Scottish Health Survey 2013 - volume 1: main report

Presents results for the 2013 Scottish Health Survey, providing information on the health and factors relating to health of people living in Scotland.

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References and notes

1 Bromley, C. 2011. Chapter 10: Multiple risks. In Bromley, C. and Given, L. [eds.] The 2010 Scottish Health Survey - Volume 1: Main Report. Edinburgh, Scottish Government.

2 Murray, C. J. L. and Lopez, A. 2013. Measuring the Global Burden of Disease. New England Journal of Medicine. 369: 448-457.

3 Hughes, L.D., McMurdo, M.E.T. & Guthrie, B., 2013. Guidelines for people not for diseases: the challenges of applying UK clinical guidelines to people with multimorbidity. Age and Ageing, 42(1), pp.62-9.

4 Boyd, C.M. & Fortin, M., 2010. Future of Multimorbidity Research: How Should Understanding of Multimorbidity Inform Health System Design? Public Health Reviews, 32(2), pp.451-474.

5 Ebrahim S, Taylor F, Ward K, Beswick A, Burke M, Davey Smith G. Multiple risk factor interventions for primary prevention of coronary heart disease. Cochrane Database of Systematic Reviews 2011, Issue 1. Art. No.: CD001561. DOI: 10.1002/14651858.CD001561.pub3.

6 NICE. 2013. Smoking cessation services. NICE Public Health guidance 10.

7 Nuffield Council on Bioethics. 2007. Public health - ethical issues.

8 Marmot M; Friel, S; Bell, R; and Houweling, TA. Closing the gap in a generation: health equity through action on the social determinants of health. Lancet 2008 372: 1661-1669.

9 Macintyre S. Inequalities in health in Scotland: What are they and what can we do about them? Glasgow: MRC Social and Public Health Sciences Unit, 2007, Working Paper #17.

10 Almirall, J. & Fortin, M., 2013. The coexistence of terms to describe the presence of multiple concurrent diseases. Journal of Comorbidity, 3, pp.4-9.

11 Huntley, A. et al., 2012. Measures of Multimorbidity and Morbidity Burden for Use in Primary Care and Community Settings: A Systematic Review and Guide. Annals of Family Medicine, 10, pp.134-141.

12 Valderas, J., Sibbald, B. & Salisbury, C., 2009. Defining Comorbidity: Implications for Understanding Health and Health Services. Annals Of Family Medicine, pp.357-363

13 Diederichs, C., Berger, K. & Bartels, D.B., 2011. The measurement of multiple chronic diseases - a systematic review on existing multimorbidity indices. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 66(3), pp.301-11

14 Safford, M.M., Allison, J.J. & Kiefe, C.I., 2007. Patient complexity: more than comorbidity. The vector model of complexity. Journal of General Internal Medicine, 22 Suppl 3, pp.382-90.

15 Krieger, N., 2011. Epidemiology and the people's health, Oxford: Oxford University Press.

16 One of the definitions of multimorbidity that has been proposed includes both health conditions and risk factors and vulnerabilities, though this chapter does not adopt that approach. See: Le Reste, J.Y., Nabbe, P., Manceau, B., et al., 2013. The European General Practice Research Network presents a comprehensive definition of multimorbidity in family medicine and long term care, following a systematic review of relevant literature. Journal of the American Medical Directors Association, 14(5), pp.319-25.

17 Lawder, R., Harding, O., Stockton, D., Fischbacher, C., Brewster, D., Chalmers, A., Finlayson, A. and Conway, D. (2010). Is the Scottish Population living dangerously? Prevalence of multiple risk factors: the Scottish Health Survey 2003.BMC Public Health. 10:330.

18 Ben-Shlomo Y. and Kuh D. A life course approach to chronic disease epidemiology: conceptual models, empirical challenges and interdisciplinary perspectives. International Journal of Epidemiology. 2002: 31, 285-293

19 Marmot M. Fair Society, Healthy Lives - The Marmot Review. London: Strategic Review of Health Inequalities in England post-2010; 2010

20 Scott S, Curnock E, Mitchell R, Robinson M, Taulbut M, Tod E, McCartney G. 2013. What would it take to eradicate health inequalities? Testing the fundamental causes theory of health inequalities in Scotland. Glasgow : NHS Health Scotland.

21 Respondents were asked if they had a physical or mental health condition or illness, which has lasted, or is expected to last for at least 12 months. Details of up to 6 such conditions were recorded. Similar conditions, such as back and neck problems, or depression and anxiety disorders were only counted once. This measure used the full 40 condition codes in the codeframe, rather than the 15 ICD chapter-level condition codes that previous SHeS reports have used, and are provided as routine in the main datasets.

22 This item was intended to capture information about the impact of long-term conditions on people's lives, it was not intended as a severity weight. Therefore, whereas each individual condition people reported contributed to the index, reporting that daily activities were limited as a result of a condition only contributed once.

23 Selection of the most appropriate solution was made based on both statistical and substantive considerations. This included an examination of 'goodness of fit' statistics. Recommended guidelines are that a model which fits the data well should have lower BIC, AIC and AIC3 values, although BIC has been highlighted as the most robust and consistent statistic to consider. Classification error should be low, meaning that the likelihood that someone does not really belong to the group they have been assigned is low, the model should have good stability meaning that it can be replicated and finally the resulting groups should make substantive sense

24 Barnett, K. et al., 2012. Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet, 380, pp.37-43.

25 To minimise correlations between the factors entered into the Latent Class Analysis the two family risks variables were used to create a single summary measure with four categories, as follows: 1) Parent died of CVD and relative CVD <60, 2) Parent died of CVD, 3) relative CVD <60, 4) Neither risks. The WEMWBS and GHQ12 variables were also made into a single summary measure: 1) GHQ12 >=4 and low wellbeing (WEMWBS), 2) low wellbeing (WEMWBS), 3) GHQ12 >=4, 4) Neither risks.

26 Respondents were asked when they last spoke to a doctor on their own behalf - apart from at a hospital - either in person or by phone. It is presumed that a doctor fitting this description would be a GP. Hospital outpatient use included day-patient treatment and accident and emergency department visits.


Email: Julie Landsberg

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