HEALTH INTERVIEW SURVEY 2008 – SUMMARY STATISTICS
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HEALTH INTERVIEW SURVEY 2008 – SUMMARY STATISTICS
European Health Interview Survey 2008
Summary Statistics
Department of Health Information and Research Strategy and Sustainability Division Ministry for Social Policy
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HEALTH INTERVIEW SURVEY 2008 – SUMMARY STATISTICS
Foreword
Health is a top priority sector for this Government. This is because we believe that every Maltese citizen has a right to live as healthy a life as possible. When our health is threatened by illness or injury we seek to obtain the necessary healthcare that will assist us to return to a productive and fulfilling life.
Over the past decade our efforts were mainly concentrated on improving public hospital services. These efforts have borne fruit and further projects to continue to enhance health and long-term care services are in the pipeline. Malta presently has top ratings in healthy life expectancy in Europe (at around 10 years for both men and women aged 65). This statistic, which is hard to achieve and harder to maintain; is testimony to the investment that has taken place over the past years.
However, if we want to truly ensure that our high level of health is maintained and improved, focussing on health services alone is not enough and we need to implement a series of public health strategies that will strive to bring about healthy well-being for the Maltese population now and in the future.
Targeting our efforts to reach those in greatest need is essential for our strategies to be both successful and sustainable. We need to know who the population groups at greatest risk for ill health in Malta are. Often social aspects are associated with differences in the health of individuals. Health services need to identify these individuals to better communicate the need to adopt healthy lifestyles and provide support for everyone to make responsible choices that improve health.
Research initiatives such as the European Health Interview Survey provide an opportunity for Government to take a snapshot of the health of the nation, to compare this snapshot with other European countries and to establish trends over time. The best tools for the measurement of morbidity and associated risk factors in a population at community level are health surveys.
Government will be noting the results from the 2008 health survey and will be drawing heavily on these results in the planning of our health strategies for the next decade.
Hon. Dr. Joseph Cassar Parliamentary Secretary for Health
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HEALTH INTERVIEW SURVEY 2008 – SUMMARY STATISTICS
Preface
The European Health Interview Survey 2008 is the second such survey conducted in the Maltese islands by the Department of Health Information and Research. The first survey was carried out in 2002 with its Summary Statistics report published in 2003. This edition of the survey is the first one that is being launched in almost all the Member States of the European Union simultaneously in a standardised manner. The European Health Interview Survey is now a five-yearly commitment in all Member States of the European Union following the enactment of the Regulation (EC) No 1338/2008 of the European Parliament and of the Council of 16 December 2008 on Community statistics on public health and health and safety at work. As a result, in the coming years, not only will it be possible to compare results between Member States but also to compare trends over time.
This survey was conducted in a randomly selected sample of 5500 adults resident in Malta. A response rate of 72% was attained, which is one of the best response rates reported among Southern European countries. This is to the credit of the project team and the numerous Maltese companies who supported this initiative and provided incentive gifts for the respondents of the survey.
This report gives a broad overview of the whole survey and includes a summary of the main highlights from the survey findings. Four thematic reports are being prepared, covering the areas of health care resource utilisation, lifestyles, mental health and well-being and the elderly. These reports will all be available in the coming months. The questionnaire, which mostly contains standardised items that are used across European Union survey countries, had a number of sections covering socio-demographic characteristics, perceived health, morbidity, lifestyle, use of health care resources and expenditure on health, among others.
Around 80% of Maltese adults perceive themselves to be in good health. However an increasing proportion of the population reported having a long-standing illness or health problem when compared to 2002. The most commonly reported condition is high blood pressure (22%). This condition, in fact, tops the list in terms of medication requirements, followed by high blood cholesterol and diabetes. All three conditions are important risk factors for cardiovascular disease, the main cause of death in Malta. .
A clear picture of the pattern of health care service use among the Maltese has emerged, with the private sector dominating the market in family medicine whilst for specialist and hospital services patient activity takes place far more commonly in the public sector.
In terms of lifestyle, while obesity is still a public health issue that needs to be addressed with urgency one notes slight improvements from 2002 in obesity rates. A drop in daily smoking rates is also noted. Sexual lifestyles are also a cause of public health concern with a high percentage of persons having more than one sexual partner in the previous twelve months still reporting not using protection during sexual encounters.
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HEALTH INTERVIEW SURVEY 2008 – SUMMARY STATISTICS
This survey has been made possible through over €240,000 of European funding from various schemes, including Transition Facility Funds, EUROSTAT grants and the Public Health Programme. The remainder of the funds required have made available by the Ministry of Social Policy.
The use of health interview surveys to complement routine health statistics in the provision of information and research is important to prioritise evidence-based public health programmes and health strategies for the coming years. In this manner, we can continue with our endeavours to prevent disease and provide appropriate and effective health services for the whole population in a sustainable manner.
We augur that this overview will provide useful information to all those interested in the health and well being of the population as well as raising interest in the forthcoming thematic reports that are being derived from this survey.
Dr. Neville Calleja Dr. Natasha Azzopardi Muscat Director Director General Department of Health Information and Research Strategy and Sustainability Division
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HEALTH INTERVIEW SURVEY 2008 – SUMMARY STATISTICS
Acknowledgements
The Department of Health Information and Research wishes to take this opportunity to thank all survey respondents as well as Informa, the market research company which was contracted to conduct the fieldwork, for their contribution towards the success of this exercise.
Special thanks are also due to our colleagues at EUROSTAT who have supported this project with 3 direct grants amounting to €204,124.95 and a Multi-Beneficiary Grant under the Transitional Facility Funds 2004 of €36,180.10 to a total of €240,304.95 in EU funding. The Maltese HIS team is also indebted for technical support supplied through the Technical Group and Core Group on Health Interview Surveys, in particular, Mr. Lucian Agafitei (EUROSTAT), Ms. Marleen de Smedt (EUROSTAT) and Dr. Niels Rasmussen (DK), who had helped set out the roadmap for this project back in 2007.
Thanks also go to our sponsors for the support and gifts they have offered to aid in the success of this survey. These included:
Little People/Home Trends Mellieha Holiday Complex Digital Planet Europharma Medical Centre Calypso Hotel Michael & Guy Alf Mizzi & Sons JB Stores Vernon’s Zammit & Cachia Bristow A. Falzon Energy Projects AIRMALTA Cornucopia Hotel Kekoo Modi CAA Jokate The Plaza Hotel Chemimart Azzopardi Fisheries The Victoria Hotel Corinthia Group of Companies Unicare Petrolea Ltd Tip Top Ltd. GO Mobile Ramis St. Lucia Confectionary Klikk Eden Superbowl Merlin Library Cynergi Health & Fitness Club Topaz Hotel
Locally, DHIR is indebted to NSO, particularly to Mr. Silvan Zammit and Mr. Etienne Caruana for carrying out the sampling and, the Directorate-General Strategy and Sustainability, led by Dr. Natasha Azzopardi Muscat, and the Ministry of Social Policy for its continued support for this project.
Finally, this project would have not materialised without the unstinting efforts of the project team and several staff members who shouldered this survey over and above their normal routine duties. The list is endless but a special mention goes to a number of German students from the Schule für Medizinische Dokumentation in Ulm and the University of Bremen who have been attached to this project.
This report has been compiled by Ms. Mandy Borg and Dr. Antonella Sammut
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HEALTH INTERVIEW SURVEY 2008 – SUMMARY STATISTICS
Table of Contents
European Health Interview Survey (EHIS) ...... 10 Introduction ...... 10 Background ...... 10 Methodology ...... 10 Demography of the surveyed population ...... 11
Health Aspects ...... 13 Perceived health status ...... 13 Attitudes towards health ...... 13 Medication ...... 13
Health Care Service Use ...... 15 Hospital care ...... 15 Health care professionals ...... 15 Level of satisfaction ...... 15 Unmet need for health care ...... 15 Preventive care ...... 15
Disability ...... 17 Mobility ...... 17 Self care tasks ...... 17 Household activities ...... 17
Indirect Costs ...... 18 Accidents ...... 18 Absence from work ...... 18 Home ...... 18 Work ...... 18
Health Financing ...... 19 Health insurance ...... 19 Out-of-pocket payment ...... 19
Lifestyle ...... 20 Consumption of fruit and vegetables ...... 20 Body Mass Index ...... 20 Physical exercise ...... 20 Smoking ...... 20 Alcohol...... 20 Drugs ...... 21 Sexual activity ...... 21
Conclusion ...... 22
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HEALTH INTERVIEW SURVEY 2008 – SUMMARY STATISTICS
Contents - Figures Figure 1: Distribution of respondents by gender ...... 23 Figure 2: Legal marital status of respondents ...... 23 Figure 3: Level of education of respondents by gender ...... 24 Figure 4: Current labour status of respondents ...... 24 Figure 5: Sources of income of respondents ...... 25 Figure 6: Self perceived health ...... 25 Figure 7: Morbidity rates ...... 26 Figure 8: Rate of prescribed medication consumption by condition ...... 27 Figure 9: Rate of prescribed medication consumption by age ...... 27 Figure 10: Health professional consultation rates in a four week and twelve month period ...... 28 Figure 11: Visits to paramedics in the previous year ...... 28 Figure 12: Utilisation of community services in the previous year ...... 29 Figure 13: Reason for unmet need for healthcare ...... 29 Figure 14: Reason for unmet need for specialist care ...... 30 Figure 15: Rate of blood testing undertaken at least once ...... 30 Figure 16: Rate of screening undertaken at least once ...... 31 Figure 17: Reasons for undertaking a cervical smear test ...... 31 Figure 18: Reasons for undertaking a mammograph ...... 32 Figure 19: Accidents and care sought in the previous year ...... 32 Figure 20: Rate of absence from work due to injury or health problems ...... 33 Figure 21: Rate of exposure to pollution at home ...... 33 Figure 22: Rate of exposure to stressful situations at the workplace ...... 34 Figure 23: BMI and education ...... 35 Figure 24: Years as daily smokers ...... 35 Figure 25: Daily smokers by age ...... 36 Figure 26: Number of cigarettes smoked daily ...... 36 Figure 27: Rate of alcohol consumption over the past year ...... 37 Figure 28: Alcohol consumption over the past year by gender ...... 37 Figure 29: Rate of drug use within the past year ...... 38
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Contents - Tables Table 1: ISCO occupation by gender ...... 39 Table 2: Over the counter medication consumption by education ...... 39 Table 3: Public and private GP visits in the previous 4 weeks in those reporting at least one consultation ...... 39 Table 4: Public and private specialist visits in the previous 4 weeks in those reporting at least one consultation ...... 40 Table 5a: Satisfaction rates for private and public GP services ...... 40 Table 5b: Satisfaction rates for private and public specialist services ...... 40 Table 5c: Satisfaction rates for private and public hospitals ...... 40 Table 6: Rate of reported difficulty for activities of daily living related to mobility ...... 41 Table 7: Self-care tasks ...... 41 Table 8: Number of days absent from work due to injury or health problems ...... 41 Table 9: Number of days absent from work due to injury or health problems by gender ...... 42 Table 10: Source of health insurance funding ...... 42 Table 11: Out-of-pocket expenditure on dental care in the previous 4 weeks ...... 42 Table 12: Out-of-pocket expenditure on GP and specialist consultations in the previous 4 weeks ...... 43 Table 13: Out-of-pocket expenditure on medication in the previous 2 weeks ...... 43 Table 14: Fruit and vegetable consumption ...... 43 Table 15: BMI rates ...... 44 Table 16: BMI and gender ...... 44 Table 17: BMI and age ...... 44 Table 18: Vigorous exercise during the past 7 days ...... 45 Table 19: Amount of vigorous exercise (mins) performed in a week ...... 45 Table 20: Amount of vigorous exercise (mins) performed in a week by gender ...... 45 Table 21: Moderate exercise during the past 7 days ...... 45 Table 22: Amount of moderate exercise (mins) performed in a week ...... 46 Table 23: Amount of moderate exercise (mins) performed in a week by gender...... 46 Table 24: Smoking and gender ...... 46 Table 25: Exposure to smoking...... 46
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HEALTH INTERVIEW SURVEY 2008 – SUMMARY STATISTICS
European Health Interview Survey (EHIS)
Introduction increase in particulate matter is causing an increase in allergies among the inhabitants. The A Health interview Survey is a valid tool whereby demographics are also changing. The trend is a information on health related issues is reduction in birth rate and an increase in life systematically collected by means of interviews span. These two factors are leading to an ageing in a representative sample of the population. population. The Maltese are becoming a more Such epidemiological information on the health secular society and this brings about a change in status and the determinants of health in Malta lifestyles and practices. All these developments provides a unique opportunity from a public call for a revision and re-evaluation of the health health perspective to analyse the state of health status and the health needs of our population. of the population and also to provide information to policy makers to make evidence- Methodology based policy decisions on health prevention and health care services. The information provided The information for the survey was collected by through this survey provides an opportunity to means of internationally accepted participate in collaborative programmes questionnaires. Validated survey techniques coordinated by international organizations such were applied as recommended by international as EUROSTAT, World Health Organization and bodies including WHO (World Health others and also to identify health inequalities in Organisation) and EUROSTAT (Statistical Office Malta and highlight any problems particular to of European Communities). The questionnaires Malta. were then adapted to the local situation including those aspects of health which are Background more related to our population. Field testing on a random sample of 430 individuals was carried Although Malta is situated in the out in 2007. Mediterranean, the Maltese do not strictly follow a Mediterranean diet as the long British The European Health Interview Survey was rule has influenced our dietary habits. conducted between June and August 2008 on a Unfortunately our relaxed Mediterranean randomly selected sample of 5,500 individuals attitude and hot climate does not induce one to aged 15 years and over who were residing in the practice much sport. Although health promotion Maltese Islands. The sample was drawn from a together with an increase in sport facilities over population register provided by the National the islands have contributed to making us lead a Statistics Office and was stratified by age, more active lifestyle, much remains to be done gender and locality. Out of the total sample, 416 in order to overcome our ingrained habits. The individuals were excluded for the following primary health problems of the population are reasons; 44 were deceased, 82 were abroad and consistent with the Metabolic Syndrome i.e. 290 had the wrong contact address and could obesity, diabetes mellitus, not be traced. The actual number of participants hypercholesterolaemia and hypertension. was of 3,680 and the response rate was of 72%.
Malta is a densely populated island with a high Information for the survey was collected via two number of cars. This is contributing to more questionnaires. The first longer questionnaire motor vehicle accidents and pollution. The was completed during a face to face interview 10
HEALTH INTERVIEW SURVEY 2008 – SUMMARY STATISTICS
and the second, shorter questionnaire, Age was subdivided into 10-year containing more sensitive topics, was filled in by intervals with the youngest group being the interviewee. Both questionnaires were between 15 and 24 years and the oldest collected by the interviewer at the end of the age group being that of 75+. session. The interview was carried out at the convenience and the location of choice of the Education was categorized into four participant. groups namely primary, secondary, post-secondary and tertiary. The interviews and questionnaires were kept in Income was subdivided into quintiles complete confidence. Every effort was made to with the lowest income being ≤€579 and strike a balance between comprehensiveness the highest being ≥€1979. and length of questionnaire. The questionnaires were available in both the Maltese and English Demography of the surveyed language so each respondent could answer in population his/her preferred language. In order to ensure that the questions conveyed the same meaning The questionnaire was answered by 3,680 in both languages, the English questionnaire was individuals, of which 97.8% were answered by translated to Maltese and reviewed by public the selected individual and 2.1% were answered health experts to ensure that the concepts were by proxy through another member of the identical, as per EUROSTAT recommendations. household. There were more female The interviewers explained the objective of the respondents than male (Fig. 1) with nearly 95% survey to the participant and guardian (when of the participants being born in Malta. The the interviewee was below 18 years of age) and participants were nearly all EU Nationals. The the interview was carried out. majority of the respondents were married and one third of the respondents were single (Fig. 2). This publication contains the overall analysis of The level of education attained by the the 2008 European Health Interview Survey participants categorized by gender is shown in (EHIS) and is subdivided into the following figure 3. Any analysis performed by level of categories: education is confounded by age. The older age group tended to have a lower level of education, Health aspects had a higher morbidity and a lower household Health care service use income. These factors should be kept in mind Disability when performing the analysis of this survey. Indirect costs Health financing The current labour status of the survey Lifestyle participants is shown in figure 4. Nearly half of the participants were working for profit. The Only the completed questions were analysed. vast majority of those in the workforce were This survey explored the relationship between employees (84%) with the remainder being self- the socio-demographic characteristics of the employed. Amongst those presently employed population namely gender, age, level of as well as those who used to work for profit, the education and income with the various aspects highest percentage held an occupation within of health. These socio-demographic class 5 of the ISCO classification of employment, characteristics were categorised as follows: service workers and shop market sales workers, while the lowest percentage was within class 6,
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skilled agricultural and fishery workers. There Work was the main source of income for the was a significant difference between gender and respondents. A little over 40% of the employment type, with female employees interviewees received old-age or survivor’s predominating categories 2, 4, 5 and 8 (Table 1). pension (Fig. 5).
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HEALTH INTERVIEW SURVEY 2008 – SUMMARY STATISTICS
Health Aspects
Perceived health status was keeping in touch with family and friends and eating healthy food. The vast majority of the participants perceived their health to be either good or very good and Medication less than 3% reported that their health was either bad or very bad (Fig.6). Men and Prescribed medication had been taken by nearly individuals with a high level of education tend to half of the respondents in the previous two have a better perception of health. These weeks. The commonest medications prescribed findings were statistically significant. Older were antihypertensives and this correlates well individuals tend to have a worse attitude with morbidity rates since it was the commonest towards health and this correlation was also medical condition reported by the respondents. statistically significant. One third of the This was followed by lipid lowering drugs and respondents suffered from a longstanding illness treatment for diabetes (Fig. 8). and a quarter of the interviewees claimed to have been limited by a health problem in the Prescribed medication was more common previous 6 months. within the older age groups (Fig. 9). Less than one third of the respondents below 44 years of The commonest health condition that an age took prescribed medication. Above this age, individual had ever experienced was an increase of intake of prescribed medication hypertension closely followed by low back pain was noted with up to 78% of those in the 75+ and allergies (Fig. 7). With regards to mental age group making use of these medications. health, 7.8% of the respondents claimed to be Thus the over 75 age group consumes nearly anxious and 6.6% claimed to be depressed. three times the amount of those below 44 Nearly two thirds of the population described years. 10% of the respondents had been their feelings over the previous 4 weeks as “full prescribed antibiotics in the previous two of life, calm and peaceful”. weeks. A quarter of the participants had resorted to self medication. Attitudes towards health The most frequent complaint for which over- The vast majority of the respondents stated that the-counter medication was taken was their health would be better if they were headache or migraine. Respondents with a exposed to less pollution and less stress. higher degree of education showed an increased Information about their health was mainly tendency to take medication without obtained from the General Practitioner, health prescription (Table 2). centre and from the media. The factors which were mostly deemed to contribute to health
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78.3% of the participants perceived their health to be very good or good
22.1% of the respondents were hypertensive, 22.1% had suffered from low back pain, 20.3% had suffered an allergy
17.2% had been prescribed antihypertensives, 7.5% lipid lowering drugs and 6% treatment for diabetes
The 75+ age group consumes nearly three times as much medication as those below 44 years of age
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Health Care Service Use
Hospital care common paramedic visited by the participants in the previous year was the physiotherapist (Fig. Ten percent of the respondents had been 11). Alternative medical practitioners were admitted overnight to hospital in the previous visited by less than 1% of respondents. The twelve months and 12% had been admitted as community service availed of most frequently day patients. The average number of separate was home help (Fig. 12). stays in hospital as an inpatient during the previous year was two while the average Level of satisfaction number of stays was one. The average number of nights spent in hospital was while the median The interviewees were asked to give their level was 3. The median gives a more accurate of satisfaction with the health care services indication of the length of hospital stay. For day provided. In general satisfaction was higher for patient admissions, the average number of services in the private sector. The services given separate stays as a day patient was of two by specialists in both sectors attained nearly the admissions while the median was one. same level of satisfaction (Tables 5a – 5b).
Health care professionals Unmet need for healthcare
The health professional mostly frequented both Two percent of the respondents were advised in the previous year and in the previous 4 weeks hospitalisation by a doctor but ultimately did is the general practitioner (Fig. 10). The number not go ahead with hospitalisation. The main of participants who had visited a private GP in reason given was waiting lists (Fig. 13). Caution the previous 4 weeks was nearly three times should be exercised in the interpretation of this more than those visiting a public GP (Table 3). data since the numbers are small. Interestingly, there was a correlation between the number of consultations with both private Four percent of the interviewees had refused to and public GPs and income, with those in the consult a specialist although they had been lower income brackets having more frequent advised to do so. The main reasons attributed consultations to both. This correlation was more were waiting lists or because they adopted a significant for the use of public GP service. A wait and see approach (Fig. 14). One must keep relationship was observed between number of in mind that the number of respondents in this visits to the public GP and age, the older the age category was of only 148 individuals. group the more frequent the visits. Participants with a lower income, lower education level and Preventive care older age group tended to use the services of a public specialist in preference to that of private Sixty percent of the respondents had been specialist. This relationship was highly significant vaccinated against influenza at some point in (p<0.001) (Table 4). their lifetime. One third had been vaccinated either within the current year or during the More than a quarter of the interviewees had previous year. The vaccine was taken up mostly made use of a medical laboratory or attended a in October and November. This coincides with radiology clinic in the previous year. The most
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the health promotion campaign and is the had taken the test for a check up and other optimal time when the vaccine should be taken. reasons (Fig. 18).
Blood pressure is the commonest parameter For both mammographic and cervical smear ever checked by a health professional reported testing there was no correlation between those by respondents, followed by blood sugar and who had undertaken the test at least once, with blood cholesterol (Fig. 15). Among the female age, educational attainment or job category. For respondents, cervical smear test is the most faecal occult blood (FOB) testing, there was a frequent screening test undertaken (Fig. 16). highly significant correlation between those that Three quarters of female respondents having had taken the test at least once with age. The had a smear test did so for reasons of a check up respondents in the older age group were more and other reasons (Fig. 17). When asked the likely to take the test. As with the other reason why the participants had undergone screening tests there was no correlation mammography nearly 60% also said that they between the test and job category, education and for faecal occult blood test with gender.
10% had been admitted to hospital as inpatients 12% were admitted as day patients
The ratio of private to public GP visits was 3: 1
Level of satisfaction with private service surpassed that of public service
63.4% of females had undergone at least one cervical smear test during their lifetime
32.1 % of females had undergone at least one mammogram during their lifetime
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Disability
priority in enabling them to perform such Mobility activities. The type of help claimed not to be provided in adequate amounts was that of Over 90% of the respondents could walk a personal assistance. distance of 500 metres on a flat terrain without any help or assistance. The biggest limitation in mobility was experienced when bending and Household activities kneeling down without assistance. The least problems encountered were in fine hand When the participants were asked if they movements such as grasping or handling a small encountered any problems with activities such object (Table 6). as preparing meals, using the phone, shopping and others, the vast majority found no difficulty .The task which presented the greatest Self care tasks challenge was heavy house work. The main reason why the respondents could not carry out The most common difficulty encountered with such tasks was attributed to their state of these tasks was getting in and out of bed (Table health, their disability or because of old age. 7). Only a small number of respondents required Personal assistance for at least one activity was assistance and when asked if such support was the commonest source of support among those usually available, the respondents claimed that who answered this question. they considered housing adaptation a top
17.9% experienced some degree of difficulty to bend and kneel 4.5% experienced some difficulty to get out of bed or chair
90% of respondents could walk a distance of 500m on flat terrain with no assistance
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Indirect Costs
Accidents attributed their absenteeism from work in the previous year to health problems or injuries (Fig. The response to the question referring to 20). The majority took up to three days off work whether the participants had experienced an (Table 8). Males tended to take more days off accident which resulted in permanent injury or work than females (Table 9). defect in the previous 12 months was only completed by one fifth of the respondents. A Home minimal number had suffered an accident in the previous year which resulted in permanent The most common pollutant that individuals injury. The greatest number of accidents claimed to be exposed to while they were at occurred when either the individual was at home was air pollution (Fig. 21). Exposure to home or was engaged in leisure activities. Those crime, violence or vandalism while at home was experiencing an injury tended to visit the low with 86.2% of respondents reporting no emergency department rather than consulting a exposure. doctor or nurse (Fig. 19). Work Absence from work This set of questions relating to conditions Ten percent of respondents claimed that the encountered at the work place in the previous disease they suffered from during the previous year was only asked to respondents who were 12 months was either caused or made worse by working. The condition that the respondents their current job or any job they had done in the claimed to be mostly exposed to was time past. Nearly one third of the respondents pressure or overload of work (Fig. 22).
2.2% had an accident in the previous year which resulted in permanent injury
Injured persons tended to visit the emergency department rather than consulting a doctor or nurse
Most injuries happened while at home or during leisure activities
29% were absent from work in the past year due to injury or health problems
86.6% were absent from work in the past year due to injury or health problems for 3 days or less
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Health Financing
Health insurance Out-of-pocket payment for health care One fifth of the surveyed population claimed to services have health insurance. Nearly half of the people paid out of pocket for their health insurance Out of pocket payment for dental care on behalf policy (Table 10). Individuals with a higher of the participant during the previous 4 weeks is income and with a higher education were more depicted in table 11. Of those who consulted a likely to have health insurance. Also, males tend GP or specialist in the previous 4 weeks, over to have more insurance coverage than females, 40% had paid less than €20 (Table 12). Over one this finding was statistically significant. quarter of the respondents had spent less than However, when only the participants who were €20 out of pocket for medicines in the previous working for profit were considered, this 2 weeks (Table 13). difference in insurance coverage between genders did not reach significance.
21.5% had health insurance 47.2% self funded health insurance
28.2% had spent less than €20 on medicines in the previous 2 weeks
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Lifestyle
Consumption of fruit and vegetables (Table 21). Nearly half of these perform more than three hours of moderate exercise a week Nearly three quarters of the interviewees ate (Table 22). There is no gender difference in fruit once or twice a day; and this was also performance of moderate exercise (Table 23). similar for the reported consumption of vegetables or fruit and vegetable juices (Table Smoking 14). Smokers can be categorised into daily smokers Body Mass Index and social smokers. One fifth of the interviewees were smokers. One third of the The Body Mass Index (BMI) is used to indicate population had smoked daily or almost daily for whether an individual is over or underweight. In at least one year. Smokers showed preference adults a BMI of between 18.5 and 25 is towards manufactured cigarettes with the least advisable. A BMI of 25 to 30 is considered to be preferred being pipefuls of tobacco. The largest overweight and this leads to an increased risk of percentage of daily smokers has been smoking weight related problems such as high blood for 10 years or less (Fig. 24). The 45-54 age pressure, high blood cholesterol, heart disease group had the highest number of daily smokers and diabetes. A person with a BMI between 30 (Fig. 25). Daily smoking amongst males is more and 40 is considered to be obese and this frequent than amongst females with males presents a higher risk of weight related approximately two times more likely to smoke problems. More than one third of the daily. However, there are slightly more female respondents were overweight and over one fifth occasional smokers than male (Table 24). Sixty were obese (Table 15). An increase in BMI, when percent of daily smokers smoked less than a compared to the 2002 data, was observed in packet of cigarettes per day (Fig. 26). respondents with a lower education level Approximately a quarter of the respondents (Fig.23), males (Table 16) and participants claimed to be somewhat exposed to passive between the ages of 45 and 64 years (Table 17). smoking when either at home or in public places These correlations were highly significant (Table 25). (p<0.001). Alcohol Physical exercise The alcohol consumption questionnaire could The number of days on which the respondents differentiate between social drinkers, regular performed vigorous activity in the previous drinkers and those who binge drink. About one week is shown in table 18. The amount of time third of the participants did not drink alcohol in that the participants spent performing such the past 12 months while five percent drank activity is shown in table 19. Up to 180 minutes, alcohol on a daily basis (Fig.27). Saturday was females are more active than males; above this seen as the day with the largest amount of cut off males supersede their female alcohol consumption while a regular drinking counterparts. This finding was highly significant pattern was identified throughout the rest of (Table 20). The amount of respondents who the week. Nearly half of the female respondents perform moderate exercise is nearly twice as said they never drank alcohol in the past 12 much as those performing vigorous exercise months (Fig.28). 20
HEALTH INTERVIEW SURVEY 2008 – SUMMARY STATISTICS
Drugs Sexual activity
Only a minimal amount of the respondents Approximately 80% of respondents reported admitted to making use of illicit drugs or having sexual intercourse at least once in their tranquillizers without prescription. The most lifetime. More than half of these reported popular illicit drug was cannabis (Fig. 29). having had their first sexual experience before the age of twenty one. Sexual activity usually Those over 45 tend to use non-prescribed starts between the age of sixteen and twenty tranquillisers more. This practice was also more years. Nearly 74% of those who have reported common amongst females. The most frequent being sexually active had only 1 sexual partner users of all types of illicit drugs are under thirty in the previous year while 22% reported having four years of age. no partners in the previous year. Over 60% of those who were sexually active in the previous year never used any form of contraception while over 75% reported never using a condom.
36.3% of the respondents were overweight
22.3% of the respondents were obese 20.3% of respondents were smokers
The ratio of male to female daily smokers is nearly 2:1 In the past year 5% of respondents drank alcohol on a daily basis
1.9% had used illicit drugs in the previous year Nearly 74% of those sexually active had one sexual partner in the previous year
62% of those sexually active in the past year never used contraception.
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Conclusion
This cross sectional study provides an overview These issues provide a body of evidence to the of the lifestyle and attitudes that affect the policy maker in order to review the quality of health of the population. It provides information health care provided and to make it more about the demands on healthcare, the use of relevant to today’s needs. All these efforts the service but also the unmet needs. This study would make health care more equitable, gives an insight of the health perception of the efficient, cost effective and sustainable while interviewees and how they safeguard their well improving the quality of life of the population. being. It gives an indication of the quality of life of those who need support.
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Figures and Tables
male 46.60% 53.40% female
Figure 1: Distribution of respondents by gender
Divorced/Separated 3.8%
Widowed 5.5%
Married 58.7%
Single 32%
Figure 2: Legal marital status of respondents
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50% 45% 43.1% 44.1% 40% 35%
30% 26.8%
25% 21.6% 19.6% 20% 17.0% 15.7% 15% 12.2% 10% 5% 0% Primary Education Secondary Education Post -Secondary Tertiary Education Education
male female
Figure 3: Level of education of respondents by gender
Domestic work 26%
Permanently disabled 1%
Retirement / given up business 14%
Student 6%
Unemployed 5%
Working for pay 48%
Figure 4: Current labour status of respondents
24
HEALTH INTERVIEW SURVEY 2008 – SUMMARY STATISTICS
Income from work 76.4 Old-age and survivor benefits 40.4 Family/children benefits 30.0 Education allowances 10.3 Sickness and disability benefits 9.4 No source of income 8.2 Other benefits 6.7 Unemployment benefits 5.1 Housing allowances 1.4
0 10 20 30 40 50 60 70 80 90 %
Figure 5: Sources of income of respondents
60% 53.0% 50%
40%
30% 26.0%
19.0% 20%
10% 2.0% 1.0% 0% Very good Good Fair Bad Very bad
Figure 6: Self perceived health
25
HEALTH INTERVIEW SURVEY 2008 – SUMMARY STATISTICS
Hypertension 22% Low Back Disorder 20% Allergy 20% Osteo Arthritis 15% Migraine 14% Neck Disorder 11% Asthma 9% Diabetes Mellitus 8% Chronic Anxiety 8% Chronic Depression 6% Cataract 5% Stomach Ulcer 5% Cirrhosis of the Liver 5% Urinary Incontinence 4% Gynaecological Problems 4% Chronic Obstructive Pulmonary Disease 4% Permanent Injury 3% Rheumatoid Arthritis 3% Myocardial Infarction 3% Kidney Stones 3% Coronary heart disease 3% Osteoporosis 2% Prostate Problems 2% Cancer 2% Other Mental Problems 1% Stroke 1% Eating Disorders 0
0% 5% 10% 15% 20% 25%
Figure 7: Morbidity rates
26
HEALTH INTERVIEW SURVEY 2008 – SUMMARY STATISTICS
Hypertension 17.2% Cholesterol 7.5% Other pain 6.7% Diabetes 6.0% Depression 5.3% Neck pain 5.3% Headache or migraine 4.9% Joint pain 4.9% Cardiovascular disease 4.6% Tension or anxiety 4.5% Stomach problems 3.5% Allergy 3.4% Asthma 2.8% Osteoporosis 2.0% Cancer 0.4% Chronic obstructive pulmonary disease 0.3%
Figure 8: Rate of prescribed medication consumption by condition
75+ 78%
65 - 74 63%
55 - 64 56%
Age Group 45 - 54 43%
35 - 44 27%
25 - 34 32%
15 - 24 25%
Figure 9: Rate of prescribed medication consumption by age
27
HEALTH INTERVIEW SURVEY 2008 – SUMMARY STATISTICS
Rate of consultation, previous 4 weeks Rate of consultation, previous year
10% Medical/Surgical Specialist 39%
27% General Practitioner 78%
10% Dental/Orthodontic 43%
Figure 10: Health professional consultation rates in a four week and twelve month period
Medical laboratory, radiology centre 28.6%
Pysiotherapist / Kinesitherapist 9.2%
Other paramedics 3.9%
Nurse, midwife 2.9%
Dietician / Nutritionist 2.6%
Psychologist or psychotherapist 2.5%
Chiropractor, manual therapist 1.3%
Occupational therapist 0.6%
Speech therapist 0.2%
Figure 11: Visits to paramedics in the previous year
28
HEALTH INTERVIEW SURVEY 2008 – SUMMARY STATISTICS
Other home care services 1.1%
Transport service 1.1%
Meals on wheels service 0.2%
Home help for housework or for elderly 2.2%
Service provided by nurse or midwife 1.7%
Figure 12: Utilisation of community services in the previous year
30.0% 25.6% 25.0%
20.0% 18.6% 16.3% 15.0%
10.0% 4.7% 5.0%
0.0% Could not afford Waiting list Did not have the Fear to time because of work...
Figure 13: Reason for unmet need for healthcare
29
HEALTH INTERVIEW SURVEY 2008 – SUMMARY STATISTICS
25.0%
20.9% 20.3% 20.0% 18.9%
15.0% 13.5%
9.5% 10.0%
5.4% 5.0%
0.7% 0.7% 0.0% Could not Waiting list Did not Too far Wait and Did not Other Don't know afford have time see know good reason because of approach specialist work
Figure 14: Reason for unmet need for specialist care
88.6%
65.4% 60.7%
Blood Pressure Blood Cholesterol Blood Glucose
Figure 15: Rate of blood testing undertaken at least once
30
HEALTH INTERVIEW SURVEY 2008 – SUMMARY STATISTICS
63.4%
32.1%
5.0%
Cervical Smear test Mammogram Faecal Occult Blood
Figure 16: Rate of screening undertaken at least once
Other/checkup 76%
Other medical reason 4%
Invitation 1%
Because I visited a gynaecologist 15%
Because of symptoms 4%
0% 10% 20% 30% 40% 50% 60% 70% 80%
Figure 17: Reasons for undertaking a cervical smear test
31
HEALTH INTERVIEW SURVEY 2008 – SUMMARY STATISTICS
Other/check -up 59%
Invitation 4%
Breast cancer in my familiy 8%
Advice - without something wrong 14%
Visit - something not quite right 15%
0% 10% 20% 30% 40% 50% 60% 70%
Figure 18: Reasons for undertaking a mammograph
Visited doctor or nurse(%) Visited emergency department (%)
25% 21% 20% 17% 17%
15% 13% 10% 10% 7% 6% 5% 2%
0% Road Traffic Work School Home & Leisure activities
Figure 19: Accidents and care sought in the previous year
32
HEALTH INTE RVIEW SURVEY 2008 – SUMMARY STATISTICS
Figure 20: Rate of a bsence from work due to injury or health problems
Noise Air Pollution Bad Smells
80 69.2 70 60 56.5 50 40 35.4 33.3 31.5 30.9 30 21.5 20.3 20 9.6 10 0 Severly exposed(%) Somewhat exposed(%) Not exposed(%)
Figure 21: Rate of exposure to pollution at home
33
HEALTH INTERVIEW SURVEY 2008 – SUMMARY STATISTICS
Accident Risk
Difficult of work postures/movement
Noise
Chemicals
Time Pressure
Violence
Discrimination
Harrassment/Bullying
0 10 20 30 40 50 60 70 80 90 100
Not exposed(%) Somewhat exposed(%) Severly exposed(%)
Figure 22: Rate of exposure to stressful situations at the workplace
34
HEALTH INTERVIEW SURVEY 2008 – SUMMARY STATISTICS
Primary Education Secondary education Post -Secondary education Tertiary education 50.0%
45.0%
40.0%
35.0%
30.0%
25.0%
20.0%
15.0%
10.0%
5.0%
.0% <=18.00 18.01 - 20.00 20.01 - 25.00 25.01 - 30.00 >=30.01 BMI Category
Figure 23: BMI and education
61 - 70 0.8
51 - 60 1.9
41 - 50 4.8
31 - 40 10.3 Years 21 - 30 15.0
11 - 20 21.8
<=10 45.2
0.0 10.0 20.0 30.0 40.0 50.0 %
Figure 24: Years as daily smokers
35
HEALTH INTERVIEW SURVEY 2008 – SUMMARY STATISTICS
30.0 26.8 25.3 24.1 25.0 19.3 20.0 18.2
% 15.0 13.1
10.0 6.2 5.0
0.0 15 - 24 25 - 34 35 - 44 45 - 54 55 - 64 65 - 74 75+ Age
Figure 25: Daily smokers by age
50.0 47% 45.0
40.0
35.0 28.8% 30.0
% 25.0
20.0
15.0 12.9% 10.0 5.1% 4.7% 5.0 0.3% 0.8% 0.1% 0.3% .0 <= 10 11 - 18 19 - 26 27 - 34 35 - 42 43 - 50 59 - 66 67 - 74 75+ Number of Cigarettes
Figure 26: Number of cigarettes smoked daily
36
HEALTH INTERVIEW SURVEY 2008 – SUMMARY STATISTICS
Everyday 5%
4-6 times a week 5%
2-3 times a week 10%
2-4 times a month 21%
Monthly or less 22%
Never 36%
0% 10% 20% 30% 40%
Figure 27: Rate of alcohol consumption over the past year
50.0% 46.3% 45.0% 40.0% 35.0% 30.0% 25.1% 24.0% 24.2% 25.0% 19.9% 20.0% 17.8% male 14.6% 15.0% female 10.0% 7.8% 8.4% 6.5% 5.4% 5.0% 2.7% 0.0% Never Monthly or 2-4 times a 2-3 times a 4-6 times a Everyday less month week week Frequency of alcohol consumption
Figure 28: Alcohol consumption over the past year by gender
37
HEALTH INTERVIEW SURVEY 2008 – SUMMARY STATISTICS
Others 0.2
Cocaine 0.4
Ecstasy 0.2
Cannabis 1.1
Tranquilisers not prescribed 0.5
Tranquilisers prescribed 4.1
0 1 2 3 4 5 %
Figure 29: Rate of drug use within the past year
38
HEALTH INTERVIEW SURVEY 2008 – SUMMARY STATISTICS
Table 1: ISCO occupation by gender GENDER Male Female ISCO Occupation Total
Category Count % Count % Armed Forces 24 1.6% 1 .1% 25 .9% Legislators, Senior 192 12.6% 73 5.3% 265 9.1% Officials and Managers Professiona ls 184 12.1% 223 16.2% 407 14.0% Technicians and 101 6.6% 56 4.1% 157 5.4% Associate Professionals Clerks 118 7.8% 245 17.8% 363 12.5% Service Workers and Shop and Market Sales 223 14.7% 299 21.7% 522 18.0% Workers Skilled Agricultural and 30 2.0% 10 .7% 40 1.4% Fishery Workers Craft and Related Trade 258 17.0% 36 2.6% 294 10.1% Workers Plant and Machine Operators and 146 9.6% 227 16.4% 373 12.9% Assemblers Elementary Occupations 246 16.2% 210 15.2% 456 15.7% Total 1522 100% 1380 100% 2902 100%
Table 2: Over the counter medication consumption by education
Primary Secondary Post-Secondary Tertiary Count % Count % Count % Count %
Yes 210 24.8% 403 25.6% 190 27.7% 166 33.3% No 637 75.1% 1170 74.4% 497 72.3% 332 66.7% Total 848 100.0% 1573 100.0% 687 100.0% 498 100.0%
Table 3: Public and private GP visits in the previous 4 weeks in those reporting at least one consultation Number of Private GP Public GP Visits Count % Count % 1 677 80.9 264 82.3 2 100 11.9 36 11.0 3 34 4.1 10 3.0 >=4 26 3.1 12 3.7 Total 837 100 322 100
39
HEALTH INTERVIEW SURVEY 2008 – SUMMARY STATISTICS
Table 4: Public and private specialist visits in the previous 4 weeks in those reporting at least one consultation Number of Private Specialist Public Specialist Visits Count % Count % 1 199 84.6 157 82 .6 2 23 10.0 20 10.5 3 4 1.7 4 2.6 >4 8 3.8 8 4.2 Total 234 100 189 100
Table 5a: Satisfaction rates for private and public GP services Private GP Public GP Count % Count %
Satisfied 3121 96% 1318 78.3% Undecided 98 3% 277 16.5% Dissatisfied 11 0.3% 88 5.2% Total 3230 100% 1683 100
Table 5b: Satisfaction rates for private and public specialist services Private Specialist Public Specialist Count % Count %
Satisfied 1775 91.1% 1431 87.1% Undecided 132 6.8% 154 9.4% Dissatisfied 41 2.1% 58 3.5% Total 1948 100% 1643 100%
Table 5c: Satisfaction rates for private and public hospitals Private Hospital Public Hospital Count % Count %
Satisfied 1286 86.8% 2092 74.1 % Undecided 163 11.0% 469 16.6% Dissatisfied 32 2.2 % 264 9.3 % Total 1481 100% 2825 100%
40
HEALTH INTERVIEW SURVEY 2008 – SUMMARY STATISTICS
Table 6: Rate of reported difficulty for activities of daily living related to mobility
Walking Walking up Getting in Bending Carrying a Fine hand 500m of and down & out of and bag of 5 movements flat terrain the stairs bed or a kneeling kilos for at chair down least 10 metres No difficulty (%) 91.1 88.1 95.3 82 87.3 97 Some difficulty (%) 4.4 6.9 3.3 8.7 6.1 1.7 A lot of difficulty (%) 2.6 2.8 0.7 4.7 2.7 0.8 Completely unable to fulfil task (%) 1.9 2.2 0.4 4.5 3.6 0.5
Table 7: Self-care tasks Feeding Getting in Dressing/ Using Bathing/ and out of undressing toilets showering bed/chair No difficulty (%) 97.9 95.6 96.5 97.7 96.4 Yes some difficulty 1.5 3.4 2.4 1.5 2.3 (%) Yes a lot of difficult y .4 .7 .4 .4 .5 (%) I can’t achieve it by .2 .4 .6 .5 .8 myself (%)
Table 8: Number of days absent from work due to injury or health problems
Number of days Count % ≤ 3 3186 86.6 4 - 6 83 2.3 7 - 9 94 2.6 10 - 12 43 1.2
13 - 15 53 1.4 16 - 18 28 .8 19 - 21 31 .8 22 - 24 10 .3 25 - 27 93 2.5 28 - 30 16 .4 31+ 43 1.2 Total 3680 100.0
41
HEALTH INTERVIEW SURVEY 2008 – SUMMARY STATISTICS
Table 9: Number of days absent from work due to injury or health problems by gender
Number of Male Female days Count % Count % ≤3 896 84.3% 542 80.3% 4 - 6 60 5.6% 61 9.0% 7 - 9 25 2.4% 15 2.2% 10 - 12 13 1.2% 18 2.7% 13 - 15 25 2.4% 12 1.8% 16 - 18 1 .1% 2 .3% 19 - 21 8 .8% 4 .6% 22 - 24 0 .0% 3 .4% 25 - 27 0 .0% 1 .1% 28 - 30 11 1.0% 3 .4% 31+ 24 2.3% 14 2.1% Total 1063 100.0% 675 100.0%
Table 10: Source of health insurance funding Frequency % Self 385 47.2 Employer 268 32.9 Both 122 15
Don’t know / Not applicable 40 4.9 Total 815 100
Table 11: Out-of-pocket expenditure on dental care in the previous 4 weeks Euros ( €) Count % 1-10 15 6.2 11 -20 32 13.2 21 -30 48 19.8 31 -50 51 21.0 51 -100 50 20.6 >100 47 19.3 Total 243 100
42
HEALTH INTERVIEW SURVEY 2008 – SUMMARY STATISTICS
Table 12: Out-of-pocket expenditure on GP and specialist consultations in the previous 4 weeks Euros (€) Count % 1-10 247 36.2 11-20 152 22.3 21 -30 63 9.2 31 -50 105 15.4 51 -100 76 11.1 >100 39 5.7 Total 682 100
Table 13: Out-of-pocket expenditure on medication in the previous 2 weeks
Euros (€) Count % 1-10 196 24.3 11 -20 227 28.2 21 -30 129 16.0 31 - 50 146 18.1
51 - 10 0 72 8.9 >100 36 4.5
Total 806 100
Table 14: Fruit and vegetable consumption Vegetables / Fruit drinks / Fruits Salads Vegetable juices Twice or more a day (%) 44.3 19 5.7 Once a day (%) 29.6 31.5 16 >once a day at least 4 a week (%) 10 .6 20.7 7.5 >4 a week but at least once a week (%) 9.6 20.6 12.3 >once a week (%) 3 5 15 Never (%) 2.8 3 43.3
43
HEALTH INTERVIEW SURVEY 2008 – SUMMARY STATISTICS
Table 15: BMI rates Count % ≤18.00 49 1.7 18.01 - 20.00 160 5.5 20.01 - 25.00 988 34.2 25.01 - 30.00 1048 36.3 ≥30.01 644 22.3 Total 2889 100
Table 16: BMI and gender Gender Male Female Total 10 39 49 ≤18.00 .7% 2.6% 1.7% 33 127 160 18.01 - 20.00 2.4% 8.4% 5.6 % 385 602 987 20.01 - 25.00 28.0% 40.0% 34.2% 615 427 1042 25.01 - 30.00 44.7% 28.4% 36.2% 334 310 644 ≥30.01 24.3% 20.6% 22.3% 1377 1505 2882 Total 100.0% 100.0% 100.0%
Table 17: BMI and age BMI ≤18.00 18.01 - 20.00 20.01 - 25.00 25.01 - 30.00 ≥30.01 15 - 24 57.4% 38.8% 23.4% 10.3% 5.9% 25 - 34 18.4% 25.6% 17.7% 12.8% 15.3% 35 - 44 8.2% 8.1% 16.2% 14.8% 12.8% 45 - 54 2.0% 6.3% 17.1% 23.2% 20.7% 55 - 64 10.2% 8.8% 13.4% 20.8% 24.3% 65 - 74 0% 6.3% 7.0% 11.4% 13.8% 75+ 4.1% 6.3% 5.3% 6.7% 7.2%
44
HEALTH INTERVIEW SURVEY 2008 – SUMMARY STATISTICS
Table 18: Vigorous exercise during the past 7 days
Male Female Time (mins) Count % Count % 10 -60 57 13.7 52 18.2 61 -120 63 15.1 57 20 121 -180 50 12 56 19.6 >180 246 59.1 120 42.1 Total 416 100 285 100
Table 19: Amount of vigorous exercise (mins) performed in a week Time (mins) Count % 10 - 60 109 15.4 61 - 120 121 17.2 121 - 180 107 15.2 181+ 367 52.1 Total 704 100
Table 20: Amount of vigorous exercise (mins) performed in a week by gender Days Count % 1-2 230 31.8 3-4 201 27.8
5-6 139 19.2 7 153 21.2 Total 723 100.0
Table 21: Moderate exercise during the past 7 days Days Count % 1-2 412 35.3 3-4 281 24.1 5-6 213 18.3 7 260 22.3 Total 1166 100
45
HEALTH INTERVIEW SURVEY 2008 – SUMMARY STATISTICS
Table 22: Amount of moderate exercise (mins) performed in a week Time (mins) Count % 10 9 0.8 11 -60 225 19.5 60 -120 219 19 121 -180 166 14.4 >180 536 46.4 Total 1155 100
Table 23: Amount of moderate exercise (mins) performed in a week by gender Time (mins) Male Female
Count % Count % 10 3 0.5 6 1 11 -60 109 18.8 116 20.2 60 -120 107 18.5 112 19.5 121 -180 77 13.3 89 15.5 >180 283 48.9 252 43.8 Total 579 100 575 100
Table 24: Smoking and gender Male Female Total Yes daily Count 435 310 745 % 25.6 15.8 20.4 Yes occasionally Count 92 108 200 % 5.41 5.52 5.47 Not at all Count 1175 1539 2714 % 69.0 78.6 74.2 Total Count 1702 1957 3659 % 100 100 100
Table 25: Exposure to smoking Exposure to Exposure to tobacco Exposure to tobacco tobacco smoke at smoke in public smoke at the workplace home places/indoors (for those currently employed) Never/almost never (%) 75.8 71.3 72.0 <1hour/day (%) 10.5 19.1 13.6 1-5 hours a day (%) 8.9 6.1 8.2 >5hours a day (%) 3.5 1.5 3.7
46
HEALTH INTERVIEW SURVEY 2008 – SUMMARY STATISTICS
47