Urban Rural Health Comparisons Key results of the 2002/03 New Zealand Health Survey

Transcription

1 Urban Health Comparisons Key results of the 22/3 New Zealand Health Survey Public Health Intelligence Occasional Bulletin No. 41

2 Citation: Ministry of Health. 27. Urban Health Comparisons: Key results of the 22/3 New Zealand Health Survey. Wellington: Ministry of Health. Published in February 27 by the Ministry of Health PO Box 513, Wellington, New Zealand ISBN (Book) ISBN (Internet) HP 4355 This document is available on the Ministry of Health s website:

3 Foreword The New Zealand Health Strategy highlights the need to provide accessible and appropriate health services for all New Zealanders, including people living in areas, and to reduce health inequalities in the New Zealand population. Public Health Intelligence (PHI), the epidemiology group of the Ministry of Health, monitors the health of the New Zealand population. The 22/3 New Zealand Health Survey, part of the New Zealand Health Monitor, is a key tool in carrying out this monitoring. This report, Urban Health Comparisons: Key results of the 22/3 New Zealand Health Survey, compares the health of people living in and areas using the 22/3 New Zealand Health Survey. This survey involved approximately 13, face-to-face interviews with New Zealanders who were randomly selected from throughout the country. The purpose of the report is to provide information on differences in health status between people living in areas and people living in areas. In particular, this report compares the prevalence of selected chronic diseases, risk and protective factors, the use of health services and self-reported health status for and dwellers. We welcome any feedback on the content, relevance and direction of this report and how its findings might be translated into policy and improved health for New Zealanders. Please direct any comments to Public Health Intelligence, Ministry of Health, PO Box 513, Wellington. Barry Borman Manager (Epidemiologist) Public Health Intelligence Urban Health Comparisons iii

4 Acknowledgements This report was written by Sue Triggs and prepared for publication by Kylie Mason and Barry Borman (Public Health Intelligence, Ministry of Health). The authors are grateful to Niki Stefanogiannis (Public Health Intelligence, Ministry of Health) and Elisabeth Wells (Christchurch School of Medicine and Health Sciences, University of Otago) for reviewing this report and providing useful feedback. We are grateful to the participants of the survey, who freely gave their time to take part. iv Urban Health Comparisons

5 Contents Foreword Acknowledgements Executive Summary iii iv ix Chapter 1: Introduction and Methodology 1 Introduction 1 Methodology and analysis 2 Chapter 2: Chronic Diseases 9 Introduction 9 Results 9 Chapter 3: Risk and Protective Factors 23 Introduction 23 Results 24 Chapter 4: Health Service Utilisation 43 Introduction 43 Results 44 Chapter 5: Self-reported Health Status 67 Introduction 67 Results 68 Appendices Appendix 1: Sample Sizes 74 Appendix 2: Demographic Profile 75 References 77 Urban Health Comparisons v

6 List of Tables Table 1: Content of the 22/3 New Zealand Health Survey 2 Table 2: Definition of and areas 4 Table 3: Prevalence of diagnosed chronic diseases, by sex and /, percent (agestandardised rate), 22/3 1 Table 4: Prevalence of diagnosed chronic diseases, females, by area type, percent (crude rate), 22/3 21 Table 5: Prevalence of diagnosed chronic diseases, males, by area type, percent (crude rate), 22/3 22 Table 6: Protective factors, by sex and /, percent, self-reported (age-standardised rate), 22/3 25 Table 7: Risk factors, by sex and /, percent, self-reported (age-standardised rate), 22/3 31 Table 8: Prevalence of risk and protective factors, females, by area type, percent (crude rate), 22/3 41 Table 9: Prevalence of risk and protective factors, males, by area type, percent (crude rate), 22/3 42 Table 1: Use of GP services, by sex and /, percent, self-reported (age-standardised rate), 22/3 44 Table 11: Reason for last GP visit, among those who had visited a GP in the last 12 months, by sex and /, percent, self-reported (age-standardised rate), 22/3 47 Table 12: Cost of last GP visit, among those who had visited a GP in the last 12 months, by sex and /, percent, self-reported (age-standardised rate), 22/3 48 Table 13: Unmet need for GP services, by sex and /, percent, self-reported (agestandardised rate), 22/3 48 Table 14: Use of other health providers in the last year, by sex and /, percent, selfreported (age-standardised rate), 22/3 51 Table 15: Use of other hospital services in the last year, by sex and /, percent, selfreported (age-standardised rate), 22/3 56 Table 16: Prescriptions in the last year, by sex and /, percent, self-reported (agestandardised rate), 22/3 59 Table 17: Health service utilisation, females, by area type, percent (crude rate), 22/3 61 Table 18: Health service utilisation, males, by area type, percent (crude rate), 22/3 64 Table 19: Item groupings and abbreviated item content for the SF Table 2: Mean SF-36 scores, by sex and / (age-standardised rate), 22/3 69 Table A1-1: Sample sizes for / and sex, for the CURF version of the 22/3 New Zealand Health Survey 74 Table A1-2: Sample size for / area type and sex, for the CURF version of the 22/3 New Zealand Health Survey 74 Table A1-3: Sample sizes for /, sex and NZDep21 groups, for the CURF version of the 22/3 New Zealand Health Survey 74 Table A2-1: 21 Census populations by / and sex, aged 15 years and over 75 Table A2-2: 21 Census populations by / area type and sex, aged 15 years and over 75 Table A2-3: 21 Census populations by / area type and prioritised ethnicity, aged Table A2-4: 21 Census populations by / area type and lifecycle age group 76 vi Urban Health Comparisons

7 List of Figures Figure 1: Prevalence of heart disease, by sex and area type (age-standardised) 11 Figure 2: Prevalence of heart disease, by sex, / and deprivation level (agestandardised) 12 Figure 3: Prevalence of diabetes, by sex and area type (age-standardised) 13 Figure 4: Prevalence of diabetes, by sex, / and deprivation level (age-standardised) 13 Figure 5: Prevalence of asthma (ages 15 45), by sex and area type (age-standardised) 14 Figure 6: Prevalence of asthma (ages 15 45), by sex, /, and deprivation level (agestandardised) 15 Figure 7: Prevalence of cancer, by sex and area type (age-standardised) 16 Figure 8: Prevalence of cancer, by sex, / and deprivation level (age-standardised) 16 Figure 9: Prevalence of arthritis, by sex and area type (age-standardised) 17 Figure 1: Prevalence of arthritis, by sex, / and deprivation level (age-standardised) 18 Figure 11: Prevalence of spinal disorders, by sex and area type (age-standardised) 19 Figure 12: Prevalence of spinal disorders, by sex, / and deprivation level (agestandardised) 19 Figure 13: Prevalence of osteoporosis, by sex and area type (age-standardised) 2 Figure 14: Fruit intake (two or more servings a day), by sex and area type (age-standardised) 25 Figure 15: Fruit intake (two or more servings a day), by sex, / and deprivation level (age-standardised) 26 Figure 16: Vegetable intake (three or more servings a day), by sex and area type (agestandardised) 27 Figure 17: Vegetable intake (three or more servings a day), by sex, / and deprivation level (age-standardised) 28 Figure 18: Regularly physically active, by sex and area type (age-standardised) 29 Figure 19: Regularly physically active, by sex, / and deprivation level (agestandardised) 3 Figure 2: Prevalence of overweight or obesity, by sex and area type (age-standardised) 32 Figure 21: Prevalence of overweight or obesity, by sex, / and deprivation level (agestandardised) 32 Figure 22: Current smoking, by sex and area type (age-standardised) 33 Figure 23: Current smoking, by sex, / and deprivation level (age-standardised) 34 Figure 24: Have not drunk alcohol in last year, by sex and area type (age-standardised) 35 Figure 25: Potentially hazardous drinking, by sex and area type (age-standardised) 35 Figure 26: Have not drunk alcohol in last year, by sex, / and deprivation level (agestandardised) 36 Figure 27: Potentially hazardous drinking, by sex, / and deprivation level (agestandardised) 37 Figure 28: Identified high blood pressure, by sex and area type (age-standardised) 38 Figure 29: Identified high blood pressure, by sex, / and deprivation level (agestandardised) 38 Figure 3: Identified high cholesterol, by sex and area type (age-standardised) 39 Figure 31: Identified high cholesterol, by sex, / and deprivation level (agestandardised) 4 Figure 32: Have a usual health provider and that provider is a GP, among total population, by sex and area type (age-standardised) 45 Figure 33: Have a usual health provider and that provider is a GP, among total population, by sex, / and deprivation level (age-standardised) 46 Figure 34: Unmet need for GP in last year, by sex and area type (age-standardised) 49 Urban Health Comparisons vii

8 Figure 35: Unmet need for GP in last year, by sex, / and deprivation level (agestandardised) 5 Figure 36: Seen dentist or dental therapist in last year, by sex and area type (age-standardised) 52 Figure 37: Seen dentist or dental therapist in last year, by sex, /, and deprivation level (age-standardised) 52 Figure 38: Seen medical specialist in last year, by sex, / and deprivation level (agestandardised) 53 Figure 39: Seen alternative/complementary provider in last year, by sex and area type (agestandardised) 54 Figure 4: Seen alternative/complementary provider in last year, by sex, / and deprivation level (age-standardised) 54 Figure 41: Seen optometrist/optician in last year, by sex and area type (age-standardised) 55 Figure 42: Seen optometrist/optician in last year, by sex, / and deprivation level (agestandardised) 56 Figure 43: Public hospital use in the last year, by sex and area type (age-standardised) 57 Figure 44: Public hospital use in the last year, by sex, / and deprivation level (agestandardised) 57 Figure 45: Private hospital use in the last year, by sex, / and deprivation level (agestandardised) 58 Figure 46: Doctor wrote prescription at last visit, among people who visited a doctor in the last 12 months, by sex and area type (age-standardised) 6 Figure 47: Doctor wrote prescription at last visit, among people who visited a doctor in the last 12 months, by sex, / and deprivation level (age-standardised) 6 Figure 48: Mean SF-36 scores for the Physical Functioning scale, by sex and area type (agestandardised) 7 Figure 49: Mean SF-36 scores for the Role Physical scale, by sex and area type (agestandardised) 7 Figure 5: Mean SF-36 scores for the Bodily Pain scale, by sex and area type (agestandardised) 71 Figure 51: Mean SF-36 scores for the General Health scale, by sex and area type (agestandardised) 71 Figure 52: Mean SF-36 scores for the Vitality scale, by sex and area type (age-standardised) 72 Figure 53: Mean SF-36 scores for the Social Functioning scale, by sex and area type (agestandardised) 72 Figure 54: Mean SF-36 scores for the Role Emotional scale, by sex and area type (agestandardised) 73 Figure 55: Mean SF-36 scores for the Mental Health scale, by sex and area type (agestandardised) 73 viii Urban Health Comparisons

9 Executive Summary Introduction This report compares the health of New Zealanders aged 15 years and over living in and areas using data from the 22/3 New Zealand Health Survey (NZHS). The 22/3 NZHS is part of the New Zealand Health Monitor (Ministry of Health 22), a programme of population health surveys used by the Ministry of Health to monitor New Zealanders health. As well as comparing the health status of people living in and areas, this report also looks at health status across socioeconomic deprivation levels, and across five area types: main areas, secondary areas, minor areas, s, and true areas. In some comparisons between area types, each type (main, secondary, minor ) is compared with the overall total, and each type (, true ) is compared with the overall total. Key results Chronic diseases Urban dwellers were significantly more likely to have been diagnosed with heart disease than dwellers, for both males and females. There were no significant differences in the prevalence of diabetes between and dwellers. However, in areas the prevalence of diabetes was significantly higher in areas of high socioeconomic deprivation than in areas of low or medium deprivation, for both males and females. For females aged 45 or less, the prevalence of asthma was significantly higher in dwellers than in dwellers. For females, the prevalence of diagnosed arthritis and osteoporosis was significantly higher in areas than in areas. The prevalence of arthritis was particularly high for females in secondary and minor areas. For males, the prevalence of spinal disorders was significantly higher in areas than in areas. This difference was particularly marked between true areas and main areas. Risk and protective factors Urban females were significantly less likely than females to eat the recommended two or more servings of fruit a day. For females, the rate of adequate fruit consumption decreased with increasing socioeconomic deprivation. People who live in main areas were significantly less likely than people to eat the recommended three or more servings of vegetables a day, for both males and females. Urban dwellers were significantly less likely than people to be physically active, for both males and females. Urban females were significantly more likely to be underweight than females. Urban Health Comparisons ix

10 Females living in minor towns and s were significantly more likely to be current smokers than females living in either main s or true areas. In areas, but not areas, the prevalence of current smoking increased significantly with deprivation, for both males and females. Both males and females in areas were significantly more likely than dwellers to have not drunk alcohol in the last year. The rate of alcohol abstention increased with increasing deprivation. Urban females in the least deprived areas had a significantly lower prevalence of potentially hazardous drinking than females in the most deprived areas, but otherwise, the prevalence of potentially hazardous drinking did not differ between areas. Males and females from secondary and minor areas tended to have a higher prevalence of high blood pressure and high cholesterol than people living in main areas or true areas, although the difference was only statistically significant for females from minor areas compared to main and true areas. Health service utilisation females were significantly less likely to have seen a general practitioner (GP) in the last year compared to females. At their last GP visit, females were significantly more likely than females to have seen a GP for an immunisation or vaccination. males were significantly more likely than males to have seen a GP due to injury or poisoning. Urban females were significantly more likely than females to have paid more than $4 for their last GP visit. Females in main areas were significantly more likely to have had unmet need for a GP in the last year than females in true areas. Unmet need for GP services increased with level of deprivation in areas, but not areas. Females and males from true areas were significantly more likely to have seen a dentist or dental therapist in the last year compared to people from areas. Females from true areas were significantly more likely to have seen an alternative or complementary provider in the last year than females from s or areas. The use of opticians or optometrists decreased with increasing levels of deprivation, and females were significantly more likely to have seen an optician or optometrist in the last year than females at each deprivation level. The use of public and private hospitals did not differ significantly between and areas overall, for either sex. However, females in s had a significantly higher rate of using public hospitals in the last year compared to all other people. Females in areas were significantly more likely to have received a prescription at their last doctor s visit than females in areas. x Urban Health Comparisons

11 People in the most deprived areas were significantly more likely to have received a prescription at their last doctor s visit than those in the least deprived areas, but the same trend did not occur in areas. Among females, dwellers were significantly more likely to have had no prescription items in the last year than dwellers. Self-rated health status For 15 out of the 16 comparisons between mean SF-36 scores (ie, eight scales for two sexes), people had the higher average score. However, for most of the scales the differences were small and not statistically significant. females had significantly higher average scores than females on the Physical Functioning and Role Emotional scales. males had significantly higher average scores than males on the General Health and Mental Health scales. Urban Health Comparisons xi

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13 Chapter 1: Introduction and Methodology Introduction This report compares the health of adult New Zealanders living in and areas using data from the 22/3 New Zealand Health Survey (NZHS). This chapter provides an overview of the aims and methodology underlining the study. Aims The aims of the 22/3 NZHS were to measure the: health status of New Zealand adults, including their self-reported physical and mental health status, and the prevalence of selected health conditions prevalence of risk and protective factors associated with these health conditions use of health services, including barriers to accessing health services. The aims of this report were to compare these measures between adult New Zealanders living in and areas, and to examine differences between sub-groups of these populations (as defined by sex, type of or area and the New Zealand Index of Deprivation 21). Comparisons between males and females, and between age groups and ethnic groups, are not included in this report because they were covered in detail in A Portrait of Health (Ministry of Health 24). Background The 22/3 NZHS was the third national health survey of New Zealanders aged 15 years and over. All people aged 15 years and over who were usually resident within permanent private dwellings were eligible for selection in the 22/3 NZHS. The survey involved face-to-face interviews with 12,929 adults, and had a response rate of 72 percent. The 22/3 NZHS has four health-related modules and a sociodemographic module (see Table 1). Urban Health Comparisons 1

14 Table 1: Content of the 22/3 New Zealand Health Survey Module Topics Details Chronic disease Health service use Risk and protective factors Self-reported health status Sociodemographic Heart disease, stroke, diabetes, asthma, chronic obstructive pulmonary disease, arthritis, spinal disorders, osteoporosis, cancer, other long-term illnesses Māori health providers, Pacific health providers, general practitioners, medical specialists, nurses, pharmacists and prescriptions, complementary and alternative medicine providers, other health providers, telephone and internet help lines, hospitals High blood pressure, high blood cholesterol, overweight and obesity, physical activity, tobacco smoking, marijuana smoking, vegetable and fruit intake, alcohol use, gambling General health, vision, hearing, digestion, breathing, pain, mental health, sleep, energy and vitality, understanding and remembering, communicating, physical functioning, self-care, usual activities, social functioning Age, sex, ethnicity and responses to ethnicity, country of birth, household characteristics, education, income support, employment, income, medical insurance, NZDep21 (from meshblock) Prevalence, age at diagnosis, treatments Frequency of contact, reasons for visit, satisfaction levels and reasons for dissatisfaction, unmet need and barriers to access Prevalence SF-36 Health Status Questionnaire embedded within the World Health Organization Long Form Health Status Questionnaire Methodology and analysis Survey method Details of the methodology of the NZHS are described in detail in A Portrait of Health (Ministry of Health 24), including population and frame, sample design and selection, questionnaire design, testing and data collection, coding and quality control. A copy of the 22/3 NZHS questionnaire is available on the Ministry of Health s website at The analysis in this report on comparisons used the Confidentialised Unit Record File (CURF) version of the 22/3 NZHS data set. This version of the data set did not include the respondents from the Chatham Islands due to confidentiality reasons, although the data set was weighted to include these respondents in the total population. The sample size was 12,529 respondents for this data set. The sample sizes for and categories are provided in Appendix 1. 2 Urban Health Comparisons

15 Data analysis Weighting estimation The survey was conducted on only a sample of respondents, so each person represented a number of other people in the population. Therefore, each respondent has a weight that indicates how many population units they represented. Survey weights allow a sample to be used to produce estimates for the entire population. The 22/3 NZHS was benchmarked to the 21 Census population. Full details of the weighting procedure are given in A Portrait of Health (Ministry of Health 24). Calculation of sample error The unit record data contains replicate survey weights to enable confidence intervals to be calculated easily. The Ministry of Health calculated sampling errors for survey estimates using a replication method, called the Delete-a-Group (DAG) jack-knife method (Kott 1998). The idea behind the replication approach was to divide the sample into G random groups, and then estimate the variance of the full sample survey estimate. For the 22/3 NZHS, 1 random groups were chosen (G = 1). In summary, the formulae for calculating the variance of an estimate, y, using this method are: ( G 1 ) ( ) 2 Variance( y ) = y G g g y where: y = weighted estimate from the full sample y g = weighted estimate, having applied the weights for replicate group g G = 1 (the number of replicate groups) g = 1, 2,..., G. For the 95 percent confidence interval of an estimate, y, the following formulae were used: Sampling error( y ) = 1.96 variance( y) Confidence interval( y ) = y ± sampling error( y) The precision of each survey result is indicated by the 95 percent confidence interval (CI). If multiple survey samples were obtained, even at the same time, they would provide results that differed. The 95 percent CI is the interval that would be expected to contain the true population value 95 percent of the time if many samples were taken. Urban Health Comparisons 3

16 Age-standardised weights Age is an important determinant of health status. Therefore, when making comparisons between sub-groups of the population, the different age distribution of the comparison population must be taken into account. Age-standardisation was performed by the direct method using the WHO world population age distributions (Ahmad et al 2), applied to population counts from the 21 Census. In addition to the New Zealand population survey weight, an age-standardised weight exists. All results presented by sex, area type and deprivation level (NZDep21) in the body of this report have been age-standardised. This is to allow comparisons between population sub-groups without differences in the age distribution of the comparison populations influencing results. Therefore, use the age-standardised estimates to compare one population with another. However, note that age-standardised estimates have no meaning by themselves: they are meaningful only when compared with other age-standardised estimates. If you want to know the actual burden experienced by the population of interest (eg, the prevalence of obesity or diabetes in males or females), use the crude results shown in the summary tables at the end of the relevant chapter. Definition of / areas Results in this report have been presented at two different levels of / classification. These were based on the 21 Census classifications, and defined according to Statistics New Zealand definitions (Department of Statistics 1992). The first level of classification is a broad categorisation of areas as either or. Urban areas are defined as those cities and towns with a population of at least 1 people. The second level of classification is a more detailed categorisation of areas by area type. This includes three types of areas (main areas, secondary areas, and minor areas) and two types of areas ( s and true areas). The term true areas has been used to differentiate truly areas from s and from the more general classification, which includes both s and truly areas (see Table 2). The definitions for these five area types were based on the 21 Census populations, and are given in Table 2. Table 2: Definition of and areas Urban/ classification Area type Definition Urban Towns and cities with a minimum population of 3, people Towns with a population between 1, and 29,999 people Towns with a population between 1 and 9999 people Population between 3 and 999 people 4 Urban Health Comparisons

17 Population less than 3 people Socioeconomic deprivation The New Zealand Deprivation Index 21 (NZDep21) was used as the key indicator of socioeconomic status (Salmond and Crampton 22). It is an area-based index of deprivation that measures the level of deprivation for each meshblock, according to a combination of Census 21 variables: income, transport (access to car), living space, home ownership, employment status, qualifications, support (sole-parent families) and access to a telephone. There are 1 NZDep21 categories (deciles), with decile 1 representing the least deprived 1 percent of small areas, and decile 1 representing the most deprived 1 percent of small areas. For this report, NZDep21 deciles were collapsed into three groups: low deprivation: NZDep21 deciles 1 3 medium deprivation: NZDep21 deciles 4 7 high deprivation: NZDep21 deciles 8 1. Prevalence of chronic disease The prevalence rates for chronic diseases presented in this report are lifetime prevalence rates. In this survey, the prevalence of chronic diseases was determined by asking participants if a doctor had ever told them they had any of the selected chronic diseases. This will underestimate the true prevalence of most chronic diseases, because not all people with the disease will have been diagnosed. Liability Care and diligence have been taken to ensure the information in this document is accurate and up to date. However, the Ministry of Health accepts no liability for the accuracy of the information, its use or the reliance placed on it. Presentation of results in this report This survey provides a cross-sectional picture of the New Zealand population by describing the situation at one point in time. As such, it merely describes associations and cannot distinguish between causality and selection. For example, it cannot determine if an environment causes a particular outcome, or if the association results from selection, such as people with chronic diseases moving from areas to areas because their health does not permit them to work in areas any longer. All results presented in the body of this report are weighted, age-standardised estimates with 95 percent confidence intervals. Crude weighted estimates are shown at the end of each chapter. When an unweighted individual cell contained a value of less than 1, results were suppressed for reasons of reliability and confidentiality. All rate calculations excluded the very small proportion of respondents who said they didn t know or refused to answer. Urban Health Comparisons 5

18 Ninety-five percent confidence intervals The rates in this report have been given with 95 percent confidence intervals, which give an indication of the sampling error. The confidence interval is influenced by the sample size of the group. When the sample size is small, the confidence interval becomes wider. When the confidence intervals of two groups do not overlap, the difference in rates between the groups is statistically significant. The word significant is used throughout this report to refer to the 5 percent significance level. However, in some cases when the confidence intervals of two groups overlap, there may still be a statistically significant difference in rates. In these cases, the differences in rates have been tested with a t test. It should be noted that with such a large number of comparisons, a few significant results are likely to occur by chance. Cross-tabulation categories and comparisons Three types of cross-tabulation are presented in this report: 1 sex by /: tables of prevalence rates with 95 percent confidence intervals (in brackets), for each of the survey questions analysed sex by area type (main, secondary, minor,, true ): graphs of prevalence rates with 95 percent confidence error bars, for selected questions sex by / by NZDep21: graphs of prevalence rates with 95 percent confidence error bars, for selected questions. This report comments only on findings that are statistically significant at the 5 percent level. Because differences are the main focus of this report, statistical comparisons in the text are generally made between and areas of the same type. For example, females in areas of high deprivation are compared to females in areas of high deprivation. For comparisons of area types, each type (main, secondary, minor ) is compared with the overall total, and each type (, true ) is compared with the overall total. However, other comparisons of interest may also be noted, such as a significant difference between main and secondary areas. 1 Results are also available in spreadsheet format for (i) sex by / by life-cycle age group; (ii) sex by / by Māori/non-Māori ethnicity. 6 Urban Health Comparisons

19 How to interpret results tables Tells us what the table is about Prevalence or other rate (eg, proportion of male population at a given time with the disease or condition) Table X: Prevalence of diagnosed* chronic diseases, by sex and /, percent (age-standardised rate), 22/3 Indicator Females Males Urban Urban Tells us about the indicator Heart disease Stroke 9. (8., 1.) 1.5 (1.2, 1.9) 4.8 (2.6, 6.9) 1.4 (.5, 2.3) 1.1 (8.8, 11.4) 1.9 (1.5, 2.4) 7.1 (5., 9.2) 1.6 (.5, 2.7) Diabetes 3.9 (3.2, 4.6) 2.4 (1., 3.9) 4.7 (3.9, 5.5) 3.5 (1.6, 5.3) Asthma (ages 45 and under only) 24.8 (22.6, 27.) 18.8 (13.5, 24.1) 2.2 (16.8, 23.6) 13.4 (7.5, 19.3) COPD (ages 46+ only) 38.8 (31.8, 45.8) 35.4 (17.4, 53.4) 38. (28.7, 47.3) 3.2 (12.6, 47.8) * Have you ever been told by a doctor that you have... Note: COPD = chronic obstructive pulmonary disease. Tells us information about the indicators The 95 percent confidence interval Urban Health Comparisons 7

20 How to interpret results figures Tells us what the graph is about Figure Y: Prevalence of heart disease, by sex and area type (age-standardised) 25 2 The 95 percent confidence interval Females Males 15 1 The scale of the prevalence (y) axis is generally 1%, but for sections in which the prevalence is very small, smaller axes are used (eg, 25%). 5 Tells us the groups that the prevalence rates are for How to interpret results text In the text, comments are made about the statistical significance of comparisons. For comparisons of area types, specific area types are compared with the overall total. Similarly, specific area types are compared with the overall total. Refers to the rate in a specific area type true areas (given in Figure Y) People living in true areas were significantly less likely to have been diagnosed with heart disease compared to dwellers, for both males and females (Figure Y, Table X). Shows where the data is given for the comparisons the rate for true areas is given in Figure Y, and the rate for areas is given in Table X Refers to the overall rate for areas (given in Table X) 8 Urban Health Comparisons

21 Chapter 2: Chronic Diseases Introduction A chronic disease is a physical or mental illness that has lasted, or is expected to last, for more than six months. The symptoms may come and go or be present all the time. This section of the report presents the lifetime prevalence rates of chronic diseases. In this survey, the prevalence rates of chronic diseases were determined by asking participants if a doctor had ever told them they had any of the selected chronic diseases. This will underestimate the true prevalence of most chronic diseases, because not all people with the disease will have been diagnosed. The proportion of people who are not diagnosed will vary by disease depending on several factors, such as the presence and severity of symptoms. All results presented by sex, area type and NZDep21 in the body of this report have been agestandardised by the direct method using the WHO world population as the standard population. This is to allow comparisons between population sub-groups without differences in the age distribution of the comparison populations influencing results. However, age-standardised estimates have no meaning by themselves; they are meaningful only when compared with other age-standardised estimates. Therefore, only those age-standardised estimates should be used to compare one population sub-group with another. If you want to know the actual burden experienced by the population of interest (eg, the prevalence of diabetes in males), use the crude (unadjusted) estimates shown in the summary tables at the end of this chapter. In this report, comparisons are made between areas and areas. In addition to this, for comparisons of area types, each type (main, secondary, minor ) is compared with the overall total, and each type (, true ) is compared with the overall total. Comments are also made in the text on comparisons between and areas of the same deprivation level, and on any other comparisons of interest. Ninety-five percent confidence intervals are presented for all descriptive results, following the estimate in the table or as error bars in graphs. Results Key points Urban dwellers were significantly more likely to have been diagnosed with heart disease than dwellers, for both males and females. There were no significant differences in the prevalence of diabetes between and dwellers. However, in areas, the prevalence of diabetes was significantly higher in the most deprived areas, compared to areas of low or medium deprivation, for both males and females. Urban Health Comparisons 9

22 For females aged 45 or less, the prevalence of asthma was significantly higher in dwellers than in dwellers. For females, the prevalence of diagnosed arthritis and osteoporosis was significantly higher in areas than in areas. The prevalence of arthritis was particularly high for females in secondary and minor areas. For males, the prevalence of spinal disorders was significantly higher in areas than in areas. This difference was particularly marked between true areas and main areas. The prevalence of diagnosed stroke, chronic obstructive pulmonary disease, cancer, migraine and serious mental health disorders did not differ significantly between and people. Prevalence of chronic diseases The lifetime prevalence rates of diagnosed chronic diseases are shown in Table 3. Table 3: Prevalence of diagnosed* chronic diseases, by sex and /, percent (agestandardised rate), 22/3 Indicator Females Males Urban Urban Heart disease 9. (8., 1.) Stroke 1.5 (1.2, 1.9) Diabetes 3.9 (3.2, 4.6) Asthma (ages 45 and under only) 24.8 (22.6, 27.) COPD (ages 46+ only) 38.8 (31.8, 45.8) Cancer 6.8 (6., 7.6) Arthritis 14.8 (13.8, 15.9) Spinal disorders (neck or back problem) 22.7 (21., 24.4) Osteoporosis 3. (2.5, 3.6) Migraine 8. (6.7, 9.2) Serious mental health (bipolar disorder, schizophrenia or depression) 3.3 (2.5, 4.) 4.8 (2.6, 6.9) 1.4 (.5, 2.3) 2.4 (1., 3.9) 18.8 (13.5, 24.1) 35.4 (17.4, 53.4) 5.8 (4., 7.5) 11.7 (9., 14.3) 23.4 (18.7, 28.1) 1.9 (1., 2.7) 8.1 (4.5, 11.8) 2.4 (1.1, 3.6) 1.1 (8.8, 11.4) 1.9 (1.5, 2.4) 4.7 (3.9, 5.5) 2.2 (16.8, 23.6) 38. (28.7, 47.3) 4.8 (4., 5.6) 12.3 (11.2, 13.4) 23.4 (21.5, 25.4).8 (.4, 1.1) 4.1 (3.1, 5.1) 2.1 (1.4, 2.9) 7.1 (5., 9.2) 1.6 (.5, 2.7) 3.5 (1.6, 5.3) 13.4 (7.5, 19.3) 3.2 (12.6, 47.8) 5.2 (3.3, 7.1) 12.7 (9.5, 15.9) 32.5 (26.8, 38.1).6 (., 1.3) 2.5 (1., 4.1) 1.6 (.1, 3.1) * Have you ever been told by a doctor that you have... Note: COPD = chronic obstructive pulmonary disease. 1 Urban Health Comparisons

23 Heart disease Heart disease includes heart attack, angina, abnormal heart rhythm and heart failure. Urban dwellers were significantly more likely to have been diagnosed with heart disease than dwellers, for both males and females (Table 3). Females in all three types of areas had significantly higher rates of diagnosed heart disease compared to females in areas (Figure 1, Table 3). Males in minor areas had significantly higher rates of heart disease than males in areas. People living in true areas were significantly less likely to have been diagnosed with heart disease compared to dwellers, for both males and females. Figure 1: Prevalence of heart disease, by sex and area type (age-standardised) 25 Females Males The difference in the prevalence of diagnosed heart disease was significant for females in areas of medium deprivation and for males in areas of low deprivation, with people having lower prevalence of heart disease than dwellers (Figure 2). The prevalence of heart disease tended to increase with increasing levels of deprivation in both and areas. Urban Health Comparisons 11

24 Figure 2: Prevalence of heart disease, by sex, / and deprivation level (agestandardised) 25 Urban females females Urban males males Low Medium High Low Medium High Low Medium High Low Medium High Deprivation level Note: Deprivation levels are defined by NZDep21 deciles (low or least deprived areas = deciles 1 3, medium = deciles 4 7, high or most deprived = deciles 8 1). Stroke Stroke refers to the sudden interruption of the blood supply to the brain that can cause permanent or temporary damage. This kind of interruption of the blood supply can be caused by either blood clots (ischaemic stroke) or bleeding in the brain (haemorrhagic stroke). The prevalence of stroke did not differ significantly between and dwellers, for either males or females (Table 3), for any area type or deprivation level. Diabetes Diabetes is characterised by raised blood glucose due to insulin deficiency, insulin resistance or both. There were no significant differences in prevalence rates of diabetes between and dwellers (Table 3). However, males in minor areas had significantly higher rates of diabetes compared to males in areas (Figure 3, Table 3). 12 Urban Health Comparisons

25 Figure 3: Prevalence of diabetes, by sex and area type (age-standardised) 12 Females Males For dwellers, the prevalence of diabetes was significantly higher in areas of high deprivation compared to areas of low and medium deprivation, for both males and females (Figure 4). Figure 4: Prevalence of diabetes, by sex, / and deprivation level (agestandardised) 9 Urban females females Urban males males * * * Low Medium High Low Medium High Low Medium High Low Medium High Deprivation level * Numbers were too low for reliable estimation. Note: Deprivation levels are defined by NZDep21 deciles (low or least deprived areas = deciles 1 3, medium = deciles 4 7, high or most deprived = deciles 8 1). Urban Health Comparisons 13

26 Asthma Asthma is an inflammatory disorder of the airways that causes air flow in to and out of the lungs to be restricted. It is characterised by periodic attacks of wheezing, breathlessness and coughing and is reversible with appropriate treatment. About half of people with asthma develop it before age 1, and most develop it before age 3. In this survey, adults aged years were asked if a doctor had ever told them they have asthma. For females aged 45 or less, dwellers were significantly more likely to have been diagnosed with asthma than dwellers (Table 3). The higher prevalence of asthma in areas tended to occur in all types of areas compared to areas (Figure 5, Table 3), with females living in secondary areas significantly more likely to have been diagnosed with asthma compared to female dwellers. Figure 5: Prevalence of asthma (ages 15 45), by sex and area type (age-standardised) 4 Females Males The higher prevalence of asthma in areas than areas was significant only for areas of medium deprivation for females and low deprivation for males (Figure 6). 14 Urban Health Comparisons

27 Figure 6: Prevalence of asthma (ages 15 45), by sex, /, and deprivation level (age-standardised) 4 Urban females females Urban males males Low Medium High Low Medium High Low Medium High Low Medium High Deprivation level Note: Deprivation levels are defined by NZDep21 deciles (low or least deprived areas = deciles 1 3, medium = deciles 4 7, high or most deprived = deciles 8 1). Chronic obstructive pulmonary disease Chronic obstructive pulmonary disease (COPD) refers to several chronic lung disorders that are characterised by non-reversible airflow restriction into and out of the lungs. Emphysema and chronic bronchitis are the most common forms of COPD. In this survey, adults aged over 45 years were asked if a doctor had ever told them they have chronic bronchitis or emphysema. Asthma has not been included in our definition of COPD (which is permanent), as it is reversible. The prevalence of COPD did not differ significantly between and dwellers, for either males or females (Table 3), for any area type or deprivation level. Cancer Cancer involves the uncontrolled growth of cells, which can prevent the normal functioning of vital organs. There are at least 2 different kinds of cancer and they can develop in almost any organ or tissue. The following results are for the lifetime diagnosis of all cancers, not differentiated by site. The prevalence of cancer did not differ significantly between and dwellers, for either males or females (Table 3) or for any area type (Figure 7). Urban Health Comparisons 15

28 Figure 7: Prevalence of cancer, by sex and area type (age-standardised) 18 Females Males For people in the most deprived areas, the prevalence of cancer was significantly higher for dwellers than people, for both females and males (Figure 8). In contrast, for males in areas of medium deprivation, the prevalence of cancer was significantly higher in areas than in areas. Figure 8: Prevalence of cancer, by sex, / and deprivation level (age-standardised) 14 Urban females females Urban males males Low Medium High Low Medium High Low Medium High Low Medium High Deprivation level Note: Deprivation levels are defined by NZDep21 deciles (low or least deprived areas = deciles 1 3, medium = deciles 4 7, high or most deprived = deciles 8 1). 16 Urban Health Comparisons

29 Arthritis Arthritis is a group of diseases that involve inflammation of one or more joints. The prevalence of arthritis was significantly higher in areas than areas for females (Table 3). In particular, females in secondary and minor areas were significantly more likely to have arthritis than females in areas (Figure 9, Table 3). Figure 9: Prevalence of arthritis, by sex and area type (age-standardised) 25 Females Males In areas, the prevalence of arthritis was significantly higher in the most deprived areas compared to the least deprived areas, for both males and females (Figure 1). There were no significant differences between and areas of equivalent deprivation levels. Urban Health Comparisons 17

30 Figure 1: Prevalence of arthritis, by sex, / and deprivation level (age-standardised) 3 Urban females females Urban males males Low Medium High Low Medium High Low Medium High Low Medium High Deprivation level Note: Deprivation levels are defined by NZDep21 deciles (low or least deprived areas = deciles 1 3, medium = deciles 4 7, high or most deprived = deciles 8 1). Spinal disorders Spinal disorders include disorders of the back or neck (eg, lumbago, sciatica, chronic back or neck pain, and vertebrae or disc problems). Spinal disorders are usually caused by injury, overuse, muscle disorders, pressure on a nerve or poor posture. For males, the prevalence of spinal disorders was significantly higher in areas than areas (Table 3). In particular, males in true areas had significantly higher rates of spinal disorders than males in main areas (Figure 11). 18 Urban Health Comparisons

31 Figure 11: Prevalence of spinal disorders, by sex and area type (age-standardised) 5 45 Females Males Among females, the prevalence of spinal disorders was significantly higher in low deprivation areas compared to high deprivation areas (Figure 12). Figure 12: Prevalence of spinal disorders, by sex, / and deprivation level (agestandardised) 5 45 Urban females females Urban males males Low Medium High Low Medium High Low Medium High Low Medium High Deprivation level Note: Deprivation levels are defined by NZDep21 deciles (low or least deprived areas = deciles 1 3, medium = deciles 4 7, high or most deprived = deciles 8 1). Urban Health Comparisons 19

32 Osteoporosis Osteoporosis is the thinning of bones resulting in a loss of bone density. It occurs when not enough new bone is formed, too much bone is reabsorbed, or both. The prevalence of osteoporosis was significantly higher in areas than in areas for females (Table 3). Females in main areas were significantly more likely to have a higher rate of osteoporosis than females in areas (Figure 13, Table 3). Males have low rates of osteoporosis, and the numbers were too low to present prevalence rates by deprivation level. Figure 13: Prevalence of osteoporosis, by sex and area type (age-standardised) 6 Females Males * * * * Numbers were too low for reliable estimation. Migraine Migraine headaches occur repeatedly in some people. They are different from other headaches because they typically occur with nausea, vomiting or sensitivity to light. The prevalence of migraine did not differ significantly between and areas for either sex (Table 3), or by area type or deprivation level. 2 Urban Health Comparisons

33 Serious mental disorders Serious mental disorders include depressive disorder, bipolar disorder and schizophrenia. Depressive disorders affect the way a person feels about themselves and how they think about things, and is associated with feelings of sadness, hopelessness and helplessness. Bipolar disorder (manic depression) is characterised by periods of excitability (mania) alternating with periods of depression, often with abrupt changes between the two moods. Schizophrenia is a serious disorder of thinking and feeling, typically including auditory hallucinations. The prevalence of serious mental health disorders did not differ significantly between and areas for either sex (Table 3), or by area type or deprivation level. Summary tables of crude rates Table 4 (females) and Table 5 (males) summarise the crude prevalence rates of selected chronic diseases for and areas. Use these crude estimates if you want to know the actual burden experienced by the population of interest. However, differences in crude rates may arise from differences in age distributions, which is why age-standardised rates have been used in the body of the report. Table 4: Prevalence of diagnosed chronic diseases, females, by area type, percent (crude rate), 22/3 Indicator Urban total total Heart disease 1.5 (9.5, 11.5) Stroke 1.9 (1.5, 2.4) Diabetes 4. (3.3, 4.7) Asthma (ages 45 and under only) COPD (ages 46+ only) 23.1 (21.2, 24.9) 4.5 ( ) Cancer 7.9 (7.1, 8.8) Arthritis 17.9 (16.8, 19.) Spinal disorders 23.9 (22.4, 25.5) Osteoporosis 4.1 (3.5, 4.7) Migraine 7.8 (6.7, 8.9) Serious mental health (bipolar disorder, depression, schizophrenia) 3.1 (2.5, 3.7) 5.5 (3.3, 7.8) 1.6 (.5, 2.6) 2.6 (1.2, 4.) 19. (13.8, 24.2) 37.1 (18.5, 55.7) 7. (5., 9.1) 13.6 (1.6, 16.5) 24.5 (19.8, 29.2) 2.3 (1.2, 3.3) 7.8 (4.4, 11.2) 2.5 (1.2, 3.7) 9.4 (8.3, 1.6) 1.7 (1.2, 2.1) 3.9 (3.1, 4.7) 22.3 (2.2, 24.5) 4.7 (33.3, 48.2) 7.5 (6.5, 8.5) 16.8 (15.6, 18.1) 23.2 (21.6, 24.9) 4. (3.3, 4.7) 7.8 (6.6, 8.9) 3. (2.2, 3.7) 16.8 (12.4, 21.1) 3.3 (1.4, 5.2) 3.9 (1.7, 6.2) 28. (21.1, 34.9) 48.6 (29.5, 67.6) 9.1 (5.8, 12.5) 23. (17.8, 28.3) 27. (21., 33.) 4.8 (2., 7.5) 7.7 (3.9, 11.5) 4.2 (1.6, 6.9) 14.3 (1.6, 18.1) 3.1 (1.1, 5.1) 4.8 (2.5, 7.) 25.8 (18., 33.7) 3.2 (15.3, 45.1) 11. (7.2, 14.7) 22.7 (17.8, 27.7) 27.3 (22.7, 32.) 4.7 (2.3, 7.) 7.6 (4.4, 1.9) 3.2 (1.3, 5.1) 8.4 (3.2, 13.7) 2.7 (., 5.9) 5.2 (.7, 9.7) 16. (3.7, 28.4) 36.8 (., 81.2) 11.3 (4.4, 18.2) 14.8 (7.4, 22.2) 22.4 (12.8, 31.9) 2.7 (.1, 5.3) 9.6 (1.1, 18.1) 5. (2.6, 7.4) 1.3 (.2, 2.5) 2.1 (.6, 3.6) 19.6 (13.9, 25.2) 37.1 (17.8, 56.5) 6.2 (4.1, 8.3) 13.3 (1.2, 16.5) 24.9 (19.6, 3.3) 2.2 (1.1, 3.4) 7.4 (3.6, 11.2) 2.3 (.9, 3.6) Notes: A dash ( ) indicates that numbers were too low for reliable estimation; COPD = chronic obstructive pulmonary disease. Urban Health Comparisons 21

34 Table 5: Prevalence of diagnosed chronic diseases, males, by area type, percent (crude rate), 22/3 Indicator Urban total total Heart disease 11.4 (1.1, 12.6) Stroke 2.4 (1.8, 3.) Diabetes 5. (4.1, 5.9) Asthma (ages 45 and under only) COPD (ages 46+ only) 19. (16., 22.) 4.9 (31.1, 5.6) Cancer 5.9 (5.1, 6.8) Arthritis 13.8 (12.6, 14.9) Spinal disorders 24.6 (22.8, 26.3) Osteoporosis.8 (.4, 1.2) Migraine 3.9 (3., 4.9) Serious mental health (bipolar disorder, depression, schizophrenia) 2. (1.4, 2.6) 8.2 (5.7, 1.7) 2. (.6, 3.4) 3.2 (1.7, 4.8) 12. (7.3, 16.8) 3.5 (11.7, 49.3) 6.2 (3.8, 8.6) 15. (11.2, 18.9) 34.2 (28.7, 39.6).8 (., 1.7) 3. (1.1, 4.9) 1.7 (.2, 3.3) 1.3 (9., 11.6) 2.3 (1.6, 3.) 4.5 (3.7, 5.4) 18.7 (15.7, 21.6) 39.2 (28.8, 49.7) 5.2 (4.3, 6.2) 12.4 (11.1, 13.7) 23.7 (21.8, 25.7).9 (.4, 1.3) 3.7 (2.7, 4.7) 2.2 (1.5, 3.) 14.9 (9.5, 2.3) 17.6 (11.8, 23.3) 3.5 (1., 6.) 5.5 (2.1, 8.9) 17. (7.5, 26.4) 8.2 (4.8, 11.5) 24. (14., 34.1) 53.8 (31., 76.6) 7.6 (3.7, 11.5) 2.3 (14.5, 26.2) 29.5 (21.7, 37.4) 1.7 (6.3, 15.1) 19.7 (14.7, 24.6) 27.1 (2.3, 34.) 8.7 (2.5, 14.8) 3.6 (., 9.6) 3.5 (.9, 6.1) 1.3 (., 22.1) 8.1 (5.3, 11.) 1.7 (.4, 3.) 3.2 (1.5, 4.9) 12.4 (7.4, 17.4) 28.8 (7.8, 49.7) 6.5 (.3, 12.7) 12. (4., 2.) 36.1 (22.4, 49.7) 6.2 (3.5, 8.9) 15.6 (11.2, 19.9) 33.8 (28.1, 39.5).9 (., 2.) 5.8 (2.1, 9.5) 4.6 (1.1, 8.1).5 (., 1.4) 3.2 (1., 5.5) 2. (.2, 3.8) Notes: A dash ( ) indicates that numbers were too low for reliable estimation; COPD = chronic obstructive pulmonary disease. 22 Urban Health Comparisons