Overview of Participants
A total of 11,296 working age adults completed the NHS. Of these 638 met criteria for inclusion in the DSP recipient group, 442 to the NSA group and 8440 to the wage earners group. A further 1776 individuals of working age participated in the survey but did not fit the inclusion criteria of any group, and were excluded from analyses.
The DSP group was older than the other groups (Table 1). Females comprised 49%, 54%, and 57% of the wage earners, DSP and NSA groups, respectively. Differences in education and socioeconomic status were also observed. Less than one in five DSP and NSA recipients had private health insurance, compared to two thirds of the wage earners group. Thirty percent of DSP recipients reported severe core activity limitation and 44% mild/moderate limitation. Just under three quarters of wage earners reported no disability or long-term health condition. In the NSA group, 47% reported no disability or long-term health condition, 24% reported a mild/moderate core activity limitation and 4% severe limitation. Physical disability was the most common main disability type reported in all groups. In both DSP and NSA groups, psychological disability was the second most common main disability type, followed by ‘other’ disabilities and then disability in sight, hearing and speech.
Table 1
Characteristics of Study Groups
| Wage Earners (Column %) | DSP Group (Column %) | NSA Group (Column %) |
Total Number | 8440 (100%) | 638 (100%) | 442 (100%) |
Age in Years | | | |
18 to 24 | 765 (9.1%) | 25 (3.9%) | 34 (7.7%) |
25 to 34 | 1945 (23.0%) | 36 (5.6%) | 70 (15.8%) |
35 to 44 | 2117 (25.1%) | 98 (15.4%) | 107 (24.2%) |
45 to 54 | 1957 (23.2%) | 171 (26.8%) | 113 (25.6%) |
55 to 64 | 1656 (19.6%) | 308 (48.3%) | 118 (26.7%) |
Sex | | | |
Male | 4310 (51.1%) | 293 (45.9%) | 188 (42.5%) |
Female | 4130 (48.9%) | 345 (54.1%) | 254 (57.5%) |
Highest Level of Education | | | |
Less than Year 12 | 1232 (14.8%) | 331 (53.0%) | 172 (39.9%) |
Year 12 | 1125 (13.5%) | 83 (13.3%) | 48 (11.1%) |
Certificate or Diploma | 2902 (34.9%) | 166 (26.6%) | 160 (37.1%) |
Bachelor Degree | 1948 (23.4%) | 37 (5.9%) | 36 (8.4%) |
Postgraduate Degree | 1101 (13.3%) | 8 (1.3%) | 15 (3.5%) |
Index of Relative Socio-economic Disadvantage |
Lowest socioeconomic half | 3526 (41.8%) | 506 (79.3%) | 318 (71.9%) |
Highest socioeconomic half | 4914 (58.2%) | 132 (20.7%) | 124 (28.1%) |
Disability Status | | | |
No disability or long-term health condition | 6174 (73.2%) | 71 (11.1%) | 208 (47.1%) |
No limitation or specific restriction | 1248 (14.8%) | 18 (2.8%) | 52 (11.8%) |
Schooling/employment restriction only | 296 (3.5%) | 78 (12.2%) | 58 (13.1%) |
Mild/moderate core activity limitation | 613 (7.3%) | 279 (43.7%) | 106 (24.0%) |
Severe/profound core activity limitation | 109 (1.3%) | 192 (30.1%) | 18 (4.1%) |
Main Disability Type | | | |
Sight, hearing, speech | 549 (6.5%) | 31 (4.9%) | 37 (8.4%) |
Physical | 1281 (15.2%) | 299 (46.9%) | 129 (29.2%) |
Intellectual | 53 (0.6%) | 25 (3.9%) | 5 (1.1%) |
Psychological | 141 (1.7%) | 104 (16.3%) | 36 (8.1%) |
Head injury, stroke or brain damage | 7 (0.1%) | 24 (3.8%) | < 5 |
Other | 235 (2.8%) | 84 (13.2%) | 27 (6.1%) |
Not applicable | 6174 (73.2%) | 71 (11.1%) | 208 (47.1%) |
Private Health Insurance Status |
With private health insurance | 5599 (66.5%) | 104 (16.3%) | 84 (19.1%) |
Without private health insurance | 2819 (33.5%) | 534 (83.7%) | 356 (80.9%) |
Note: All data is presented as Number (column percentage); DSP = Disability Support Pension; NSA = Newstart Allowance. Count data has been suppressed in cells with fewer than 5 cases (presented as < 5) |
Health Professional Consultations
More than 80% of respondents in all groups consulted a GP at least once in the previous 12 months. The next most common healthcare practitioner groups were specialists and dentists (Table 2), noting that these three responses were prompted by the interviewer. Respondents in the DSP group were more likely to report consultations with all health professionals except for dentists, chiropractors, naturopaths, acupuncturists, and osteopaths. After adjustment for age and sex, DSP recipients were significantly more likely than wage earners to have consulted 15 of the 22 types of health professionals and significantly less likely to have consulted three (Fig. 1). NSA recipients were significantly more likely than wage earners to have consulted five types of health professionals and significantly less likely to have seen four types (Fig. 2). In both the DSP and NSA groups, the largest differences from wage earners were observed for consultations with a social worker or welfare officer.
Table 2
Prevalence of Health Professional Consultations, Hospital Attendance/Admission and Medication /Supplement Use by Study Group.
| Wage Earners Group | DSP Group | NSA Group |
N Respondents | 8440 (100.0%) | 638 (100.0%) | 442 (100.0%) |
Health Professionals | | | |
General Practitioner | 7100 (84.2%) | 611 (95.8%) | 391 (88.5%) |
Specialist | 2746 (32.5%) | 389 (61.0%) | 171 (38.7%) |
Dentist | 4133 (49.0%) | 232 (36.4%) | 162 (36.7%) |
Chemist (for advice only) | 761 (9.0%) | 151 (23.7%) | 56 (12.7%) |
Psychologist | 420 (5.0%) | 120 (18.8%) | 55 (12.4%) |
Other Health Professional | 427 (5.1%) | 87 (13.6%) | 33 (7.5%) |
Nurse | 273 (3.2%) | 83 (13.0%) | 30 (6.8%) |
Optician/Optometrist/Orthoptist | 566 (6.7%) | 82 (12.9%) | 19 (4.3%) |
Physiotherapist/Hydrotherapist | 848 (10.1%) | 80 (12.5%) | 26 (5.9%) |
Dietitian/Nutritionist | 181 (2.1%) | 68 (10.7%) | 14 (3.2%) |
Radiographer | 380 (4.5%) | 66 (10.3%) | 31 (7.0%) |
Social Worker/Welfare Officer | 49 (0.6%) | 52 (8.2%) | 20 (4.5%) |
Podiatrist | 245 (2.9%) | 50 (7.8%) | 9 (2.0%) |
Diabetes Educator | 81 (1.0%) | 44 (6.9%) | 7 (1.6%) |
Counsellor | 147 (1.7%) | 42 (6.6%) | 22 (5.0%) |
Occupational Therapist | 74 (0.9%) | 26 (4.1%) | 5 (1.1%) |
Chiropractor | 514 (6.1%) | 20 (3.1%) | 14 (3.2%) |
Audiologist/Audiometrist | 50 (0.6%) | 15 (2.4%) | 6 (1.4%) |
Sonographer | 110 (1.3%) | 13 (2.0%) | 6 (1.4%) |
Naturopath | 206 (2.4%) | 12 (1.9%) | 10 (2.3%) |
Acupuncturist | 190 (2.3%) | 10 (1.6%) | 5 (1.1%) |
Osteopath | 150 (1.8%) | 6 (0.9%) | < 5 |
Hospital Admission / Attendance | | | |
Hospital Admission | 826 (9.8%) | 164 (25.7%) | 69 (15.6%) |
Emergency Presentation | 872 (10.3%) | 148 (23.2%) | 69 (15.6%) |
Medications and Supplements | | | |
Medications | 3879 (46.0%) | 551 (86.4%) | 252 (57.0%) |
Supplements | 3592 (42.6%) | 261 (40.9%) | 159 (36.0%) |
Note: Data represent the number (column percentage) participants in each group who consulted a health professional or health centre in the previous 12 months and the number (column percentage) who took a medication or supplement in the previous 2 weeks. DSP = Disability Support Pension; NSA = Newstart Allowance. Count data has been suppressed in cells with fewer than 5 cases (presented as < 5). |
The frequency of consultations with GPs and specialists were significantly different between groups (see Table 3). More than 40% of DSP recipients reported consulting a GP more than 10 times in the past 12 months, compared with less than 5% of wage earners and 19% of NSA recipients. Over 10% of DSP recipients visited a specialist more than 10 times, in comparison to 1.8% and 2.9% of the wage earners and NSA recipients, respectively. Age and sex adjusted IRRs demonstrated that these differences in frequency were significant, with both DSP and NSA groups reporting greater frequency than wage earners (Fig. 3). Dental consultations were significantly lower in NSA recipients but not significantly different between DSP recipients and wage earners.
Table 3
Frequency of Health Professional Consultations, Hospital Admission/Attendance and Medication / Supplement Use by Study Group.
| Wage Earners | DSP Group | NSA Group |
General Practitioner | | | |
0 | 1340 (15.9%) | 27 (4.2%) | 51 (11.5%) |
1–5 | 5721 (67.8%) | 205 (32.1%) | 227 (51.4%) |
6–10 | 971 (11.5%) | 134 (21.0%) | 82 (18.6%) |
11+ | 408 (4.8%) | 272 (42.6%) | 82 (18.6%) |
Dentist | | | |
0 | 4307 (51.0%) | 406 (63.6%) | 280 (63.3%) |
1–5 | 3954 (46.8%) | 197 (30.9%) | 150 (33.9%) |
6+ | 179 (2.1%) | 35 (5.5%) | 12 (2.7%) |
Specialist | | | |
0 | 5694 (67.5%) | 249 (39.0%) | 271 (61.3%) |
1–5 | 2319 (27.5%) | 265 (41.5%) | 139 (31.4%) |
6–10 | 276 (3.3%) | 55 (8.6%) | 19 (4.3%) |
11+ | 151 (1.8%) | 69 (10.8%) | 13 (2.9%) |
Hospital Admission | | | |
0 | 7614 (90.2%) | 474 (74.3%) | 373 (84.4%) |
1 | 642 (7.6%) | 98 (15.4%) | 42 (9.5%) |
2+ | 183 (2.2%) | 65 (10.2%) | 25 (5.7%) |
Missing | < 5 | < 5 | < 5 |
Emergency Presentation | | | |
0 | 7568 (89.7%) | 490 (76.8%) | 373 (84.4%) |
1 | 644 (7.6%) | 67 (10.5%) | 42 (9.5%) |
2+ | 227 (2.7%) | 79 (12.4%) | 27 (6.1%) |
Missing | < 5 | < 5 | < 5 |
Medications | | | |
0 | 4561 (54.0%) | 87 (13.6%) | 190 (43.0%) |
1 | 1978 (23.4%) | 90 (14.1%) | 93 (21.0%) |
2–5 | 1773 (21.0%) | 281 (44.0%) | 132 (29.9%) |
6+ | 128 (1.5%) | 180 (28.2%) | 27 (6.1%) |
Supplements | | | |
0 | 4848 (57.4%) | 377 (59.1%) | 283 (64.0%) |
1 | 1692 (20.0%) | 122 (19.1%) | 76 (17.2%) |
2–5 | 1785 (21.1%) | 131 (20.5%) | 74 (16.7%) |
6+ | 115 (1.4%) | 8 (1.3%) | 9 (2.0%) |
Note: Data represent the number (column percentage) participants in each group who consulted a health professional or health centre in the previous 12 months by frequency of consultations, and the number (column percentage) who took a medication or supplement in the previous 2 weeks by frequency of consultation. DSP = Disability Support Pension; NSA = Newstart Allowance. Count data has been suppressed in cells with fewer than 5 cases (presented as < 5). |
Factors associated with a greater rate of GP consultations among DSP recipients included being female, daily smoking starting under the age of 18, and presence of severe or very severe pain in the past 4 weeks (see Table 1, Supplemental Digital Content, which describes results of regression model). There was a statistical association between GP consultations and comorbid conditions. In reference to those with 0 to 4 conditions, the IRR for those with 5 to 9 conditions was 1.29 (95% CI: 1.12–1.47), for 10–14 conditions the IRR was 1.35 (95% CI: 1.16–1.56), and for 15 + conditions the IRR was 1.48 (95% CI: 1.26–1.75). Having a postgraduate qualification and better self-reported health status was associated with lower rate of GP consultations.
Hospital Attendance and Admission
A greater proportion of DSP recipients reported attending an emergency department (23.2%) or being admitted to hospital as an inpatient (25.7%) at least once in the past 12 months than the NSA and wage earner groups (Table 2). The age and sex adjusted RRs for DSP recipients compared to wage earners were 2.37 (95% CI: 2.02–2.78) for attending an emergency department and 2.51 (95% CI: 2.15–2.93) for hospital admission (Fig. 4). Age and sex adjusted RRs for NSA recipients compared to wage earners were 1.53 (95% CI: 1.22–1.92) for attending an emergency department and 1.55 (95% CI: 1.23–1.94) for hospital admission (Fig. 4).
[Insert Fig. 4 here]
DSP recipients also reported significantly more hospital attendance and admission than respondents in the other groups (Fig. 3 & Table 3). Age and sex adjusted IRRs for DSP recipients compared to wage earners were 3.85 (95% CI: 3.10–4.79) for hospital admission as an inpatient and 4.41 (95% CI: 3.51–5.55) for attending an emergency department. Age and sex adjusted IRRs for NSA recipients compared to wage earners were 1.70 (95% CI: 1.26–2.28) for attending emergency and 1.85 (95% CI: 1.39–2.45) for inpatient admission.
Factors associated with a higher rate of hospital admission among DSP recipients included age less than 25 years, perceiving oneself as being underweight, and having hypertension (Supplementary Table 2). There was also an increased rate of hospital admission in those with more comorbid conditions. In reference to those with 0–4 conditions, for 5–9 conditions the IRR was 1.74 (95% CI: 0.96–3.18), for 10–14 conditions the IRR was 2.26 (95% CI: 1.20–4.26), and for 15 + conditions the IRR was 4.05 (95% CI: 2.07–7.95). Those with better self-assessed health were less likely to be admitted to hospital, in comparison to those with poor health.
Medication and Supplement Use
Eighty-six percent of DSP recipients reported having taken a medication in the previous two weeks in comparison to 57% of NSA recipients and 46% of wage earners (Table 2). In contrast, wage earners were most likely to report supplement use in the past two weeks. After age and sex adjustment the RR for DSP recipients for medication use was 3.38 (95% CI: 2.78–4.12) and for NSA recipients 1.17 (95% CI: 1.05–1.30) in reference to wage earners (Fig. 4). For supplement use the risk was significantly lower for both DSP recipients (RR: 0.89, 95% CI: 0.81–0.98) and NSA recipients (RR: 0.81, 95% CI: 0.71–0.92) in reference to wage earners.
Seventy-two percent of DSP recipients reported taking multiple medications and 28% took more than five medications in the past two weeks (Table 3). This compares to 36% and 6% in NSA recipients and 23% and 2% in wage earners. After age and sex adjustment the IRRs for medication use in reference to wage earners was 3.32 (95% CI: 3.03–3.63) for DSP recipients and 1.60 (95% CI: 1.42–1.81) for NSA recipients (Fig. 3). The age and sex adjusted IRRs for supplement use was 0.83 (95% CI: 0.73–0.94) for DSP recipients and 0.79 (95% CI: 0.68–0.93) for NSA recipients.