Health Interview Surveys: Trend Analysis

Participants were asked to rate their general health status on the following scale: very good, good, fair, bad, and very bad. The majority perceive their health as good or very good. The proportion of respondents who rated their health status as good/very good increased over time,

Participants were then asked whether they have any long-standing illnesses or health problems, long-standing meaning illnesses or health problems lasting or expected to last for at least six months. The proportion of persons having a long-standing illness or health problem increased across survey iterations, with more than half of respondents (51.1%) reporting a health problem or illness in 2019/2020 as compared with 25.1% of respondents in 2002 (Figure 2).

To assess activity limitation due to health problems, participants were asked to what extent they felt limited in doing activities people normally do because of a health problem or illness, for at least the previous six months. Most respondents (over 75%) reported not being limited in activities due to health problems or illnesses. The proportion of respondents reporting limitations in activities remained stable over time, except for a decrease in the proportion reporting being severely limited in 2019/2020 (4.4%) when compared with the previous years

Participants were asked about the degree of physical pain experienced over the previous four weeks and whether such pain interfered with their normal work, both work outside their home

The proportion of respondents who reported experiencing no pain increased from 51.2% in 2008 to 55.5% in 2014/2015 and 58.4% in 2019/2020, whilst the proportion of respondents reporting moderate and severe pain decreased across survey iterations (Figure 4). This question was not included in the 2002 Health Interview Survey.

In 2014/2015 and 2019/2020, participants were asked about the degree to which physical pain interfered with their work, both work outside the home and housework, in the previous four weeks. Among those who reported some degree of physical pain in the previous four weeks, the majority (50.0% in 2014/2015 and 47.2% in 2019/2020) reported that such pain did not interfere with their work. The proportion who reported that the pain interfered with their ability to work to some degree remained stable across the two survey iterations (Figure 5).

Participants were given a list of 23 conditions or diseases and asked to report lifetime prevalence, that is, whether they have or ever had the condition/disease, and prevalence in the previous 12 months, that is, whether they had the condition/disease in the previous 12 months. Tables 6 and 7 show the top 10 conditions reported by the participants in the most recent survey (2019/2020), together with the trend in prevalence for these conditions over the years. In 2019/2020, the most commonly reported condition was hypertension, with 19.1% of all participants reporting having had this condition at some point in their life and 18.1% reporting

Participants were asked about the state of their oral health, that is, the state of their teeth and gums. The majority of respondents reported having only their natural teeth (no dentures/implants) despite having some teeth missing (51.6% in 2002 which decreased to 40.7% in 2014/2015 and 43.1% in 2019/2020). The proportion of respondents having all their natural teeth increased from 25.8% in 2002 to 36.9% in 2019/2020 (Figure 6). This question was

In the 2014/2015 and 2019/2020 surveys, participants were asked to rate the state of their teeth and gums on a five-point scale ranging from very good to very poor. The vast majority of respondents reported very good or good oral health in both survey iterations, with the trend analysis showing an increasing proportion of adults describing their oral health as good or very

In the 2014/2015 and 2019/2020 survey iterations, participants were presented with the eight- item Personal Health Questionnaire Depression Scale (PHQ-8). This tool measures depression in the general population through eight items assessing symptom frequency over a two-week period. Combining the scores for the eight items gives a measure of the presence of depressive symptoms and severity. The proportion of adults classified as having depressive symptoms increased from 5.7% in 2014/2015 to 8.8% in 2019/2020, although the proportion with major depressive symptoms remained stable at 1.5% (Figure 8).

When assessing the individual items of the scale, the majority of respondents denied any of the symptoms, namely having little interest or pleasure in doing things, feeling down, depressed or hopeless, having trouble falling or staying asleep or sleeping too much, feeling tired or lacking energy, having a poor appetite or overeating, feeing bad about oneself or feeling like a failure, having trouble concentrating on things, and moving too slowly or being too restless. Over time, the proportion of respondents who denied having any of the above symptoms in the previous two weeks decreased. In 2019/2020, around one in five respondents reported symptoms of little interest or pleasure in doing things, feeling down, depressed or hopeless, and having trouble with sleep on several days in the previous two weeks, whilst around one in four reported feeling tired or lacking energy on several days, and this proportion increased from 2014/2015.

Participants were asked about accidents that led to an injury in the previous 12 months. The proportion of respondents reporting injury due to a road traffic accident decreased from 5.4% in were also asked about accidents at home and accidents during leisure activities outside the home. The most frequent type of accident leading to injury was reported as accidents occurring during leisure activities, as shown in Figure 9.

Those who reported sustaining an injury in the previous 12 months were asked about the type of medical treatment sought for their injury. For accidents occurring at home or during leisure activities, most respondents visited a doctor or nurse, whereas in the case of road traffic accidents, most respondents reported needing no medical intervention following the injury.

With respect to physical functional limitations, participants were asked whether they encounter any difficulties when walking 500 metres on flat ground and when walking up or down a flight of stairs (12 steps) without the use of a stick or other walking aid or assistance. The majority (around 90%) reported having no difficulty when walking on flat ground or up/down the stairs unaided. The proportion of respondents reporting some difficulty with these tasks increased across the survey iterations, although the proportion reporting a lot of difficulty or being unable to carry out these tasks unaided decreased slightly over time (Figures 11 and 12).

Participants who were employed were asked if they were absent from work in the previous 12 months due to a health problem. Among the employed population, 41.2% of respondents reported being absent from work due to health reasons in the 2019/2020 survey. This represents an increase compared with previous survey iterations (28.9% in 2008 and 39.9% in 2014/2015)

Participants were then asked about the number of days of absence from work due to health reasons in the previous 12 months. The average number of days of absence was 10 days in

Tables 25 and 26 present this data subdivided by gender, age, and education. It must be noted that the number of employed participants aged 65 years and over was low, hence the results presented for the 65-74 years and 75+ years age groups may be unreliable.

This section relates to self-care activities, also known as activities of daily living (ADLs), amongst the population aged 65 years and over. Participants were given a list of five self-care activities (feeding oneself, getting in and out of bed/chair, dressing/undressing, using the toilet, and bathing/showering) and asked to rate how difficult it is to achieve each activity without help. Difficulty was measured on a four-point scale, namely no difficulty, some difficulty, a lot of difficulty, and unable to do it alone. In 2019/2020, 12.8% of those aged 65 and over reported difficulty in achieving at least one self-care activity without help. This proportion decreased

When assessing individual self-care activities, the vast majority (around 90% or more) of respondents aged 65 years and over reported no difficulty with feeding, getting in and out of bed or a chair, dressing and undressing, using the toilet, and bathing or showering without assistance. Feeding was the activity with the highest proportion of persons reporting no difficulty, followed by using the toilet. In contrast, the greatest difficulty was reported for getting in and out of bed or a chair. The proportion of persons reporting a lot of difficulty or being unable to perform these activities without help decreased across the survey iterations for all self-care

This section relates to domestic care activities, also known as instrumental activities of daily living (IADLs), amongst the population aged 65 years and over. Participants were given a list of seven domestic care activities (preparing meals, using the telephone, shopping, managing medication, light housework, occasional heavy housework, and managing finances and everyday administrative tasks) and asked to rate how difficult it is to achieve each activity without help. Difficulty was measured on a four-point scale, namely no difficulty, some difficulty, a lot of difficulty, and unable to do it alone. If participants never tried this task or do not need to do it in their everyday lives, their reply was considered as not applicable; these were excluded from the analysis to allow comparability across survey iterations. In 2014/2015 and 2019/2020, half of those aged 65 and over reported difficulty in achieving at least one domestic care activity without help, whilst this proportion was slightly lower in 2008 (Figure 15).

When assessing individual domestic care activities, the majority of respondents aged 65 years and over reported no difficulty with preparing meals, using the telephone, shopping, managing medication, light and heavy housework, and managing finances without assistance. Using the telephone was the activity recording the highest proportion of persons reporting no difficulty. In contrast, the greatest difficulty was reported for occasional heavy housework. The proportion of persons reporting a lot of difficulty or being unable to perform these activities without help decreased across the survey iterations for all domestic care activities.

This section presents an overview of indicators related to health care and an analysis of trends over time. The following subsections are addressed:

Consultations with private and public medical and surgical specialists in the past 12 months and frequency of use in the past four weeks.

Consultations with private and public general practitioners in the past 12 months and frequency of use in the past four weeks.

Consumption of any and selected prescribed and over-the-counter medications in the past two

Frequency of blood pressure measurement, blood testing for cholesterol and glucose measurement, and screening procedures (faecal occult blood test, mammography, and cervical

Self-reported unmet need for health care in the past 12 months due to waiting lists, distance/transport problems, family/work responsibilities, and financial reasons.

Participants were asked whether they were admitted to hospital as an inpatient, that is, required to stay overnight for a minimum of one night, and as a day patient, that is, admitted for treatment or other types of health care but not required to stay overnight, in the preceding year. The trend for inpatient hospitalisation remained stable, with less than 10% being admitted to hospital as an inpatient in the previous 12 months. On the contrary, the proportion of respondents admitted as a day patient increased steadily across survey iterations, from 8.3% in

Participants were asked about their most recent consultation with private and/or public medical and/or surgical specialists. Around one third of respondents reported consulting a specialist at least once in the preceding 12 months, and this proportion remained stable since 2002 (Figure 17). When looking at private and public specialists separately, respondents were more likely to have a private specialist consultation over a specialist consultation in the public sector.

Participants who consulted any type of specialist in the preceding 12 months were then asked about the number of visits over the previous four weeks. The mean and median number of

Participants were asked about their most recent consultation with private and/or public General Practitioners (GPs)/family doctors. Around 80% of respondents reported consulting a GP at least once in the preceding 12 months, and this proportion remained stable since 2008 (Figure 18). When looking at private and public GPs separately, respondents were more likely to have a private GP consultation over a GP consultation in the public sector.

Participants who consulted any type of GP in the preceding 12 months were then asked about the number of visits over the previous four weeks. The mean and median number of

Participants were asked about their most recent visit to a dental professional. In 2014/2015 and 2019/2020, over half of respondents reported visiting a dentist or orthodontist at least once in the previous 12 months. There was an increase in the proportion of persons visiting a dentist or orthodontist across the survey iterations (Figure 19).

Participants were asked about consultations with allied health professionals in the previous 12 months. The most visited allied health professional across all survey iterations was the physiotherapist, with 9-12% of participants reporting consulting a physiotherapist in the previous year. This was followed by podiatrist/podologist in the 2014/2015 and 2019/2020 surveys, dietician/nutritionist, and psychologist or psychotherapist. Less than 1% of the population consult occupational therapists and speech therapists, whilst visiting an acupuncturist has become slightly more common in recent years (Figure 20).

Note: Information on certain professions was not collected in all survey waves: podiatrist/podologist was not included in 2008, chiropractor/osteopath was not included in 2014/2015, and occupational therapist and speech therapist were not included in 2019/2020.

A selected list of home care services was provided, and participants were asked about the use of such services in the previous 12 months. The use of carer (non-nursing) services decreased over time, although it was the most commonly used service in 2008 and 2019/2020. Telecare was the most popular home care service in 2014/2015, although its use has diminished since then (Figure 21). It must be noted that this service was not included in the list of home care services provided to participants in the 2008 survey.

Participants were asked whether they provide care or assistance to one or more persons suffering from an age-related problem, chronic health condition, or infirmity, at least once a week, excluding care provided as part of their profession. In 2014/2015, 20.8% of respondents reported providing informal care at least once a week, which decreased to 14.8% in 2019/2020

Among those who provide informal care, over 80% provide assistance to members of their family (Figure 23). When considering the number of hours of care provided per week by those providing informal care, the majority (over 60%) reported providing less than 10 hours of care

Participants were asked about the use of prescribed and over-the-counter medications in the previous two weeks. The use of prescribed medications remained stable over the years, with 43.4% of respondents reporting use of prescribed medications in the previous two weeks in question included the use of contraception in 2008; however, this was excluded in subsequent surveys. Use of over-the-counter medicines, dietary supplements, herbal medicines, vitamins, and other supplements not prescribed or recommended by a doctor increased over time, with 26.8% of respondents reporting consuming these in the previous two weeks in 2008, which

Participants were provided with a list of prescribed medications and medicines and supplements not prescribed by a doctor and asked if they took any of these in the previous two weeks. The most common type of prescribed medication consumed was medication for high blood pressure. Among all participants, 13.6% reported taking medication for high blood pressure in the previous two weeks in 2002, which increased to 16.8% in 2008 and 20.1% in

When looking at over-the-counter medicines and supplements, pain medication was the most common type of over-the-counter medication that was consumed by participants in the

Participants were asked about their use of preventive and screening health interventions. When considering blood pressure measurement, approximately 10% of respondents reported never having had their blood pressure measured, although this proportion decreased to 5.9% in

When considering blood testing for cholesterol and glucose measurement, the proportion of respondents who had their blood cholesterol or glucose measured increased over time. Conversely, those who reported never having had their blood cholesterol or glucose checked decreased over time, with just over 15% reporting never having had their blood cholesterol or blood glucose measured in 2019/2020 (Figures 27 and 28).

Participants were asked to rate their satisfaction with a number of health care services, both private and public, on a five-point scale ranging from very satisfied to very dissatisfied. If participants had never used the service, they indicated as such. These participants were

Similar to hospital services, the majority of respondents reported being very/fairly satisfied when consulting medical or surgical specialists. 90.9% reported being satisfied with the services provided by private medical/surgical specialists in 2008, which increased to 93.6% of respondents in 2014/2015. 87.3% of respondents reported being satisfied with the services provided by government medical/surgical specialists in 2008, which increased to 89.6% in 2014/2015. In the 2019/2020 survey, participants who had visited a private or public medical or surgical specialist in the previous 12 months were asked to rate the quality of their most recent consultation on a five-point scale ranging from very good to very bad. 94.8% rated their most recent consultation with a private medical/surgical specialist as very good/good, whilst 90.8% rated their most recent consultation with a government medical/surgical specialist as very

Note: Results for the 2019/2020 survey in the above figure reflect the quality of the most recent consultation as opposed to the participants’ satisfaction with the services overall.

Satisfaction with general practitioner (GP) services was also reported to be high. For private GPs, 96.7% of respondents reported that they were very/fairly satisfied in 2008, which increased slightly to 97.7% in 2014/2015. For the public sector, 78.4% reported being very/fairly satisfied in 2008, which increased to 84.5% in 2014/2015. In the 2019/2020 survey, participants who had visited a private or public GP in the previous 12 months were asked to rate the quality of their most recent consultation on a five-point scale ranging from very good to very bad. 97.2% rated their most recent consultation with a private GP as very good/good, whilst 90.7% rated their most recent consultation with a government GP as very good/good (Figure 34).

Note: Results for the 2019/2020 survey in the above figure reflect the quality of the most recent consultation as opposed to the participants’ satisfaction with the services overall.

Similarly, satisfaction with dental services was also high. For private dental services, 95.0% and 95.8% reported being very/fairly satisfied in 2008 and 2014/2015 respectively. For government dental services, 78.1% reported being very/fairly satisfied in 2008, increasing to 84.0% in

Participants who needed health care in the previous 12 months were asked if they experienced any delay in receiving the health care they required due to specific reasons. 26.6% reported a delay in health care due to long waiting lists in 2014/2015, although this proportion decreased to 17.0% in 2019/2020. Around 4% of respondents reported delays in getting health care due to family- or work-related commitments in both survey iterations. Furthermore, less than 3% of respondents reported delays in health care due to distance or transport issues (Figure 36).

When referring to unmet need for health care due to financial reasons, around 5% of those who needed medical and dental care in the previous 12 months reported not being able to afford it in 2014/2015, although this proportion decreased in 2019/2020. Similarly, 3.4% reported not being able to afford prescribed medicines in 2014/2015, although this proportion decreased to 2.6%

Participants were asked whether they are covered by a private health insurance. The proportion of persons reporting private health insurance coverage increased from 21.3% in 2002 to 25.4%

In 2002 and 2008, the majority of respondents with private health insurance reported that the insurance is paid for by themselves, whereas in 2014/2015 and 2019/2020, the majority reported that the insurance is paid for by their employer (Figure 39). In the 2014/2015 and 2019/2020 surveys, participants could indicate other persons who paid for their insurance, with most replies being that they are covered through family members. These participants (around 5% of those who had private health insurance in 2014/2015 and around 10% in 2019/2020) were excluded from the analysis to enable comparison of the results across all survey iterations.

Across all survey years, over 60% of respondents with private health insurance reported coverage for outpatient consultations, while more than three quarters reported coverage for local hospital care. In contrast, less than 40% reported that their private health insurance covers hospital treatment abroad (Figure 40).

Participants who reported recently using specific health care services on their own behalf were asked if they paid out-of-pocket for these services. Out-of-pocket expenses refer to expenses related to health, including medicines, that are not reimbursed by an insurance agency.

Among those who made use of dental services in the previous 12 months and paid out of pocket, the average expenditure was of €149.75 (SD: 356.32) in 2014/2015, which increased to €238.09 (SD: 645.06) in 2019/2020. For private GP visits in the previous four weeks, the average out-of-pocket cost was of €27.13 (SD: 44.50) in 2014/2015, which increased to €36.51 (SD: 79.95) in 2019/2020. For private medical or surgical specialist visits in the previous four weeks, the average cost was of €84.97 (SD: 111.08) in 2014/2015, which increased to €119.51 (SD: 229.21) in 2019/2020. With respect to out-of-pocket spending on medicines prescribed by a doctor in the previous two weeks, the average cost was of €33.40 (SD: 52.24) in 2008, which

This section presents an overview of indicators related to health determinants and an analysis of trends over time. The following subsections are addressed:

Participants were asked to report their weight (in kilogrammes) and height (in centimetres). The weight and height values were used to calculate the body mass index (BMI) in kilogrammes per square metre (kg/m2). The World Health Organization (WHO) adult BMI classification was used to group these values into underweight (less than 18.5 kg/m2), normal (18.5-24.9kg/m2), pre- obese/overweight (25-29.9kg/m2) and obese (30kg/m2 or greater). The BMI among participants showed a gradual increase over time, from a mean BMI of 26.8kg/m2 (SD: 6.94) in 2002 to a

Overall, 40.0% had a BMI that was considered normal in 2002, although this decreased to 34.2% in 2019/2020 (Figure 41). The proportion being pre-obese or obese increased from 57.2%

Participants were asked about the time spent doing different types of physical activity in a typical week. They were asked about walking for at least 10 minutes continuously to get to and from places, for example to work, to school, or for shopping. In 2014/2015, around one in three (32.8%) reported walking for transport purposes on a daily basis in a typical week, although this

Participants were also asked about walking for at least 10 minutes continuously for fitness or recreation (leisure) in a typical week. The majority, amounting to just over half of respondents, reported no leisure walking. The proportion of persons who reported walking for fitness or recreational purposes every day or almost every day decreased between 2014/2015 and

Participants were asked about moderate physical activity for sports, fitness or recreational purposes, for at least 10 minutes continuously, in a typical week. Moderate activities are activities that make a person breathe somewhat harder than normal, such as cycling at a regular pace or tennis. The majority of respondents reported that they did not carry out such activities, although this proportion decreased from 82.1% in 2014/2015 to 73.9% in 2019/2020 (Figure 44). Conversely, the proportion who reported carrying out moderate physical activity on

Participants were asked about physical activities designed to strengthen muscles, such as resistance training, weight lifting, push-ups or sit-ups, in a typical week. The vast majority reported that they did not carry out such activities (92.0% in 2014/2015 and 83.9% in

Participants were asked about the frequency of fruit consumption (excluding fruit juices) and vegetable consumption (excluding potatoes and soup/juices) in a week. The proportion of respondents who reported eating fruit and vegetables daily decreased over time. Daily fruit

whilst daily vegetable consumption decreased from 50.6% in 2008 to 40.1% in 2014/2015 and 29.6% in 2019/2020 (Figure 47). It must be noted that the question was amended in the 2019/2020 survey to specify the exclusion of soup from vegetable consumption.

Participants were then asked about the frequency of consumption of chicken, rabbit, fish, meat, and meat products during the previous week. The majority reported consuming these food items on 1-2 days per week. Over one third of respondents reported never consuming fish, whilst around one in four reported never consuming meat products across survey iterations

Participants were asked about the frequency of consumption of sweets and sweet pastries. The majority reported consuming sweets and sweet pastries on 1-2 days in the previous week, except for 2002 whereby the majority reported never consuming sweets. Consumption of sweets and sweet pastries daily or almost daily increased over time (Figures 52 and 53).

When asked about consumption of soft drinks, most respondents reported never consuming regular (sugar-sweetened) or sugar-free soft drinks. The proportion of respondents who reported drinking regular soft drinks on a daily basis decreased from 14.3% in 2014/2015 to 12.4% in

When asked about their current smoking behaviour, around one in five respondents reported daily smoking, and this proportion remained stable across survey iterations. The proportion of persons who smoke occasionally varied, ranging from 2.8% in 2002 to 5.5% in 2008, 4.0% in 2014/2015 and 4.5% in 2019/2020. The vast majority reported not smoking at all (Figure 58). It must be noted that, in 2002, participants were asked specifically about smoking cigarettes, whereas in the subsequent surveys, this was not specified, and participants were then given a list of tobacco products to indicate which product they mostly consume. Nevertheless, the trends in smoking behaviour remained constant.

Participants who reported smoking only occasionally or not smoking at all were asked whether they ever smoked cigarettes, cigars, or pipes on a daily, or almost daily, basis in the past for a duration of at least one year. The proportion of respondents reporting past smoking decreased

With respect to exposure to tobacco smoke indoors, the majority of respondents reported that they are never or almost never exposed to tobacco smoke indoors. The most common place of exposure to tobacco smoke indoors is in public places, with 27.4% of respondents reporting

However, when it comes to exposure to tobacco smoke indoors for at least one hour daily, exposure at home is more prevalent than in public spaces or at the workplace (Figure 60).

In the statistics on exposure to tobacco smoke indoors, to allow comparability across survey iterations, the variable ‘Less than 1 hour per day’ included the following categories for 2019/2020: ‘Less than 1 hour per day’, ‘At least once a week, but not everyday’, and ‘Less than once a week’. For 2008 data, the variable ‘1 hour or more per day’ included two categories: ‘1-5 hours a day’ and ‘More than 5 hours a day’.

Participants were asked about the frequency of consumption of alcohol in the previous 12 months. In 2008, most respondents (36.2%) reported not drinking any alcohol. In the same year, 5.0% reported drinking alcohol daily or almost daily, while 15.7% reported consuming alcoholic drinks on a weekly basis, that is, on one or more days per week. In the following years, the pattern of alcohol consumption changed such that the proportion consuming alcohol on a daily

When interpreting these results, it must be noted that the question in the 2008 EHIS varied slightly, in that it also excluded those who initially reported consuming alcohol monthly or less than monthly. Those who consumed alcohol more than once a month and those who consumed alcohol on a weekly or daily basis were included.

In the 2014/2015 and 2019/2020 surveys, the answer categories were more numerous, such that the variable ‘weekly’ in the above figure includes ‘1-2 days a week’, ‘3-4 days a week’, and ‘5- 6 days a week’, whilst the variable ‘monthly’ includes ‘once a month’ and ‘2-3 days a month’.