Health, care and social relations, survey on living conditions

Long standing health problem/illness. Disease or health problem that have lasted for 6 months or longer or a state that is expected to be permanent.

Health problem that affects everyday life. In 2012 and earlier years the questionnaire spesified that health problems should include all kinds of problems: pain, anxiety, sleeping problems, fatigue, limitations in what one can do.  In 2015 there was no such spesification.

Diagnostic groups. In 2012 and earlier years diseases and health problems were coded according til ICD-10 classification. See the documentation reports (links below) about the disease classification. In 2015 respondents were asked about 16 specified types of diseases.

Depressive symptoms. In 2015 a measure of depression symptoms was used. This is an index called PHQ8, which is recommended by Eurostat, and is based on 8 questions about depressive symptoms during the last 14 days.  Depressive symtoms are calculated as having 2 or more symptoms for in more than half of the days in the 14-days period.

In 2012 and before mental health was defined as a score 1.75 or higher on HSCL-25. THe measure is based on a list of questions called the "Hopkins Symptom Check List". This is a list of 25 question about different symptoms on mental problems. Ten of the questions capture anxiety and fifteen questions capture depression. The answer catagories range from not bothered at all to very bothered. The scores from 1 to 4 is summed for all 25 questions. The sum is divided with the number of questions. People with a score 1.75 or higher are seen as having considerable mental health problems.

Symptoms and pains. Small changes in the wording of the question may have lead to more respondents reporting pains during the last 3 months in 2015 compared to earlier surveys. The sentence "Only lasting or recurring pains should be counted...," was read to all in previous data collections, while in 2015 the interviewer could read this if the respondent was in doubt. The subordinate clause "...do not count temporary pains for instance related to colds." which was part of the question in previous surveys, was not included in 2015.

High alcohol consumption. People are registered with a high alcohol consumption if they drink alcohol twice a week or more often.

BMI (body mass index): Self-reported weight divided by height in meters squared

Redused physical mobility. People that are unable to walk up or down a flight of stairs without resting or that is unable to walk for 5 minutes in a quick pace.

Participation. These questions were not asked in 2015. In 2012 and previous years it was defined as difficulty moving around inside the dwelling, using public communication, participate in leisure activities or involve in social relations. People that answer that this is difficult, very difficult or not possible.

Reduced working capacity. Not registered in 2015. In 2012 and earlier years this included people that had reported an illness, injury or impairment are asked if the health problem lead to limitations in their capacity to have or to hold paid employment.

In need of help. People that are unable to do groceryshopping or cleaning own dwelling without assistance. The questions are posed to people 67 years (in 2015 65) or older or to people with a health problem regardless of age.

In need of care. People that are unable to dress or undress or take care of personal hygiene without assistance.

Households with persons in need of help or care . People that are living alone and in need of help and people in households with more than one person that say that there are persons in need of care or that need help to manage everyday tasks due to illness, impairment, injury or old age.

Receiving unpaid help on a regular basis. Help is spesified as practical help or care for sick, disabled or elderly people outside the household. The percentage that are giving help to parents is calculated on basis of those that still have their parents alive.

New variables and important changes in 2015 compared to previous years.

Drinking alcohol

Age

Persons are grouped by age at year-end for the completion of the main part of the interview.

Region

The regions include the following counties:

Oslo and Akershus

Eastern Norway: excluding Oslo and Akershus: Østfold, Vestfold, Hedmark, Oppland, Buskerud and Telemark, Agder and Rogaland:

Agder og Rogaland: Aust-Agder, Vest-Agder and Rogaland

Western Norway: Hordaland, Sogn og Fjordane, Møre and Romsdal,

Trøndelag: Sør-Trøndelag and Nord-Trøndelag,

Northern Norway: Nordland, Troms and Finnmark.

Area of residence

Persons are grouped according to sparsely populated areas or densely populated areas of different sizes. Sparsely populated areas include clusters of houses with less than 200 inhabitants. Densely populated areas include areas with 200 inhabitants or more, and a distance between houses - as a main rule - not more than 50 meters.

Family cycle phase

Persons are grouped mainly by age, marital status and whether the person has children. There is a distinction between singles and couples, where couples include both married and cohabitants. The concept single persons do not necessarily refer to persons living alone in the household.

The groups with children consist of persons living with their own child(ren) (including stepchildren and adopted children) aged 0-19 years in the household.

Educational level

Highest level of attained education divided in three levels; basic, secondary and tertiary education.

Name: Health, care and social relations, survey on living conditions
Topic: Health

Division for Health, care and social statistics

National. Counties (2015 only), regional and residential area.

The survey of health, care and social relations and living conditions is, starting from 2015, integrated in the European Health Interview survey (EHIS). This will be done every 6 years. Earlier the survey on living conditions has been an annual survey. The survey topics change during a three-year cycle. Every three years there is a health interview survey. Health, care and social contact were focus topics in 1998, 2002, 2005, 2008 and 2012, and again i 2015.

Data for 2015 will be reported to Eurostat. Data on self-assessed health and overweight is regularly sent to OECD.

Data files with results from the interviews and statistical files with coded variables, linked information and weights are stored. Anonymised files are also available for researchers through the NSD - Norwegian Centre for Research Data . An adapted verion of the data will, starting from the 2015 data, be made available through Eurostat.

The Survey of living conditions has two main purposes. One is to shed light on the main aspects of the living conditions in general and for various groups of people. Another purpose is to monitor the development in living conditions, both in level and distribution. Over a three-year period this cross-sectional survey cover all aspects of the living conditions. The health interview survey, which is carried out every 3 years, map the population's health, functional level, lifestyle and use of health services.

The very first health interview survey in Norway was carried out in 1968. Similar surveys were carried out in 1975, 1985 and 1995. After 1996 this survey was integrated in the system of living condition surveys and are now conducted every three years. The survey covers themes in relation to health status, disability, participation, care, lifestyle and use of health services.

The main users of data from the health interview survey are the ministries, directorates, universities and research institutions within the field of health and living conditions in general.

Data from the survey is also widely used by the media and the general public.

No external users have access to the statistics and analyses before they are published and accessible simultaneously for all users on ssb.no at 10 am. Prior to this, a minimum of three months' advance notice is given inthe Statistics Release Calendar. This is one of Statistics Norway’s key principles for ensuring that all users are treated equally.

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Voluntary participation.

EU regulation 1339/2008 and implementation regulation 141/2013.

The survey covers the population 16 years and older who are living in private households (not institutions). The statistical unit is individuals, however, the survey also include some information on the respondents´ household. The survey in 2005 and 2012 also included information on the health of children.

The main sample for the health interview survey has been 5000 persons. In 1998, 2002, 2005, 2008 and 2012 the survey included additional samples, externally funded. In total gross 10 000 persons.

All samples until and including 2012 are drawn according to Statistics Norway's general sampling plan, which is described in the publication "Levekårsundersøkinga 1996-1998 NOS C 704". The 2015 survey was drawn as a stratified sample, using county as stratification variable. A total of 700 peolple were drawn in all counties except Oslo, where 1400 persons were drawn. The final figures are weighted, to correct for varying sampling probability in th counties, and for non-response

The data are collected through a combination of computer-assisted personal interviews (CAPI) and telephone interviews (CATI). Data for the health interview survey are primarily collected in the autumn. The respondents also receive a postal questionnaire about sensitive information on mental health and alcohol use.

Respondents are not replaced when non-eligible or by non-response. Information on demography, income, education and financial aid are extracted from administrative registers.

Interviews are collected by means of a computer-based questionnaire. Control subroutines are employed in order to avoid erroneous responses and incorrect data registration. In some cases the interviewer is notified in cases of doubtful data entries. In other cases variables have a limited valuerange in order not to enter values exceeding what is considered as reasonable values. There are built-in control subroutines for valid outcomes for the response options.

For surveys in which industry affiliation and profession are of interest, data are merged with data from central registers. Information on the respondents disease, impairment and injury is coded according to the ICD classification.

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Statistics Norway has guidelines for merging data from different data sources (registers) for statistical purposes. The guidelines are based on Statistics Norway's authorisation given by the Data Inspectorate for person registers, and the Statistics Act. According to these guidelines responses given in surveys can only serve for the purpose of producing statistics. i.e. information concerning groups of people will be given, but not for individuals. When survey data files are coupled to registers, encryption techniques are used in order to ensure that it is impossible to identify persons from the survey or register information in the merged data file.

The living condition survey on health/Health interview survey is more or less a continuation of the national health surveys. The first health survey was conducted in 1968, and then every ten years, 1975, 1985, 1995. Some time series can also be found in the traditional living condition surveys 1980-1995. Breaches in the timeseries is commented in footnotes in the tables in the statbank.

Both in total counts and sample surveys erratic responses may occur. Errors may arise both in the collection as well as in the data revision process. Computers are used in the collection of data in the health interview survey. The interviewer reads the questions from the screen, and registers the answers directly into the data programme. An important advantage by using PC-based registering is that pre-programmed skipping of questions is employed in order to avoid placing questions to respondents for whom certain questions are inappropriate.

PC assisted interviewing gives the opportunity to monitor response consistency between the different questions directly. For every question a range of proper values are defined. In addition, error messages are programmed in order to alert the interviewer when typing values that not are consistent with previous responses. We avoid entering invalid input and we achieve reduced non-response on certain questions by reduced risk for skipping questions that should have been posed.

Errors may occur when respondents give wrong answers. One reason is that it is hard for the respondent to remember circumstances far back in time. Questions may also be misunderstood. When questions relate to issues people find hard to respond to, we must expect that erratic responses may be found. Data collection errors may also result from questions respondents find sensitive. In such cases, respondents may intentionally reply incorrectly. Responses may also be influenced by what the respondent consider socially desirable.

Processing of errors take place when there are discrepancy between the values registered and the values reported. Such errors may occur for instance when coding. Such errors are reduced through testing.

When all errors as far as possible are corrected, experience indicate that statistical outcomes in most cases to a relatively little extent are affected by collection and processing errors. However, the effect of such errors may have importance in some cases, and every error will not necessarily be detected.

The response rate in the Health interview survey has varied from 73 per cent (1998) to 67 per cent (2008) and 58 per cent in 2012.

The gross sample for the survey is drawn in order to reflect the whole population, however, because non-response is not equally distributed , the net sample will not be fully representative. This bias will vary for different groups and variables in question. In order to adjust for some of the biases the data is weighted for gender, age, education and family size.

Uncertainty of data based on only a part of the population is often called sampling variance. Standard deviation is a measure of this uncertainty. The size of standard deviation depends, among other factors, on the number of observations in the sample, and on the distribution of a variable in the whole population.

Statistic Norway has not made exact calculations of standard deviation of the data. However, in table 1, the approximate size of the standard deviation is given for a selection of observed percentages.

To illustrate the uncertainty associated with a percentage, we can use an interval to give the level of the true value of an estimated quantity (the value obtained if making observation on the whole population instead of observation based on a part of the population). Such intervals are called confidence intervals if constructed in a special way. In this connection one can use the following method: let M be the estimated quantity, and S the estimate of standard deviation of M. The confidence interval will be an interval with limits (M - 2*S) and (M + 2*S).

This method will give, with approximately 95 per cent probability, an interval containing the true value.

The following example illustrates the use of table 1 for finding confidence intervals: The estimate of standard deviation of 70 percent is 3.2 when the estimate is based on 300 observations. The confidence interval for the true value has limits 70 ± 2*3.2, which means the interval, is from 63.6 to 76.4 per cent.

Table 1. Standard deviation in per cent

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