Results of the analyses are classified into self-assessed health and factors influencing self-assessed health covering non-communicable chronic diseases and injuries and age factor. All these sections are explained across age, administrative area and periodic examinations for both general and Saudi population, wherever possible.
a. Levels of self-assessed health
The self-assessed (perceived) health status as good, as reported in the survey 2017, demonstrates that females are at an advantage: more than two-thirds reporting good health (Fig. 1). These results show the supremacy of females over males on their health status, which might have reasons of reduced risks and exposures to road traffic accidents, pollution, occupational hazards, infections from crowded commercial places, food poisons from restaurants, long travels, frequent visits to deserts, and so on.
Moreover, there is marked age differentials in the percentage of population assessing health as good (Fig. 2). A higher proportion of both males and females in ages 15–19 years and 20–24 years assesses their health as good. But thereafter, with increasing age, their percentages fall up to age 40–44 years: further increased in proportions till old age. This trend is similar to both males and females, but with a steep increase in females of age 40–44 to 50–54 years and thereafter a stagnation till 60–64 years. This male female difference indicates advantages of females of 40 to 54 years (the older adulthood, typically mothers of grown up children): probably, attributed to the reduced domestic responsibilities, higher self-esteem, and increased parental responsibilities. This transition in a woman’s life might impact positively upon health assessment.
On the other hand, males show a marked increase in their percentage reporting good self-assessed health (an increase of 20.8 points) between the age group of 60–64 and 65 + years. That is, males in older ages have better self-assessed health than younger males. This is a unique situation, contrary to the expected compression of morbidity theory in the old age. Probably, old aged males in Saudi Arabia are more realistic and optimistic than others in accepting ill-health and senility (21).
However, the male female gap in health assessment as good is negligible in the early ages (15–19 and 20–24 years); thereafter it increases slowly till 40–44 years and widens further till 50–54 years (gap is nearly 40 points). In the further age groups, the difference reduces and converges in the old age (13.3 points difference). Such a male female gap in the self-assessed health is clearer across major age groups: minimum (2.0 points – 80.2% of females as against 78.3% of males) in younger ages (15–19 and 20–24 years); higher (23.2 points – 64.1% of females as against 40.9% of males) in the middle ages (25–59 years) and moderate (22.1 points – 83.6% in females as against 61.5% in males) in old age (60 years and above). Overall, 79.2 percent of young adults, 49.7 percent of middle aged and 69.8 percent of old aged have good self-assessed health. It is also to be noted that the percentage of persons assessing good health is low in the age groups from 30–34 years to 45–49 years: 45.8 percent (37.2% of males, 60.1% of females) and with a male female gap of 22.9 points.
Males of age 40–44 years reported the lowest (32.1%) and 65 + years the highest (72.9%) as against females of age 40–44 years (54.3%) and 65 + years (86.2%). As of the total persons, the lowest percentage in 40–44 years (40.1%) and highest in 65 + years (78.4%). In all cases the lowest proportions are found in the age of early 40s and highest in the old age. This might be introspective for the poor health perceptions and assessment at peak adult ages and good at senile ages (13). On the other hand, it explains the connections with the myth/reality of age 40 as the starting point of non-communicable diseases like hypertension, diabetes, cardiovascular diseases, kidney troubles, liver complications, etc. Thus, the early 40s are troublesome suffering ages while the old age is an age of acceptance.
Saudi Arabia is divided into 13 administrative areas: major areas (Riyadh, Makkah, Madina, and Eastern region) and others (21,22,23.24). Major areas have a low percentage of persons reporting good self assessed health; among them Makkah Al-Mokarramah has the lowest (48.7%) while Eastern Region has the highest (56.9%). The highest male female difference is in Eastern Region (25.3 points), followed by Riyadh (20.3 points), Al-Madina Al-Monawarah (19.3 points) and Makkah Al-Mokaramah (16.0), in the order. Of the other areas Al-Baha has the highest percent reporting good self-assessed health (74.3%), followed by Jazan (73.5%), Tabouk (73.4%), Aseer (73.2%), Northern Borders (73.2%), and Hail (70.1%), in the order.
Al-Qaseem, Al-Baha and Al-Jouf have higher male female gap (more than 22 points). In short, major areas have 51.7 percent of persons reporting good self-assessed health as against 70.8 percent in other areas, with a male-female gap of 19.5 points and 21.1 points, correspondingly. So, based on the percentage of persons with good self-assessed health, administrative areas could be classified into three namely, prominently good health having more than 70 percent (Aseer, Tabouk, Hail, Northern Borders, Jazan, and Al-Baha), moderately good health having 60–70 percent (Al-Qaseem, Najran, and Al-Jouf) and subtly good health having below 60 percent (Riyadh, Makkah Al-Mokarramah, Al-Madina Al-Monawarah, and Eastern Region). On the other hand, the administrative areas are classified into three on the basis of male female difference in good self-assessed health such as: minimum gap - less than 20 percentage points (Jazan, Makkah Al-Mokarramah, and Al-Madina Al-Monawarah); moderate – 20–23 points (Riyadh, Aseer, Tabouk, Hail, Northern Borders, Najran, Al-Baha); and high – 24 points and more (Al-Qaseem, Eastern Region, and Al-Jouf).
b. Factors influencing self-assessed health
Self-assessment of health might reflect objective health condition resulting form diseases, disabilities, and periodic medical examinations/medications. These three variables are analyzed and interpreted here for their probable influence on health status and assessments.
i. Chronic Non-communicable Diseases
Differences and patterns of health assessments could be, possibly, attributed to the prevalence rate of non-communicable chronic diseases and injuries. Four major diseases, recorded, are hypertension (High BP), diabetes, cancer, and cardiovascular diseases (CVD); the common chronic diseases in the Kingdom. These diseases together have a prevalence rate of 182.3 per 1000 persons, which is considered to be higher (Table 2).
Table 2
Prevalence rate of chronic diseases (age 15 years and above) per 1000 persons
Age groups/areas
|
General population
|
Saudi Population
|
BP
|
Diabetes
|
Cancer
|
CVD
|
Total
|
BP
|
Diabetes
|
Cancer
|
CVD
|
Total
|
15–19
20–24
25–29
30–34
35–39
40–44
45–49
50–54
55–59
60–64
65+
Total
|
0.8
2.2
3.0
10.3
22.4
47.5
100.7
192.0
282.3
434.1
916.5
78.1
|
4.7
6.4
8.4
14.1
29.2
61.8
111.3
233.5
343.6
485.3
901.4
90.2
|
0.3
0.5
0.9
0.8
0.8
1.7
1.6
3.8
3.8
10.2
15.1
1.8
|
1.3
1.7
0.9
1.0
3.1
5.7
9.9
20.7
35.3
69.6
201.1
12.1
|
7.1
10.7
13.2
26.2
55.6
116.8
223.6
450.0
665.0
999.2
2034.0
182.3
|
1.1
2.2
4.1
10.7
28.8
63.2
121.8
234.4
302.7
406.2
522.0
93.4
|
5.4
7.3
9.9
17.7
32.2
65.1
129.2
259.3
344.7
441.1
521.7
102.0
|
0.3
0.6
1.1
1.4
1.3
4.1
1.8
4.4
5.0
10.8
7.2
2.4
|
1.3
1.9
0.7
1.1
3.9
9.3
14.4
28.5
42.3
61.2
119.3
15.9
|
8.1
11.9
15.8
31.0
66.2
141.8
267.2
526.6
694.7
919.3
1170.3
213.7
|
Riyadh
Makkah Al-Mokarramah
Al-Madina Al-Monawarah
Al-Qaseem
Eastern Region
Aseer
Tabouk
Hail
Northern Borders
Jazan
Najran
Al-Baha
Al-Jouf
Total
|
67.9
87.6
67.1
81.6
77.0
93.5
84.8
73.1
85.3
81.6
59.5
86.6
60.2
78.1
|
83.0
103.3
86.5
85.0
83.5
98.3
104.8
87.7
84.1
74.9
80.7
98.0
80.1
90.2
|
2.1
2.0
0.7
0.5
1.9
1.8
0.9
2.0
2.1
2.4
1.3
2.3
1.6
1.8
|
10.4
14.7
6.1
9.7
10.2
14.1
18.2
13.2
8.8
15.6
12.2
17.1
12.8
12.1
|
163.4
207.6
160.5
176.7
172.5
207.6
208.6
176.0
180.3
174.5
153.7
204.0
154.8
182.3
|
87.4
100.4
72.9
102.8
96.2
106.5
89.7
94.9
103.4
90.9
69.4
92.6
74.3
93.4
|
101.6
108.1
96.0
104.7
99.4
107.5
108.4
106.7
99.0
80.1
97.7
106.8
96.6
102.0
|
2.9
2.5
1.1
0.7
2.6
2.3
1.1
2.7
2.8
3.0
2.8
2.8
2.3
2.4
|
14.8
19.4
8.0
12.8
14.8
17.3
15.4
15.6
11.6
18.1
16.4
19.8
18.0
15.9
|
206.7
230.4
178.0
221.0
213.0
233.6
214.6
219.8
216.8
192.1
186.3
222.0
191.2
213.7
|
Out of these diseases, diabetes is the most common recording a prevalence rate of 90.2, followed by hypertension (78.1) cardiovascular diseases (12.1) and cancer (1.8). There is a positive relation between prevalence and age: increasing prevalence along with age. These diseases are higher among those aged 40 years and above; conforming to an already established fact of 40 years as the beginning of health complications and life style diseases. It increases thereafter, seriously, adding vulnerability to old age, moreover, evidencing multiplicity of diseases (co-morbidity), especially in old age (65 + years). In short, an older person aged 65 years and above has more than two diseases (prevalence rate of 2034 per 1000 persons). In comparison, Saudi population has slightly higher prevalence rates up to age 60 years, in all the four chronic diseases considered, but with variations across age. In other words, disease prevalence in old aged Saudi population (60–64 and 65 + years) remains lower in comparison with the total population of the same age. That is, the prevalence rate of diseases of Saudi population differ from that of the total population, while analyzed through age groups, especially in old age.The picture is clearer while analyzing across the broad age groups: all these diseases have its presence since adolescent/youth, but their prevalence increases with age: old age (60 years and above) marks an age of all these diseases exemplifying the theory of compression of morbidity (Fig. 3). Both the general population as well as the Saudi population follow a similar trend but with varying rates of prevalence across age groups. Saudi population has a comparatively lower prevalence rate in old age, which could be attributed to their life styles, food habits, occupations, and living arrangements. But during other ages Saudi population has comparatively higher prevalence of these diseases as compared to general population.
Tabouk, Aseer and Makkah Al-Mokarramah areas have high prevalence rate, almost equal among the general population. While Al-Baha has a prevalence close to those mentioned areas, others have low prevalence. Najran has the lowest prevalence, followed by Al-Jouf, Al-Madina Al-Monawarah, and Riyadh in the order. In the case of Saudi population, Aseer has the highest prevalence of chronic diseases, followed by Makkah Al-Mokarramah, Al-Baha, Al-Qaseem, and Hail, in the order. Al-Riyadh has a prevalence of 206.7, referring that nearly 207 persons (out of 1000) suffer from one or more of the diseases considered including co-morbidity. On the other hand, Al-Madina Al-Monawarah has the lowest prevalence, followed by Najran, Al-Jouf, and Jazan in the order. Overall, such variations of disease prevalence in some of the major areas and minor areas make the area wise differences negligible.
ii. Injuries
Another probable cause of ill-health inflicting upon self-assessments would be the injuries of various kinds victimized by the population, sources of which are grouped into traffic accidents and others (Table 3). No doubt, roads and traffics forms a major source of injury not only in the Arabian Gulf but also in the developing countries, due to unsafe road conditions, driving regulations, and security measures. It shows that 2.2 percent of persons, in general, victimize injuries: its percentage among Saudi is slightly lower (1.3%). Of the total injured, the share of traffic accidents is less than one-third, in both the groups. There are certain age groups vulnerable to injuries; both traffic accidents and others. Old age has seriously affected, as expected, due to reduced motor skills and physical capabilities.
Table 3
Percent of Population injured (15 years and above) by type injury
Age groups/regions
|
General population
|
Saudi Population
|
Traffic
accidents
|
Others
|
Total
|
Traffic
accidents
|
Others
|
Total
|
15–19
20–24
25–29
30–34
35–39
40–44
45–49
50–54
55–59
60+
Total
|
0.6
1.0
0.8
0.8
0.6
0.7
0.6
0.6
0.4
0.8
0.7
|
1.0
1.0
1.2
1.5
1.4
1.5
1.8
1.9
1.2
3.1
1.5
|
1.6
2.0
2.0
2.3
2.1
2.2
2.4
2.6
1.6
3.9
2.2
|
0.5
1.0
0.5
0.6
0.5
0.2
0.2
0.3
0.2
0.6
0.5
|
0.7
0.9
0.8
0.7
0.6
0.6
0.7
0.8
0.6
2.6
0.8
|
1.2
1.8
1.3
1.4
1.1
0.8
0.9
1.1
0.8
3.2
1.3
|
Riyadh
Makkah Al-Mokarramah
Al-Madina Al-Monawarah
Al-Qaseem
Eastern Region
Aseer
Tabouk
Hail
Northern Borders
Jazan
Najran
Al-Baha
Al-Jouf
Total
|
0.5
0.6
0.5
0.4
1.0
1.1
2.4
0.7
0.3
0.9
1.5
0.6
0.5
0.7
|
1.0
1.9
0.6
1.2
1.4
1.5
5.3
1.8
3.9
0.7
3.0
0.9
0.5
1.5
|
1.4
2.5
1.1
1.6
2.3
2.6
7.7
2.5
4.2
1.5
4.5
1.5
1.0
2.2
|
0.4
0.3
0.3
0.3
0.6
0.9
1.4
0.6
0.3
0.8
1.2
0.4
0.4
0.5
|
0.5
0.8
0.4
0.8
0.8
1.1
3.0
0.7
2.3
0.5
2.0
0.8
0.3
0.8
|
0.8
1.1
0.7
1.1
1.5
2.0
4.4
1.2
2.6
1.3
3.2
1.2
0.7
1.3
|
Risks of injuries increases with increasing age (from adolescent/youth to old aged): those in working (adult) age have lesser risks, both in general and Saudi population. There is an increase in the incidences of injuries (other than traffic accidents) to the old aged population, which could, probably, have a direct impact on their perceived (self-assessed) health (Fig. 4). On the other hand, the major administrative areas have lesser risks of injuries as compared to other smaller areas. This, probably, shows the safety standards, regulations, and quality of housings, pavements, and infrastructure.
A large majority of these injuries took place in the house: risks of movements, complexity of equipments, modern bathrooms or even the interpersonal conflicts possible (Fig. 5). There are many injuries from the workplace/schools, and also from public places, pointing to, occupational hazards, school based injuries, and accidents/falls at public places.
While those injured at house are highest in the old age, followed by 45–49 years and 50–54 years respectively, but are less frequent among adolescent/youth ages. Three age groups (40–44, 45–49, and 50–54) are more susceptible to injuries in the workplace/school (Fig. 6). Injuries at public places are higher for age groups 25–29, 30–34, and 35–39 years but lower in 45–49, 50–54, and 65 + years. Injuries from other places are more frequent in case of those aged 55–59 years but lowest in case of 40–44 years. These differences indicates the age susceptibility of injuries by place.
Area wise, injuries from home are more frequent in Northern Borders, Al-Qaseem, and Makkah Al-Mokarramah but least frequent in Al-Madina Al-Monawarah, Hail, and Al-Jouf. On the other hand, injuries from workplace/school are more in Northern Borders, Hail, Al-Jouf, and Makkah Al-Mokarramah whereas lesser in Al-Madina Al-Monawarah, Jazan, and Al-Baha. Injuries at public places are higher in Al-Baha, Hail, and Al-Qaseem whereas less in Jazan, Al-Jouf, and Tabouk.
iii. Periodic medical examinations
A recent health care mechanism introduced to monitor public health is the periodicity of examinations as a part of disease surveillance based on a strategy of symptom identification, diagnosis, and treatment at the right time to control further infections or deteriorations leading to disabilities. Nearly one-third of the persons, without respect to age, undergo periodic medical examinations ranging from weekly to more than a year among both the general and Saudi population. In comparison, females undergo periodic examinations more often than males (Table 4).
Table 4
Percentage of persons undergoing periodic medical examinations
Frequency
|
General population
|
Saudi Population
|
Male
|
Female
|
Persons
|
Male
|
Female
|
Persons
|
Weekly
Monthly
Quarterly
Half yearly
Yearly
More than an year
Total
|
0.5
2.7
4.8
6.7
11.2
6.4
32.2
|
0.5
4.4
6.2
7.1
10.4
7.4
36.1
|
0.5
3.4
5.3
6.9
10.9
6.8
33.7
|
0.6
3.3
5.3
6.2
6.7
5.8
28.0
|
0.6
4.8
6.4
6.9
8.3
6.6
33.7
|
0.6
4.1
5.9
6.6
7.5
6.2
30.7
|
c. Age Factor
Health status and assessments have close link with age and developmental stages, mostly, related to physical capabilities and physiological functioning. Thus, it is essential to consider interrelationship while addressing the self-assessed health. It is, therefore, assumed that people of young age – adults - often consider themselves as healthier due to their peak physical performance involving motor skills and bodily functions. The persons reporting good self-assessed health are at a young adult age (32.7 years): both males and females (Table 5).
On the other hand, median age, as an indicator, shows the pattern of chronic disease prevalence in the specific population groups. For e.g. 56.1 years is median age of general population with chronic diseases: Saudi population have a slightly higher median age (59.1 years). Age differences along specific diseases are in such a way that cancers have the earliest age of onset (in general population and Saudi population) starting immediately on completing 50 years; for general (61.5 years) and Saudi population (63.1 years); diabetes and hypertension have a different age (before cardiovascular but after cancers), in both general and Saudi population.
Table 5. Median age calculated for various dimensions of health status (15 years and above)
Indicators
|
Total population
|
Saudi Population
|
Population assess own health as good Male
Female
Total
|
32.9
32.6
32.7
|
-
-
-
|
Chronic diseases
High BP
Diabetes
Cancer
Cardiovascular diseases
Total
|
57.3
55.3
52.2
61.5
56.9
|
59.4
58.5
519
63.1
59.1
|
Type of injury
Traffic accidents
Other than traffic accidents
Total
|
34.2
39.1
37.5
|
31.1
37.1
34.3
|
Place of injury
In the house
At work/School
Public place
Others
|
41.3
38.9
34.6
36.1
|
-
-
-
-
|
Frequency
|
Total population
|
Saudi Population
|
Male
|
Female
|
Persons
|
Male
|
Female
|
Persons
|
Weekly
Monthly
Quarterly
Half yearly
Yearly
More than an year
|
52.2
54.1
50.7
44.7
40.6
40.6
|
61.0
48.9
48.8
41.1
36.9
37.0
|
54.5
52.0
49.9
43.5
39.4
39.2
|
56.0
57.3
51.9
46.0
40.5
38.6
|
60.3
51.8
51.0
42.5
37.8
36.9
|
58.6
54.3
51.4
44.4
39.0
37.6
|
Injuries happens to the general population at an earlier age, the peak adulthood age (in the 30s): earlier to Saudi population. Traffic accidents which occurs earlier to others in both general and Saudi population. However, injuries at public places happen earlier than at house or work/school. Adding up to this are the age details of periodic medical examinations, the frequency of which increases along median age of the person.