商业健康保险目录标准制定与长期发展中国保险行业协会中国卫生信息与健康医疗大数据学会太平洋健康保险股份有限公司微信公众号-今日保条-搜集整理，版权归原作者保险新闻资讯和资料分享平台，侵删01编委会名单主.
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医疗健康行业投资与退出趋势生物制药健康科技诊断/工具医疗器械22022医疗健康行业投资与退出趋势年年度报告目录3市场亮点5医疗健康行业基金募资和投资情况24深挖计算生物学28医疗健康行业SPAC动态3.
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加州医疗保健服务部Medi-Cal 牙科计划 会员手册2021 年目录前言.1加州 Medi-Cal 牙科计划.2网站和在线资源.3如何联系我们.5语言协助.6授权代表.7使用.Medi-Cal 旗下.
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National Population Health Survey 2021(Household Interview)COPYRIGHT NOTICE NATIONAL POPULATION HEALTH SURVEY 2021 (Household Interview)ISBN 978-981-18-4552-9 Epidemiology&Disease Control Division,Ministry of Health,Republic of Singapore All rights reserved.No part of this publication may be reproduced without proper citation.Suggested Source Citation Epidemiology&Disease Control Division and Policy,Research&Surveillance Group Ministry of Health and Health Promotion Board,Singapore CONTENTS Foreword 1 Executive Summary 2 Main Report 1 Alcohol Consumption 11 2 Cigarette Smoking 19 3 Physical Activity 24 4 Self-reported Diabetes Mellitus 37 5 Self-reported Hypertension 41 6 Self-reported Hyperlipidaemia 45 7 Chronic Disease Screening 49 8 Breast Cancer Screening 57 9 Cervical Cancer Screening 60 10 Colorectal Cancer Screening 64 11 Vaccination 68 12 Mental Health 73 13 Survey Methodology 77 References 84 Acknowledgements 87 Annexes A Survey Questionnaire 88 B Project Team 156 1 Foreword The National Population Health Survey(NPHS)is a cross-sectional population health survey series to monitor the health and risk factors,as well as lifestyle practices of Singapore residents.This survey replaces the three population health surveys(i.e.,National Health Survey(NHS),National Health Surveillance Survey(NHSS)and Health Behaviour Surveillance of Singapore(HBSS)previously conducted by the Ministry of Health and Health Promotion Board respectively.The NPHS is conducted annually to provide timely and regular information on the prevalence of non-communicable diseases such as diabetes mellitus,hypertension,hyperlipidaemia and related risk factors like smoking,alcohol consumption and physical inactivity from a representative sample of the resident population.The NPHS also captures information on practice of chronic disease and cancer screenings,mental health as well as influenza and pneumococcal vaccination among Singapore residents.Though there were some improvements in screening participation over the years,the results from NPHS 2021 showed that fewer Singapore residents participated in chronic disease and cancer screenings in 2021 compared to 2019.This might be due to the various safe management measures(SMMs)implemented in the healthcare institutions(e.g.,deferment of non-urgent services)to manage the COVID-19 pandemic situation.Some of these SMMs might have also impacted the risk factors as the latest data on smoking and regular exercise have remained similar to 2019,temporarily slowing down the progress made to reduce the smoking prevalence and physical inactivity.The age-standardised prevalence of chronic diseases seemed to have stabilised in recent years even though the crude prevalence continued to increase due to our aging population.These findings from the survey will help the Ministry of Health and Health Promotion Board to develop and evaluate policies and programmes and to improve the health of Singapore residents.I would like to gratefully acknowledge and thank all who have,in one way or another,contributed to the successful completion of the survey,particularly under the challenging COVID-19 situation.In particular,I would like to thank all respondents who have given their time to take part in the survey,and whose support makes this report possible.ASSOCIATE PROF KENNETH MAK Director of Medical Services November 2022 2 Executive Summary The National Population Health Survey(NPHS)is a cross-sectional population health survey conducted annually by the Ministry of Health and Health Promotion Board to monitor the health and risk factors,as well as lifestyle practices of Singapore residents.This survey replaces the three population health surveys(i.e.,National Health Survey(NHS),National Health Surveillance Survey(NHSS)and Health Behaviour Surveillance of Singapore(HBSS)that were conducted in the earlier years.The NPHS monitors the behavioural risk factors such as smoking and alcohol consumption;chronic diseases such as diabetes mellitus and hypertension as well as preventive health behaviour such as the practice of health screening.The survey findings will be used by the Ministry of Health and Health Promotion Board to track progress towards national heath targets and for planning and evaluation of health policies,programmes,and health care services.The NPHS consists of two components1:(i)Household Interview and(ii)Health Examination.This report presents the survey findings from the Household Interview of all Singapore residents aged 18 to 74 years.The findings from the Health Examination which comprises mainly measured indicators such as obesity and chronic disease prevalence will be reported in 2023 on a two-year survey cycle(i.e.,NPHS 2021 2022)to ensure that there are enough data for a detailed analysis2.The reporting coverage in terms of age differs from previous national health surveys to reflect the growing size of the older population.While the survey results in the earlier publications of the national health surveys were based on Chinese,Malay and Indian residents aged 18 to 69 years,the NPHS report is based on all Singapore residents aged 18 to 74 years.Time-series data for the extended reporting coverage are available from 2007 onwards3.1 More details on the survey design,method and fieldwork are covered in“Chapter 13:Survey Methodology”.2 Data collection for the“Health Examination”component requires more efforts and a longer time duration for completion.This is because it requires respondents to attend a health examination/screening at designated locations and hence there are relatively fewer respondents as compared to the“Household Interview”component.3 Data from the earlier national health surveys are presented for trend analysis over a longer time period.However,there are differences in the survey design across the health surveys and examination of differences across the survey series should take this into consideration.3 Trend analysis is presented when there are sufficient data(inclusive of NHS,NHSS and NPHS)to gauge the directional change of an indicator.Comparison of survey results between 2019 and 2021 is also carried out to highlight changes in the health behaviours and health practices among Singapore residents possibly due to COVID-19 pandemic4.Alcohol consumption The crude and age-standardised prevalence of regular alcohol consumption increased significantly from 2007 to 2021(crude:1.2%in 2007;2.8%in 2021;age-standardised:1.2%in 2007;2.7%in 2021).Between 2019 and 2021,the crude prevalence of regular drinking did not change significantly(2.1%in 2019,2.2%in 2020,2.8%in 2021).In 2021,4.6%of the males and 1.1%of the females were regular drinkers.Regular alcohol consumption was most common among males in the 50 to 59 years age group(7.2%).The rise in both the crude and age-standardised prevalence of binge drinking was significant between 2007 and 2021(crude:4.3%in 2007;9.6%in 2021;age-standardised:4.2%in 2007;10.3%in 2021).However,the crude prevalence of binge drinking remained stable between 2019 and 2021(10.2%in 2019,10.5%in 2020,9.6%in 2021).Binge drinking was more common among males(13.8%)than females(5.6%).Binge drinking was especially common among young adults aged 18 to 29 years,where about one in five(20.4%)males were binge drinkers compared to about one in ten(10.7%)females in 2021.4 NPHS 2021 results are compared with NPHS 2019 results to highlight changes in the health behaviours and health practices among Singapore residents possibly due to COVID-19.Fieldwork for NPHS 2019 was conducted from August 2018 to July 2019 where COVID-19 pandemic had not started yet(pre COVID-19).Fieldwork for NPHS 2020 was affected by COVID-19 as data were collected for only three-quarter of the survey year(July 2019 to March 2020)and fieldwork for April to June 2020 was cancelled due to the Circuit Breaker from 7 April to 1 June 2020(inclusive).Fieldwork for NPHS 2021 was carried out from July 2020 to June 2021 and it was the first year where data collection was conducted with COVID-19 restrictions.4 Cigarette Smoking The crude and age-standardised prevalence of daily smoking decreased significantly between 2007 and 2021(crude:13.3%in 2007;10.4%in 2021;age-standardised:13.3%in 2007;10.7%in 2021).However,between 2019 and 2021,the crude prevalence of daily smoking remained stable at around 10%(10.6%in 2019,10.1%in 2020,10.4%in 2021).The prevalence of daily smoking was higher among males(17.8%)than females(3.3%)in 2021.Male daily smokers smoked an average of 12 cigarettes a day while female daily smokers smoked an average of 8 cigarettes a day.Daily smoking was most prevalent in adults aged 30 to 39 years(12.8%)and least prevalent among younger adults aged 18 to 29 years and older adults aged 60 to 74 years(both 8.3%)in 2021.About half(49.4%)of the daily smokers in 2021 had intention to quit smoking.However,only 18.4%of them planned to quit smoking within the next 12 months or less.Physical Activity The crude and age-standardised prevalence of leisure-time regular exercise increased significantly from 2007 to 2021(crude:24.1%in 2007;32.5%in 2021;age-standardised:24.3%in 2007;33.4%in 2021).Though the crude prevalence of leisure-time regular exercise showed a slight decline since 2019(35.2%in 2019,33.4%in 2020,32.5%in 2021),the changes in prevalence were not significant.The COVID-19 restrictions on recreational facilities(e.g.,temporary closure of sports and recreational facilities,gardens,parks and nature reserves)and the preference of most people to stay home to reduce the risk of being infected with COVID-19 might have contributed to the lower prevalence on regular exercise in the last two years.In 2021,about one in three(32.5%)Singapore residents aged 18 to 74 years engaged in regular exercise during their leisure time.The highest proportion of adults with regular exercise was observed among young adults aged 18 to 29 years(40.5%)while the lowest was among older adults aged 60 to 74 years(24.0%).5 Leisure-time regular exercise was more prevalent among males(37.5%)than females(27.7%).The downward trend in the proportion of residents with sufficient total physical activity between 2007 and 2021 was not significant(crude:82.3%in 2007;71.1%in 2021;age-standardised:82.4%in 2007;71.7%in 2021).However,there was a steady significant decrease from 2019(crude:80.1%)to 2021(crude:71.1%).The new working arrangement(where workdays were split between home and office)and the restrictions on recreational facilities(e.g.,temporary closure of sports and recreational facilities,gardens,parks and nature reserves)in the last two years had possibly contributed to the reduction in physical activity across all domains(i.e.,work,commuting and leisure-time).In 2021,more males(73.0%)compared with females(69.3%)were able to meet this recommended total physical activity level.Young adults in the 18 to 29 years age group(76.3%)had the highest level of sufficient total physical activity while the older adults aged 60 to 74 years had the lowest proportion at 65.1%.The largest contributor to total physical activity per week was commuting(47.0%),followed by leisure-time physical activity(27.5%)and work-related physical activity(25.5%).More than one in three(35.5%)Singapore residents aged 18 to 74 years reported having sufficient muscle-strengthening activities in 2021.This was more common among younger adults aged 18 to 39 years(18 to 29 years:46.4%;30 to 39 years:37.0%)while the proportion dropped to around one-third for those aged 40 to 74 years old.Males(40.0%)had higher proportion with sufficient muscle-strengthening activities compared with females(31.2%).Self-reported Diabetes Mellitus While the overall crude prevalence of self-reported diabetes showed a significant increasing trend from 2007(4.9%)to 2021(6.9%),the upward trend for the age-standardised prevalence was not significant(5.2%in 2007,5.4%in 2021).6 From 2019 to 2021,the crude prevalence of self-reported diabetes remained stable at around 7%(6.9%in 2019,7.0%in 2020,6.9%in 2021),In 2021,about one in 15(6.9%)Singapore residents aged 18 to 74 years reported that they had diabetes mellitus and were currently prescribed medication.Slightly more males(7.6%)reported having diabetes than females(6.2%).The prevalence of self-reported diabetes mellitus increased with age,from 0.9%in young adults aged 30 to 39 years to 18.3%among those aged 60 to 69 years and reached 21.7%among those aged 70 to 74 years.Self-reported Hypertension(or High Blood Pressure)Both the overall crude and age-standardised prevalence of self-reported hypertension did not show significant upward trend from 2007 to 2021(crude:12.7%in 2007;15.7%in 2021;age-standardised:13.4%in 2007;12.4%in 2021).From 2019 to 2021,the crude prevalence of self-reported hypertension remained stable around 16%(15.6%in 2019,15.1%in 2020,15.7%in 2021),In 2021,about one in six(15.7%)Singapore residents aged 18 to 74 years reported that they had hypertension(or high blood pressure)and were currently prescribed medication.More males(17.2%)reported having hypertension than females(14.2%).The prevalence of self-reported hypertension increased with age,from 2.0%in young adults aged 30 to 39 years to 37.8%among those aged 60 to 69 years and reached 52.7%among those aged 70 to 74 years.Self-reported Hyperlipidaemia(or High Blood Cholesterol)The overall crude prevalence of self-reported hyperlipidaemia showed an increasing trend from 2007(8.2%)to 2021(13.9%)but the age-standardised prevalence did not show similar significant increasing trend(8.7%in 2007,10.8%in 2021).From 2019 to 2021,the crude prevalence of self-reported hyperlipidaemia remained stable at around 14%(13.6%in 2019,13.1%in 2020,13.9%in 2021),In 2021,about one in seven(13.9%)Singapore residents aged 18 to 74 years reported that they had hyperlipidaemia(or high blood cholesterol)and were currently prescribed medication.7 More males(15.2%)reported having high blood cholesterol than females(12.6%).The prevalence of self-reported high blood cholesterol increased with age,from 1.1%in young adults aged 30 to 39 years to 35.8%among those aged 60 to 69 years and reached 43.4%among those aged 70 to 74 years.Chronic Disease Screening The proportion of Singapore residents aged 40 to 74 years with no previous diagnosed chronic diseases(i.e.,diabetes mellitus,high blood pressure,and high blood cholesterol(“DHL”)and were screened for these three conditions within the recommended screening frequencies displayed no significant upward trend over the period 2007 to 2021.The screening participation for residents with no previous diagnosis of DHL in 2021(59.2%)was significantly lower compared with 2019(66.3%).The lower screening participation could be due to deferment of non-urgent services e.g.,health screening in healthcare institutions arising from the COVID-19 situation in the last two years.Looking at individual chronic disease alone regardless of the co-morbidity with other chronic diseases,the crude proportion of residents who had diabetes and hypertension screening increased significantly from 2007 to 2021 while the proportion for hyperlipidaemia did not show significant upward trend over the same period.Between 2019 and 2021,the screening participation for all three chronic diseases in 2021 were significantly lower compared with 2019(diabetes:81.0%in 2019,78.5%in 2020,76.6%in 2021;hypertension:86.0%in 2019,83.3%in 2020,82.4%in 2021;hyperlipidaemia:77.9%in 2019,76.5%in 2020,72.5%in 2021).Based on individual disease alone,76.6%of adults aged 40 to 74 years without known diabetes were screened for diabetes within the past three years in 2021,82.4%of those without known high blood pressure had their blood pressure checked within the past two years,and 72.5%of those with no previous diagnosis of high blood cholesterol were screened for this disease within the past three years.8 Cancer Screening Although the crude screening participation for breast and cervical cancer showed decreasing trend between 2007 and 2021,the decline was significant for cervical cancer(57.9%in 2007 to 41.0%in 2021)but not so for breast cancer(41.0%in 2007 to 31.1%in 2021).The age-standardised screening participation for both breast and cervical cancers did not show significant downward trend(breast:41.2%in 2007 to 32.0%in 2021;cervical:57.5%in 2007 to 42.7%)in the same period.The crude and age-standardised screening participation for colorectal cancer rose significantly between 2007 and 2021(crude:14.6%in 2007 to 36.6%in 2021,age-standardised:14.6%in 2007 to 35.9%in 2021).Comparing between 2019 and 2021,the screening participations for all three cancers in 2021 were significantly lower than 2019(breast cancer:38.7%in 2019,37.9%in 2020,31.1%in 2021;cervical cancer:48.2%in 2019,45.4%in 2020,41.0%in 2021;colorectal;42.0%in 2019,41.1%in 2020,36.6%in 2021).The lower screening participation in 2021 was probably due to the COVID-19 situation(e.g.,deferment of non-urgent services such as health screening)in the last two years.Breast Cancer Screening:In 2021,close to one-third(31.1%)of Singapore women in the 50 to 69 years age group reported that they had gone for mammography in the last two years.Cervical Cancer Screening In 2021,about two in five(41.0%)women reported that they had gone for a cervical cancer screening(had done a Pap smear test in the past three years or a HPV test in the past five years).Women aged 30 to 59 years were most likely to have undergone cervical cancer screening.9 Colorectal Cancer Screening Overall in 2021,36.6%of Singapore residents aged 50 to 74 years had undergone colorectal screening within the recommended screening frequency.Close to one in five(19.0%)of these residents reported having undergone Faecal Occult Blood Test(FOBT)at least once in the past one year while about one in four(26.0%)had undergone colonoscopy in the past 10 years.The practice of taking a FOBT or a colonoscopy was more prevalent among males(39.1%)than females(34.2%).Vaccination The overall self-reported influenza vaccination(a flu injection in the past 12 months)among Singapore residents aged 18 to 74 years did not show significant increasing trend between 2017 and 2021.Arising possibly from greater awareness about the importance of vaccination due to COVID-19,the proportion of older residents aged 65 to 74 who reported having influenza vaccination rose significantly in 2021(32.4%)compared with 2019(24.2%).Almost one in five(18.7%)Singapore residents aged 18 to 74 years reported they had an influenza injection in 2021,with more females(19.1%)having influenza vaccination compared with males(18.4%).Despite a significant increase in the self-reported pneumococcal vaccination among Singapore residents aged 65 to 74 years from 10.3%in 2019 to 22.4%in 2021,the increase in vaccination over a longer period from 2017 to 2021 was however not significant.The self-reported pneumococcal vaccination in 2021 was higher in females(22.8%)than males(21.9%).Mental Health Between 2019 and 2021,the proportion of residents who were willing to seek help from healthcare professionals(if they were constantly unable to cope with stress)increased significantly between 2019(47.8%)and 2021(58.3%).However,the proportion of residents who were willing to seek help from informal support networks dropped significantly between 2019(74.5%)and 2021(69.1%).10 In 2021,Singapore residents aged 18 to 74 years were more willing to seek help informally from their social circle(69.1%)than formally from healthcare professionals(58.3%).Females were more willing to seek help from healthcare professionals and informal support networks compared to males in 2021.Among the age groups,Singapore residents aged 60 to 74 years(45.8%)were the least willing to seek help from healthcare professionals while those aged 30 to 39 years(67.7%)were the most willing to seek help from healthcare professionals in 2021.Similarly,the willingness to seek help from informal support networks decreased with age,it was the highest among younger adults aged 18 to 29 years(84.3%)and the lowest among older adults aged 60 to 74 years(50.3%)in 2021.11 Chapter 1 Alcohol Consumption Key Points 2.8%of Singapore residents aged 18 to 74 years consumed alcohol regularly in 2021,with 4.6%of the males and 1.1%of the females being regular drinkers.Regular alcohol consumption was most common among males in the 50 to 59 years age group(7.2%).The prevalence of binge drinking was 9.6%in 2021,and it was more common among males(13.8%)than females(5.6%).Young adults in the 18 to 29 years age group were most likely to binge drink compared to the other age groups,especially among males where about one in five(20.4%)were binge drinkers compared to about one in ten(10.7%)females.Introduction Alcohol is a toxic and psychoactive substance with dependence producing properties.Alcohol consumption is a major contributor to the global burden of disease.Several diseases such as liver and pancreas disease,neuropsychiatric disease,cardiovascular diseases and certain cancers,are entirely or partially caused by alcohol consumption.In addition to these disease risks that affect the drinkers in the long run,alcohol consumption can also cause immediate social harm to both the drinkers and the other people around.The impact of alcohol intake is largely determined by the pattern of drinking and volume of alcohol consumed(WHO 2018).Definition Alcohol consumption was classified according to the frequency of alcohol intake in Table 1.1.Table 1.1:Classification of alcohol consumption Classification Frequency of alcohol consumption Regular drinker 4 days a week Frequent drinker 1 4 days a week Occasional drinker 3 days a month 12 Binge drinking was defined as consumption of at least five alcoholic drinks5 for males or at least four alcoholic drinks for females in any single drinking session during the past month preceding the survey.Method Used An interviewer-administered questionnaire was used.Respondents were shown a card with pictures of standard alcoholic drinks(Diagram 1)and asked questions on alcohol consumption within the past 12 months at the time of the survey.Diagram 1:Alcohol Card Alcohol Consumption The survey found that among Singapore residents aged 18 to 74 years,2.8%consumed alcohol regularly,11.3%frequently,30.7%occasionally and 55.2%were non-drinkers(Table 1.2).5 1 alcoholic drink refers to 1 glass(100 mls)of wine or 1 measure(30 mls)of spirits.1 can/mug/small bottle(330ml)of beer represents 1.5 servings of alcoholic drink.13 Table 1.2:Alcohol consumption(%)among Singapore residents aged 18 to 74 years by gender,2021 Alcohol Consumption Total Males Females Non-drinker 55.2 46.2 63.7 Occasional drinker 30.7 33.6 28.0 Frequent drinker 11.3 15.6 7.2 Regular drinker 2.8 4.6 1.1 Prevalence of Regular Alcohol Consumption Among Singapore residents aged 18 to 74 years,4.6%of the males and 1.1%of the females consumed alcohol regularly(Table 1.3).Regular alcohol consumption was most common among males in the 50 to 59 years age group(7.2%).Among the ethnic groups,regular drinking was most common in Chinese(3.2%)(Graph 1.1).A slightly higher proportion of residents with primary education(2.9%)and post-secondary education(2.9%)were regular drinkers,compared to those with secondary education(2.5%)(Table 1.4).Table 1.3:Age-specific crude prevalence(%)of regular alcohol consumption among Singapore residents aged 18 to 74 years by gender,2021 Age(years)Total Males Females 18-29 s s s 30-39 1.7 2.5 s 40-49 2.7 4.2 1.4 50-59 3.9 7.2 s 60-74 3.2 5.3 1.2 18-74 2.8 4.6 1.1 s:Data have been suppressed due to small counts or high sampling variability.14 Graph 1.1:Crude prevalence(%)of regular alcohol consumption among Singapore residents aged 18 to 74 years by gender and ethnicity,2021 Note:Data for Malays and Indian females have been suppressed due to small counts or high sampling variability.Trends in Regular Alcohol Consumption The crude and age-standardised prevalence of regular alcohol consumption increased significantly from 2007 to 2021(Table 1.4).The significant rise in prevalence of regular drinking was observed mainly among adults aged 30 to 49 years,males,Chinese,and those with post-secondary education.Between 2019 and 2021,the prevalence of regular drinking did not change significantly.3.25.41.12.33.80.01.02.03.04.05.06.0TotalMalesFemalesPercent of respondentsChineseMalaysIndians 15 Table 1.4:Crude prevalence(%)of regular alcohol consumption among Singapore residents aged 18 to 74 years by age,gender,education,and ethnicity,2007 to 2021 NHSS NHSS NPHS NPHS NPHS NPHS 2007 2013 2017 2019 2020 2021 Total 1.2 1.2 2.2 (1.6,2.7)2.1 (1.6,2.6)2.2 (1.7,2.6)2.8b (2.1,3.4)ASR 1.2 1.2 2.1 1.9 2.1 2.7b 18-29 s s s s s s 30-39 0.9 s s 1.1 (0.5,1.8)1.8 (0.9,2.8)1.7b (1.0,2.5)40-49 1.2 2.0 2.3 (1.1,3.4)2.1 (1.0,3.1)2.0 (1.2,2.8)2.7b (1.6,3.9)50-59 1.9 1.5 3.8 (2.1,5.4)2.4 (1.3,3.4)3.4 (2.2,4.6)3.9(2.7,5.1)60-74 s 1.4 3.7 (2.0,5.4)4.3 (2.7,5.9)3.0 (2.1,3.8)3.2 (2.3,4.1)Males 2.1 2.0 3.7 (2.7,4.8)3.6 (2.6,4.5)3.4 (2.7,4.1)4.6b (3.3,5.8)Females s 0.4 s 0.7 (0.3,1.0)1.0 (0.6,1.4)1.1 (0.7,1.4)Primary 1.5 1.8 s 3.3 (1.9,4.6)3.2 (1.9,4.4)2.9 (1.8,4.0)Secondary 1.3 1.6 2.6 (1.4,3.7)2.3 (1.4,3.1)1.9 (1.3,2.5)2.5 (1.8,3.3)Post-secondary 1.0 0.8 1.9(1.1,2.7)1.7(1.1,2.3)2.1(1.5,2.6)2.9b(1.9,3.8)Chinese 1.3 1.3 2.3 (1.6,2.9)2.2 (1.6,2.8)2.4 (1.9,2.9)3.2b (2.3,4.0)Malays s s s s s s Indians s 1.0 s s s 2.3 (1.2,3.3)Notes:(1)Figures in()refer to the 95%confidence intervals.a Indicates that the results for any two consecutive survey years are significantly different statistically at 5%significance level as the confidence intervals for these two survey years did not overlap(i.e.,between NPHS 2017 and NPHS 2019,NPHS 2019 and NPHS 2020,NPHS 2020 and NPHS 2021).(2)s:Data have been suppressed due to small counts or high sampling variability.(3)ASR:Age-standardised rate.The reference population used is Singapore Census 2010 resident population.(4)Analysis based on highest education attained served as a proxy to socio-economic factors.Primary education:No formal qualification/Primary/PSLE.Secondary education:Secondary/GCE O/N level.Post-secondary education:GCE A Level/Polytechnic&other diploma/Degree&professional qualification.(5)b Indicate statistically significant linear upward trend between 2007 and 2021 with p-value 0.05.16 Prevalence of Binge Drinking Among Singapore residents aged 18 to 74 years,the prevalence of binge drinking was 9.6%(Table 1.5).Binge drinking was more prevalent among males(13.8%)than females(5.6%).Both genders had the highest proportion of binge drinkers in the 18 to 29 years age group(males:20.4%,females:10.7%).Among the ethnic groups,the prevalence of binge drinking was higher in Indians(10.6%)and Chinese(10.2%)than Malays(2.1%)(Graph 1.2).The proportion of binge drinkers was higher among those with post-secondary education(11.7%),compared to those with lower education levels(primary education:4.8%,secondary education:6.6%)(Table 1.6).Table 1.5:Age-specific crude prevalence(%)of binge drinking among Singapore residents aged 18 to 74 years by gender,2021 Age(years)Total Males Females 18-29 15.6 20.4 10.7 30-39 12.8 16.9 9.0 40-49 9.7 13.8 5.9 50-59 6.4 11.0 1.8 60-74 4.3 7.5 1.1 18-74 9.6 13.8 5.6 Graph 1.2:Crude prevalence(%)of binge drinking among Singapore residents aged 18 to 74 years by gender and ethnicity,2021 Note:Data for Malay females have been suppressed due to small counts or high sampling variability.10.214.56.12.12.610.615.85.10.02.04.06.08.010.012.014.016.018.020.0TotalMalesFemalesPercent of respondentsChineseMalaysIndians 17 Trends in Binge Drinking The rise in both the crude and age-standardised prevalence of binge drinking was significant between 2007 and 2021(Table 1.6).This upward trend was also observed in all age groups except those aged 60 to 74 years,in both genders,among Chinese and Indians;and those with post-secondary education over the same period between 2007 and 2021.Between 2019 and 2021,the prevalence of binge drinking remained stable.Table 1.6:Crude prevalence(%)of binge drinking among Singapore residents aged 18 to 74 years by age,gender,education,and ethnicity,2007 to 2021 NHSS NHSS NPHS NPHS NPHS NPHS 2007 2013 2017 2019 2020 2021 Total 4.3 7.4 8.8 (7.6,10.0)10.2 (9.1,11.3)10.5 (9.5,11.5)9.6b (8.6,10.6)ASR 4.2 7.3 9.1 10.7 11.2 10.3b 18-29 8.1 14.6 12.4 (9.2,15.6)16.6 (13.5,19.7)17.1 (13.8,20.3)15.6b (12.0,19.3)30-39 4.6 7.7 10.6 (7.5,13.7)13.8 (10.9,16.6)14.5 (12.0,17.0)12.8b (10.7,14.9)40-49 3.7 5.3 9.3 (6.8,11.7)8.8 (6.8,10.7)9.6 (7.7,11.6)9.7b (7.9,11.5)50-59 2.3 4.9 7.3 (5.0,9.7)6.9 (5.0,8.8)6.8 (5.1,8.5)6.4b (4.9,7.8)60-74 s 3.2 4.0 (2.4,5.7)5.0 (3.4,6.6)4.9 (3.5,6.2)4.3 (3.2,5.3)Males 6.4 10.7 13.1 (11.1,15.1)14.9 (13.1,16.6)14.6 (13.0,16.3)13.8b (12.1,15.5)Females 2.2 4.2 4.7 (3.4,6.0)5.7 (4.6,6.8)6.5 (5.3,7.7)5.6b (4.5,6.7)Primary 3.1 2.7 4.2 (2.3,6.2)5.4 (3.6,7.2)4.4 (2.9,5.9)4.8 (3.2,6.3)Secondary 4.5 5.7 8.4 (6.5,10.4)7.3 (5.9,8.7)7.5 (6.0,8.9)6.6 (5.4,7.8)Post-secondary 4.5 9.8 10.3 (8.6,12.0)12.5 (10.9,14.2)13.0 (11.5,14.5)11.7b (10.2,13.1)18 Table 1.6:Crude prevalence(%)of binge drinking among Singapore residents aged 18 to 74 years by age,gender,education,and ethnicity,2007 to 2021(continued)NHSS NHSS NPHS NPHS NPHS NPHS 2007 2013 2017 2019 2020 2021 Chinese 4.7 8.6 9.4 (8.0,10.9)11.5 (10.1,12.8)11.6 (10.3,12.8)10.2b (9.0,11.4)Malays 1.1 1.5 s 2.3 (1.0,3.6)1.7 (0.7,2.7)2.1 (1.0,3.2)Indians 4.5 6.6 13.4 (9.2,17.6)10.5 (7.8,13.1)11.4 (7.9,14.8)10.6b (6.3,14.8)Notes:(1)Figures in()refer to the 95%confidence intervals.a Indicates that the results for any two consecutive survey years are significantly different statistically at 5%significance level as the confidence intervals for these two survey years did not overlap(i.e.,between NPHS 2017 and NPHS 2019,NPHS 2019 and NPHS 2020,NPHS 2020 and NPHS 2021).(2)s:Data have been suppressed due to small counts or high sampling variability.(3)ASR:Age-standardised rate.The reference population used is Singapore Census 2010 resident population.(4)Analysis based on highest education attained served as a proxy to socio-economic factors.Primary education:No formal qualification/Primary/PSLE.Secondary education:Secondary/GCE O/N level.Post-secondary education:GCE A Level/Polytechnic&other diploma/Degree&professional qualification.(5)b Indicate statistically significant linear upward trend between 2007 and 2021 with p-value 0.05.19 Chapter 2 Cigarette Smoking Key Points 10.4%of Singapore residents aged 18 to 74 years smoked cigarettes daily in 2021.More males(17.8%)smoked daily than females(3.3%).Daily smoking was most prevalent in adults aged 30 to 39 years(12.8%)and least prevalent among younger adults aged 18 to 29 years and older adults in the 60 to 74 years(both 8.3%)in 2021.Male daily smokers smoked an average of 12 cigarettes a day while female daily smokers smoked an average of 8 cigarettes a day.About half(49.4%)of the daily smokers had intention to quit smoking.However,only 18.4%of them planned to quit smoking within the next 12 months or less.Introduction Tobacco use is a source of preventable morbidity and mortality.Active smoking increases the risk of several diseases such as respiratory diseases,cardiovascular diseases and certain cancers.In addition to these disease risks that affect the smokers,smoking also implicates the other people around who are exposed to second-hand smoke.Cigarette smoking is the most common form of smoking.The impact of tobacco use is largely determined by the pattern of smoking and number of cigarettes smoked(US Department of Health and Human Services,2014).20 Definition Smoking status was classified according to the frequency of cigarette smoked as shown in Table 2.1,which followed the World Health Organization(WHO)classification criteria(WHO,1998).Table 2.1:Classification of smoking status Classification Frequency of cigarette smoking Daily smoker Smokes cigarettes at least once a day(including people who smoke every day but have to stop temporarily because of religious fasting or medical reasons)Occasional smoker Smokes cigarettes but not every day Ex-smoker Formerly a daily smoker,but currently does not smoke at all Non-smoker Never smoked before or smoked too little in the past to be regarded as an ex-smoker Method Used An interviewer-administered questionnaire was used.The questionnaire was based on WHOs recommended core questions for assessing smoking status(WHO,1998).Smoking Status The survey showed that among Singapore residents aged 18 to 74 years,10.4%were daily smokers,3.0%were occasional smokers,7.7%were ex-smokers and 79.0%were non-smokers(Table 2.2).Table 2.2:Smoking status(%)of Singapore residents aged 18 to 74 years by gender,2021 Smoking Status Total Males Females Daily smoker 10.4 17.8 3.3 Occasional smoker 3.0 4.9 1.1 Ex-smoker 7.7 12.2 3.4 Non-Smoker 79.0 65.1 92.3 Note:Data might not sum to 100%due to rounding.21 Prevalence of Daily Smoking The prevalence of daily smoking among Singapore residents aged 18 to 74 years was 17.8%among males and 3.3%among females(Table 2.3).Daily smoking was most prevalent in the 30 to 39 years age group for both genders(males:20.8%,females:5.5%).Daily smoking prevalence was higher among Malays(22.4%)than Chinese(8.6%)and Indians(9.2%)(Graph 2.1).The prevalence of daily smoking among Singapore residents with below post-secondary education(primary education:16.5%,secondary education:15.5%)was about two times higher than residents with post-secondary education(7.2%)(Table 2.4).Table 2.3:Age-specific crude prevalence(%)of daily smoking among Singapore residents aged 18 to 74 years by gender,2021 Age(years)Total Males Females 18-29 8.3 14.4 2.1 30-39 12.8 20.8 5.5 40-49 11.6 18.8 5.0 50-59 11.3 20.0 2.8 60-74 8.3 15.7 1.1 18-74 10.4 17.8 3.3 Graph 2.1:Crude prevalence(%)of daily smoking among Singapore residents aged 18 to 74 years by gender and ethnicity,2021 Note:Data for Indian females have been suppressed due to small counts or high sampling variability.8.614.82.922.438.07.19.216.70.05.010.015.020.025.030.035.040.045.050.0TotalMalesFemalesPercent of respondentsChineseMalaysIndians 22 Age of Initiation and Onset of Daily Smoking Among Daily Smokers Among Singapore residents who are daily smokers,the mean age of initiation,or the age at which they first tried smoking,was 17 years old.The mean age at which they established their habit of daily smoking was 19 years old.Among the younger daily smokers aged 18 to 24 years,the mean age of initiation and age at which they established their daily smoking habit was 16 and 17 years old respectively.Smoking Intensity of Daily Smokers The mean number of cigarettes smoked per day among the daily smokers was 11 cigarettes.Male daily smokers on average smoked more cigarettes per day(12 cigarettes)than female daily smokers(8 cigarettes).Daily smokers in the 60 to 74 years age group on average smoked the highest number of cigarettes per day(13 cigarettes),compared to the other age groups.Quit Intention of Daily Smokers About half(49.4%)of the daily smokers had intention to quit smoking.However,only about one in five(18.4%)daily smokers planned to quit smoking within the next 12 months or less.Slightly more than one in four(27.5%)daily smokers indicated that they did not plan to quit smoking at all but planned to cut down on the number of cigarettes smoked.About one in four(23.1%)daily smokers did not plan to quit smoking or reduce the number of cigarettes smoked.Daily smokers who had abstained from smoking for a period of at least 24 hours in the past 12 months reported that on average they had tried quitting smoking three times during the past 12 months preceding the survey.Trends in Daily Smoking The crude and age-standardised prevalence of daily smoking decreased significantly between 2007 and 2021(Table 2.4).This downward trend was also significant in younger adults aged 18 to 29 years,in both males and females,among the Chinese and those with post-secondary education over the same period.Although the overall crude prevalence of daily smoking remained stable from 2019(10.6%)to 2021(10.4%),there were some increases among the 30 to 49 years age group,and those with post-secondary education over the last three years,though these increases were not significant.23 Table 2.4:Crude prevalence(%)of daily smoking among Singapore residents aged 18 to 74 years by age,gender,education,and ethnicity,2007 to 2021 NHSS NHS NHSS NPHS NPHS NPHS NPHS 2007 2010 2013 2017 2019 2020 2021 Total 13.3 13.9 13.1 11.8 (10.6,13.0)10.6 (9.5,11.7)10.1 (9.2,11.0)10.4c (9.6,11.2)ASR 13.3 13.9 13.2 12.0 10.6 10.3 10.7c 18-29 17.4 16.0 12.6 9.8 (7.1,12.5)8.4 (6.5,10.2)8.8 (6.8,10.8)8.3c (6.2,10.4)30-39 12.5 16.0 14.7 12.6 (9.5,15.7)11.4 (9.3,13.5)9.9 (7.9,11.8)12.8 (10.9,14.7)40-49 12.8 14.3 15.4 14.5 (11.6,17.4)10.6 (8.7,12.5)10.6 (8.5,12.7)11.6 (9.5,13.7)50-59 12.7 11.4 13.3 11.9 (9.2,14.6)12.6 (10.0,15.2)13.4 (10.8,16.0)11.3 (9.4,13.3)60-74 9.8 10.1 8.5 10.2 (7.5,12.8)10.2 (8.0,12.4)8.0 (6.5,9.5)8.3 (6.9,9.6)Males 23.1 24.0 23.0 20.6 (18.5,22.8)18.4 (16.3,20.5)17.0 (15.4,18.6)17.8c (16.3,19.3)Females 3.8 4.1 3.6 3.3 (2.3,4.3)3.2 (2.4,3.9)3.4 (2.5,4.3)3.3c (2.6,4.0)Primary 16.3 19.4 15.8 17.2 (13.6,20.9)18.3 (15.2,21.4)16.5 (13.7,19.3)16.5 (13.5,19.5)Secondary 18.0 18.1 19.6 17.5 (14.8,20.2)16.7 (14.3,19.0)16.4 (14.2,18.6)15.5 (13.6,17.3)Post-secondary 8.4 9.3 8.3 6.9 (5.6,8.2)6.1 (5.1,7.1)6.0 (5.0,6.9)7.2c (6.3,8.1)Chinese 12.0 12.6 11.5 9.9 (8.6,11.2)8.6 (7.5,9.7)8.6 (7.7,9.5)8.6c (7.8,9.5)Malays 23.0 26.1 24.9 23.1 (19.0,27.3)23.0 (19.4,26.6)21.1 (17.3,24.9)22.4 (19.1,25.8)Indians 11.1 10.0 10.5 12.6 (8.4,16.9)10.9 (8.0,13.8)8.9 (6.0,11.9)9.2 (6.8,11.7)Notes:(1)Figures in()refer to the 95%confidence intervals.a Indicates that the results for any two consecutive survey years are significantly different statistically at 5%significance level as the confidence intervals for these two survey years did not overlap(i.e.,between NPHS 2017 and NPHS 2019,NPHS 2019 and NPHS 2020,NPHS 2020 and NPHS 2021).(2)ASR:Age-standardised rate.The reference population used is Singapore Census 2010 resident population.(3)Analysis based on highest education attained served as a proxy to socio-economic factors.Primary education:No formal qualification/Primary/PSLE.Secondary education:Secondary/GCE O/N level.Post-secondary education:GCE A Level/Polytechnic&other diploma/Degree&professional qualification.(4)c Indicate statistically significant linear downward trend between 2007 and 2021 with p-value 0.05.24 Chapter 3 Physical Activity Key Points About one in three(32.5%)Singapore residents aged 18 to 74 years engaged in regular exercise during their leisure time in 2021.The highest proportion of adults with regular exercise was observed among young adults aged 18 to 29 years(40.5%)while the lowest was among older adults aged 60 to 74 years(24.0%).Leisure-time regular exercise was more prevalent among males(37.5%)than females(27.7%).Based on all domains of physical activity(including work-related,transportation-related and leisure-time),71.1%of Singapore residents had sufficient total physical activity in 2021.More males(73.0%)compared with females(69.3%)were able to meet this recommended total physical activity level.Young adults in the 18 to 29 years age group(76.3%)had the highest level of sufficient total physical activity while the older adults aged 60 to 74 years had the lowest proportion at 65.1%.The largest contributor to total physical activity per week was commuting(47.0%),followed by leisure-time physical activity(27.5%)and work-related physical activity(25.5%).More than one in three(35.5%)Singapore residents aged 18 to 74 years reported having sufficient muscle-strengthening activities in 2021.This was more common among younger adults aged 18 to 39 years(18 to 29 years:46.4%;30-39 years:37.0%)while the proportion dropped to around one-third for those aged 40 to 74 years old.Males(40.0%)had higher proportion with sufficient muscle-strengthening activities compared with females(31.2%).25 Introduction Physical activity is important for maintaining good health for all ages.For adults,it has been shown to reduce the risk of premature death in general and in particular the risk of developing cardiovascular diseases,hypertension and diabetes mellitus.In addition,physical activity improves mental and cognitive health,sleep and prevents unhealthy weight gain.In older adults aged 65 years and above who are physically active,they are less likely to experience falls and falls-related injuries and have better functional capacity and mobility to live longer independently(US Department of Health and Human Services 2018;WHO 2020;WHO 2010).Definition of Leisure-Time Physical Activity Leisure-time physical activity focuses on participation in sports,exercise and recreation activity independent of the work and transportation domain.The classification for leisure-time physical activity was adapted from the American College of Sports Medicines classification(Table 3.1)(American College of Sports Medicine,1998).Table 3.1:Classification of leisure-time physical activity participation Classification Frequency of leisure-time physical activity Regular exercise Participation in any form of sports or exercise for at least 20 minutes per occasion,for three or more days a week Occasional exercise Participation in any form of sports or exercise for at least 20 minutes per occasion,for less than three days a week No exercise(Physically inactive)No participation in any form of sports or exercise that lasted for at least 20 minutes per occasion in a week Method Used An interviewer-administered questionnaire was used.Respondents were asked about the frequency,duration and intensity of physical activity in the domain of work,transportation and leisure using the Global Physical Activity Questionnaire(GPAQ)developed by WHO(WHO 2010).26 Leisure-time Physical Activity Participation Status The survey found that among Singapore residents aged 18 to 74 years,about one-third(32.5%)exercised regularly,19.3%exercised occasionally,and 48.2%did not exercise at all(Table 3.2).Table 3.2:Leisure-time physical activity participation status(%)of Singapore residents aged 18 to 74 years by gender,2021 Physical Activity Participation Total Males Females Regular exercise 32.5 37.5 27.7 Occasional exercise 19.3 19.7 19.0 No exercise(physically inactive)48.2 42.8 53.3 Prevalence of Leisure-time Regular Exercise A higher proportion of males(37.5%)than females(27.7%)exercised regularly(Table 3.3).There was a general decline in the prevalence of regular exercise with increasing age.The highest proportion was observed among young adults aged 18 to 29 years(40.5%)before decreasing to around one-third between the ages of 30 to 59 years and a quarter(24.0%)among older adults aged 60 to 74 years.Females aged 60 to 74 years had the lowest participation in regular exercise(18.9%)across all age groups and gender.Males in the 18 to 29 years age group had the highest participation in regular exercise at 47.3%but this participation dropped steadily with increasing age,reaching about three in 10(29.3%)among males aged 60 to 74 years.Table 3.3:Age-specific crude prevalence(%)of leisure-time regular exercise among Singapore residents aged 18 to 74 years by gender,2021 Age(years)Total Males Females 18-29 40.5 47.3 33.8 30-39 32.6 39.6 26.3 40-49 33.8 35.1 32.6 50-59 32.5 36.8 28.2 60-74 24.0 29.3 18.9 18-74 32.5 37.5 27.7 27 Among the ethnic groups,Indians(42.7%)had the highest participation level in regular exercise and for both genders,followed by Chinese(32.1%)and Malays(23.9%).(Graph 3.1).Close to half(45.9%)of all Indian men exercised regularly compared to 37.6%of Chinese and 27.3%of Malay men.Malay women had the lowest participation level with about one in five(20.5%)having regular exercise.By education attainment,the proportion of residents with post-secondary education(39.7%)who exercised regularly was more than 2.5 times higher than those with primary education(14.7%)and more than 1.5 times higher than those with secondary education(22.6%)(Table 3.4).Graph 3.1:Crude prevalence(%)of leisure-time regular exercise among Singapore residents aged 18 to 74 years by gender and ethnicity,2021 Reasons for Being Physically Inactive Among Singapore residents aged 18 to 74 years who did not participate in any sports,exercise and recreation activity during their leisure time,the following reasons for being physically inactive were cited:“No time due to work/family commitments”(39.0%),“Stop exercising due to COVID-19”(15.6%),“Too lazy”(12.0%)and“Too tired due to work commitment”(9.5%).32.137.626.923.927.320.542.745.939.30.010.020.030.040.050.060.0TotalMalesFemalesPercent of respondentsChineseMalaysIndians 28 Trends in Leisure-time Regular Exercise The crude and age-standardised prevalence of leisure-time regular exercise increased significantly from 2007 to 2021(Table 3.4).The significant increases were also presented among adults between the ages of 18 to 49 years,males,Chinese and those with post-secondary education.Though the prevalence of leisure-time regular exercise showed a slight decline since 2019(35.2%in 2019,33.4%in 2020,32.5%in 2021),the changes in prevalence were not significant.Similarly,across most subgroups,the prevalence of regular exercise fluctuated from 2019 to 2021 and the differences were largely insignificant except for older residents aged 60 to 74 years and residents with secondary education.This reduction in regular exercise for the older residents(2019:30.3%,2021:24.0%)could be due to the COVID-19 advisories that urged seniors to stay at home;and minimise group activities and social gatherings in hope of reducing their risk of being infected with COVID-19.Regular exercise among residents with secondary education was also lower in 2021(22.6%)compared with 2019(28.5%).Table 3.4:Crude prevalence(%)of leisure-time regular exercise among Singapore residents aged 18 to 74 years by age,gender,education,and ethnicity,2007 to 2021 NHSS NHSS NPHS NPHS NPHS NPHS 2007 2013 2017 2019 2020 2021 Total 24.1 23.5 29.6 (27.4,31.8)35.2 (33.3,37.2)a 33.4 (31.9,34.9)32.5b (31.1,33.9)ASR 24.3 23.4 29.9 35.8 33.8 33.4b 18-29 28.2 33.5 37.1 (32.0,42.1)46.9 (42.5,51.3)a 41.2 (37.4,45.0)40.5b (36.5,44.6)30-39 18.8 20.9 33.4 (28.6,38.1)34.2 (30.4,37.9)30.0 (26.6,33.4)32.6b (29.6,35.7)40-49 22.1 18.6 29.3 (25.2,33.5)31.0 (27.7,34.2)33.0 (29.7,36.2)33.8b (30.7,37.0)50-59 24.4 20.4 23.8 (20.3,27.4)33.7 (29.6,37.8)a 33.8 (30.4,37.3)32.5 (29.0,36.0)60-74 30.0 23.7 23.6 (20.0,27.2)30.3 (26.8,33.9)29.2 (26.3,32.0)24.0(21.7,26.4)d 29 Table 3.4:Crude prevalence(%)of leisure-time regular exercise among Singapore residents aged 18 to 74 years by age,gender,education,and ethnicity,2007 to 2021(continued)NHSS NHSS NPHS NPHS NPHS NPHS 2007 2013 2017 2019 2020 2021 Males 25.4 28.1 30.2 (27.5,32.9)38.7 (36.1,41.2)a 36.2 (34.0,38.4)37.5b (35.3,39.6)Females 22.8 19.0 29.0 (26.2,31.8)32.0 (29.4,34.6)30.7 (28.7,32.8)27.7 (25.8,29.6)Primary 19.7 13.4 17.4 (13.6,21.2)19.2 (16.3,22.1)18.5 (15.5,21.5)14.7 (11.7,17.6)Secondary 23.4 20.1 24.8 (21.5,28.2)28.5 (25.7,31.3)25.1 (22.7,27.5)22.6 (20.2,25.0)d Post-secondary 26.5 28.5 35.8 (32.9,38.7)41.9 (39.3,44.4)a 40.0 (37.9,42.1)39.7b (37.7,41.6)Chinese 22.6 23.4 29.6 (27.1,32.0)34.7 (32.4,37.1)a 33.6 (31.9,35.3)32.1b (30.5,33.8)Malays 22.2 20.1 27.7 (22.9,32.6)30.0 (26.7,33.3)23.9 (20.3,27.5)23.9 (20.0,27.7)Indians 37.0 26.7 29.8 (24.6,34.9)45.2 (40.0,50.4)a 42.1 (36.6,47.6)42.7 (37.8,47.6)Notes:(1)Figures in()refer to the 95%confidence intervals.a Indicates that the results for any two consecutive survey years are significantly different statistically at 5%significance level as the confidence intervals for these two survey years did not overlap(i.e.,between NPHS 2017 and NPHS 2019,NPHS 2019 and NPHS 2020,NPHS 2020 and NPHS 2021).(2)ASR:Age-standardised rate.The reference population used is Singapore Census 2010 resident population.(3)Analysis based on highest education attained served as a proxy to socio-economic factors.Primary education:No formal qualification/Primary/PSLE.Secondary education:Secondary/GCE O/N level.Post-secondary education:GCE A Level/Polytechnic&other diploma/Degree&professional qualification.(4)Data for NPHS 2017 have been revised.(5)b Indicate statistically significant linear upward trend between 2007 and 2021 with p-value 0.05.(6)d Indicates that the results from NPHS 2019 and NPHS 2021 are significantly different statistically at 5%significance level as the confidence intervals for these two survey years did not overlap.30 Total Physical Activity WHO guidelines recognises that participation in physical activity can be achieved across three domains:work-related activity(paid or unpaid work including household chores),transportation-related activity(e.g.walking or cycling while travelling to and from places)and leisure-time physical activity(WHO 2020;WHO 2010).Physical activity participation across the three domains(i.e.work-related,transport-related and leisure-time physical activity)was assessed and could be achieved in one single session or accumulated in bouts of at least 10 minutes throughout the day.WHO recommends that adults should do at least 150 minutes of moderate-intensity physical activity or at least 75 minutes of vigorous-intensity physical activity or an equivalent combination of moderate-and vigorous-intensity physical activity per week6(WHO 2010).This recommendation is equivalent to achieving a high to moderate level of total physical activity(i.e.having sufficient total physical activity).The criteria for the three levels of total physical activity classification are in Table 3.5.Table 3.5:Classification of total physical activity7 Classification Criteria High Vigorous-intensity activity on at least 3 days achieving a minimum of at least 1,500 MET*-minutes per week OR 7 or more days of any combination of walking,moderate-or vigorous-intensity activities achieving a minimum of at least 3,000 MET-minutes per week.Moderate Not meeting the criteria for the“high”category,but meeting any of the following criteria is classified in this category:3 or more days of vigorous intensity activity of at least 20 minutes per day OR 5 or more days of moderate-intensity activity or walking of at least 30 minutes per day OR 5 or more days of any combination of walking,moderate-or vigorous-intensity activities achieving a minimum of at least 600 MET-minutes per week.Low Not meeting any of the above-mentioned criteria.*MET(Metabolic Equivalents)is the ratio of a persons working metabolic rate relative to the resting metabolic rate.1 MET is defined as the energy cost of sitting quietly and is equivalent to a caloric consumption of 1 kcal/kg/hour.6 Another approach to meet the recommendation is to achieve 30 minutes of moderate-intensity activity on at least 5 days a week(HSE 2016).7 Based on WHO Global Physical Activity Questionnaire(GPAQ)Analysis Guide Version 2.0 which classified the intensity of total physical activity into 3 levels high,moderate and low.31 Total Physical Activity Level The survey showed that the proportion of Singapore residents aged 18 to 74 years who engaged in high,moderate and low total physical activity were 29.2%,42.0%and 28.9%respectively(Table 3.6).Table 3.6:Total physical activity level(%)of Singapore residents aged 18 to 74 years by gender,2021 Total Physical Activity Level Total Males Females High 29.2 32.9 25.5 Moderate 42.0 40.1 43.8 Low 28.9 27.0 30.7 Note:Data might not sum to 100%due to rounding.Prevalence of Sufficient Total Physical Activity In 2021,71.1%of Singapore residents aged 18 to 74 years had sufficient(high and moderate)total physical activity(Table 3.7).More males(73.0%)compared with females(69.3%)were able to meet this recommended total physical activity level.Young adults in the 18 to 29 years age group(76.3%)had the highest level of sufficient total physical activity while the older adults aged 60 to 74 years had the lowest proportion at 65.1%.A higher proportion of Indians(80.2%)had sufficient total physical activity than the Malays(71.2%)and Chinese(69.7%)(Graph 3.2).Residents with post-secondary education(72.9%)had higher sufficient total physical activity compared with residents with secondary(69.8%)or primary(63.6%)education(Table 3.8).The largest contributor to total physical activity per week was commuting(47.0%),followed by leisure-time physical activity(27.5%)and work-related physical activity(25.5%).Table 3.7:Age-specific crude prevalence(%)of sufficient total physical activity among Singapore residents aged 18 to 74 years by gender,2021 Age(years)Total Males Females 18-29 76.3 81.4 71.1 30-39 71.3 71.8 70.8 40-49 69.7 69.5 69.8 50-59 74.0 75.5 72.5 60-74 65.1 67.2 63.0 18-74 71.1 73.0 69.3 Note:Sufficient:High and moderate 32 Graph 3.2:Crude prevalence(%)of sufficient total physical activity among Singapore residents aged 18 to 74 years by gender and ethnicity,2021 Note:Sufficient:High and moderate Trends in Sufficient Total Physical Activity Even though the downward trend in the proportion of residents with sufficient total physical activity at the overall level or by factors was not significant between 2007 and 2021(Table 3.8),there was a steady significant decrease from 2019 to 2021 for the overall level and most subgroups except among Indians and residents aged 50 to 59 years old.The new working arrangement(where workdays were split between home and office)and the restrictions on recreational facilities(e.g.,temporary closure of sports and recreational facilities,gardens,parks and nature reserves)in the last two years might have contributed to the reduction in participation in physical activity across all domains(i.e.,work,commuting and leisure-time).69.772.167.471.273.469.180.278.981.60.010.020.030.040.050.060.070.080.090.0100.0TotalMalesFemalesPercent of respondentsChineseMalaysIndians 33 Table 3.8:Crude prevalence(%)of sufficient total physical activity among Singapore residents aged 18 to 74 years by age,gender,education,and ethnicity,2007 to 2021 NHSS NHSS NPHS NPHS NPHS NPHS 2007 2013 2017 2019 2020 2021 Total 82.3 73.1 80.8 (78.6,83.0)80.1 (78.5,81.7)76.4 (75.1,77.7)a 71.1 (69.8,72.4)ad ASR 82.4 73.3 80.8 80.4 76.8 71.7 18-29 84.0 79.5 85.6(81.8,89.3)84.4 (81.3,87.6)82.9 (80.2,85.6)76.3 (73.0,79.6)ad 30-39 79.5 73.0 80.5 (76.4,84.7)78.0 (74.9,81.1)76.9 (73.9,79.8)71.3 (68.4,74.2)d 40-49 82.2 73.9 78.3 (74.6,82.1)79.8 (76.6,83.0)74.9 (72.0,77.8)69.7 (66.7,72.7)d 50-59 83.6 71.9 80.5 (77.0,84.0)79.0 (75.7,82.3)76.0 (73.0,79.0)74.0 (71.1,76.8)60-74 82.3 65.1 78.6 (74.7,82.6)79.3 (76.5,82.0)71.9 (69.1,74.7)a 65.1 (62.4,67.7)ad Males 81.7 74.8 81.4 (78.6,84.2)80.2 (78.1,82.4)76.4 (74.5,78.3)73.0 (71.2,74.8)d Females 82.9 71.5 80.2 (77.6,82.9)80.0 (78.1,82.0)76.5 (74.7,78.2)69.3 (67.4,71.2)ad Primary 86.1 67.6 82.2 (78.2,86.2)77.0 (73.0,81.0)72.4 (69.1,75.7)63.6 (59.8,67.4)ad Secondary 84.4 75.4 80.3 (77.0,83.7)80.9 (78.3,83.6)75.1 (72.6,77.5)a 69.8 (67.3,72.3)ad Post-secondary 79.1 73.3 80.7 (78.1,83.2)80.5 (78.4,82.6)77.8 (76.1,79.5)72.9 (71.2,74.6)ad Chinese 81.1 72.0 80.4 (78.0,82.8)78.8 (77.0,80.7)75.4 (73.8,76.9)a 69.7 (68.1,71.2)ad Malays 84.2 76.1 83.8 (79.6,88.0)82.0 (78.5,85.6)75.8 (72.1,79.4)71.2 (67.8,74.7)d Indians 88.0 76.3 79.5 (74.6,84.5)86.8 (82.8,90.7)84.4 (81.0,87.7)80.2 (76.6,83.8)Notes:(1)Figures in()refer to the 95%confidence intervals.a Indicates that the results for any two consecutive survey years are significantly different statistically 5%significance level as the confidence intervals for these two survey years did not overlap(i.e.,between NPHS 2017 and NPHS 2019,NPHS 2019 and NPHS 2020,NPHS 2020 and NPHS 2021).(2)ASR:Age-standardised rate.The reference population used is Singapore Census 2010 resident population.(3)Analysis based on highest education attained served as a proxy to socio-economic factors.Primary education:No formal qualification/Primary/PSLE.Secondary education:Secondary/GCE O/N level.Post-secondary education:GCE A Level/Polytechnic&other diploma/Degree&professional qualification.(4)Data for NPHS 2017 have been revised.(5)d Indicates that the results from NPHS 2019 and NPHS 2021 are significantly different statistically at 5%significance level as the confidence intervals for these two survey years did not overlap.34 Muscle-Strengthening Activities WHO also recommends that adults should do muscle-strengthening activities involving the major muscle groups at least two days or more in a week.Muscle-strengthening activity refers to an activity or exercise that increases skeletal muscle strength,power,endurance and mass(e.g.,strength training,resistance training or muscular strength and endurance exercises)and may involves the use of weight machines,exercise bands,hand-held weights or own body weight(e.g.,push-ups or sit-ups)(WHO 2010;Bennie et al.2019).The major muscle groups to work on include the legs,back,abdomen,chest,shoulders and arms(WHO 2010).It has been shown that muscle-strengthening exercises increase skeletal muscle strength and mass,bone density,ability to perform activities of daily living,improve cardiometabolic heath and reduce symptoms of anxiety and depression(Bennie et al.2019).Method Used Information on muscles-strengthening activities were collected since 2020 using an interviewer administered questionnaire.Respondents were asked about the number of days in a typical week that they do physical activities or exercises to strengthen their muscles.Respondents must complete at least one set of exercises involving eight to 12 repetitions to be counted as having done one day of muscle-strengthening activities.Respondents were classified as having sufficient muscle-strengthening activities if the frequency of muscle-strengthening activities are at least two days per week.Prevalence of Sufficient Muscle-Strengthening Activities More than one in three(35.5%)Singapore residents aged 18 to 74 years reported having sufficient muscle-strengthening activities in 2021(Table 3.9).This was more common among younger adults aged 18 to 39 years(18 to 29 years:46.4%;30-39 years:37.0%)while the proportion dropped to around one-third for those aged 40 to 74 years old.Males(40.0%)had higher proportion with sufficient muscle-strengthening activities compared with females(31.2%).The proportion of males in the ages 18 to 39 years with sufficient muscle-strengthening activities was almost 1.5 times that of females in the same age group.35 Table 3.9:Age-specific crude prevalence(%)of sufficient muscle-strengthening activities among Singapore residents aged 18 to 74 years by gender,2021 Age(years)Total Males Females 18-29 46.4 56.3 36.5 30-39 37.0 43.7 30.9 40-49 30.8 32.5 29.3 50-59 32.3 34.6 30.0 60-74 31.3 33.3 29.4 18-74 35.5 40.0 31.2 Among the ethnic groups,Indians had the highest proportion with sufficient muscle-strengthening activities(41.7%)and for both gender(males 45.3%,females 37.8%)(Graph 3.3).About one-third of Chinese(34.5%)and Malays(33.7%)reported having sufficient muscle-strengthening activities.While Malay(39.9%)and Chinese(38.9%)males shared similar proportion with sufficient muscle-strengthening activities,Malay females had the lowest participation in sufficient muscle-strengthening activities(27.6%).Residents with post-secondary education(40.1%)had higher proportion with sufficient muscle-strengthening activities compared with residents with secondary(30.5%)or primary(21.0%)education(Table 3.10).Graph 3.3:Crude prevalence(%)of sufficient muscle-strengthening activities among Singapore residents aged 18 to 74 years by gender and ethnicity,2021 34.538.930.333.739.927.641.745.337.80102030405060TotalMalesFemalesPercent of respondentsChineseMalaysIndians 36 Trends in Sufficient Muscle-Strengthening Activities The proportion of Singapore residents aged 18 to 74 years with sufficient muscle-strengthening activities has remained largely stable between 2020 and 2021(Table 3.10).The only significant increase was observed for the 60 to 74 years age group,whereby the proportion increased from 25.5%in 2020 to 31.3%in 2021.Table 3.10:Crude prevalence(%)of sufficient muscles-strengthening activities among Singapore residents aged 18 to 74 years by age,gender,education and ethnicity,2020 to 2021 NPHS NPHS 2020 2021 Total 33.8(32.3,35.3)35.5(34.0,37.0)ASR 34.5 36.0 18-29 44.1(40.2,48.0)46.4(42.4,50.5)30-39 30.9(27.4,34.4)37.0(33.8,40.2)40-49 33.5(30.1,36.8)30.8(27.8,33.9)50-59 35.5(32.0,39.0)32.3(29.0,35.6)60-74 25.5(22.7,28.3)31.3(28.8,33.9)a Males 40.1(37.8,42.4)40.0(37.9,42.1)Females 27.8(25.8,29.8)31.2(29.1,33.2)Primary 19.6(16.4,22.8)21.0(17.6,24.3)Secondary 27.4(24.8,30.0)30.5(28.0,33.1)Post-secondary 39.4(37.3,41.5)40.1(38.1,42.0)Chinese 32.7(31.0,34.5)34.5(32.8,36.2)Malays 32.7(28.5,36.9)33.7(29.8,37.7)Indians 41.6(36.1,47.1)41.7(36.8,46.5)Notes:(1)Figures in()refer to the 95%confidence intervals.a Indicates that the results for any two consecutive survey years are significantly different statistically from the previous survey year at 5%significance level as the confidence intervals for these two survey years did not overlap(i.e.,between NPHS 2017 and NPHS 2019,NPHS 2019 and NPHS 2020,NPHS 2020 and NPHS 2021).(2)ASR:Age-standardised rate.The reference population used is Singapore Census 2010 resident population.(3)Analysis based on highest education attained served as a proxy to socio-economic factors.Primary education:No formal qualification/Primary/PSLE.Secondary education:Secondary/GCE O/N level.Post-secondary education:GCE A Level/Polytechnic&other diploma/Degree&professional qualification.37 Chapter 4 Self-reported Diabetes Mellitus Key Points About one in 15(6.9%)Singapore residents aged 18 to 74 years reported that they had diabetes mellitus and were currently prescribed medication in 2021.Slightly more males(7.6%)reported having diabetes than females(6.2%).The prevalence of self-reported diabetes mellitus increased with age,from 0.9%in young adults aged 30 to 39 years to 18.3%among those aged 60 to 69 years and reached 21.7%among those aged 70 to 74 years.Introduction Diabetes mellitus represents a group of metabolic disorders characterised by high blood sugar(hyperglycemia)resulting from defects in insulin secretion,insulin action,or both.Diabetes mellitus can lead to death and disability through long-term complications such as blindness,kidney failure,coronary heart disease and stroke.Type 2 diabetes is the more common form of diabetes,occurring mainly in older adults and is associated with obesity(Diabetes Mellitus MOH Clinical Practice Guidelines 2014).Method Used An interviewer-administered questionnaire was used.In order to obtain an indication of the prevalence of known diabetes mellitus in the community,respondents were asked whether they had ever been told by a western-trained doctor that they had diabetes and were currently prescribed medication for diabetes.Respondents who answered“yes”to both questions were classified as having“reported diabetes mellitus”.Diabetes mellitus prevalence estimates based on reported use of medication for diabetes mellitus are likely to under-estimate the true diabetes mellitus prevalence as a proportion of diabetics will be undiagnosed.Among those with diabetes,they were also asked on the frequency of doctors visit and place of treatment to manage their diabetes.38 Prevalence of Self-reported Diabetes Mellitus The prevalence of self-reported diabetes among Singapore residents aged 18 to 74 years was 6.9%(Table 4.1).A higher proportion of males(7.6%)were reported as diabetic compared to females(6.2%)and this pattern was also observed in all age groups.Self-reported diabetes prevalence increased with age;from 0.9%among those aged 30 to 39 years to 18.3%of adults in the 60 to 69 years age group and 21.7%in those aged 70 to 74 years.Indians(13.5%)had the highest prevalence of self-reported diabetes among the ethnic groups(compared to 10.2%in Malays and 5.7%in Chinese)(Graph 4.1).The prevalence of self-reported diabetes showed an inverse relationship with education where higher educated residents had lower self-reported diabetes prevalence compared with lower educated residents(primary:19.7%,secondary 10.6%and post-secondary 3.2%).Residents with self-reported diabetes visited a doctor for their diabetes management about four times in the past 12 months,mainly in polyclinics(61.9%),private GP clinics(19.8%)and specialist outpatient clinics in public hospitals(15.4%).Table 4.1:Age-specific crude prevalence(%)of self-reported diabetes mellitus among Singapore residents aged 18 to 74 years by gender,2021 Age(years)Total Males Females 18-29 s s s 30-39 0.9 s s 40-49 3.5 3.9 3.1 50-59 9.3 11.2 7.5 60-69 18.3 19.2 17.4 70-74 21.7 23.4 20.2 18-74 6.9 7.6 6.2 s:Data have been suppressed due to small counts or high sampling variability.Trends in Prevalence of Self-reported Diabetes Mellitus The crude prevalence of self-reported diabetes showed a significant increasing trend from 2007(4.9%)to 2021(6.9%)(Table 4.2).The increase was also seen in both males and females,among Chinese and Malays,and across all education levels.The overall age-standardised prevalence after accounting for the ageing population was lower than the crude prevalence and remained stable(i.e.,no significant increasing trend)over the same period.Between 2019 and 2021,the prevalence of self-reported diabetes had remained stable across all subgroups.39 Graph 4.1:Crude prevalence(%)of self-reported diabetes mellitus among Singapore residents aged 18 to 74 years by gender and ethnicity,2021 Table 4.2:Crude prevalence(%)of self-reported diabetes mellitus among Singapore residents aged 18 to 74 years by age,gender,education,and ethnicity,2007 to 2021 NHSS NHS NHSS NPHS NPHS NPHS NPHS 2007 2010 2013 2017 2019 2020 2021 Total 4.9 5.0 5.4 6.7 (5.7,7.7)6.9 (6.1,7.7)7.0 (6.3,7.8)6.9b (6.2,7.6)ASR 5.2 5.0 5.2 5.8 5.7 5.7 5.4 18-29 s s s s s s s 30-39 0.7 s s s s 1.7 (0.8,2.6)0.9 (0.4,1.3)40-49 4.3 2.6 4.2 4.3 (2.5,6.2)5.0 (3.0,7.0)4.3 (3.1,5.6)3.5 (2.4,4.6)50-59 8.2 10.0 8.1 11.7 (8.7,14.6)9.8 (7.7,12.0)7.9 (6.2,9.6)9.3 (7.6,11.1)60-69 17.1 14.0 14.8 17.3 (13.6,21.0)17.0 (14.1,20.0)19.0 (16.1,22.0)18.3 (15.7,20.9)70-74 15.7 16.8 22.2 14.8 (9.9,19.7)21.4 (16.7,26.0)21.0 (16.6,25.5)21.7 (17.5,26.0)Males 5.3 5.1 5.8 7.7 (6.1,9.2)8.3 (7.0,9.5)7.2 (6.0,8.3)7.6b (6.6,8.7)Females 4.5 4.9 5.1 5.7 (4.5,7.0)5.6 (4.5,6.6)6.9 (6.0,7.9)6.2b (5.3,7.1)5.76.55.010.29.910.513.514.412.40.05.010.015.020.0TotalMalesFemalesPercent of respondentsChineseMalaysIndians 40 Table 4.2:Crude prevalence(%)of self-reported diabetes mellitus among Singapore residents aged 18 to 74 years by age,gender,education,and ethnicity,2007 to 2021(continued)NHSS NHS NHSS NPHS NPHS NPHS NPHS 2007 2010 2013 2017 2019 2020 2021 Primary 10.7 11.4 14.2 12.3 (9.4,15.1)19.5 (15.7,23.3)a 18.9 (15.9,22.0)19.7b (16.8,22.6)Secondary 5.6 6.2 6.8 10.3 (8.1,12.4)10.0 (8.1,11.8)10.0 (8.4,11.6)10.6b (8.9,12.3)Post-secondary 2.0 1.9 2.0 3.0 (2.1,4.0)2.7 (2.1,3.4)3.4 (2.7,4.2)3.2b (2.6,3.8)Chinese 4.1 4.1 4.6 5.6 (4.5,6.7)6.2 (5.3,7.1)6.3 (5.4,7.1)5.7b (5.0,6.5)Malays 6.2 7.5 8.2 8.2 (5.3,11.1)8.8 (6.5,11.1)8.2 (6.1,10.3)10.2b (8.1,12.4)Indians 10.8 9.7 9.6 14.7 (10.1,19.3)11.5 (8.8,14.3)12.2 (9.2,15.2)13.5 (10.2,16.8)Notes:(1)Figures in()refer to the 95%confidence intervals.a Indicates that the results for any two consecutive survey years are significantly different statistically at 5%significance level as the confidence intervals for these two survey years did not overlap(i.e.,between NPHS 2017 and NPHS 2019,NPHS 2019 and NPHS 2020,NPHS 2020 and NPHS 2021).(2)s:Data have been suppressed due to small counts or high sampling variability.(3)ASR:Age-standardised rate.The reference population used is Singapore Census 2010 resident population.(4)Analysis based on highest education attained served as a proxy to socio-economic factors.Primary education:No formal qualification/Primary/PSLE.Secondary education:Secondary/GCE O/N level.Post-secondary education:GCE A Level/Polytechnic&other diploma/Degree&professional qualification.(5)b Indicate statistically significant linear upward trend between 2007 and 2021 with p-value 0.05.41 Chapter 5 Self-reported Hypertension Key Points About one in six(15.7%)Singapore residents aged 18 to 74 years reported that they had hypertension(or high blood pressure)and were currently prescribed medication in 2021.More males(17.2%)reported having hypertension than females(14.2%).The prevalence of self-reported hypertension increased with age,from 2.0%in young adults aged 30 to 39 years to 37.8%among those aged 60 to 69 years and reached 52.7%among those aged 70 to 74 years.Introduction Hypertension or high blood pressure is a chronic medical condition in which the arterial blood pressure is elevated.Persistent hypertension is one of the key risk factors for cardiovascular diseases such as heart attack,stroke and heart failure as well as other diseases like kidney failure.It is often known as a silent killer as it rarely causes symptoms,and many people go undiagnosed.Dietary and lifestyle changes can improve blood pressure control and decrease the risk of associated health complications,although drug treatment may be necessary in patients for whom lifestyle changes prove ineffective or insufficient(WHO,2013).Method Used An interviewer-administered questionnaire was used.In order to obtain an indication of the prevalence of known hypertension in the community,respondents were asked whether they had ever been told by a western-trained doctor that they had high blood pressure and were currently prescribed medication for high blood pressure.Respondents who answered“yes”to both questions were classified as having“reported hypertension”.Hypertension prevalence estimates based on reported use of medication for high blood pressure are likely to under-estimate the true hypertension prevalence as a proportion of hypertensives will be undiagnosed.Among those with hypertension,they were also asked on the frequency of doctors visit and place of treatment to manage their hypertension.42 Prevalence of Self-reported Hypertension The prevalence of self-reported hypertension among Singapore residents aged 18 to 74 years was 15.7%(Table 5.1).Overall,more males(17.2%)were reported as hypertensive compared to females(14.2%)and this trend was typically observed across all age groups.However,the reverse pattern was seen among the Malays where more females(16.9%)were reported as hypertensive compared to males(14.7%)(Graph 5.1).Self-reported hypertension prevalence was also found to increase with age,from 2.0%in young adults aged 30 to 39 years to 37.8%among those aged 60 to 69 years and reached 52.7%among those aged 70 to 74 years.The prevalence of self-reported hypertension appeared to be similar across the three ethnic groups,with the Malays(15.8%)and Chinese(15.7%)being only slightly higher than the Indians(15.3%).Similar to self-reported diabetes,residents with lower level of education had higher prevalence of self-reported hypertension(primary:39.1%,secondary:23.0%and post-secondary:8.6%).Residents with self-reported hypertension visited a doctor for their high blood pressure management about four times in the past 12 months,mainly in polyclinics(53.5%),private GP clinics(32.6%)and specialist outpatient clinics in public hospitals(9.0%).Table 5.1:Age-specific crude prevalence(%)of self-reported hypertension among Singapore residents aged 18 to 74 years by gender,2021 Age(years)Total Males Females 18-29 s s s 30-39 2.0 3.2 s 40-49 8.5 11.6 5.7 50-59 22.5 23.4 21.6 60-69 37.8 40.2 35.4 70-74 52.7 53.4 52.1 18-74 15.7 17.2 14.2 s:Data have been suppressed due to small counts or high sampling variability.Trends in Prevalence of Self-reported Hypertension The crude and age-standardised prevalence of self-reported hypertension did not show significant increasing trend between 2007 and 2021(Table 5.2).On the other hand,the prevalence for males and across all education levels were trending upwards significantly over this period.The increase in overall prevalence was lower after age-standardisation,indicating that the increase was partly attributable to population ageing.Between 2019 and 2021,the prevalence of self-reported hypertension had remained stable across the demographic profiles.43 Graph 5.1:Crude prevalence(%)of self-reported hypertension among Singapore residents aged 18 to 74 years by gender and ethnicity,2021 Table 5.2:Crude prevalence(%)of self-reported hypertension among Singapore residents aged 18 to 74 years by age,gender,education,and ethnicity,2007 to 2021 NHSS NHS NHSS NPHS NPHS NPHS NPHS 2007 2010 2013 2017 2019 2020 2021 Total 12.7 14.0 12.9 12.7 (11.4,14.1)15.6 (14.3,16.9)a 15.1 (14.1,16.2)15.7 (14.6,16.7)ASR 13.4 14.0 12.2 11.3 12.8 12.1 12.4 18-29 s s s s s s s 30-39 2.1 3.7 2.7 s s 2.1 (1.2,3.1)2.0 (1.1,2.9)40-49 8.1 9.9 8.4 9.4 (6.7,12.0)9.0 (7.0,11.0)8.8 (7.0,10.5)8.5 (6.6,10.5)50-59 22.9 24.5 20.2 20.7 (17.1,24.2)22.8 (19.6,25.9)18.8 (16.1,21.4)22.5 (19.5,25.4)60-69 47.4 42.4 34.8 31.0 (26.2,35.8)37.2 (33.6,40.8)39.7 (36.1,43.2)37.8 (34.7,40.9)70-74 44.2 45.3 58.2 46.8(39.0,54.5)55.8 (49.7,61.9)51.1 (45.3,56.9)52.7 (47.4,58.0)Males 12.9 14.8 13.5 13.8 (11.8,15.7)16.8 (14.9,18.7)15.9 (14.3,17.5)17.2b (15.7,18.7)Females 12.5 13.2 12.3 11.7 (10.1,13.4)14.5 (12.8,16.1)14.4 (13.0,15.7)14.2 (12.8,15.7)15.717.613.915.814.716.915.318.212.30.05.010.015.020.025.0TotalMalesFemalesPercent of respondentsChineseMalaysIndians 44 Table 5.2:Crude prevalence(%)of self-reported hypertension among Singapore residents aged 18 to 74 years by age,gender,education,and ethnicity,2007 to 2021(continued)NHSS NHS NHSS NPHS NPHS NPHS NPHS 2007 2010 2013 2017 2019 2020 2021 Primary 26.3 30.1 29.9 25.9 (21.5,30.3)38.4 (34.2,42.6)a 37.5 (33.8,41.2)39.1b (35.2,43.0)Secondary 13.9 15.6 15.8 16.6 (14.1,19.2)21.2 (18.9,23.5)20.2 (18.0,22.3)23.0b (20.6,25.3)Post-secondary 6.3 7.2 6.2 6.9 (5.4,8.3)8.1 (6.8,9.4)8.6 (7.4,9.7)8.6b (7.6,9.7)Chinese 13.3 14.4 13.4 13.0 (11.4,14.6)15.8 (14.3,17.3)15.9 (14.6,17.1)15.7 (14.5,16.9)Malays 12.4 14.3 11.5 10.5 (7.9,13.1)16.7 (13.5,20.0)a 14.9 (12.1,17.8)15.8 (13.1,18.5)Indians 10.1 11.7 11.6 14.1 (9.9,18.3)12.6 (9.6,15.7)11.5 (8.7,14.3)15.3 (11.7,19.0)Notes:(1)Figures in()refer to the 95%confidence intervals.a Indicates that the results for any two consecutive survey years are significantly different statistically at 5%significance level as the confidence intervals for these two survey years did not overlap(i.e.,between NPHS 2017 and NPHS 2019,NPHS 2019 and NPHS 2020,NPHS 2020 and NPHS 2021).(2)s:Data have been suppressed due to small counts or high sampling variability.(3)ASR:Age-standardised rate.The reference population used is Singapore Census 2010 resident population.(4)Analysis based on highest education attained served as a proxy to socio-economic factors.Primary education:No formal qualification/Primary/PSLE.Secondary education:Secondary/GCE O/N level.Post-secondary education:GCE A Level/Polytechnic&other diploma/Degree&professional qualification.(5)b Indicate statistically significant linear upwards trend between 2007 and 2021 with p-value 0.05.45 Chapter 6 Self-reported Hyperlipidaemia Key Points About one in seven(13.9%)Singapore residents aged 18 to 74 years reported that they had hyperlipidaemia(or high blood cholesterol)and were currently prescribed medication in 2021.More males(15.2%)reported having high blood cholesterol than females(12.6%).The prevalence of self-reported high blood cholesterol increased with age,from 1.1%in young adults aged 30 to 39 years to 35.8%among those aged 60 to 69 years and reached 43.4%among those aged 70 to 74 years.Introduction Hyperlipidaemia or high blood cholesterol is a major risk factor for coronary heart disease.Elevated blood cholesterol,in particular LDL-cholesterol,causes atherosclerosis and increases the risk for coronary heart disease.HDL-cholesterol has been shown to have a protective effect against coronary heart disease.Low HDL-cholesterol has been shown to be an important independent risk factor for development of coronary heart disease.The adoption of healthier lifestyle behaviours such as reduced dietary intake of saturated fats and cholesterol,being more physically active,weight control,as well as clinical management of those persons at increased risk helps lower the cholesterol levels in the population(JAMA 2001;NIH 2002).Method Used An interviewer-administered questionnaire was used.In order to obtain an indication of the prevalence of known hyperlipidaemia in the community,respondents were asked whether they had ever been told by a western-trained doctor that they had high blood cholesterol and were currently prescribed medication for high blood cholesterol.Respondents who answered“yes”to both questions were classified as having“reported high blood cholesterol”.High blood cholesterol prevalence estimates based on reported use of medication for high blood cholesterol are likely to under-estimate the true high blood cholesterol prevalence as a proportion of those with hyperlipidaemia will be undiagnosed.Among those with hyperlipidaemia,they were also asked on the frequency of doctors visit and place of treatment to manage their high blood cholesterol.46 Prevalence of Self-reported Hyperlipidaemia The prevalence of self-reported high blood cholesterol among Singapore residents aged 18 to 74 years was 13.9%(Table 6.1).Overall,more males(15.2%)reported having hyperlipidaemia compared to females(12.6%)but more females in the older age group of 60 to 74 years reported having hyperlipidaemia compared to their male counterparts.Self-reported hyperlipidaemia prevalence was also found to increase with age,from 1.1%in young adults aged 30 to 39 years to 35.8%among those aged 60 to 69 years and reached 43.4%among those aged 70 to 74 years.Indians had the highest prevalence of self-reported hyperlipidaemia among the ethnic groups(15.8%compared to 14.0%in Chinese and 13.1%in Malays)(Graph 6.1).The prevalence of self-reported high blood cholesterol among lower educated residents was higher compared with higher educated residents(primary:29.5%,secondary:23.5%and post-secondary:7.2%).Residents with self-reported hyperlipidaemia visited a doctor for their high blood cholesterol management about three times in the past 12 months,mainly in polyclinics(58.6%),private GP clinics(23.9%)and specialist outpatient clinics in public hospitals(13.7%).Table 6.1:Age-specific crude prevalence(%)of self-reported hyperlipidaemia among Singapore residents aged 18 to 74 years by gender,2021 Age(years)Total Males Females 18-29 s s s 30-39 1.1 2.0 s 40-49 6.6 9.6 3.9 50-59 20.9 24.7 17.1 60-69 35.8 35.4 36.1 70-74 43.4 40.6 46.2 18-74 13.9 15.2 12.6 s:Data have been suppressed due to small counts or high sampling variability.Trends in Prevalence of Self-reported Hyperlipidaemia The crude prevalence of self-reported hyperlipidaemia increased significantly from 8.2%in 2007 to 13.9%in 2021(Table 6.2).This significant increase was also seen among males,Chinese and those with primary or secondary education over the same period.After age-standardisation,the increase in overall prevalence was less pronounced indicating that the increase was partly attributable to population ageing.The slight increasing trend in the age-standardised prevalence of self-reported hyperlipidaemia was not significant between 2007 and 2021.47 Between 2019 and 2021,the prevalence of hyperlipidaemia for residents with secondary education showed a significant increase from 18.5%(2019)to 23.5%(2021)while other subgroups did not display any significant changes.Graph 6.1:Crude prevalence(%)of self-reported hyperlipidaemia among Singapore residents aged 18 to 74 years by gender and ethnicity,2021 Table 6.2:Crude prevalence(%)of self-reported hyperlipidaemia among Singapore residents aged 18 to 74 years by age,gender,education,and ethnicity,2007 to 2021 NHSS NHS NHSS NPHS NPHS NPHS NPHS 2007 2010 2013 2017 2019 2020 2021 Total 8.2 12.3 10.4 11.0 (9.7,12.3)13.6 (12.5,14.6)a 13.1 (12.1,14.1)13.9b (12.9,14.9)ASR 8.7 12.3 9.9 9.6 11.1 10.6 10.8 18-29 s s s s s s s 30-39 2.1 2.4 1.3 1.7 (0.7,2.7)1.6 (0.7,2.5)s 1.1 (0.5,1.8)40-49 5.0 7.2 6.7 6.4 (4.3,8.6)7.6 (6.0,9.1)7.1 (5.5,8.8)6.6 (5.1,8.2)50-59 15.9 22.9 17.9 19.9 (16.2,23.6)22.1 (19.1,25.1)18.5 (15.7,21.2)20.9 (17.6,24.1)60-69 29.0 37.7 28.7 26.3 (22.0,30.7)33.5 (30.0,36.9)34.3 (30.8,37.8)35.8 (32.6,38.9)70-74 25.3 46.8 40.7 36.5 (29.4,43.6)42.4 (35.9,48.8)43.4 (37.7,49.2)43.4 (38.2,48.7)14.015.113.013.114.012.315.819.911.40.05.010.015.020.025.0TotalMalesFemalesPercent of respondentsChineseMalaysIndians 48 Table 6.2:Crude prevalence(%)of self-reported hyperlipidaemia among Singapore residents aged 18 to 74 years by age,gender,education,and ethnicity,2007 and 2021(continued)NHSS NHS NHSS NPHS NPHS NPHS NPHS 2007 2010 2013 2017 2019 2020 2021 Males 8.6 12.4 10.7 12.4 (10.6,14.2)15.3 (13.6,16.9)13.9 (12.4,15.5)15.2b (13.7,16.8)Females 7.9 12.1 10.1 9.6 (8.2,11.1)12.0 (10.6,13.3)12.3 (11.0,13.6)12.6 (11.2,14.0)Primary 17.6 26.0 23.1 22.6 (18.7,26.5)34.8 (31.1,38.5)a 33.2 (29.7,36.8)29.5b (26.3,32.8)Secondary 8.1 13.4 13.3 14.6 (12.0,17.1)18.5 (16.3,20.6)17.0 (14.9,19.0)23.5b (21.0,25.9)ad Post-secondary 4.6 6.7 4.8 5.8 (4.6,7.0)6.7 (5.7,7.8)7.7 (6.5,8.8)7.2 (6.2,8.3)Chinese 8.5 12.1 10.3 11.1 (9.7,12.6)13.9 (12.6,15.1)13.5 (12.3,14.7)14.0b (12.8,15.2)Malays 8.0 12.8 10.4 8.3 (5.2,11.4)13.4 (10.6,16.2)11.5 (9.0,13.9)13.1 (10.8,15.5)Indians 7.7 15.0 11.5 14.3 (9.8,18.7)12.5 (9.6,15.4)15.2 (11.8,18.7)15.8 (11.9,19.6)Notes:(1)Figures in()refer to the 95%confidence intervals.a Indicates that the results for any two consecutive survey years are significantly different statistically at 5%significance level as the confidence intervals for these two survey years did not overlap(i.e.,between NPHS 2017 and NPHS 2019,NPHS 2019 and NPHS 2020,NPHS 2020 and NPHS 2021).(2)s:Data have been suppressed due to small counts or high sampling variability.(3)ASR:Age-standardised rate.The reference population used is Singapore Census 2010 resident population.(4)Analysis based on highest education attained served as a proxy to socio-economic factors.Primary education:No formal qualification/Primary/PSLE.Secondary education:Secondary/GCE O/N level.Post-secondary education:GCE A Level/Polytechnic&other diploma/Degree&professional qualification.(5)b Indicate statistically significant linear upwards trend between 2007 and 2021 with p-value 0.05.(6)d Indicates that the results from NPHS 2019 and NPHS 2021 are significantly different statistically at 5%significance level as the confidence intervals for these two survey years did not overlap.49 Chapter 7 Chronic Disease Screening Key Points Among Singapore residents aged 40 to 74 years with no previous diagnosis of diabetes,high blood pressure,and high blood cholesterol(“DHL”),(i.e.not told by a doctor that they have these diseases),close to three-fifths(59.2%)were screened for all three health conditions within the recommended screening guidelines in 2021.Among Singapore residents aged 40 to 74 years without known diabetes,76.6%had their blood glucose tested within the past three years.Among Singapore residents aged 40 to 74 years without known high blood pressure,82.4%did their blood pressure check in the past two years.Among Singapore residents aged 40 to 74 years without known high blood cholesterol,72.5%were screened within the past three years.Introduction Health screening is an effective strategy for disease prevention in the population.It is important to go for appropriate and regular health screening as it helps to detect risk factors or diseases early even when there are no symptoms.Early detection of diabetes mellitus,high blood pressure and high blood cholesterol could result in better treatment,fewer complications and increased chances of better outcomes(HPB,2019).Method Used An interviewer-administered questionnaire was used.Respondents were asked whether they were ever told by a doctor that they had diabetes,high blood pressure or high blood cholesterol.Respondents who reported that they were not told by a doctor that they have diabetes or high blood cholesterol were asked on the last time they had a blood test to check for these health conditions.Those who were not told by a doctor to have high blood pressure were asked on the last time they had checked their blood pressure.Respondents were also asked where they last had their screening for these chronic diseases.Under the national“Screen for Life”(SFL)screening programme,Singapore residents aged 40 years and above are encouraged to go for diabetes and hyperlipidaemia screening once every three years and hypertension screening once every two years.50 Practice of Health Screening Health screening practice was relatively common among Singapore residents aged 40 to 74 years who were not told by a doctor to have any chronic diseases(diabetes,high blood pressure and high blood cholesterol(DHL).59.2%of them were screened for all three health conditions within the recommended screening guidelines in 2021(Table 7.1).The majority of them with no known DHL were screened at the private GP clinics at 41.0%,followed by polyclinics(15.7%),specialist outpatient clinics in public hospitals(12.7%)and workplaces(10.9%).Health screening practice was found to be more prevalent among older adults(aged 70 to 74),with close to three-quarters of them(72.6%)having screened for all three health conditions within the recommended screening guidelines.Among the ethnic groups,Indians(65.7%)had a higher screening prevalence for all three chronic diseases,followed by Chinese(59.7%)and Malays(48.3%).Singapore residents with higher education level were more likely to have gone for chronic disease screening compared to those with lower education level.Looking at individual chronic disease alone regardless of the co-morbidity with other chronic diseases,76.6%of adults aged 40 to 74 years without known diabetes were screened for diabetes within the past three years,82.4%of those without known high blood pressure had their blood pressure checked within the past two years,and 72.5%of them with no previous diagnosis of high blood cholesterol were screened for this health condition within the past three years(Tables 7.3 to 7.5).Of those Singapore residents aged 40 to 74 years without having any known diabetes,hypertension or hyperlipidaemia and had not gone for screening for the respective conditions,the following were cited as reasons for not doing screening:Rank Diabetes screening High blood pressure screening High blood cholesterol screening 1 Not necessary as I am healthy(66.9%)Not necessary as I am healthy(74.7%)Not necessary as I am healthy(68.1%)2 No time due to work/family commitment(8.3%)No time due to work/family commitment(8.4%)No time due to work/family commitment(9.8%)3 Not suggested by doctors(7.6%)s Not suggested by doctors(6.5%)Note:s:Data have been suppressed due to small counts or high sampling variability.51 Trends in Health Screening Looking at the trend data over the period from 2007 to 2021,significant increases in the screening participation for residents with no previous diagnosis of DHL were observed among those aged 40 to 49 years and those with post-secondary education(Table 7.2).The overall and age-standardised chronic disease screening participation did not show significant upward trend between 2007 and 2021.For the individual chronic disease,the crude proportion of residents who had diabetes and hypertension screening increased significantly from 2007 to 2021 while the proportion for hyperlipidaemia did not show similar upward trend over the same period(Table 7.3 and 7.5).For diabetes,the screening participation also improved in the age groups of 40 to 49 years and 70 to 74 years;among males,Chinese and Indians,and those with post-secondary education.For hypertension,the significant improvements were observed for both males and females,among Chinese and those aged 40 to 49 years.Comparing with pre-COVID(2019),the screening participation for residents with no previous diagnosis of DHL in 2021(59.2%)was significantly lower compared with 2019(66.3%).Significantly lower screening participation were found among female residents,Malays,residents aged 50 to 69 years and residents with secondary or post-secondary education in 2021 compared with 2019.Likewise for the individual chronic diseases,their screening participation in 2021 were also significantly lower compared with 2019.The lower screening participation could be due to deferment of non-urgent services such as health screening in healthcare institutions arising from the COVID-19 situation.52 Table 7.1:Health screening practice(%)among Singapore residents who did not have any of the corresponding self-reported chronic diseases aged 40 to 74 years by socio-demographic characteristics,2021 Characteristic Screened for all 3 diseases within the recommended intervals Diabetes screening at least once in the past 3 years Hypertension screening at least once in the past 2 years High blood cholesterol screening at least once in the past 3 years Total 59.2 76.6 82.4 72.5 Age(years)40-49 60.8 74.2 81.9 71.6 50-59 55.3 73.8 79.7 68.7 60-69 58.6 79.2 85.3 74.4 70-74 72.6 90.0 89.7 88.2 Gender Males 61.3 78.6 81.8 74.2 Females 57.5 74.7 82.9 71.0 Highest Education Attained Primary 56.4 75.2 80.4 75.7 Secondary 50.1 72.7 81.7 64.0 Post-secondary 64.1 79.2 83.2 76.0 Ethnic group Chinese 59.7 76.6 81.6 72.9 Malays 48.3 69.1 83.8 62.2 Indians 65.7 85.1 87.2 79.8 Note:Analysis based on highest education attained served as a proxy to socio-economic factors.Primary education:No formal qualification/Primary/PSLE.Secondary education:Secondary/GCE O/N level.Post-secondary education:GCE A Level/Polytechnic&other diploma/Degree&professional qualification.53 Table 7.2:Chronic disease screening participation(%)among Singapore residents who did not have any of the self-reported chronic diseases aged 40 to 74 years by age,gender,education,and ethnicity,2007 to 2021 NHSS NHS NHSS NPHS NPHS NPHS NPHS 2007 2010 2013 2017 2019 2020 2021 Total 58.1 45.2 56.0 66.4 (63.1,69.6)66.3 (63.7,68.9)63.0 (60.4,65.6)59.2 (56.7,61.8)d ASR 60.3 45.2 56.3 67.0 66.9 63.1 58.6 40-49 54.5 44.7 55.0 60.7 (56.2,65.1)62.6 (58.6,66.6)62.5 (58.5,66.6)60.8b (56.8,64.7)50-59 60.4 47.9 54.8 69.1 (63.6,74.5)66.2 (61.5,70.9)63.1 (58.6,67.6)55.3 (50.5,60.1)d 60-69 68.6 37.4 61.8 71.1 (64.6,77.5)72.1 (67.3,77.0)62.9 (57.2,68.5)58.6 (53.5,63.6)d 70-74 68.9 53.3 56.9 85.2 (77.2,93.2)79.0 (71.6,86.3)66.7 (54.3,79.0)72.6 (64.8,80.4)Males 59.9 47.8 55.0 65.9 (61.3,70.5)67.5 (63.5,71.5)63.9 (60.2,67.7)61.3 (57.9,64.6)Females 56.4 42.8 56.9 66.8 (62.6,71.0)65.2 (61.7,68.8)62.2 (58.7,65.8)57.5 (53.7,61.3)d Primary 57.8 32.7 43.7 60.9 (53.3,68.6)57.2 (50.7,63.8)50.4 (44.3,56.6)56.4 (49.9,62.9)Secondary 57.6 45.4 53.7 64.4 (59.0,69.7)61.1 (56.7,65.6)55.9 (51.2,60.7)50.1 (45.2,54.9)d Post-secondary 59.0 54.1 64.5 71.0 (66.7,75.4)71.4 (67.8,75.1)69.8 (66.3,73.3)64.1b (60.8,67.4)d Chinese 57.2 44.6 55.7 65.8 (62.1,69.5)64.9 (61.8,67.9)63.5 (60.6,66.5)59.7 (56.7,62.7)Malays 57.2 40.0 48.2 62.2 (53.4,71.1)64.4 (56.4,72.3)48.4 (39.7,57.0)48.3 (40.5,56.0)d Indians 70.1 59.3 68.9 80.0 (71.9,88.1)78.7 (71.7,85.7)75.4 (68.3,82.5)65.7 (58.7,72.7)54 Table 7.3:Diabetes screening participation(%)among Singapore residents who did not have self-reported diabetes aged 40 to 74 years by age,gender,education,and ethnicity,2007 to 2021 NHSS NHS NHSS NPHS NPHS NPHS NPHS 2007 2010 2013 2017 2019 2020 2021 Total 72.4 63.9 70.3 77.8 (75.6,80.0)81.0 (79.3,82.8)78.5 (76.8,80.3)76.6b (74.9,78.2)d ASR 73.2 63.9 70.2 77.6 80.3 78.1 75.6 40-49 67.3 58.3 65.9 71.4 (67.7,75.1)75.4 (72.0,78.8)75.2 (72.0,78.5)74.2b (71.4,77.0)50-59 74.8 64.4 68.9 80.0 (76.2,83.7)81.4 (78.3,84.5)79.0 (75.9,82.1)73.8 (70.5,77.1)d 60-69 80.0 73.9 78.1 81.7 (77.3,86.2)85.7 (83.1,88.3)79.8 (76.4,83.2)79.2 (76.3,82.1)d 70-74 79.9 71.8 84.2 92.1 (87.7,96.6)91.2 (87.9,94.5)87.8 (83.1,92.6)90.0b (87.1,93.0)Males 73.1 64.7 70.2 78.9 (75.8,82.0)82.6 (80.2,84.9)80.8 (78.4,83.1)78.6b (76.5,80.7)Females 71.8 63.0 70.5 76.9 (73.8,80.0)79.7 (77.1,82.3)76.4 (73.8,79.1)74.7 (72.2,77.1)Primary 70.7 58.4 63.9 75.4(70.6,80.3)77.8 (74.4,81.2)73.8 (69.8,77.8)75.2 (71.3,79.0)Secondary 72.2 61.7 69.0 75.8 (72.0,79.6)79.7 (77.1,82.3)74.6 (71.2,78.0)72.7 (69.5,75.9)d Post-secondary 74.4 71.0 76.0 81.3 (78.1,84.5)83.0 (80.4,85.7)82.2 (79.8,84.7)79.2b (77.1,81.3)Chinese 72.7 64.4 70.0 76.9 (74.4,79.5)80.5 (78.5,82.5)78.9 (76.9,80.8)76.6b (74.7,78.5)Malays 68.4 54.5 65.7 76.5 (69.6,83.3)77.7 (71.9,83.4)69.8 (63.2,76.4)69.1 (63.8,74.3)Indians 79.2 74.2 79.9 88.1 (82.3,94.0)89.3 (84.8,93.8)88.0 (83.0,93.0)85.1b (81.0,89.2)55 Table 7.4:Hypertension screening participation(%)among Singapore residents who did not have self-reported hypertension aged 40 to 74 years by age,gender,education,and ethnicity,2007 to 2021 NHSS NHS NHSS NPHS NPHS NPHS NPHS 2007 2010 2013 2017 2019 2020 2021 Total 77.7 79.9 77.8 82.9 (80.8,85.0)86.0 (84.4,87.6)83.3 (81.4,85.1)82.4b (80.7,84.1)d ASR 78.6 79.9 78.0 82.9 86.2 83.3 81.8 40-49 75.8 78.3 76.4 79.9 (76.1,83.6)84.6 (81.6,87.6)82.7 (79.6,85.8)81.9b (79.2,84.6)50-59 77.5 82.9 76.2 81.6 (78.1,85.2)85.7 (82.9,88.5)83.0 (79.8,86.1)79.7 (76.3,83.1)60-69 85.0 78.5 84.4 88.3 (84.6,92.1)88.1 (85.2,91.1)84.8 (81.4,88.3)85.3 (82.5,88.2)70-74 82.2 79.5 79.3 94.1 (89.9,98.3)90.8 (86.3,95.2)83.6 (75.0,92.1)89.7 (85.6,93.8)Males 77.1 80.5 77.0 81.3 (77.8,84.8)85.5 (83.1,88.0)83.2 (80.6,85.8)81.8b (79.4,84.2)Females 78.2 79.4 78.5 84.4 (81.7,87.0)86.5 (84.3,88.6)83.4 (80.8,86.0)82.9b (80.5,85.3)Primary 76.5 72.9 68.7 80.1 (75.0,85.2)78.4 (74.2,82.6)78.4 (74.2,82.6)80.4 (76.3,84.6)Secondary 79.9 80.5 76.7 82.3 (78.7,86.0)85.4 (82.9,87.8)79.2 (75.6,82.8)a 81.7 (78.4,85.1)Post-secondary 75.6 84.6 84.2 85.2 (82.1,88.4)88.7 (86.5,91.0)86.8 (84.3,89.2)83.2 (81.0,85.3)d Chinese 76.7 79.9 76.9 82.2 (79.8,84.6)85.8 (84.0,87.7)83.1 (81.0,85.2)81.6b (79.6,83.6)d Malays 79.3 76.6 76.4 82.6 (76.3,88.8)81.4 (76.0,86.8)74.7 (67.3,82.0)83.8 (79.5,88.0)Indians 87.6 86.7 86.7 92.8 (88.4,97.3)92.5 (88.5,96.5)92.4 (89.0,95.9)87.2 (82.9,91.5)56 Table 7.5:Hyperlipidaemia screening participation(%)among Singapore residents who did not have self-reported hyperlipidaemia aged 40 to 74 years by age,gender,education,and ethnicity,2007 to 2021 NHSS NHS NHSS NPHS NPHS NPHS NPHS 2007 2010 2013 2017 2019 2020 2021 Total 78.1 61.1 73.0 78.2 (75.9,80.5)77.9 (76.0,79.9)76.5 (74.5,78.6)72.5 (70.5,74.5)d ASR 78.9 61.1 73.2 78.2 77.5 76.3 71.8 40-49 74.8 59.3 70.8 73.0 (69.2,76.7)73.3 (69.7,76.8)74.5 (71.1,78.0)71.6 (68.3,74.8)50-59 79.9 62.9 70.7 78.7 (74.6,82.9)76.9 (73.3,80.5)75.3 (71.7,79.0)68.7 (64.7,72.7)d 60-69 86.2 63.1 79.4 84.1 (80.0,88.2)84.0 (80.9,87.1)79.0 (75.2,82.8)74.4 (70.6,78.1)d 70-74 77.9 61.5 84.8 90.3 (85.0,95.7)89.8 (85.2,94.4)85.7 (79.3,92.1)88.2 (84.2,92.2)Males 77.9 62.8 71.8 78.6 (75.2,82.0)79.0 (76.0,82.0)77.5 (74.7,80.3)74.2 (71.7,76.7)Females 78.3 59.5 74.1 77.8 (74.8,80.9)77.0 (74.5,79.6)75.7 (72.8,78.6)71.0 (67.9,74.0)d Primary 73.8 53.7 66.2 74.9 (69.4,80.4)74.2 (69.4,79.0)68.1 (63.1,73.1)75.7 (71.4,80.0)Secondary 77.7 61.1 72.1 76.4 (72.2,80.6)75.1 (71.9,78.4)72.3 (68.5,76.1)64.0 (60.0,68.1)ad Post-secondary 82.4 67.1 78.3 81.7 (78.5,84.9)80.9 (77.9,83.9)81.3 (78.7,84.0)76.0 (73.5,78.5)a Chinese 78.1 61.8 72.5 77.7 (75.1,80.3)77.9 (75.6,80.2)77.3 (75.1,79.5)72.9 (70.6,75.2)d Malays 74.0 53.8 69.6 77.7 (70.8,84.6)75.1 (68.9,81.4)63.0 (55.5,70.6)62.2 (55.3,69.0)Indians 83.1 67.6 82.2 86.3 (80.7,91.9)83.6 (77.7,89.4)84.8 (79.4,90.2)79.8 (74.9,84.7)Notes applicable to Table 7.2 to 7.5:(1)Figures in()refer to the 95%confidence intervals.a Indicates that the results for any two consecutive survey years are significantly different statistically at 5%significance level as the confidence intervals for these two survey years did not overlap(i.e.,between NPHS 2017 and NPHS 2019,NPHS 2019 and NPHS 2020,NPHS 2020 and NPHS 2021).(2)ASR:Age-standardised rate.The reference population used is Singapore Census 2010 resident population.(3)Analysis based on highest education attained served as a proxy to socio-economic factors.Primary education:No formal qualification/Primary/PSLE.Secondary education:Secondary/GCE O/N level.Post-secondary education:GCE A Level/Polytechnic&other diploma/Degree&professional qualification.(4)b Indicate statistically significant linear upward trend between 2007 and 2021 with p-value 0.05.(5)d Indicates that the results from NPHS 2019 and NPHS 2021 are significantly different statistically at 5%significance level as the confidence intervals for these two survey years did not overlap.57 Chapter 8 Breast Cancer Screening Key Points In 2021,close to one-third(31.1%)of Singapore women in the 50 to 69 years age group reported that they had gone for mammography in the last two years.Introduction Breast cancer remained the most common cancer among Singapore women in the past 50 years(NRDO 2020).For the five-year period from 2016-2020,the age-standardised incidence rate of breast cancer was 73.8 per 100,000 women.It was the leading cause of cancer death among females in 2016-2020,accounting for 17.2%of cancer deaths among females.Breast cancer has been linked to a number of risk factors including age,family history of breast cancer,smoking,high-fat diet and obesity.The earlier breast cancer is diagnosed,the better the chances for successful treatment.As early breast cancer usually does not present with any symptoms,screening is therefore important.Mammography for women over 50 years old is widely accepted as appropriate and beneficial.The Ministry of Healths Clinical Practice Guidelines on Cancer Screening(2010)and the national“Screen for Life”(SFL)screening programme recommended women aged 50 to 69 years to go for mammography once every two years.Method Used An interviewer-administered questionnaire was used.Female respondents were asked on their practice of mammography as well as where they took their mammography.58 Practice of Mammography Close to one-third(31.1%)of Singapore women in the 50 to 69 years age group reported that they had gone for a mammography within the last two years,in accordance with the recommended frequency of mammography in this age group(Table 8.1).A higher proportion of Indian(37.7%)and Chinese(31.7%)women had undergone mammography 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8.2).On the other hand,the overall breast screening participation dropped to 31.1%in 2021,significantly lower than 38.7%in 2019,probably due to the impact of COVID-19 situation(e.g.,with the deferment of non-urgent services such as health screening).Similar decreases in screening participation were also observed in the residents with secondary education and among Chinese between 2019 and 2021.59 Table 8.2:Breast cancer screening participation(%)amo
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