63 59 57 58
Limiting long-term conditions 23 23 25 26 28
Non-limiting long-term conditions 15 14 16 17 14
Total with conditions 38 37 41 43 42
Women
No long-term conditions 58 58 55 54 51
Limiting long-term conditions 28 27 30 30 35
Non-limiting long-term conditions 15 15 15 16 14
Total with conditions 42 42 45 46 49
All adults
No long-term conditions 59 60 57 56 54
Limiting long-term conditions 26 25 28 28 32
Non-limiting long-term conditions 15 14 16 16 14
Total with conditions 41 40 43 44 46
Bases (weighted):
Men 3087 3597 3465 3610 2306
Women 3377 3926 3777 3932 2505
All adults 6464 7523 7242 7542 4811
Bases (unweighted):
Men 2840 3283 3112 3280 2125
Women 3623 4241 4129 4262 2686
All adults 6463 7524 7241 7542 4811

Table 8.2 Prevalence of long-term conditions in adults, 2012, by age and sex

Aged 16 and over 2012
Long-term conditions and limiting long-term conditions Age Total
16-24 25-34 35-44 45-54 55-64 65-74 75+
% % % % % % % %
Men
No long-term conditions 85 74 70 56 42 31 21 58
Limiting long-term conditions 8 16 20 29 38 45 63 28
Non-limiting long-term conditions 6 10 10 15 20 23 15 14
Total with conditions 15 26 30 44 58 69 79 42
Women
No long-term conditions 75 71 55 53 39 31 24 51
Limiting long-term conditions 16 17 30 34 45 48 62 35
Non-limiting long-term conditions 9 12 15 14 16 21 13 14
Total with conditions 25 29 45 47 61 69 76 49
All adults
Total with conditions 20 28 38 46 60 69 77 46
Bases (weighted):
Men 339 383 380 418 362 251 172 2306
Women 326 376 414 455 383 287 263 2505
All adults 665 760 795 873 745 539 434 4811
Bases (unweighted):
Men 170 228 346 408 364 385 224 2125
Women 228 329 473 499 443 388 326 2686
All adults 398 557 819 907 807 773 550 4811

Table 8.3 Doctor-diagnosed asthma, 1998 to 2012, by age and sex

All persons 1998 to 2012
Respiratory symptoms
and asthma
1998 2003 2008/2010 combined 2012
% % % %
Males
Wheezed in last 12 monthsa
0-15 n/a 16 14 15
2-15 16 16 14 15
16-74 16 16 14 17
16+ n/a 16 14 17
Doctor-diagnosed asthma
0-15 n/a 20 14 15
2-15 19 21 15 17
16-74 11 13 13 16
16+ n/a 13 13 16
Females
Wheezed in last 12 monthsa
0-15 n/a 12 11 11
2-15 14 11 10 11
16-74 15 16 16 18
16+ n/a 16 16 18
Doctor-diagnosed asthma
0-15 n/a 12 12 9
2-15 16 14 14 10
16-74 12 14 16 17
16+ n/a 14 15 17
All
Wheezed in last 12 monthsa
0-15 n/a 14 12 13
2-15 16 13 12 13
16-74 16 16 15 18
16+ n/a 16 15 18
Doctor-diagnosed asthma
0-15 n/a 16 13 12
2-15 18 18 14 13
16-74 11 13 14 17
16+ n/a 13 14 16
Bases (weighted):
Males 0-15 n/a 1701 960 914
Males 2-15 1096 1516 841 803
Males 16-74 4423 3588 2068 2136
Males 16+ n/a 3847 2228 2309
Females 0-15 n/a 1623 917 873
Females 2-15 1046 1449 786 760
Females 16-74 4577 3821 2178 2243
Females 16+ n/a 4290 2432 2506
All 0-15 n/a 3322 1877 1786
All 2-15 2142 2963 1627 1563
All adults 16-74 8996 7409 4247 4380
All adults 16+ n/a 8137 4660 4815
Bases (unweighted):
Males 0-15 n/a 1656 994 879
Males 2-15 1987 1465 867 764
Males 16-74 3941 3277 1801 1902
Males 16+ n/a 3603 1999 2127
Females 0-15 n/a 1668 883 907
Females 2-15 1905 1468 746 785
Females 16-74 5106 4043 2360 2362
Females 16+ n/a 4536 2659 2688
All 0-15 n/a 3322 1877 1786
All 2-15 3892 2931 1613 1549
All adults 16-74 9042 7320 4161 4264
All adults 16+ n/a 8139 4658 4815
a Wheezing or whistling in the chest

Table 8.4 Doctor-diagnosed asthma, 2012, by age and sex

All persons 2012
Respiratory symptoms
and asthma
Age All aged 16+
0-15 16-24 25-34 35-44 45-54 55-64 65-74 75+
% % % % % % % % %
Males
Wheezed in last 12 monthsa 15 16 13 18 19 21 18 18 17
Doctor-diagnosed asthma 15 33 19 11 11 12 13 11 16
Females
Wheezed in last 12 monthsa 11 15 14 18 18 25 19 16 18
Doctor-diagnosed asthma 9 22 19 21 16 13 13 10 17
All
Wheezed in last 12 monthsa 13 15 14 18 18 23 18 17 18
Doctor-diagnosed asthma 12 28 19 16 14 13 13 11 16
Bases (weighted):
Males 914 339 383 380 420 362 251 173 2309
Females 873 326 376 414 456 383 287 263 2506
All 1786 665 760 795 876 745 539 435 4815
Bases (unweighted):
Males 879 170 228 346 409 364 385 225 2127
Females 907 228 329 474 500 443 388 326 2688
All 1786 398 557 820 909 807 773 551 4815
a Wheezing or whistling in the chest

Table 8.5 Doctor-diagnosed COPD, 2008 to 2012

Aged 16 and over 2008 to 2012
Doctor-diagnosed COPD 2008 2009 2010 2011 2012
% % % % %
Men
Yes 3.3 2.9 4.2 3.0 3.5
No 96.7 97.1 95.8 97.0 96.5
Women
Yes 4.2 3.5 4.8 4.3 4.4
No 95.8 96.5 95.2 95.7 95.6
All adults
Yes 3.8 3.2 4.5 3.7 4.0
No 96.2 96.8 95.5 96.3 96.0
Bases (weighted):
Men 3088 3601 3468 3609 2309
Women 3377 3929 3777 3931 2506
All adults 6465 7530 7245 7540 4815
Bases (unweighted):
Men 2842 3288 3115 3279 2127
Women 3623 4242 4130 4261 2688
All adults 6465 7530 7245 7540 4815

Table 8.6 Doctor-diagnosed COPD, 2012, by age and sex

Aged 16 and over 2012
Doctor-diagnosed COPD Age Total
16-24 25-34 35-44 45-54 55-64 65-74 75+
% % % % % % % %
Men
Yes 0.4 0.5 1.6 2.9 7.9 7.0 7.8 3.5
No 99.6 99.5 98.4 97.1 92.1 93.0 92.2 96.5
Women
Yes - 0.3 2.1 4.4 7.4 8.1 10.7 4.4
No 100.0 99.7 97.9 95.6 92.6 91.9 89.3 95.6
All adults
Yes 0.2 0.4 1.9 3.7 7.6 7.6 9.6 4.0
No 99.8 99.6 98.1 96.3 92.4 92.4 90.4 96.0
Bases (weighted):
Men 339 383 380 420 362 251 173 2309
Women 326 376 414 456 383 287 263 2506
All adults 16+ 665 760 795 876 745 539 435 4815
Bases (unweighted):
Men 170 228 346 409 364 385 225 2127
Women 228 329 474 500 443 388 326 2688
All adults 16+ 398 557 820 909 807 773 551 4815

Table 8.7 Any CVD, any CVD or diabetes, doctor-diagnosed diabetes, IHD, stroke, IHD or stroke, 1995 to 2012

Aged 16 and over 1995 to 2012
Any CVDa / any CVD or diabetes / doctor-diagnosed diabetesb / IHDc / stroke / IHD or stroke 1995 1998 2003 2008 2009 2010 2011 2012
% % % % % % % %
Men
Any CVD
16-64 8.4 8.1 9.7 9.9 9.5 10.5 9.8 10.3
16+ n/a n/a 14.9 15.1 15.2 16.3 15.6 16.6
Any CVD or diabetes
16-64 9.4 9.7 11.1 12.2 12.7 13.6 12.7 13.0
16+ n/a n/a 16.8 18.2 19.0 20.1 19.2 20.1
Doctor-diagnosed diabetes
16-64 1.5 2.2 2.4 3.3 4.7 4.5 4.0 4.1
16+ n/a n/a 3.8 5.3 6.2 6.3 6.1 6.2
IHD
16-64 4.0 4.0 4.1 3.2 3.6 3.4 3.4 3.3
16+ n/a n/a 8.2 6.9 7.4 7.5 7.5 7.3
Stroke
16-64 1.0 0.7 1.2 1.1 1.1 1.8 1.3 1.0
16+ n/a n/a 2.4 2.5 2.7 3.3 2.9 2.8
IHD or stroke
16-64 4.6 4.4 5.0 4.2 4.4 4.8 4.3 4.0
16+ n/a n/a 9.6 8.7 9.4 9.8 9.4 9.2
Women
Any CVD
16-64 8.9 8.5 8.9 10.7 9.0 9.3 8.4 11.3
16+ n/a n/a 14.5 15.5 13.7 14.0 13.8 15.9
Any CVD or diabetes
16-64 10.1 9.6 10.2 12.8 11.2 11.3 10.8 13.9
16+ n/a n/a 16.4 18.2 16.5 16.7 17.0 19.3
Doctor-diagnosed diabetes
16-64 1.5 1.8 2.0 2.8 2.9 2.8 3.2 3.4
16+ n/a n/a 3.7 4.1 4.5 4.4 4.9 4.9
IHDb
16-64 2.9 2.7 2.6 2.2 1.9 2.2 1.8 2.3
16+ n/a n/a 6.5 5.6 5.2 5.2 4.9 5.7
Stroke
16-64 0.5 0.6 0.7 1.2 0.9 1.1 1.0 1.5
16+ n/a n/a 2.1 2.8 2.2 2.5 2.7 2.8
IHD or stroke
16-64 3.2 3.0 3.2 3.1 2.4 3.1 2.6 3.5
16+ n/a n/a 8.0 7.5 6.7 7.0 6.7 7.7
All adults
Any CVD
16-64 8.7 8.4 9.3 10.3 9.3 9.9 9.1 10.8
16+ n/a n/a 14.7 15.3 14.4 15.1 14.6 16.2
Any CVD or diabetes
16-64 9.8 9.7 10.6 12.5 11.9 12.4 11.8 13.5
16+ n/a n/a 16.6 18.2 17.7 18.3 18.1 19.7
Doctor-diagnosed diabetes
16-64 1.5 1.8 2.2 3.1 3.8 3.7 3.6 3.7
16+ n/a n/a 3.7 4.6 5.3 5.3 5.5 5.5
IHDb
16-64 3.5 3.3 3.3 2.7 2.7 2.8 2.6 2.8
16+ n/a n/a 7.3 6.2 6.2 6.3 6.2 6.5
Stroke
16-64 0.8 0.6 1.0 2.6 1.0 1.5 1.2 1.3
16+ n/a n/a 2.2 2.6 2.5 2.9 2.8 2.8
IHD or stroke
16-64 3.9 3.7 4.0 3.6 3.4 3.9 3.5 3.7
16+ n/a n/a 8.8 8.1 8.0 8.3 8.0 8.4
Bases (weighted):
Men 16-64 3898 3953 3188 2542 2955 2837 2953 1885
Men 16+ n/a n/a 3857 3086 3601 3465 3608 2308
Women 16-64 3988 3989 3327 2640 3068 2947 3069 1956
Women 16+ n/a n/a 4291 3372 3926 3774 3931 2506
All adults 16-64 7886 7946 6517 5182 6023 5784 6023 3841
All adults 16+ n/a n/a 8142 6459 7526 7240 7539 4814
Bases (unweighted):
Men 16-64 3520 3367 2771 2084 2408 2293 2423 1517
Men 16+ n/a n/a 3610 2840 3287 3112 3277 2125
Women 16-64 4397 4212 3461 2694 3211 3083 3178 1974
Women 16+ n/a n/a 4538 3618 4239 4127 4261 2688
All adults 16-64 7917 7583 6233 4778 5619 5376 5601 3491
All adults 16+ n/a n/a 8142 6458 7526 7239 7538 4813
a Any cardiovascular condition, excluding diabetes or high blood pressure
b Excludes diabetes diagnosed during pregnancy
c Heart attack or angina

Table 8.8 Any CVD, any CVD or diabetes, doctor-diagnosed diabetes, IHD, stroke, IHD or stroke, 2012, by age and sex

Aged 16 and over 2012
Any CVDa / any CVD or diabetes / doctor-diagnosed diabetesb / IHDc / stroke / IHD or stroke Age Total
16-24 25-34 35-44 45-54 55-64 65-74 75+
% % % % % % % %
Men
Any CVD 2.2 5.3 9.7 12.8 20.8 36.9 55.8 16.6
Any CVD or diabetes 3.5 7.3 10.4 17.6 25.3 45.0 61.8 20.1
Doctor-diagnosed diabetes 1.4 2.0 2.0 6.3 8.3 15.0 16.2 6.2
IHD - - 1.4 3.5 11.8 21.0 30.7 7.3
Stroke - 0.2 0.3 1.4 3.4 6.5 17.1 2.8
IHD or stroke - 0.2 1.7 4.3 13.6 25.7 41.9 9.2
Women
Any CVD 7.1 5.7 11.4 12.8 18.2 26.6 39.3 15.9
Any CVD or diabetes 8.8 6.9 14.3 16.1 22.3 31.3 46.3 19.3
Doctor-diagnosed diabetes 1.7 1.2 3.6 3.4 6.8 9.0 11.7 4.9
IHD - 0.7 1.4 2.1 7.1 14.5 21.2 5.7
Stroke - 0.7 1.4 1.6 3.4 5.0 10.1 2.8
IHD or stroke - 1.1 2.5 3.4 9.8 18.2 28.2 7.7
All Adults
Any CVD 4.6 5.5 10.6 12.8 19.4 31.4 45.8 16.2
Any CVD or diabetes 6.1 7.1 12.5 16.8 23.8 37.7 52.4 19.7
Doctor-diagnosed diabetes 1.5 1.6 2.9 4.8 7.5 11.8 13.5 5.5
IHD - 0.3 1.4 2.7 9.4 17.5 25.0 6.5
Stroke - 0.4 0.9 1.5 3.4 5.7 12.9 2.8
IHD or stroke - 0.6 2.1 3.8 11.7 21.7 33.6 8.4
Bases (weighted):
Men 339 383 380 420 362 251 172 2308
Women 326 376 414 456 383 287 263 2506
All adults 665 760 795 876 745 538 435 4814
Bases (unweighted):
Men 170 228 346 409 364 384 224 2125
Women 228 329 474 500 443 388 326 2688
All adults 398 557 820 909 807 772 550 4813
a Any cardiovascular condition, excluding diabetes or high blood pressure
b Excludes diabetes diagnosed during pregnancy
c Heart attack or angina