1 / 19

Social, biological and lifestyle risk factors for hospital admission: Analysis of the Scottish Health Survey linked to

Social, biological and lifestyle risk factors for hospital admission: Analysis of the Scottish Health Survey linked to hospital records. Matt Sutton. Contributors. Richard Lawder (Information Services, NHS NSS) Andrew Elders (Information Services, NHS NSS)

cheung
Download Presentation

Social, biological and lifestyle risk factors for hospital admission: Analysis of the Scottish Health Survey linked to

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Social, biological and lifestyle risk factors for hospital admission: Analysis of the Scottish Health Survey linked to hospital records Matt Sutton

  2. Contributors • Richard Lawder (Information Services, NHS NSS) • Andrew Elders (Information Services, NHS NSS) • David Clark (Information Services, NHS NSS) • David Walsh (NHS Health Scotland) • Phil Hanlon (University of Glasgow) • Bruce Whyte (NHS Health Scotland) • Laura Kelso (NHS Health Scotland)

  3. Outline of talk • Project aims • Overview of Scottish Health Surveys • The linked file • Analysis • Results

  4. Project aims • To determine the relative impact of a range of risk factors on the likelihood of hospital admission • To test whether deprivation is an independent predictor of hospital admission • To model the impact on future hospital utilisation of current targets for the reduction of behavioural, biological and social risk factors

  5. Survey data • 1995 Scottish Health Survey • 7,932 respondents aged 16-64 years • 7,363 (93%) consented to follow-up studies • 1998 Scottish Health Survey • 9,047 respondents aged 16-74 years • 8,305 (92%) consented to follow-up studies

  6. Survey content • Individual and household life circumstances • Area deprivation • Individual lifestyles (smoking, drinking, activity) • Self-reported health • Self-reported diagnoses • Biomedical measures (nurse visit)

  7. Record linkage • Respondents linked to the September 2004 version of ISD’s linked SMR01 catalog • 11,396 (73%) respondents linked to • SMR01 hospital admissions • SMR04 psychiatric admissions • GRO death records up to 31 March 2004 • Cancer registrations up to 31 December 2001 • Total of 58,913 administrative records

  8. Linkage results • 11,325 (72.4%) have experienced at least one hospital episode (acute or psychiatric) • 502 (3.2%) have experienced at least one psychiatric hospital admission • 1,003 (6.4%) have had at least one cancer registration • 743 (4.7%) have died

  9. 1980s 1998 2004 * * * * * * * * * hospitalisation migration death survey Following respondents

  10. Outmigration • May bias results – ‘healthy migrant effect’ • Based on link to CHI registrations • 331 (4%) respondents excluded from 1998 follow-up • Independent predictors (in multivariate analysis) • Age – highest in 20-24 age group • Higher social class • Degree qualification • Privately rented accommodation • Least deprived areas • Urban/City Centre residence • Country of birth outside Scotland • Ex-drinkers(!)

  11. Analysis • Follow-up of 1998 survey respondents, 16-74 years • Survival analysis of time to event • First hospital admission • First ‘Costly and Complex’ hospital admission • Death • Models allow for: • Survey weights • Clustering by PSU • Competing risk of death in admission models • Different start times

  12. Outcome Hospital admission(s) Death Factors considered Social Area deprivation Income Employment Education Housing Access Summary health stock Self-assessed health Limiting longstanding illness GHQ-12 Prior hospital admissions Biological Body Mass Index Waist-Hip Ratio Blood pressure Total cholesterol HDL cholesterol Gamma-GT Fibrinogen C-Reactive Protein Forced Expiratory Volume Behavioural Smoking Drinking Physical activity Diet

  13. Inventory of models • Three types of event • Any hospital admission • ‘Costly and Complex’ hospital admission • Death • Univariate versus multivariate models • Including and excluding ‘health stock’

  14. Summary of results • Each risk factor has expected results for admissions and deaths in single risk factor models • Health stock is important and reduces significance of lifestyle and social risk factors substantially • Smoking is important in multiple risk factor models • Biological risk factors have little marginal effect in multiple risk factor models (except FEV) and many missing values • Individual/household social factors are more important than area deprivation and influence deaths more than admissions

  15. Self-assessed health and risk of ‘Costly and Complex’ admission *** p<0.001 ** p<0.01 * p<0.05

  16. Smoking status and risk of ‘Costly and Complex’ admission *** p<0.001 ** p<0.01 * p<0.05

  17. Housing tenure and events • Influences risk of death but no significant effect on risk of hospital admission *** p<0.001 ** p<0.01 * p<0.05

  18. Economic activity and events • Unemployment influences risk of death but no significant effect on risk of hospital admission *** p<0.001 ** p<0.01 * p<0.05

  19. Summary • The linked Scottish Health Survey is a valuable resource for examining social, behavioural and biological effects at the individual level • Main strength is for follow-up analysis • Future work will: • focus on admissions for specific diagnoses • simulate the effect of risk factor changes

More Related