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Health status

Monitoring the health status of a population helps to detect emerging patterns of illness and disease and provides information to inform health policy and planning health services. This chapter reports: self-rated health status, current asthma, blood pressure measured in the last 2 years, ever had high blood pressure, cholesterol measured in the last 2 years, ever had high cholesterol, diabetes or high blood glucose, psychological distress, visited a dental professional in the last 12 months, all natural teeth missing, overweight, obese, and overweight or obese.

Self-rated health status

Self-rated health is among the most frequently assessed health perceptions in epidemiological research. A large number of cross-sectional and longitudinal studies have demonstrated how a person's appraisal of his or her general health is a powerful predictor of future morbidity and mortality even after controlling for a variety of factors such as age, sex, socioeconomic status, health behaviours, and health status.[1-8]

In 2006-2009, just under 8 in 10 Aboriginal adults (76.2 per cent) rated their health positively (as excellent, very good, or good). A significantly higher proportion of males (82.2 per cent) than females (71.1 per cent) rated their health positively. Among males, a significantly higher proportion of those aged 16-24 years (95.7 per cent) rated their health positively, compared with the overall Aboriginal adult male population. Among females, a significantly higher proportion of those aged 16-24 years (80.9 per cent), and a significantly lower proportion of those aged 55-64 years (52.3 per cent), rated their health positively, compared with the overall Aboriginal adult female population.

There was no significant difference between urban and rural health areas. A significantly higher proportion of adults in the Northern Sydney & Central Coast Area Health Service (90.0 per cent) rated their health positively, compared with the overall Aboriginal adult population.

Since 1997-1998, there has been no significant change in the proportion of Aboriginal adults who rated their health positively (as excellent, very good, or good).

Current asthma

Asthma is a chronic inflammatory disorder of the airways in which, in response to a wide range of triggers, the airways narrow too much and too easily, resulting in episodes of wheeze, chest tightness, and shortness of breath. The effects of asthma can include disturbed sleep, tiredness, and reduced participation in the workforce or organised sport or other activities. Asthma remains a significant health problem in Australia, with prevalence rates high by international standards. Among Australian adults, there has been an overall decrease in the rate of asthma-related general practice consultations between 1998 and 2008, and an overall decrease in asthma-related hospitalisations between 1993-94 and 2006-07.[9-10]

In 2006-2009, just over 2 in 10 Aboriginal adults (20.2 per cent) have current asthma; that is, doctor diagnosed asthma with recent symptoms or treatment. There was no significant difference between males and females. Among males, there was no significant difference among age groups. Among females, a significantly lower proportion of those aged 55-64 years (13.3 per cent) had current asthma, compared with the overall Aboriginal adult female population.

There was no significant difference between urban and rural health areas. A significantly lower proportion of adults in the Sydney West Area Health Service (10.1 per cent) have current asthma, compared with the overall Aboriginal adult population.

Since 1997-1998, there has been no significant change in the proportion of Aboriginal adults who have current asthma.

Blood pressure measured in the last 2 years

High blood pressure (hypertension) is a precursor for coronary heart disease, stroke, congestive heart failure, and renal insufficiency. The risk of coronary heart disease increases as the level of blood pressure increases.

In 2006-2009, just over 8 in 10 Aboriginal adults (81.6 per cent) had their blood pressure measured by a medical practitioner or nurse in the last 2 years. There was no significant difference between males and females.

A significantly higher proportion of Aboriginal adults in urban health areas (90.7 per cent) than rural health areas (74.3 per cent) had their blood pressure measured by a medical practitioner or nurse in the last 2 years. Estimates for area health services cannot be provided because of the low sample size for this indicator.

Since 1997-1998, there has been no significant change in the proportion of Aboriginal adults who had their blood pressure measured by a medical practitioner or nurse in the last 2 years; however, there has been a significant increase in urban health areas (77.1 per cent to 90.7 per cent).

Ever had high blood pressure

In 2006-2009, just over 3 in 10 Aboriginal adults (31.2 per cent) had ever been told by a doctor or hospital they had high blood pressure. There was no significant difference between males and females.

A significantly lower proportion of Aboriginal adults in urban health areas (22.2 per cent) than rural health areas (40.5 per cent) had ever been told by a doctor or hospital they had high blood pressure. Estimates for area health services cannot be provided because of the low sample size for this indicator.

Since 1997-1998, there has been a significant increase in the proportion of Aboriginal adults who had ever been told by a doctor or hospital they had high blood pressure (11.0 per cent to 31.2 per cent). The increase has been significant in females and in rural health areas.

Cholesterol measured in the last 2 years

Similarly, high blood cholesterol is also a precursor for coronary heart disease and for some types of stroke. If levels of cholesterol in the blood are too high an artery clogging process known as atherosclerosis can cause heart attacks, angina, or stroke.

In 2006-2009, just under 5 in 10 Aboriginal adults (48.3 per cent) had their cholesterol measured in the last 2 years. A significantly lower propotion of males (35.2 per cent) than females (63.2 per cent) had their cholesterol measured in the last 2 years.

There was no significant difference between urban and rural health areas. Estimates for area health services cannot be provided because of the low sample size for this indicator.

Since 1997-1998, there has been no significant change in the proportion of Aboriginal adults who had their cholesterol measured in the last 2 years; however, there has been a significant increase in females (38.6 per cent to 63.2 per cent) and in rural health areas (36.4 per cent to 52.1 per cent).

Ever had high cholesterol

In 2006-2009, under 3 in 10 Aboriginal adults (26.0 per cent) had ever been told by a doctor or hospital they had high cholesterol. There was no significant difference between males and females.

There was no significant difference between urban and rural health areas. Estimates for area health services cannot be provided because of the low sample size for this indicator.

Since 1997-1998, there has been no significant change in the proportion of Aboriginal adults who had ever been told by a doctor or hospital they had cholesterol; however, there has been a significant increase in females (14.7 per cent to 31.0 per cent) and in rural health areas (15.5 per cent to 34.1 per cent).

Diabetes or high blood glucose

Diabetes is a chronic disease characterised by high blood glucose levels, resulting from the body either not producing insulin or not using insulin properly. Insulin is a hormone needed for glucose to enter the cells and be converted to energy. Diabetes affects a person's health in 2 ways: by direct metabolic complications, which can be immediately life threatening if not treated promptly; by long term complications involving the eyes, kidneys, nerves, and major blood vessels including those in the heart.[11]

There are 3 main forms of diabetes: type 1, or insulin dependent diabetes mellitus, which occurs when the pancreas no longer produces insulin; type 2, or non insulin dependent diabetes mellitus, which occurs when the pancreas is not producing enough insulin and the insulin it produces is not working effectively; and gestational diabetes, which occurs in pregnancy and should disappear after the birth. The management of type 2, which is the most common form of diabetes, depends on careful control of glucose levels, blood lipid levels (especially cholesterol levels), blood pressure, and regular screening for complications.[11]

In 2006-2009, just under 1 in 10 Aboriginal adults (7.7 per cent) had ever been told by a doctor or hospital they had diabetes or high blood glucose. There was no significant difference between males and females. Among males, a significantly lower proportion of those aged 16-24 years (0.0 per cent) and 35-44 years (2.2 per cent), and a significantly higher proportion of those aged 55-64 years (37.7 per cent) and 65 years and over (26.4 per cent), had ever been told by a doctor or hospital they had diabetes or high blood glucose, compared with the overall Aboriginal adult male population. Among females, a significantly lower proportion of those aged 25-34 years (2.9 per cent) and 35-44 years (3.2 per cent), and a significantly higher proportion of those aged 45-54 years (18.1 per cent), 55-64 years (19.2 per cent), and 65 years and over (21.7 per cent), had ever been told by a doctor or hospital they had diabetes or high blood glucose, compared with the overall Aboriginal adult female population.

There was no significant difference between urban and rural health areas. A significantly lower proportion of adults in the North Coast Area Health Service (4.4 per cent) had ever been told by a doctor or hospital they had diabetes or high blood glucose, compared with the overall Aboriginal adult population.

Since 1997-1998, there has been no significant change in the proportion of Aboriginal adults who had ever been told by a doctor or hospital they had diabetes or high blood glucose.

Mental health: psychological distress

Psychological distress has a major effect on the ability of people to work, study, and manage their day-to-day activities. The Kessler 10 Plus (K10+) measure of non-specific psychological distress is included in the New South Wales Population Health Survey to monitor this in people aged 16 years and over.[12] K10+ contains a 10-item questionnaire that measures symptoms such as anxiety, depression, agitation, and psychological fatigue in the most recent 4-week period, plus additional questions to establish the effect of the distress. At both the population level and individual level the K10+ measure is brief and accurate screening scales for mental health.[13-19]

For each of the 10 items in the questionnaire, there is a 5-level response scale based on the amount of time (from none of the time to all the time) the person experienced the particular symptom. When scoring responses, between 1 and 5 points were assigned to each symptom, with a value of 1 indicating the person experienced the symptom none of the time and 5 indicating all of the time. The total score for each person ranges from 10 points (all responses are none of the time) to 50 points (all responses are all of the time). Responses are classified into 4 categories: low psychological distress when the score is 10-15, moderate psychological distress when the score is 16-21, high psychological distress when the score is 22-29, and very high psychological distress when the score is 30 or higher.

The scores calculated for the New South Wales Population Health Survey are a combination of actual and imputed scores. Where a respondent answered all 10 questions, the score was simply the sum of the individual scores for each question. Where the respondent answered 9 questions, the score for the missing question was imputed as the mean score of the 9 answered questions.

Respondents who scored 16 points and above in the 10 item questionnaire were asked the additional questions to assess functioning and related factors.

In 2006-2009, just over 2 in 10 Aboriginal adults (22.4 per cent) had high or very high levels of psychological distress. There was no significant difference between males and females. Among males, a significantly lower proportion of those aged 65 years and over (5.1 per cent) had high or very high levels of psychological distress, compared with the overall Aboriginal adult male population. Among females, a significantly lower proportion of those aged 65 years and over (14.1 per cent) had high or very high levels of psychological distress, compared with the overall Aboriginal adult female population.

There was no significant difference between urban and rural health areas, or among area health services.

Since 1997-1998, there has been no significant change in the proportion of Aboriginal adults who had had high or very high levels of psychological distress.

Visited a dental professional in the last 12 months

Australians enjoy a high standard of oral health. However, there are inequalities, with higher rates of dental caries and edentulism among people with higher levels of socioeconomic disadvantage, people living in rural and remote areas, indigenous people, people born overseas, and people from older generations. There is also differential access to dental services according to country of birth, indigenous status, language spoken at home, health insurance status, socioeconomic status, and educational status.[20-22]

There have been improvements in oral health, particularly among the "fluoride generation" born since 1970.[20-22] In spite of this, there is a population divide between those who have regular visits to a dental professional and those who visit a dental professional infrequently or only when they have an oral health problem. The latter group is worse off on almost all measures of oral health.[20-22] Also, a higher percentage of patients who use public dental services have inadequate dentition or decayed teeth, compared with the Australian population.[23] Regular visits to a dental professional have a significant and positive effect on oral health.[24-25]

In 2006-2009, just under 5 in 10 Aboriginal adults (49.2 per cent) had visited a dental professional in the last 12 months. There was no significant difference between males and females. A significantly lower proportion of adults aged 25-34 years (36.7 per cent), and a significantly higher proportion of adults aged 45-54 years (63.4 per cent), had visited a dental professional in the last 12 months, compared with the overall Aboriginal adult population.

A significantly higher proportion of adults in urban health areas (59.5 per cent) than rural health areas (42.7 per cent) had visited a dental professional in the last 12 months. A significantly lower proportion of adults in the Greater Western Area Health Service (33.2 per cent), and a significantly higher proportion of adults in the Sydney West Area Health Service (70.7 per cent), had visited a dental professional in the last 12 months, compared with the overall Aboriginal adult population.

Since 2002-2005, there has been no significant change in the proportion of Aboriginal adults who had visited a dental professional in the last 12 months.

All natural teeth missing

In 2006-2009, just over 1 in 20 Aboriginal adults (5.7 per cent) had all their natural teeth missing. A significantly lower proportion of Aboriginal males (3.3 per cent) than Aboriginal females (7.9 per cent) had all their natural teeth missing. Among males, a significantly lower proportion of those aged 16-54 years (approximately 0.0 per cent), and a significantly higher proportion of those aged 55-64 years (22.1 per cent) and 65 years and over (35.2 per cent), had all their natural teeth missing, compared with the overall Aboriginal adult male population. Among females, a significantly lower proportion of those aged 25-34 years (approximately 0.0 per cent) and 35-44 years (2.7 per cent), and a significantly higher proportion of those aged 55-64 years (21.9 per cent) and 65 years and over (39.0 per cent), had all their natural teeth missing, compared with the overall Aboriginal adult female population.

There was no significant difference between urban and rural health areas. A significantly lower proportion of adults in the North Coast Area Health Service (1.4 per cent) had all their natural teeth missing, compared with the overall Aboriginal adult population.

Since 1997-1998, there has been no significant change in the proportion of Aboriginal adults who had all their natural teeth missing.

Overweight

In its broadest sense, a healthy weight can be defined as a weight associated with a high level of physical, social and emotional health, linked with a low risk of future chronic illness and premature death.[26] There is no ideal weight that suits everyone. Each person is different and healthy weight is determined by different factors.[27] However, preventing weight gain in people with healthy weight, and avoiding further weight gain among those already overweight, are important public health priorities.[28]

The two most useful measures for characterising excessive fat are Body Mass Index (BMI) and waist circumference. BMI is calculated from a person's weight and height and gives a reasonable estimate of total adiposity.[26] BMI is calculated by dividing a person's weight (in kilograms) by their height (in metres) squared. The resulting BMI is then classified into 4 categories: underweight when the BMI is less than 18.5, acceptable or ideal weight when the BMI is greater than or equal to 18.5 and less than 25, overweight when the BMI is greater than or equal to 25 and less than 30, and obese when the BMI is greater than or equal to 30.

The New South Wales Population Health Survey calculates BMI from self-reported height and weight. The validity of self-reported height and weight have been investigated in adult, adolescent, and young adult populations. While many studies have observed a high correlation (96 per cent agreement) between BMI calculated from self-reported and measured height and weight, there is ample evidence that self-reported height and weight is not as exact as measured height and weight, but is adequate for conducting epidemiological research. Therefore, while caution should be used when interpreting BMI calculated from self-reported height and weight, it is still useful for ongoing surveillance of population health.[29-34]

In 2006-2009, just over 3 in 10 Aboriginal adults (30.2 per cent) were overweight: that is, had a BMI between 25 and 30. There was no significant difference between males and females. Among males, a significantly lower proportion of those aged 25-34 years (13.6 per cent) were overweight, compared with the overall Aboriginal adult male population. Among females, a significantly lower proportion of those aged 16-24 years (18.7 per cent) were overweight, compared with the overall Aboriginal adult female population.

There was no significant difference between urban and rural health areas, or among area health services.

Since 1997-1998, there has been no significant change in the proportion of Aboriginal adults who were overweight; however, there has been a significant increase in urban health areas (20.1 per cent to 33.9 per cent).

Obese

In 2006-2009, just under 3 in 10 Aboriginal adults (29.9 per cent) were obese: that is, had a BMI of 30 or over. There was no significant difference between males and females. Among males, there was no significant difference among age groups. Among females, a significantly lower proportion of those aged 16-24 years (15.6 per cent) were obese, compared with the overall Aboriginal adult female population.

A significantly lower proportion of Aboriginal adults in urban health areas (22.5 per cent) than rural health areas (34.3 per cent) were obese. A significantly lower proportion of adults in the South Eastern Sydney & Illawarra Area Health Service (13.2 per cent) were obese, compared with the overall Aboriginal adult population.

Since 1997-1998, there has been a significant increase in the proportion of Aboriginal adults who were obese (18.6 per cent to 29.9 per cent). The increase has been significant in males and females, and in rural health areas.

Overweight or obese

In 2006-2009, just under 6 in 10 Aboriginal adults (60.0 per cent) were overweight or obese: that is, had a BMI of 25 or over. There was no significant difference between males and females. Among males, there was no significant difference among age groups. Among females, a significantly lower proportion of those aged 16-24 years (34.3 per cent), and a significantly higher proportion of those aged 55-64 years (77.4 per cent), were overweight or obese, compared with the overall Aboriginal adult female population.

There was no significant difference between urban and rural health areas. A significantly higher proportion of adults in the Greater Western Area Health Service (71.7 per cent) were overweight or obese, compared with the overall Aboriginal adult population.

Since 1997-1998, there has been a significant increase in the proportion of Aboriginal adults who were overweight or obese (43.5 per cent to 60.0 per cent). The increase has been significant in males and females, and in urban and rural health areas.

References

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Graphs

Source: New South Wales Population Health Survey 2006-2009 (HOIST). Centre for Epidemiology and Research, NSW Department of Health.
Print version: Although this page can be printed directly from your web browser, a higher quality version is available as a PDF file that can be printed or viewed on screen.
Produced by: Centre for Epidemiology and Research, Population Health Division, NSW Department of Health.
Last updated on: 1 August 2010

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