Health Survey for England, 2022 Part 2

This report examines the general and mental health of adults aged 16 and over, as well as prevalence of diabetes, raised cholesterol, and hypertension. These aspects of health are covered in the government’s Major Conditions Strategy, which focuses on six groups of major health conditions that affect mortality and morbidity in England.

Detailed tables accompanying this report can be accessed here.

• In 2022, 41% of adults had at least one longstanding illness or condition.
• Women (21%) were more likely than men (16%) to have a GHQ score of 4 or more, indicative of probable psychological disturbance or mental ill health.
• Total diabetes, including doctor-diagnosed and undiagnosed diabetes, was higher among adults living in the most deprived areas (17%) compared with the least deprived areas (7%).
• The proportion of adults with raised cholesterol was 53%, and this was greater among women (56%) than men (49%).
• The proportion of adults with untreated hypertension was 13%, and increased with age, from 3% among those aged 16 to 34 to 21% among those aged 75 and over.

Self-assessed general health is an important indicator of the general health of the population. It is a valid measure for predicting future health outcomes and can be used to project use of health services and provide information useful for policy development. In older people, self-assessed poor overall health has been associated with increased mortality risk (Mossey and Shapiro, 1982) and functional decline (Idler and Kasi, 1995)

Participants were asked ‘How is your health in general?’ and offered five response options: very good, good, fair, bad, very bad. The responses to this question are described as self-reported general health.

In 2022, 75% of adults reported good or very good general health. 18% said their health was fair and 7% reported bad or very bad health.

A higher proportion of women (8%) than men (6%) reported bad or very bad general health.

For more information: Table 1

Between 1993 and 2022, the proportion reporting very good or good general health varied between 74% and 78% among men and between 73% and 76% among women with no clear pattern.

The prevalence of very bad or bad general health among adults remained steady at 5% between 1993 and 1995. From 1996 to 2022, this proportion varied between 6% and 8%.

Note that 2021 data are not directly comparable with other years due to changes in survey methodology and response rates.

Acute sickness is defined as any illness or injury (including any longstanding condition) that has caused the participant to cut down on things they usually do in the last two weeks.

16% of adults reported that they were affected by acute sickness in the last two weeks. The prevalence of acute sickness was higher among women (19%) than men (13%).

Over the period 1993 to 2022, the prevalence of acute sickness was consistently higher in women than in men. Acute sickness varied between 12% and 16% of men and between 14% and 19% of women.

Note that 2021 data are not directly comparable with other years due to changes in survey methodology and response rates.

For more information: Table 1

Longstanding conditions affect the body or mind for 12 months or more. Most longstanding conditions increase in prevalence with age (Moody, 2019), and vary in their effects on individuals, from minimal impact to disability. Most longstanding conditions are managed in the community, but some require inpatient stays, or domiciliary or residential care. Some of the longstanding conditions treated by GPs are monitored through the Quality Outcomes Framework (QOF) for prevalence and achievement of treatment targets.

The questions on longstanding illness are included in the main interview. Prior to 2012, the question referred to ‘an illness, disability or infirmity…that has troubled you over a period of time or that is likely to affect you over a period of time’. In 2012, the questions on longstanding illness were changed to be consistent with the Office for National Statistics (ONS) harmonised disability questions designed for use in social surveys (HSE 2012). Participants were asked this question: ‘Do you have any physical or mental health conditions or illnesses lasting or expected to last 12 months or more?’

Participants who reported that they had a physical or mental health condition or illness lasting or expected to last 12 months or more were further asked ‘What is the matter with you?’, and their answers for up to six conditions were recorded verbatim. These were coded into 42 conditions, which were further grouped into the 14-chapter categories of the ICD-10, covering infectious and non-communicable diseases of the body and mind.

In 2022, 41% of adults aged 16 and over had at least one longstanding illness or condition. Participants could record up to six conditions and so the overall prevalence of having any longstanding condition is lower than the combined prevalence of individual conditions.

The most common conditions were:

• conditions of the musculoskeletal system (14%)
• mental, behavioural and neurodevelopmental conditions (11%)
• conditions of the heart and circulatory system (9%)
• diabetes and other endocrine and metabolic conditions (8%)
• conditions of the respiratory system (7%)
• conditions of the digestive system (5%)

Other types of longstanding conditions had prevalence levels below 5%, and for infectious diseases below 0.5%.

Women were more likely than men to have one or more longstanding conditions (43% compared with 39%).

Among the most common conditions, women were more likely than men to have:

• musculoskeletal conditions (15% compared with 13%)
• mental, behavioural and neurodevelopmental conditions (12% compared with 10%)
• conditions of the digestive system (5% compared with 4%)

Heart and circulatory conditions were more commonly reported by men than women (11% compared with 8%).

For more information: Table 2

The current question wording for longstanding illness was introduced in 2012, and as such trends prior to 2012 are not discussed. Note that 2021 data are not directly comparable with other years due to changes in survey methodology and response rates.

Since 2012, there has been a gradual increase in the prevalence of longstanding illness among men, from 35% in 2012 to 40% in 2016. Since 2016 it has fluctuated between 39% and 41%. Among women, prevalence was stable between 2012 and 2015 when it started to increase, ranging from 41% in 2015 to 45% in 2019. Prevalence of longstanding illness was 39% among men and 43% among women in 2022.

For more information: Table 1

Mental well-being is a fundamental indicator of overall quality of life, encompassing positive emotions, ability to carry out meaningful activities, cope with life stresses, and overall life satisfaction, and is integral to mental health (Source: World Health Organization). A complex relationship exists between well-being and mental health with mental health existing on a continuum, being more than the absence of mental disorders. In the UK, and worldwide mental health conditions including disorders persist as a major health concern, contributing to disability and reducing life expectancy (Source: Gov.uk).

The 12-item General Health Questionnaire (GHQ-12) is a widely used and validated measure of mental health. It is a screening instrument for general, non-psychotic psychiatric morbidity and should not be used to diagnose specific psychiatric problems. The GHQ-12 concentrates on the broader components of psychological morbidity (ill health) as compared with the original 60-item longer form. It consists of 12 items measuring such characteristics as general levels of happiness, depression, anxiety, sleep disturbance and self-confidence.

Adults were asked the GHQ-12 as part of the self-completion questionnaire. Each item is rated on a four-point scale, and standard scoring was based on the presence and severity of symptoms scored in the following way: 0 if ’not at all present’ or present ‘no more than usual’, or 1 for symptoms that were present ‘rather more than usual’ or ‘much more than usual’. No formal threshold exists for identifying probable mental ill health. Consistent with previous HSE surveys, participants’ scores are grouped according to three categories:

• 0 (indicating no evidence of probable mental ill health)
• 1 to 3 (indicating less than optimal mental health)
• 4 or more (indicating probable psychological disturbance or mental ill health)

In 2022, 19% of adults had a GHQ-12 score of 4 or more (probable psychological disturbance or mental ill health). 56% had a score of 0 (indicating no evidence of probable mental ill health).

Women were more likely than men to report a GHQ-12 score of 4 or more, 21% of women compared with 16% of men. Among women, prevalence of a GHQ-12 score of 4 or more was highest for young women aged 16 to 24 (28%). It was lowest among women aged 75 and over (15%). Among men, the prevalence of a GHQ-12 score of 4 or more was highest among men aged 35 to 54 (18% to 19%), and lowest among men aged 65 to 74 (9%).

For more information: Table 3

The English Index of Multiple Deprivation (IMD) is a measure of area deprivation, based on 37 indicators, across seven domains of deprivation. IMD is a measure of the overall deprivation experienced by people living in a neighbourhood, although not everyone who lives in a deprived neighbourhood will be deprived themselves. To enable comparisons, areas are classified into quintiles (fifths). For further information about the IMD, see the HSE 2022 Methods.

GHQ-12 scores varied by area deprivation. Adults living in the most deprived areas were more likely to have higher GHQ-12 scores indicative of worse mental health. 25% of adults living in the most deprived areas had a GHQ-12 score of 4 or higher, compared with 17% in the least deprived areas.

For more information: Table 4

Diabetes is characterised by high blood glucose levels (hyperglycaemia).

Untreated, hyperglycaemia is associated with damage and possible failure of many organs, especially the eyes, kidneys, nerves, heart, and blood vessels. Diabetes substantially increases the risk of cardiovascular disease (CVD) and tends to worsen the effect of other risk factors for CVD, such as abnormal levels of blood fats, raised blood pressure, smoking and obesity (Gacia et al, 1974). Diabetes mellitus (both Types 1 and 2) is a leading cause of avoidable mortality. (Source: World Health Organization)

Methods

The HSE measures diabetes in two ways. The prevalence of self-reported doctor-diagnosed diabetes is included in the main interview.

In addition to the interview question, glycated haemoglobin (HbA1c) levels are measured in blood samples collected at the health visit. HbA1c reflects average blood sugar levels over the previous two to three months and can therefore be used both to monitor diabetic control in people with diagnosed diabetes, and to detect undiagnosed diabetes (Source: World Health Organization).

Definitions

The presence of doctor-diagnosed diabetes is identified if a participant answers yes to two questions:

• Do you now have, or have you ever had, diabetes?
• Were you told by a doctor that you had diabetes?

This topic report does not distinguish between Type 1 and Type 2 diabetes.

Total diabetes in the population includes all participants who reported having doctor-diagnosed diabetes, as well as those with a blood sample measured as having an HbA1c level of 48mmol/mol or above, diagnostic of diabetes. Participants with a raised HbA1c who did not report having doctor-diagnosed diabetes are defined as having undiagnosed diabetes.

Further details of the protocols for collecting measurements and blood samples can be found in the HSE 2022 Methods report.

In 2022, 7% of adults reported that a doctor had told them that they had diabetes.

The prevalence of doctor-diagnosed diabetes was higher among men (8%) than women (6%). Prevalence increased with age, from 1% of adults aged 16 to 34 to 17% of adults aged 75 and over.

For more information: Table 5

Estimates of the prevalence of total diabetes, using glycated haemoglobin levels, are limited to participants with a health visit and a valid HbA1c measurement.

Consequently, the estimates of those with doctor-diagnosed diabetes in Tables 6 to 8, which are limited to only those with a blood sample, vary slightly from those in Table 5, which shows the definitive estimates.

The prevalence of total diabetes was 10%, comprised of 6% of adults with doctor-diagnosed diabetes and a further 5% with undiagnosed diabetes.

For more information: Tables 6 and 7

The prevalence of total diabetes increased with age, from 1% of adults aged 16 to 34 to 25% of adults aged 75 and over. The prevalence of total diabetes was higher among men (11%) than women (9%), particularly in the younger age groups (2% of men aged 16 to 34 and 7% of men aged 35 to 44 compared with no women aged 16 to 34 and 2% of women aged 35 to 44).

The prevalence of undiagnosed diabetes also increased with age rising to 11% among adults aged 75 and over.

For more information: Table 7

For information about diabetes and overweight and obesity see the HSE 2022 topic report.

The English Index of Multiple Deprivation (IMD) is a measure of area deprivation, based on 37 indicators, across seven domains of deprivation. IMD is a measure of the overall deprivation experienced by people living in a neighbourhood, although not everyone who lives in a deprived neighbourhood will be deprived themselves. To enable comparisons, areas are classified into quintiles (fifths). For further information about the IMD, see the HSE 2022 Methods.

The age-standardised prevalence of total diabetes varied by area deprivation. 17% of adults living in the most deprived areas had total diabetes compared with 7% living in the least deprived areas.

For more information: Table 8

The proportion of adults with doctor-diagnosed diabetes increased between 1994 and 2009, from 3% to 7% among men and from 2% to 5% among women. Between 2010 and 2022, the proportion varied between 6% and 9% of men and 5% and 6% of women.

Note that 2021 data are not directly comparable with other years due to changes in survey methodology and response rates.  

For more information: Table 5

Levels of total diabetes, as identified through HbA1c levels, have varied from 2011 to 2022 between 9% and 11% among men, and between 6% and 9% among women, with no clear pattern.

The prevalence of undiagnosed diabetes has been consistent at 2% between 2011 and 2018, from 2019 to 2022 the prevalence has fluctuated between 3% to 5%.

For more information: Table 6

Cholesterol is a fatty substance (also referred to as a lipid) found in the blood and is needed by the body to function. There are different types of cholesterol including LDL (low density lipoprotein) cholesterol, VLDL (very low-density lipoprotein) cholesterol, and HDL (high density lipoprotein) cholesterol.

HDL cholesterol is beneficial, as it carries cholesterol away from the arteries back to the liver, where it can be excreted. Too much non-HDL cholesterol is harmful as it can clog blood vessels, causing them to become stiff and narrow, reducing blood flow. High cholesterol is a significant risk factor for CVD, including narrowing of the arteries (atherosclerosis), heart attack (Peters et al, 2016) and stroke (Law, Wald and Rudnicka, 2003).

Methods

In the HSE, cholesterol levels are measured via blood samples taken at the health visit.

Full details of the HSE blood sample protocols, analytical methods and equipment can be found in the HSE 2022 Methods report

Definition

Less than optimum cholesterol levels are defined as follows:

• Raised total cholesterol is defined as total cholesterol equal to or greater than 5mmol/L.
• Lower levels of HDL cholesterol (good cholesterol) is defined as below 1mmol/L for men and 1.2mmol/L for women.
• The total/HDL ratio was calculated by dividing total cholesterol by HDL cholesterol, a value equal to or greater than 6 is considered high risk.

(Source: Heart UK)

The proportion of adults with raised cholesterol was 53%, and this was greater among women (56%) than men (49%). Prevalence of raised cholesterol rose more steeply with age for women up to age 55 to 64 where it peaked (79%). Among men the proportion was highest among those aged between 45 and 64 (65%).

For more information: Table 10

The proportion of adults with low HDL cholesterol was 11%, and this was similar for men and women (both 11%).

5% of adults had a total/HDL ratio of 6 or above, indicating high risk, and this proportion was greater among men (8%) than women (3%). Prevalence of a total/HDL ratio of 6 or above fluctuated more with age among men than women, ranging from 1% to 15% among men, and peaking among those aged 35 to 44 (15%). Among women, prevalence ranged from 2% to 4%, peaking among those aged 16-34 (4%).

For more information: Table 10

The proportion of adults with raised total cholesterol declined from 1998 to 2019, from 66% to 40% (95% Confidence Interval (CI) 37% to 43%) among men, and from 67% to 45% (95% CI 42% to 48%) among women.

In 2022, the prevalence of raised cholesterol was 49% (95% Confidence Interval (CI) 45% to 54%) among men and 56% (95% CI 52% to 59%) among women. This is higher than in 2019, reversing the downward trend. A similar higher prevalence was found in 2021 (56% (95% CI 50% to 63%) among men and 61% (95% CI 55% to 66%) among women).

In 2021 and 2022, valid cholesterol results from blood samples were obtained from 21% and 36% of adults taking part in the survey, compared with 43% in 2019. It is not possible to determine how much the higher prevalence levels of raised cholesterol reflects real change in the prevalence of raised cholesterol or differences in the profile of participants.

There is evidence to suggest some of this difference is due to real change in the population, especially as data from HSE 2022 also found an increased in raised cholesterol levels compared with recent years, when methodology of the survey replicated standard HSE years and proportion agreeing to blood collection was higher than in HSE 2021.

The COVID-19 pandemic, during which access to GPs was severely restricted may have had implications for the number of people tested for raised cholesterol. An analysis of initial prescriptions of lipid-lowering drugs for the period March 2020 to July 2021 shows that new prescriptions for lipid-lowering drugs fell during the period when compared with the pre-pandemic period. In England, Scotland and Wales, 316,018 fewer first prescriptions were recorded overall, an average of 16,744 cases a month (Dale et al, 2023).

For more information: Tables 9 and A1

Hypertension (persistent high blood pressure) is an important public health challenge worldwide because of its high prevalence and the associated risk of CVD. It is one of the most important modifiable risk factors for stroke, ischaemic heart disease (such as angina, heart attacks, and heart failure), and renal disease, and is one of the most preventable and treatable causes of premature deaths worldwide (Source: World Health Organization).

Methods

Trend data on the prevalence of hypertension are presented for 2003 and from 2005 onwards, using measurements taken with the Omron HEM207 sphygmomanometer to measure blood pressure.

The HSE cannot be completely accurate in identifying people with hypertension as the definition requires persistently raised blood pressure; the HSE measures the blood pressure of each participant three times but on a single occasion.

Definitions

Hypertension Categories

High blood pressure is defined in this report as a systolic blood pressure (SBP) at or above 140mmHg or diastolic blood pressure (DBP) at or above 90mmHg or on medication prescribed for high blood pressure. Participants are classified into one of four groups as follows:

• Normotensive untreated: SBP below 140mmHg and DBP below 90mmHg, not currently taking medication for blood pressure.
• Hypertensive controlled: SBP below 140mmHg and DBP below 90mmHg, currently taking medication for blood pressure.
• Hypertensive uncontrolled: SBP at or greater than 140mmHg and/or DBP at or greater than 90mmHg, currently taking medication for blood pressure.
• Hypertensive untreated: SBP at or greater than 140mmHg and/or DBP at or greater than 90mmHg, not currently taking medication for blood pressure.

Doctor-diagnosed and undiagnosed hypertension  

The presence of doctor-diagnosed hypertension is identified if a participant answers yes to two questions:

• Do you now have, or have you ever had, high blood pressure sometimes called hypertension?
• Were you told by a doctor or nurse that you had high blood pressure?

Undiagnosed hypertension is defined as participants with a systolic blood pressure (SBP) at or above 140mmHg or diastolic blood pressure (DBP) at or above 90mmHg, who did not report having doctor-diagnosed hypertension. It differs from the definition of hypertension categories in Tables 12 to 15 as it does not consider information on medication. The combined proportion of those in the population with doctor-diagnosed and undiagnosed hypertension is referred to as total hypertension.

30% of adults had hypertension (high blood pressure), and this was greater among men (34%) than women (27%).

Overall, the prevalence of hypertension increased with age and was highest among those aged 75 and over for both men (66%) and women (71%). The prevalence of hypertension increased more steeply at a younger age among men than women.

For more information: Tables 12 and 13

The proportion of adults with untreated hypertension (SBP at or greater than 140mmHg and/or DBP at or greater than 90mmHg, not currently taking medication for blood pressure), was 13%, and increased with age, from 3% among those aged 16 to 34 to 21% among those aged 75 and over. Untreated hypertension was greater among men (15%) than women (12%).

For more information: Table 13

The English Index of Multiple Deprivation (IMD) is a measure of area deprivation, based on 37 indicators, across seven domains of deprivation. IMD is a measure of the overall deprivation experienced by people living in a neighbourhood, although not everyone who lives in a deprived neighbourhood will be deprived themselves. To enable comparisons, areas are classified into quintiles (fifths). For further information about the IMD, see the HSE 2022 Methods.

The age-standardised prevalence of hypertension, and untreated hypertension, did not vary by area deprivation.

For more information: Table 14

Hypertension estimates by region are shown in the tables as both observed and age-standardised. Observed estimates show the actual levels of hypertension in each region. Comparisons between regions should be based on the age-standardised data, which account for the different regional age profiles.

Untreated hypertension varied by region. The age-standardised proportion of adults with untreated hypertension was highest in the West Midlands (18%), and lowest in the East Midlands (9%).

The age-standardised proportion of adults with total hypertension did not vary by region.

For more information: Table 15

Total hypertension is the combination of doctor-diagnosed hypertension and undiagnosed hypertension. It differs to the estimates of ‘all with hypertension’ in Table 13, as it includes information from the health visit on blood pressure readings and reporting a doctor-diagnosis, whereas the definitions in Tables 12 to 15 are based on information on blood pressure readings and blood pressure medication.

Doctor-diagnosed hypertension may include participants who do not have high blood pressure readings at the time of the health visit, and are not on medication, however, have reported a diagnosis of hypertension (this could be due to controlling their blood pressure through lifestyle changes for example). Therefore, estimates of hypertension may be greater using this method.

33% of adults had total hypertension, and this was greater among men (37%) than women (29%). The prevalence of total hypertension increased with age, and was highest among those aged 75 and over among men (72%) and women (67%). Prevalence of total hypertension increased more steeply from age 35 among men compared with women.

The proportion of adults with undiagnosed hypertension was 11%, and this was greater among men (13%) than women (10%). Prevalence of undiagnosed hypertension increased with age and was highest among those aged 55 to 64 for men (19%) and those aged 75 and over for women (20%). Prevalence of undiagnosed hypertension increased more steeply with age from age 35 among men compared with women.

For more information: Table 16

The prevalence of hypertension among all adults was 31% in 2003 and has remained relatively stable since. From 2021 to 2022 the prevalence of hypertension was 30% (95% CI 28% to 32%). Survey estimates are subject to a margin of error (see ‘About the survey estimates’ in the Introduction). It is likely that in 2022 the proportion of adults with hypertension was between 28% and 32%, which is similar to previous years.

The proportion of adults in the population with untreated hypertension decreased from 2003 to 2022 for both men (20% to 15%) and women (16% to 12%) with fluctuation between years.

For more information: Tables 12 and A2

Note that the measurement method differs between 2003 (denoted by symbols) and 2005 onwards.