The Scottish Health Survey: multiple risk factors in adults aged 16+ years Catherine Bromley, ScotCen Faculty of Public Health Conference Aviemore 10 November 2011

Research questions What is the prevalence of multiple risks in the adult population? What common combinations exist? How do risks relate to outcomes? Who is at greatest risk? Data source 2010 Scottish Health Survey Chapter 10 “Multiple Risks” in 2010 report (published September 2011) Plus some new analysis using combined data Presentation outline

ISD’s analysis of multiple risks in 2003 survey 1 90% of the disease burden in high income countries is accounted for by: 2 Excess alcohol consumption Smoking Low fruit and vegetable consumption Physical inactivity Obesity 1 Lawder R et al (2010) Is the Scottish population living dangerously? Prevalence of multiple risk factors: the Scottish Health Survey 2003 ; 2 Ezzati M et al (2006) Comparative quantification of mortality and burden of disease attributable to selected risk factors, in: Lopez AD et al (eds) Global Burden of Disease and Risk Factors, OUP Background

Public health interventions often focus on single risk factors – but are increasingly more integrated But, risk factors do not operate in isolation E.g. risk of liver disease is greater in people who drink excess alcohol and are obese 1 Risk factors do not exist in isolation 1 Hart C et al (2010) Effect of body mass index and alcohol consumption on liver disease: analysis of data from two prospective cohort studies, BMJ, 340:c1240 Background

Individual risks Fruit & veg <5/day: 78% Over- weight: 66% Not active enough: 58% Drinks more than advised: 45% Smokes cigarettes: 26% Scottish Health Survey 2010 (5,897 adults 16+) Measures in the scale

No. of risks None: 2% One: 11% Two: 28% Three: 35% Four: 20% Five: 4% Multiple risk scale Scottish Health Survey 2010 (5,897 adults 16+)

12% 7%3% Risk combinations Scottish Health Survey 2010 (5,897 adults 16+)

18%14% 8% 12% 7%3% Risk combinations Scottish Health Survey 2010 (5,897 adults 16+)

33% 18%14% 8% 12% 7%3% =96% of adult population Risk combinations Scottish Health Survey 2010 (5,897 adults 16+)

Scottish Health Survey 2008/09/10 (17,478 adults 16+) Risk and health outcomes

Scottish Health Survey 2008/09/10 (2,342 adults 16+)

Scottish Health Survey 2010 (5,897 adults 16+) 3+ risks by age and sex

4 or 5 risks by age and sex Scottish Health Survey 2010 (5,897 adults 16+)

4 or 5 risks by SIMD quintile and sex Scottish Health Survey 2010 (5,897 adults 16+)

Number of risks higher if: Ordinal model Linear model Logistic model (4/5 risks) Aged (versus 16-24) Permanently unable to work (versus employed) Looking for work (versus employed) Higher grades (Vs degree/HE)  Standard grades (Vs degree/HE) Other school level (Vs degree/HE) No qualifications (Vs degree/HE) Cohabiting (versus married/civil partner)  Separated (versus married/civil partner) Factors associated with multiple risks: men

Number of risks higher (*lower) if: Ordinal model Linear model Logistic model (4/5 risks) *Aged 75+ years (versus 16-24)  SIMD 2 nd most deprived quintile (v least)  SIMD most deprived quintile (v least) Intermediate NS-SEC (v professional)  Semi-routine/routine NS-SEC (v professional)  Semi-routine/routine NS-SEC in childhood (v professional)  Permanently unable to work (v employed)  Higher grades (Vs degree/HE) Standard grades (Vs degree/HE)  Other school level (Vs degree/HE)  No qualifications (Vs degree/HE)  Factors associated with multiple risks: women

Other research questions Has the profile of multiple risks changed over time? Do multiple risks help predict mortality, CVD events or cancer diagnoses? Is similar analysis of children useful? Public health policy and/or practice implications Does understanding more about multiple risks help policy makers / practitioners – or does it just make life more complicated? Discussion points

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