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CHAPTER THREE PROFILE OF PEOPLE WITH LONG-TERM HEALTH CONDITIONS

Introduction

3.1 Drawing upon data from the SHS (1999-2006), this chapter presents an overview of the biographic, social and economic characteristics of adults and households in Scotland with long-term conditions.

Prevalence of long-term health conditions amongst adults

3.2 According to SHS estimates, in 2005-2006 23.6% of adults aged 16 or over reported some form of long-term illness, health problem or disability. Prevalence of long term conditions has remained fairly constant since the inception of the SHS in 1999 ¹¹ (Table 3.1).

Table 3.1: Percentage of adults (aged 16+) with a long-term health condition

Column percentages

Source: Scottish Household Surveys 1999-2006
Note: nm=not measured - see Technical note.

Type of impairment

3.3 The impairments most commonly reported by adults with long-term health conditions were related to heart, blood pressure or circulation problems and to arthritis (Table 3.2). The figures suggest that both heart problems and diabetes (especially the latter) have increased over time. For example in 2001-2002, 30% of adults with long-term health conditions reported that their condition was related to heart problems, while 8% were related to diabetes ¹². The comparable figures for 2005-2006 were 35.5% for heart problems and 12.2% for diabetes. The incidence of impairments involving legs or feet appeared to have decreased. However, arthritis was not an option in earlier surveys so it is likely that some individuals who had impairments to their legs or feet as a result of arthritis chose in 2005-2006 to classify their impairment under arthritis.

Table 3.2: Type of impairment

Column percentages

Source: Scottish Household Survey 2005-2006
Note: Column percentages may not add up to 100 as multiple responses were allowed.

Biographic and socio-economic characteristics

Sex and age

3.4 The prevalence of long-term conditions was slightly higher amongst women. However, this can be explained by the fact that there were more women in the oldest age groups. The incidence of disability, and especially of long-term illness, increased markedly with age (Table 3.3). Two-thirds (67.7%) of disabled adults were aged 55 or over, while 61.6% of adults with long-term illnesses, and 72.3% of those with both illness and disability, were 55 or over. In contrast, the majority (69.9%) of adults without long-term conditions were under 55. (table not shown).

Table 3.3: Adults with a disability or long-term illness by sex and age

Column percentages

Source: Scottish Household Survey 2005-2006

3.5 Analysis over time of the prevalence of long-term conditions by age shows no discernable trends other than a slight increase in the proportion of the oldest age group (75 and over) who reported any long-term condition, from 49.9% in 1999-2000 to 54.1% in 2005-2006. This may be partly because this age group is growing older. Analysis of average (mean) age within this age group showed an increase from 80.3 years in 1999-2000 to 80.7 years in 2005-2006.

Marital status

3.6 The marital status of adults with a long-term health condition also reflected the concentration in the older age groups. Adults with long-term illnesses, and those with disabilities, were more likely to be widowed (17.5%; 22.7%) than those without long-term health conditions (6.0%) (Figure 3.1).

Figure 3.1: Adults with a disability or long-term illness by marital status

Employment details

3.7 Although SHS data are not nationally representative of employment patterns, they can be used to examine differences in working status between groups of adults. Again reflecting the age profile of those with long-term health conditions, in 2005-2006 53.4% of adults with disabilities and/or illnesses, and 46.2% of those with long-term illnesses only, defined themselves as permanently retired from employment. Restricting analysis to adults of working age only (men aged 16-64; women aged 16-59) revealed some important differences. Over half (51.5%) of men and some two-fifths (41.8%) of women with disabilities attributed their non-working status to their illness and/or disability. The comparative figures for those with long-term illness only were 33.6% for men and 21.5% for women. Overall, much smaller proportions of men and women with long-term health conditions (disability and/or long term illness) were in employment (full-time, part-time or self-employed) as compared to adults without long-term conditions (Figure 3.2). Numbers were too small to allow analysis by age group.

Figure 3.2: Adults with a disability or long-term illness by employment status

3.8 Analysis over time shows that, although the employment rate of men and women without long-term conditions increased since 1999-2000 (men - increased from 79.4% to 81.8%; women - increased from 68.8% to 72.8%), there was little overall change between 1999-2000 and 2005-2006 in the employment rate of those with long-term conditions (Table 3.4). The employment rate of those with long-term conditions did, however, fluctuate in the intervening years, and it is therefore too early to establish whether or not there is really a widening gap between those with and without long-term conditions.

Table 3.4: Employment rate of adults 1999-2000 - 2005-2006

Percentages

Source: Scottish Household Surveys 1999-2006

3.9 Of those who were working in 2005-2006, or had been working in the past five years, adults reporting long-term health conditions were more likely to occupy 'lower-level' occupations (e.g. semi-routine and routine occupations) and less likely to be managers compared to those without illnesses or disabilities (Table 3.5).

Table 3.5: Occupational status

Column percentages

Source: Scottish Household Survey 2005-2006
Note: - sample size too small to produce reliable figures (<100).

Education

3.10 SHS asked respondents whether or not they held a range of education qualifications. With the exception of the School Leaving Certificate, respondents with a disability or a long-term illness were markedly less likely to hold formal educational qualifications (Table 3.6). Analysis by age was conducted in those categories of qualification with sufficient numbers and confirmed that respondents in all age groups with long-term conditions were less likely to hold formal educational qualifications. (table not shown). For example, in the 35 to 44 year-old age group, 49.4% of those with a disability and 50.5 % of those with long-term illness held O Levels/Standard Grades, as compared to 65.9% of adults without an illness or disability. Similar differences were seen amongst the 55 to 64 year-old age group, where 14.9% of adults with a disability and 18% of those with a long-term illness had obtained O Levels/Standard Grades, compared to 31% of adults with no long-term health conditions.

Table 3.6: Educational qualifications obtained

Column percentages

Source: Scottish Household Survey 2005-2006
Note: Column percentages may not add up to 100 as respondents may have held more than one qualification.

Location

3.11 Although the full two-year SHS survey was representative of even the smallest local authorities, the numbers reporting long term conditions were too small to present reliable analysis of prevalence in the smaller local authorities. Thus Table 3.7 employs the SHS groupings ¹⁴ to present details of the proportions of adults with disability, long-term illness or neither within local authorities. These figures show that adults with long-term conditions were proportionately more likely to live in the West of Scotland (especially Glasgow, North Lanarkshire, Dunbartonshire and Ayrshire) and proportionately less likely to live in the East (especially Edinburgh and Grampian). These patterns are also illustrated graphically by Figures 8.1 and 8.2 in the Appendix, and show a substantial overlap with the most deprived local authority areas as defined by the Scottish Index of Multiple Deprivation ( SIMD) ¹⁵. Table 3.7 and Figures 8.1 and 8.2 also highlight the differences between the prevalence of disability and long-term illness.

Table 3.7: Prevalence of long-term conditions by local authority

Row percentages

Source: Scottish Household Survey 2005-2006

3.12 SHS also allowed for spatial analysis according to the Scottish Executive 6-fold urban/rural classification ¹⁶. People with long-term conditions were proportionately more likely to live in urban areas and less likely to live in accessible or remote rural areas. There were no substantive differences in relation to small accessible or small remote towns (Table 3.8).

Table 3.8: Prevalence of long-term conditions by urban/rural nature of location

Row percentages

Source: Scottish Household Survey 2005-2006

Prevalence of long-term health conditions amongst households

3.13 Another way of denoting prevalence is to consider the proportion of households which contain individuals with long-term health conditions. Here SHS estimates that in 2005-2006, 33.8% of households across Scotland contained at least one individual who had a long-term illness, disability or health problem. Analysis over time suggests a modest rise in the proportion of households containing at least one person with a long-term health condition from 30.0% in 1999-2000 to 33.8% in 2005-2006 (Table 3.9).

Table 3.9: Number of people in household with a disability or long-term illness

Column percentages

Source: Scottish Household Surveys 1999-2006

3.14 As the proportion of households containing two or more people with long-term health conditions was very small, all household analysis presented in this report compares households containing someone with a long-term condition to households containing no-one with a long-term condition ¹⁷.

3.15 The age, sex and marital status profiles exhibited among adults reporting long-term health conditions was mirrored in the profile of heads of households. Thus households containing someone with a long-term condition were more likely to have an older or widowed person as head of household. In addition, the prevalence of households containing someone with a long-term condition across local authorities was very similar to the patterns of prevalence of adults with long-term conditions across local authority areas. Full details can be seen in Figure 8.3 in the Appendix. The proportions of households in each local authority which contained at least one member with a long-term condition ranged from 24.6% in Edinburgh to 40.0% in Glasgow and 39.9% in Ayrshire ¹⁸.

Household type

3.16 The profile of household types differed according to whether the household contained anyone with a long-term health condition. Reflecting the older age profile of those with long-term conditions, 'older smaller' and 'single pensioner' households constituted nearly half of households containing people with a long-term health condition (Table 3.10).

Table 3.10: Households containing someone with a long-term condition by household type

Row percentages

Source: Scottish Household Survey 2005-2006

Tenure

3.17 Households containing persons with long-term health conditions were more likely to rent than to their own their own homes. This was observed for all age groups (Figure 3.3).

Figure 3.3: Proportion of each age group who own their own home

3.18 A more detailed examination of the categories of people who owned or part-owned their homes revealed that households with members who had long-term health conditions were significantly more likely to own their homes outright, whereas households containing no-one with a long-term condition were more likely to have a mortgage. As Social Focus on Disability (2004: 19) comments, these variations in tenure also reflect the older age profile of people with long-term health conditions.

Quality of housing

3.19 The potential quality of housing was measured by two variables within the SHS. The first of these, the bedroom standard ¹⁹, was a measure of overcrowding. In line with findings reported in Social Focus on Disability (2004: 18-19) based on data from 2001-2002, there were no significant differences between households with members with long-term health conditions and households without. The other measure of housing quality was whether or not the house had central heating. This was measured only up until the end of 2004. Figures from the 2003-2004 SHS reveal that 91.1% of households had full central heating and that there were no marked differences between households where someone had a long-term condition (90.0%) and those where no-one had a long-term condition (91.6%).

Income

3.20 SHS included several questions to measure income from a variety of sources, including income from employment, income from benefits and rental income. Households containing someone with a long-term condition were likely to have lower incomes (Table 3.11).

Table 3.11: Total household income

Row percentages

Source: Scottish Household Survey 2005-2006

3.21 Household income does not take into account the number of people who are dependent on the income. As was seen earlier, households containing persons with long-term conditions were more likely to be smaller (older couple or single pensioner). Nevertheless, analysis of income across household types shows that, with the exception of 'single parent' and 'single pensioner' households (where a marginal difference occurred), households containing someone with a long-term health condition were markedly more likely to be on low household income (up to £15000) ²⁰ (Figure 3.4).

Figure 3.4: Proportion of each household type with a total household income of up to £15000

3.22 Household income was closely related to household work status. Lower incomes for households containing someone with a disability or long-term illness reflected the fact that fewer adults in these households were in paid employment.

Financial services

3.23 SHS asked the highest income householder whether or not they or their partner had a bank, building society, credit union or post office account. Of the households where no-one was disabled or long-term ill, 91.6% had a bank account and 32.8% had a building society account. Households containing someone with a long-term condition had less access to these services, with just 82.7% having a bank account and 21.9% a building society account. On the other hand, reflecting the older age profile of long-term conditions, households where someone was disabled or long-term ill were markedly more likely to have a post office card account ²¹ (16.0% of such households held a post office card account, compared to only 5.0% of households where no-one was disabled or long-term ill) (Figure 3.5).

Figure 3.5: Details of financial services

3.24 The lower likelihood of a bank or building society account was also related to a lower likelihood of having savings or investments: 41.2% of households containing someone with a long-term condition had savings, compared to 55.6% of those without. These differences were seen across all household types, including 'older smaller' and 'single pensioner'. Even amongst those households who did have some savings and investments, the overall amount held was lower in households containing someone with a long-term condition. For example, of those who disclosed their level of savings (nearly one third of the sample refused to answer this question), 19.4% of households containing someone with a long-term condition had savings of less than £1000, as compared to 16.0% of households where no-one was disabled or long-term ill. At the other end of the savings spectrum, savings of £30,000 or more were held by 18.2% of households containing someone with a long-term condition and 21.2% of households containing no-one with a long-term condition.

Summary of key points

3.25 According to SHS estimates, in 2005-2006, 23.6% of adults and 33.8% of households in Scotland reported a long-term illness or disability. The proportion of households containing someone with a long-term condition showed an increase from 30% in 1999-2000.

3.26 Although overall prevalence of long-term conditions amongst adults showed little change since 1999, the proportion of adults in the oldest age group (75+) reporting long-term health conditions rose. This increase could be due to the fact that this age group is also getting older.

3.27 The most commonly reported impairments in 2005-2006 were related to heart, blood pressure or circulation problems (35.5% of all adults with a long-term condition) and to arthritis (31.6% of adults with a long-term condition). Analysis over time suggests that the incidence of heart problems and diabetes have increased.

3.28 In general, adults with long-term conditions (especially those with disabilities) were socially and economically disadvantaged across a range of indicators. They were less likely than adults without long-term conditions to be employed; there was lower occupational status amongst those who were employed; they had obtained fewer formal educational qualifications; were less likely to own their own homes; had lower household income (and were less likely to have savings); and were more likely to live in locations associated with deprivation.

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