Health Intelligence Health and Wellbeing Compendium Grampian Health and Wellbeing Compendium IV
September 2015
Contents
No. Topic Area Indicators 1 Grampian 1.1 Age and Gender Profile Demographical 1.2 Ethnic Composition Information 1.3 Disability 2 Life Expectancy 2.1. Life Expectancy at Birth - Males 2.2 Life Expectancy at Birth - Females 3 Cancer 3.1. Primary Prevention - Cancer Incidence 3.2. Secondary Prevention - Early Stage 1 Disease at Diagnosis 3.3. Premature deaths (under 75) from Cancer 4 Cardiovascular 4.1 Premature deaths (under 75) from Coronary Heart Disease Disease and Stroke 5 Smoking 5.1 Prevalence (from Scottish Household Survey) 5.2 Reach of Smoking Cessation 6 Alcohol 6.1 Drinking Prevalence from Scottish Health Survey 6.2 Alcohol Brief Interventions 6.3 Directly attributable alcohol related hospital admissions (age-sex standardised) 7 Obesity 7.1 Child Obesity in P1 7.2 Child healthy weight interventions (HEAT target) 7.3 Adult obesity 8 Physical Activity 8.1 Child activity levels 8.2 Adult activity levels 9 Oral Health 9.1 No obvious decay P1 Pupils 9.2 Decayed and missing P1 Pupils 10 Mental Health 10.1 Positive mental health-mean adult score on the Warwick-Edinburgh Mental Well-being Scale 10.2 Suicide 11 Sexual Health 11.1 Teenage pregnancy under 16 years 11.2 Abortion & Repeat Abortions 11.3 Long Acting Reversible Contraceptive Uptake 12 Immunisation 12.1 Primary Immunisation Uptake Rates by 12 months old 12.2 Primary and Booster Immunisation Uptake Rates by 24 months old 12.3 Vaccination against Human Papilloma Virus 12.4 Seasonal flu vaccination 13 Injuries in the 13.1 Unintentional injuries in the home in the under home 15 age group
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Definitions
Datazone1
The data zone is the key small-area statistical geography in Scotland. Scottish Neighbourhood Statistics has introduced, for the first time, a common, stable and consistent, small-area geography called data zones. The data-zone geography covers the whole of Scotland and nests within local authority boundaries. Data zones are groups of 2001 Census output areas and have populations of between 500 and 1,000 household residents. Where possible, they have been made to respect physical boundaries and natural communities. They have a regular shape and, as far as possible, contain households with similar social characteristics.
Intermediate Zone1
Not all statistics are suitable for release at the data-zone level because of the sensitive nature of the statistics, or for reasons of reliability, and it was apparent that a statistical geography between data zone and local authority was required. The intermediate zones are aggregations of data zones within local authorities and contain between 2,500 and 6,000 people.
There are 128 intermediate zones in Grampian.
Local analysis2 of average datazone rank, using the health board local index of multiple deprivation (2009) within each intermediate zone has enabled an analysis of deprivation by intermediate zone, for cancer premature mortality.
School Cluster
There are 37 primary school clusters in Grampian, each feeding one academy. In Aberdeen City and Moray they are called associated school groups, and in Aberdeenshire they are called community school networks.
1 Scottish Government (2005) Scottish Neighbourhood Statistics Guide available from http://www.scotland.gov.uk/publications/2005/02/20697/52626
2 NHS Grampian (2013) Health Intelligence using SIMD scores and ranks available from http://simd.scotland.gov.uk/publication-2012/download-simd-2012-data/
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1 Grampian Demographical Information
This section provides selected information to help describe the current population of Grampian. Several of the indicators in the compendium relate to the health of specific age groups. Gender is often a significant factor in morbidity and mortality.
The ethnic composition of Grampian is relevant here for a number of reasons, including: the potential for public health messages to be less effective due to language and cultural differences, leading to marginalisation of hard to reach groups; differences in genetic-disposition to disease; and the possibility of different patterns of use of health services, due to differences in cultural norms.
National insurance registrations provide another window on the changing nature of the population, with more detail on European immigrants than can be gleaned from the 2011 census.
The 2011 census has provided the opportunity to analyse self-reported disability by deprivation, and infer from this some of the challenges ahead for NHS Grampian.
1.1 Age and Gender Profile
The population of Grampian is estimated1 to be 579,000. One in six residents are under 15 years, and one in six are over 64 years. One in eight are between 15 and 24 years, and over half of the population is aged between 25 and 64 years. The figure below shows that males out-number females in the age groups up to 39 years, and the situation is reversed in the older age groups from 65 years upwards.
Grampian Age Profile in 2013 25
20
15
10
5
Population of Grampian in Thousands 0 0 - 4 5 - 9 10 - 15 - 20 - 25 - 30 - 35 - 40 - 45 - 50 - 55 - 60 - 65 - 70 - 75 - 80 - 85 - 90+ 14 19 24 29 34 39 44 49 54 59 64 69 74 79 84 89 Age Group Males Females
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1.2 Ethnic Composition
The proportion of the population reported2 as belonging to a minority ethnic group varies by Local Authority in Scotland. The highest figures are in the four Local Authorities with the large cities: Glasgow City (12%), City of Edinburgh and Aberdeen City (8%), and Dundee City (6%). This compares to less than 2% for both Aberdeenshire and Moray. The two charts below give the detailed breakdown by each ethnic group.
White Ethnic Groups as a Percentage of the Population for Scotland, Grampian and Council Areas, 2011 90 80 70 60 50 40 30 20 10
Percentageof the Population 0 Scotland Aberdeen City Aberdeenshire Moray Grampian White: Scottish 84.0 75.3 82.2 77.7 78.7 White: Other British 7.9 7.6 12.3 18.0 11.4 White: Irish 1.0 1.0 0.5 0.5 0.7 White: Gypsy/Traveller 0.1 0.1 0.1 0.1 0.1 White: Polish 1.2 3.2 1.2 1.1 1.9 Other White 1.9 4.7 2.2 1.6 3.1
Non-White Ethnic Groups as a Percentage of the Population for Scotland, Grampian and Council Areas, 2011 2.5
2.0
1.5
1.0
0.5
Percentageof the Population 0.0 Scotland Aberdeen City Aberdeenshire Moray Grampian Pakistani, Pakistani Scottish or Pakistani British 0.9 0.5 0.1 0.2 0.3 Indian, Indian Scottish or Indian British 0.6 1.5 0.2 0.1 0.7 Bangladeshi, Bangladeshi Scottish or 0.1 0.3 0.1 0.0 0.1 Bangladeshi British Chinese, Chinese Scottish or Chinese British 0.6 1.0 0.2 0.2 0.5 Other Asian 0.4 1.0 0.3 0.2 0.6 Af rican 0.6 2.3 0.2 0.1 1.0 Caribbean or Black 0.1 0.3 0.1 0.1 0.2 Mixed or multiple ethnic groups 0.4 0.7 0.3 0.2 0.4 Other ethnic groups 0.3 0.6 0.1 0.1 0.3
The percentage change in ethnic composition since 2001 was greatest in the African population in Aberdeen City (a 6-fold increase), whilst Aberdeenshire saw the greatest change in the “Other Asian” population (more than 6-fold increase), and
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Moray saw a more than 3-fold increase the “Other Asian” population, the greatest change here.
In the last decade there has also been a significant rise in the population of Eastern Europeans living and working in Grampian2 (see chart below). Of these, the greatest numbers of new National Insurance Registrations from all overseas countries were from Polish citizens. The proportion of registrations in 2003 in Grampian, from Eastern Europeans, was 5% rising to 51% in 2013.
Aberdeen City has the largest number of registrations in Grampian. In 2003, there were 56 registrations from Eastern Europeans. In 2013 there were 2,105. For Aberdeenshire the figures were 34 and 1210, and for Moray, 5 and 195 respectively. In Aberdeenshire, Eastern Europeans accounted for more than three quarters of all registrations. In Moray and Aberdeen, the proportion was lower, 61% and 43% respectively, in 2013.
National Insurance Registrations from Eastern European nationals as a percentage of adult registrations from all overseas countries
90 80 70 60 50 40 30 20
Percentage of AllPercentageof Registrations 10 0 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 Year of Registration Aberdeen City Aberdeenshire Moray Grampian
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1.3 Disability
2 The 2011 census asked all residents the following question:
“Do you have any of the following conditions which have lasted, or are expected to last, at least 12 months? Tick all that apply. Deafness or partial hearing loss Blindness or partial sight loss Learning disability (for example, Down’s Syndrome) Learning difficulty (for example, dyslexia) Developmental disorder (for example, Autistic Spectrum Disorder or Asperger’s Syndrome) Physical disability Mental health condition Long term illness, disease or condition Other condition, please write in.
The responses of residents in Grampian and in each local authority area within Grampian have been analysed by deprivation quintile for the health board and each local authority respectively, where quintile 1 is the most deprived 20%, and quintile 5 is the least deprived 20%. The five figures below display the results for each local authority, for Grampian and for Scotland. They appear to display a fairly similar pattern.
22 Scotland Disability by National Deprivation Quintile 20
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16
14 Deafness or partial hearing loss Blindness or partial sight loss 12 Learning disability Learning difficulty 10 Developmental disorder
8 Physical disability Mental health condition Percentageof Respondents 6 Other condition
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2
0 Q1 Q2 Q3 Q4 Q5 Deprivation Quintile
A linear regression has been performed on each line in the Grampian chart (not shown). In each case a negative correlation was found. The strength of the correlation ranges from 0.68 for deafness and partial hearing loss, and 0.88 for mental health condition up to 0.97 for both physical disability and learning difficulty. The figures quoted represent the degree to which the variation in disability is accounted for by the level of deprivation, where 1.0 would represent a perfect
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correlation of all points falling on a straight line (but it does not prove a causal link). Seven out of eight disabilities have a correlation coefficient of 0.88 or above indicates a very strong relationship between disability and deprivation in Grampian.
22 Grampian Disability by Local Deprivation Quintile 20
18
16
14 Deafness or partial hearing loss Blindness or partial sight loss 12 Learning disability Learning difficulty 10 Developmental disorder
8 Physical disability Mental health condition Percentageof Respondents 6 Other condition
4
2
0 Q1 Q2 Q3 Q4 Q5 Deprivation Quintile
In Aberdeen City the strength of the correlation ranges from 0.42 for deafness and partial hearing loss, and 0.78 for learning disability, 0.84 for developmental disorder, then over 0.9 for the other disabilities and 0.99 for learning difficulty. Five out of eight disabilities have a correlation coefficient of 0.9 or above indicates a strong relationship between disability and deprivation in Aberdeen City.
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22 Aberdeen City Disability by Local Authority Deprivation Quintile 20
18
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14 Deafness or partial hearing loss Blindness or partial sight loss 12 Learning disability Learning difficulty 10 Developmental disorder
8 Physical disability Mental health condition Percentageof Respondents 6 Other condition
4
2
0 Q1 Q2 Q3 Q4 Q5 Deprivation Quintile
In Aberdeenshire the strength of the correlation ranges from 0.69 for learning disability and other condition, and 0.77 for mental health condition developmental disorder, and up to 0.94 for developmental disorder and 0.99 for learning difficulty. Two out of eight disabilities have a correlation coefficient of 0.9 or above, and a further two over 0.8 indicates a strong relationship between disability and deprivation in Aberdeenshire (but less strong than Aberdeen City).
22 Aberdeenshire Disability by Local Authority Deprivation Quintile 20
18
16
14 Deafness or partial hearing loss Blindness or partial sight loss 12 Learning disability Learning difficulty 10 Developmental disorder
8 Physical disability Mental health condition Percentageof Respondents 6 Other condition
4
2
0 Q1 Q2 Q3 Q4 Q5 Deprivation Quintile
In Moray the strength of the correlation ranges from 0.01 or less (i.e. no correlation at all) for mental health condition and learning disability, then 0.62 for blindness or
8 partial sight loss; 0.7 for physical disability. Only deafness or partial hearing loss has a correlation coefficient of above 0.9, and a further three disabilities have correlations of over 0.8. (learning difficulty, developmental disorder and other condition). This constitutes a mixed picture with a strong relationship between disability and deprivation for four out of eight disabilities, and no relationship for two disabilities.
22 Moray Disability by Local Authority Deprivation Quintile 20
18
16
14 Deafness or partial hearing loss Blindness or partial sight loss 12 Learning disability Learning difficulty 10 Developmental disorder
8 Physical disability Mental health condition Percentageof Respondents 6 Other condition
4
2
0 Q1 Q2 Q3 Q4 Q5 Deprivation Quintile
To explore the consequences of the strong relationship between disability and deprivation, the deprivation gradient for each disability in each area, has been calculated using the relative index of inequality4 (RII), and is given in the figure below. The RII uses the gradient of the best fit linear regression, against deprivation, and is divided by the average disability percentage for the area concerned. By dividing by the average, the index becomes relative and is not sensitive to the magnitude of the prevalence, thereby allowing the less prevalent disabilities to be compared directly to the more prevalent disabilities.
Disability by Relative Index of Inequality 1.6 1.4 1.2 1.0 0.8 0.6 0.4 0.2 0.0 RelativeIndex of Inequality -0.2 -0.4 -0.6 One or Deafness or Blindness Developme Mental No Learning Learning Physical Other more partial or partial ntal health condition disability difficulty disability condition conditions hearing loss sight loss disorder condition Scotland -0.18 0.42 0.22 0.56 1.08 0.65 0.62 1.00 1.40 0.31 Grampian -0.14 0.37 0.24 0.55 0.79 0.66 0.49 0.93 1.15 0.27 Aberdeen City -0.16 0.43 0.19 0.52 0.84 0.86 0.71 1.03 1.32 0.31 Aberdeenshire -0.12 0.33 0.30 0.60 0.82 0.52 0.44 0.87 0.87 0.25 Moray -0.05 0.13 0.29 0.19 -0.09 -0.27 -0.34 0.22 0.00 0.19 9
The interpretation of the RII is as follows, taking the example of mental health condition (which has the highest RII of any disability for each area, except Moray):
• in Scotland, the gap between most deprived 20% and the least deprived 20% is 1.4 times the average percentage reporting a mental health condition, with reported prevalence increasing with deprivation.
• in Grampian the gap between the most deprived 20% and the least deprived 20% is 1.15 times the average percentage reporting a mental health condition, again with reported prevalence increasing with deprivation.
• in Aberdeen City the gap between the most deprived 20% and the least deprived 20% is 1.32 times the average percentage reporting a mental health condition, again with reported prevalence increasing with deprivation.
• in Aberdeenshire the gap between the most deprived 20% and the least deprived 20% is 0.87 times the average percentage reporting a mental health condition, again with reported prevalence increasing with deprivation.
• in Moray, no deprivation gradient was found, so no relationship can be inferred.
The disabilities with the second and third highest RII are physical disability and learning disability, respectively. So, for example:
• in Aberdeen City the gap between the most deprived 20% and the least deprived 20% is 1.03 times the average percentage reporting a physical disability, again with reported prevalence increasing with deprivation.
With the exception of “deafness or partial hearing loss” and “blindness or partial sight loss”, Aberdeen City always has the highest RII of the local authorities.
With the exception of “deafness or partial hearing loss”, Moray has the smallest deprivation gradient across all disabilities, and in three disabilities, shows an inverse relationship between deprivation and disability.
1. National Records of Scotland (2014) Mid year 2013 population estimate available from http://gro- scotland.gov.uk/statistics/theme/population/estimates/mid-year/mid-2013/list-of-tables.html
2. National Records of Scotland (2014) Scotland’s Census 2011 www.scotlandscensus.gov.uk [last accessed 2/7/2014] tables KS201SC and National Records of Scotland (2014) 2001 Census www.scrol.gov.uk [last accessed 2/7/2014] tables UV10 with appropriate permissions.
3. Department for Work and Pensions (2014) Stat-Xplore available at https://statxplore. dwp.gov.uk/.
4. ScotPHO (2007) Measuring Socio-Economic Inequalities in Health: A Practical Guide http://www.scotpho.org.uk/downloads/scotphoreports/scotpho071009_measuringinequalities_rep. pdf
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2.1 Male Life Expectancy
Summary for NHS Grampian
In Grampian males born between 2011 and 2013 have an average life expectancy of 78.3 years1, which is above the Scottish average.
In Aberdeen, which has the lowest life expectancy of the three Grampian CHPs, male life expectancy at birth is just above the Scottish average at 77.1 years, and places Aberdeen at rank 21 of the 32 council areas across Scotland.
For those in the 15% most deprived areas of Aberdeen, born since 2009, life expectancy at birth remains around 6 years less than for their most affluent neighbours2.
Since 1981 life expectancy has been consistently better than the Scottish average for males in each of Grampian’s CHPs, with Aberdeenshire enjoying the highest life expectancy throughout, and Aberdeen City the having the lowest in all but four periods.1,3
Indicator Definition
Life expectancy at birth for males, in years.
Rationale
All cause mortality is a fundamental and probably the oldest measure of the health status of a population. Differences in levels of all-cause mortality reflect health inequalities between different population groups, e.g. between genders, social classes and ethnic groups. Life expectancy at birth is chosen as the preferred summary measure of all cause mortality as it quantifies the differences between areas in units (years of life) that are more readily understood and meaningful to the audience.
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Male Life Expectancy in Grampian (2009-13) by Intermediate Zone
KEY Years Under 72
72 to 74
74 to 76
76 to 78
78 to 80
Over 80
Male Life Expectancy in Aberdeen City (2009-13) by Intermediate Zone (From 2015 Health & Wellbeing Profiles) KEY Years Under 72
72 to 74
74 to 76
76 to 78
78 to 80
Over 80
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Male Life Expectancy (2009-13) by Intermediate Zone4
Male Traffic CHP L.E. Intermediate Zone Name Light (years) Scotland 76.6 - Scotland – All Intermediate Zones 77.1 G Aberdeen City – All Intermediate Zones 71.8 R Ashgrove 81.8 G Balgownie and Donmouth East 80.1 G Balgownie and Donmouth West 80.8 G Braeside, Mannofield, Broomhill and Seafield East 84.9 G Braeside, Mannofield, Broomhill and Seafield North 81.2 G Braeside, Mannofield, Broomhill and Seafield South 81.1 G Bucksburn North 78.5 G Bucksburn South 73.5 A City Centre 75.2 A Cove North 81 G Cove South 80.1 G Culter 81.5 G Cults, Bieldside and Milltimber East 78.6 G Cults, Bieldside and Milltimber West 74.6 A Cummings Park 78.1 G Danestone 80.5 G Denmore Aberdeen City 76.6 G Dyce 76.6 G Ferryhill North 79.3 G Ferryhill South 78.2 G Froghall, Powis and Sunnybank 74.3 A Garthdee 72.7 A George Street 70.2 R Hanover 80.6 G Hazlehead 73.2 A Heathryfold and Middlefield 78.7 G Hilton 77.4 G Kincorth, Leggart and Nigg North 78.3 G Kincorth, Leggart and Nigg South 80.4 G Kingswells 74.8 A Mastrick 70 R Midstocket 75.7 A Northfield 74.3 A Old Aberdeen 80.5 G Oldmachar East 79.5 G Oldmachar West 75.5 A Rosemount
72.4 A Seaton 77.3 G Sheddocksley
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Male Traffic CHP L.E. Intermediate Zone Name Light (years) 75.2 A Stockethill
78.9 G Summerhill 73.7 A Tillydrone 72.2 A Torry East Aberdeen City 70.2 R Torry West 82.7 G West End North 78 G West End South 68.2 R Woodside 78.9 G Aberdeenshire – All Intermediate Zones 77.7 G Aberchirder and Whitehills 79.9 G Aboyne and South Deeside 80.1 G Auchnagatt 79 G Auchterless and Monquhitter 79.9 G Balmedie and Potterton 82.7 G Banchory 80.5 G Banchory-Devenick and Findon 74.4 A Banff 80.5 G Barrahill 83.2 G Clashindarroch 81.8 G Crathes and Torphins 80.7 G Cromar and Kildrummy Aberdeenshire 80.1 G Cruden
78 G Deer and Mormond 80.7 G Dunecht, Durris and Drumoak 83.5 G Durno-Chapel of Garioch 78.1 G East Cairngorms 78.9 G Ellon East 77.1 G Ellon West 80.9 G Fetteresso, Netherley and Catter 76.5 A Fraserburgh Central-Academy 72.4 A Fraserburgh Harbour and Broadsea 74.7 A Fraserburgh Lochpots 79.5 G Fraserburgh Smiddyhill 85.3 G Fyvie-Rothie 76 A Gardenstown and King Edward 84.1 G Garlogie and Elrick 79.5 G Howe of Alford 76.8 G Huntly 76.7 G Insch, Oyne and Ythanwells
79.7 G Inverurie North 75.2 A Inverurie South 76 A Kemnay
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Male Traffic CHP L.E. Intermediate Zone Name Light (years) 81.6 G Kintore and Blackburn
78.3 G Longside and Rattray 79.3 G Macduff 78.2 G Mearns and Laurencekirk
80.4 G Mearns North and Inverbervie 79.3 G Mearns South and Benholm 78.3 G Mintlaw
76.8 G New Pitsligo 81.3 G Newmachar and Fintray 82.9 G Newtonhill Aberdeenshire 76.5 A Peterhead Bay 71.1 R Peterhead Harbour 77.8 G Peterhead Links 81.6 G Peterhead Ugieside 81.2 G Portlethen 77.5 G Portsoy, Fordyce and Cornhill 77.1 G Rosehearty and Strathbeg 80.1 G Stonehaven North 78.7 G Stonehaven South 79.2 G Turriff 81.5 G Westhill Central 78.9 G Westhill North and South 82.9 G Ythanside 81.1 G Ythsie 77.4 G Moray – All Intermediate Zones 76.2 A Buckie Central East 75.4 A Buckie West and Mains of Buckie 80.6 G Burghead, Roseisle and Laich 78.1 G Cullen, Portknockie, Findochty, Drybridge and Berryhillock 77.7 G Elgin Bishopmill East and Ladyhill 73.7 A Elgin Bishopmill West and Newfield 73.6 A Elgin Cathedral to Ashgrove and Pinefield 81.4 G Elgin Central West Moray 83.8 G Findhorn, Kinloss and Pluscarden Valley 76.4 A Fochabers, Aultmore, Clochan and Ordiquish 78.3 G Forres Central East and seaward 75.7 A Forres South West and Mannachie 78.7 G Heldon West, Fogwatt to Inchberry 74.8 A Keith and Fife Keith 77.3 G Lhanbryde, Urquhart, Pitgavney and seaward 78.3 G Lossiemouth East and Seatown 77.7 G Lossiemouth West
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Male Traffic CHP L.E. Intermediate Zone Name Light (years) 78.5 G Mosstodloch, Portgordon and seaward 75.9 A New Elgin East 78.4 G New Elgin West Moray 77.4 G North Speyside 81.8 G Rafford, Dallas, Dyke to Dava 81.1 G Rural Keith and Strathisla 78.9 G South Speyside and the Cabrach
Key to traffic lights:
R Worse than Scotland by more than 5%
A Worse than Scotland but within 5%
G Better than or equal to Scotland
Male Life Expectancy at Birth in Council Areas with Most Deprived 15% and Least Deprived 85% For Combined Years 2009-13 84
82
80
78
76
74 Years 81.8 81.2 72 79.7 78.9 77.8 78.3 76.9 70 74.7
68 71.9
66 // 64 Least Most Overall Least Most Overall Least Most Overall Deprived 85%Deprived 15% Deprived 85%Deprived 15% Deprived 85%Deprived 15% Aberdeen City Aberdeenshire Moray 95% confidence intervals have been drawn for each category. For each council the confidence intervals for the most and least deprived do not overlap, which indicates that the difference between the most and least deprived is significant at the 5% level.
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1. National Records of Scotland (2014) Life Expectancy for Areas in Scotland, 2011- 2013 http://www.nrscotland.gov.uk/statistics-and-data/statistics/statistics-by- theme/life-expectancy/life-expectancy-in-scottish-areas/2011-2013/list-of-tables
2. National Records of Scotland (2014) Life Expectancy in Scottish Council Areas split by Deprivation, 2009-2013 http://www.nrscotland.gov.uk/statistics-and- data/statistics/statistics-by-theme/life-expectancy/life-expectancy-in-scottish- areas/life-expectancy-in-scottish-council-areas-split-by-deprivation/2009-2013- including-revised-estimates-for-2003-2007-to-2006-2010
3. National Records of Scotland (2014) Life Expectancy for Areas in Scotland, 2011- 2013 http://www.nrscotland.gov.uk/statistics-and-data/statistics/statistics-by- theme/life-expectancy/life-expectancy-in-scottish-areas/2011-2013/list-of-tables
4. ScotPHO Health & Wellbeing Profiles (2011) Life Expectancy in Intermediate Zones, 2009-2013 http://www.scotpho.org.uk/comparative-health/profiles/online-profiles-tool
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2.2 Female Life Expectancy at Birth
Summary for NHS Grampian
In Grampian, average life expectancy at birth, for the years 2011-13, is 81.8 years for females1 and is above the Scottish average. In Aberdeen, life expectancy at birth is 81.2 years for women, just above the Scottish average, and places Aberdeen at rank 17 of the 32 council areas across Scotland.
For those in the 15% most deprived areas of Aberdeen, born since 2009, life expectancy at birth remains around 4 years less than for their most affluent neighbours.2
Since 1981 life expectancy has been consistently better than the Scottish average for females in each of Grampian’s CHPs, with Aberdeenshire enjoying the highest life expectancy in all but two periods and Aberdeen City having the lowest in all but four periods.1,3
Indicator Definition
Life expectancy at birth for females, in years.
Rationale
All cause mortality is a fundamental and probably the oldest measure of the health status of a population. Differences in levels of all-cause mortality reflect health inequalities between different population groups, e.g. between genders, social classes and ethnic groups. Life expectancy at birth is chosen as the preferred summary measure of all cause mortality as it quantifies the differences between areas in units (years of life) that are more readily understood and meaningful to the audience.
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Female Life Expectancy in Grampian (2009-13) by Intermediate Zone
KEY Years Under 77
77 to 79
79 to 81
81 to 83
83 to 85
Over 85
Female Life Expectancy in Aberdeen City (2009-13) by Intermediate Zone (From 2015 Health & Wellbeing Profiles) KEY Years Under 77
77 to 79
79 to 81
81 to 83
83 to 85
Over 85
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Female Life Expectancy (2009-13) by Intermediate Zone4
Female Traffic CHP L.E. Intermediate Zone Name Light (years) Scotland 80.8 - Scotland – All Intermediate Zones 81.2 G Aberdeen City – All Intermediate Zones 77.5 A Ashgrove 87 G Balgownie and Donmouth East 80.4 A Balgownie and Donmouth West 85.1 G Braeside, Mannofield, Broomhill and Seafield East 85.2 G Braeside, Mannofield, Broomhill and Seafield North 84.1 G Braeside, Mannofield, Broomhill and Seafield South 84.8 G Bucksburn North 84.7 G Bucksburn South 83.3 G City Centre 78.5 A Cove North 85.7 G Cove South 83.2 G Culter 85.4 G Cults, Bieldside and Milltimber East 82.9 G Cults, Bieldside and Milltimber West 81.9 G Cummings Park 81 G Danestone 84.9 G Denmore Aberdeen City 81 G Dyce 78 A Ferryhill North 81.8 G Ferryhill South 83.2 G Froghall, Powis and Sunnybank 81.1 G Garthdee 78 A George Street 79 A Hanover 82.6 G Hazlehead 79.5 A Heathryfold and Middlefield 82.4 G Hilton 78.8 A Kincorth, Leggart and Nigg North 80.8 G Kincorth, Leggart and Nigg South 81.8 G Kingswells 82.9 G Mastrick 75 R Midstocket 82.7 G Northfield 77.9 A Old Aberdeen 83.4 G Oldmachar East 86.1 G Oldmachar West
82.9 G Rosemount
77.1 A Seaton 80.0 A Sheddocksley
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Female Traffic CHP L.E. Intermediate Zone Name Light (years) 80.3 A Stockethill
80.8 G Summerhill 78.8 A Tillydrone 78.8 A Torry East Aberdeen City 75.9 A Torry West 82.7 G West End North 82.5 G West End South 74.9 R Woodside 82.1 G Aberdeenshire – All Intermediate Zones 84.7 G Aberchirder and Whitehills 80.9 G Aboyne and South Deeside 90.9 G Auchnagatt 83.3 G Auchterless and Monquhitter 81.8 G Balmedie and Potterton 85.8 G Banchory 80.2 A Banchory-Devenick and Findon 78.1 A Banff 81.8 G Barrahill 89.1 G Clashindarroch 80.9 G Crathes and Torphins 83.5 G Cromar and Kildrummy 79.7 A Cruden 84.4 G Deer and Mormond 86.2 G Dunecht, Durris and Drumoak Aberdeenshire 84.9 G Durno-Chapel of Garioch 84.3 G East Cairngorms 84.8 G Ellon East 82.9 G Ellon West 85.6 G Fetteresso Netherley and Catter 81.8 G Fraserburgh Central-Academy 75 R Fraserburgh Harbour and Broadsea 80 A Fraserburgh Lochpots 80.3 A Fraserburgh Smiddyhill 82.9 G Fyvie-Rothie 82 G Gardenstown and King Edward 91.4 G Garlogie and Elrick 84.5 G Howe of Alford 82.2 G Huntly 81.2 G Insch, Oyne and Ythanwells 84.4 G Inverurie North 80.3 A Inverurie South 80.2 A Kemnay
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Female Traffic CHP L.E. Intermediate Zone Name Light (years) 84.9 G Kintore and Blackburn
80.4 A Longside and Rattray 84.4 G Macduff 80.4 A Mearns and Laurencekirk
85.7 G Mearns North and Inverbervie 82.8 G Mearns South and Benholm 86.4 G Mintlaw
83.6 G New Pitsligo 85.6 G Newmachar and Fintray 83.9 G Newtonhill
79.1 A Peterhead Bay Aberdeenshire 77.3 A Peterhead Harbour 79 A Peterhead Links 85.1 G Peterhead Ugieside 81.5 G Portlethen 77.7 A Portsoy, Fordyce and Cornhill 82.4 G Rosehearty and Strathbeg 81.9 G Stonehaven North 81.6 G Stonehaven South 81.3 G Turriff 86.2 G Westhill Central 79.5 A Westhill North and South 87.7 G Ythanside 86 G Ythsie 81.7 G Moray – All Intermediate Zones 81 G Buckie Central East 81.3 G Buckie West and Mains of Buckie 84.6 G Burghead, Roseisle and Laich 83.1 G Cullen, Portknockie, Findochty, Drybridge and Berryhillock 81.2 G Elgin Bishopmill East and Ladyhill 79 A Elgin Bishopmill West and Newfield 78.6 A Elgin Cathedral to Ashgrove and Pinefield 86.7 G Elgin Central West Moray 88.7 G Findhorn, Kinloss and Pluscarden Valley 85.4 G Fochabers, Aultmore, Clochan and Ordiquish 82.1 G Forres Central East and seaward 79.3 A Forres South West and Mannachie 81.7 G Heldon West, Fogwatt to Inchberry 81 G Keith and Fife Keith 84.2 G Lhanbryde, Urquhart, Pitgavney and seaward 83.4 G Lossiemouth East and Seatown 80.7 A Lossiemouth West
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Female Traffic CHP L.E. Intermediate Zone Name Light (years) 84.2 G Mosstodloch, Portgordon and seaward 83.7 G New Elgin East 84.3 G New Elgin West 80.9 G North Speyside 80.2 A Rafford, Dallas, Dyke to Dava 87.4 G Rural Keith and Strathisla 80.3 A South Speyside and the Cabrach
Female Life Expectancy at Birth in Council Areas with Most Deprived 15% and Least Deprived 85% For Combined Years 2009-13 84
83
82
81
80
79 Years 82.5 78 81.8 81.8 82.1 82.1 81.8 81.3 81.2 77
76 78
75 // 74 Least Most Overall Least Most Overall Least Most Overall Deprived Deprived Deprived Deprived Deprived Deprived 85% 15% 85% 15% 85% 15% Aberdeen City Aberdeenshire Moray For both Aberdeenshire and Moray, the confidence intervals for the most and least deprived overlap, which indicates that the difference between the most and least deprived is not significant at the 5% level in these council areas.
For Aberdeen City the confidence intervals for the most and least deprived do not overlap, which indicates that the difference between the most and least deprived is significant at the 5% level in these council areas.
23
1. National Records of Scotland (2014) Life Expectancy for Areas in Scotland, 2011- 2013 http://www.nrscotland.gov.uk/statistics-and-data/statistics/statistics-by- theme/life-expectancy/life-expectancy-in-scottish-areas/2011-2013/list-of-tables
2. National Records of Scotland (2014) Life Expectancy in Scottish Council Areas split by Deprivation, 2009-2013 http://www.nrscotland.gov.uk/statistics-and- data/statistics/statistics-by-theme/life-expectancy/life-expectancy-in-scottish- areas/life-expectancy-in-scottish-council-areas-split-by-deprivation/2009-2013- including-revised-estimates-for-2003-2007-to-2006-2010
3. National Records of Scotland (2014) Life Expectancy for Areas in Scotland, 2011- 2013 http://www.nrscotland.gov.uk/statistics-and-data/statistics/statistics-by- theme/life-expectancy/life-expectancy-in-scottish-areas/2011-2013/list-of-tables
4. ScotPHO Health & Wellbeing Profiles (2011) Life Expectancy in Intermediate Zones, 2009-2013 http://www.scotpho.org.uk/comparative-health/profiles/online-profiles-tool
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3.1 Primary Prevention - Cancer Incidence Summary Grampian trends1 show an increase in the number of new cancer registrations from 1988 in males and females with some yearly fluctuations (see Figure 1). This general increase can largely be explained by an ageing population and improvements in detection. After standardising for changes in population age over time, cancer rates in men are observed to decrease, in part reflecting a peak of smoking in men during the 1970s. The most common cancers diagnosed in Grampian are lung, colorectal, breast and prostate tumours. Over the five year period 2008 to 2012 (see Table 1)2, the age and sex-adjusted incidence for all cancers, lung cancer, and breast cancer (females) in Grampian was lower than the Scotland-level comparator (100).
Rationale
Cancer is one of the three biggest killers in Grampian3. Scotland is significantly below the European mean for lung, colorectal and breast cancers, and is positioned in the 3rd and 4th quartiles of the European countries for relative survival. For lung cancer, only Wales and Bulgaria have lower survival rates.4
New cancer cases are expected to increase by approximately 8% every five years up to 2020.5
Indicator Definitions . Cancer registrations (count) by gender and single year . European Age-Standardised Cancer Rate (EASR) per 100,000 population by gender and single year calculated using the European Standard Population that was revised in 2013 (ESP2013) and is not comparable to ESP1976 . Age and sex standardised Incidence Ratios . ICD-10 Codes C00-C96 excluding C44
Figure 1 New Cancer Registrations Incidence (counts and rates) in Grampian residents per year from 1988 to 2012.
25
Count and Rate by Gender of All Cancer Registrations excluding non-melanoma skin cancers 1,600 900
1,400 800
1,200 700 600 1,000 500 800 400 600 Males - Count 300 Females - Count 400 200 Number of of Number Registrations
Males - Rate Registrations of Rate EASR 200 100 Females - Rate - 0 1988 1992 1996 2000 2004 2008 2012 Year
26
Table 1. Grampian resident population - annual incidence (count) and Standardised Incidence Ratios compared to Scotland level
Annual Registrations (count) Standardised Incidence Ratio (SIR) Cancer Site / Tumour Group 5 yr period Lower 95% Upper 95% 2008 2009 2010 2011 2012 2008-2012 CI CI All cancers excluding non-melanoma skin cancer 2,902 2,858 2,856 3,046 2,904 92.5 91.0 94.0 ICD-10 C00-C96 excluding C44 Trachea, bronchus and lung 402 378 395 404 365 74.4 71.1 77.7 ICD-10 C33-C34 Colorectal cancer 419 416 377 407 388 97.8 93.6 102.2 ICD-10 C18-C20 Breast ( Females ) 443 405 442 418 437 93.4 89.5 97.5 ICD-10 C50 Prostate 272 313 305 356 346 102.0 97.0 107.1 ICD-10 C61
When comparing a small numbers of observed events or individuals, apparent differences between areas may be due to random variation. The standardised incidence ratios (SIR) shown, summarise the occurrence of new cancer cases diagnosed in Grampian over a five year period relative to a Scotland-level comparator (with a value of 100), and a 95% confidence interval range is used to quantify the imprecision in the summary estimate.
1. ISD (2014) Cancer Statistics Annual Incidence available from http://www.isdscotland.org/Health-Topics/Cancer/Cancer-Statistics/All-Types-of-Cancer/ 2. ISD (2014) Data Tables of Cancer Incidence in Scotland available from http://www.isdscotland.org/Health-Topics/Cancer/Publications/data-tables.asp?id=1233#1233 3. NHS Grampian (2013) Health Intelligence using deaths files from National Records of Scotland. 4. The Lancet (2014) Cancer survival in Europe 1999—2007 by country and age: results of EUROCARE-5—a population-based study available from http://www.sciencedirect.com/science?_ob=ArticleListURL&_method=list&_ArticleListID=- 542793546&_sort=r&_st=13&view=c&_acct=C000073167&_version=1&_urlVersion=0&_userid=10696460&md5=9834b0be5d4c3ba85eafeeef96cded48&searchtype =a 5. ISD (2010) Cancer Incidence Projections Scotland to 2020 available at http://www.isdscotland.org/Health-Topics/Cancer/Cancer-Statistics/Cancer-Incidence- Projections-Scotland-to-2020.pdf
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3.2 Secondary Prevention - Early Stage 1 Disease at Diagnosis
Summary
Grampian has a smaller proportion of patients diagnosed with breast, colorectal and lung cancer at the earliest stage, as compared to Scotland as a whole (see Table 2), but the rate of relative improvement between the baseline and year 2 in Grampian was almost equivalent to Scotland (see Table 3).
The Grampian percentage of Stage Not Known has increased for both breast cancer (from 22.5% to 24.1%) and lung cancer (from 6.9% to 7.3%) and reduced for colorectal cancer (from 14.6% to 10.3%) since the baseline year.
Rationale
The national Detect Cancer Early (DCE) programme was formally launched in February 2012, to improve five-year survival for people in Scotland diagnosed with cancer. The NHS Scotland-level delivery target is to increase the proportion of people diagnosed and treated in the first stage of breast, colorectal and lung cancer by 25% by 2014/ 2015.
Indicator Definitions
Proportion of people with stage 1 disease at diagnosis. The 2010 and 2011 data were combined to get more stable baseline figures, and then compared to year 1 (2011 and 2012 combined) and year 2 (2012 and 2013 combined).
Table 2. 2012-13 DCE Staging Data Year 2 for Stage 1 and Stage Not Known
NHS Grampian (NHSG) Scotland Level Year 2, 2012 & by residence 2013 Combined Stage 1 Stage 1 Stage Not Stage 1 Stage 1 Stage Not Number % Known % Number % Known %
Breast Cancer 3295 38.8% 4.5% 287 35.9% 24.1%
Colorectal 1198 17.7% 11.3% 89 13.7% 10.3% Cancer
Lung Cancer 1473 15.8% 4.5% 78 11.2% 7.3%
DCE Combined 5966 24.3% 6.4% 454 21.2% 14.5%
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Data Caveats
It has been acknowledged1 that the variation in the percentage of Stage 1 cancers diagnosed may reflect, at least in part, variation in the percentage of Stage Not Known both at cancer type and Health Board level.
The Stage 1 percentage can vary because of a number of other factors including the presence and uptake of national screening programmes.
Table 3. Staging Performance and Relative Percentage Change from Baseline to Year 1 and Baseline to Year 2
Baseline Year 1 Year 2 Area of % % Residence Number % Number % Change Number % Change Scotland Level 5550 23.2% 5907 24.0% 3.4% 5966 24.3% 4.7% NOSCAN 1299 22.2% 1307 22.2% 0.0% 1335 22.5% 1.4% NHS Grampian 438 20.2% 456 20.8% 3.0% 454 21.2% 5.0%
1 ISD (2014) Detecting Cancer Early Staging Data Baseline and Year 2 available from http://www.isdscotland.org/Health-Topics/Cancer/
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3.3 Premature Deaths (under 75) from Cancer
Summary
There has been a gradual decline in premature death rates in Grampian1.
Variations in premature death rate by intermediate zone and local deprivation quintile have been found2 across NHS Grampian.
Rationale
Cancer is one of the three biggest killers in Grampian3. It is well-recognised that deprivation is associated with cancer mortality4.
Indicator
European age-sex standardised rate per 100,000 population of all cancer types including non-melanoma skin cancer (ICD-10 C00-C97), by year of death registration.
Cancer Mortality Rates - Persons aged under 75 years from 1995 to 2012 180 160 140 120 100 80 60 40 sex standardised mortality standardised mortality sex rates - 20 Age 0 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 Year of death registration Grampian Scotland
The chart below shows the variation by intermediate zone5 and constructed local deprivation quintile of premature mortality rates for the combined three year period from 2007 to 2009.
30
Premature Cancer Deaths by Intermediate Zone in Grampian 2007-2009 with 95% confidence intervals 375 350 325 300 275 250 225 200 175 150 125 100 75 50
Cancer Mortality Rate per 100,000 population population 75100,000 underaged Rate perMortality Cancer 25 0
1 (Most Deprived) 2 3 4 5 (Least Deprived) LCL UCL Grampian
The chart above clearly shows an association between high deprivation and high death rates, with the main block of most deprived 20% (red) as having higher death rates, and only two out of the 22 intermediate zones from the most deprived 20% having a death rate below the overall Grampian rate. Although the 95% confidence intervals are wide, a test of the difference between the highest and lowest ten pairs of intermediate zones were found to be significant at 5%. Therefore ten highest death rates are significantly higher than the ten lowest death rates.
31
1 ISD (2013) Cancer Statistics Premature Deaths Under 75 available from http://www.isdscotland.org/Health-Topics/Cancer/Cancer-Statistics/All-Types-of-Cancer/
2 NHS Grampian (2014) Health Intelligence using ScotPHO premature mortality rates, and average datazone deprivation rank for each intermediate zone.
3 NHS Grampian (2013) Health Intelligence using deaths files from National Records of Scotland.
4 ISD (2013) Cancer Mortality available at http://www.isdscotland.org/Health- Topics/Cancer/Publications/
5 ScotPHO (2010) Community Health Partnership profiles available at http://www.scotpho.org.uk/comparative-health/profiles/online-profiles-tool
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4.1 Premature deaths (under 75) from Coronary Heart Disease and Stroke
Summary for NHS Grampian
The long term decline in premature deaths from coronary heart disease (CHD) and stroke has been sustained in Grampian over the past 25 years1. Such premature deaths tend to be commoner among men than women, but this gender gap in relation to CHD has narrowed considerably over time.
The observed decline in deaths from CHD and stroke is attributable to a combination of reduced levels of smoking in the population, improvements in the acute interventional care of myocardial infarction (MI) and stroke and improved secondary prevention (with aspirin, statins, beta-blockers, ACE inhibitors and the control of blood pressure) in primary care.
Indicator Definition
Trends in European age-standardised premature deaths (age under 75) from CHD and stroke.
Rationale
Scotland has the highest rates of premature mortality in the UK, as well as significant inequalities in premature mortality within Scotland. Reducing premature mortality is one of the Scottish Government’s national indicators.2 Cardiovascular disease is one of the big killer diseases.
Notes/ Data Caveats
For ease of presentation premature deaths from CHD and stroke have been shown on the same chart. Since death from CHD is much more common than stroke this has ‘flattened out’ the appearance of the substantial decline in deaths from stroke. The definition and identification of MI (the leading cause of CHD deaths) has changed over time, particularly in relation to the measurement of troponin (a marker of damage to heart muscle) in the blood.
33
Coronary Heart Disease & Stroke Mortality Under Age 75 in Grampian From 1980 to 2013 300
250
200
150
100 EuroStandard Rate per 100,000
50
0 2011 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2012 2013 Year Male CHD Female CHD Male Stroke Female Stroke
1 NHS Grampian (2014) Health Intelligence analysis of deaths files from National Records of Scotland.
2 Scottish Government (2013) Scotland Performs National Indicators available at http://www.scotland.gov.uk/About/Performance/scotPerforms/indicator/mortality
34
5.1 Smoking Prevalence
Summary for NHS Grampian
Smoking prevalence in Grampian followed a largely downward trend until 2012, whilst it has continued to fall since 2000 in Scotland. There is more fluctuation year on year at local authority level, due to small sample sizes.
Indicator Definition
For the Scottish Household Survey1, adults aged 16 and over were asked “Do you smoke cigarettes nowadays?”
Rationale
Smoking is the most important preventable cause of ill-health and premature death in Scotland2, with approximately 13,000 smoking-related deaths in 2009, (over 1,000 in Grampian) and an estimated 24.1% of premature deaths in Scotland. Smoking is also a major contributor to health inequalities, with some of the highest rates of smoking and smoking-related diseases found in the most disadvantaged communities.
Adult Smoking Prevalence from Scottish Household Survey 35%
30%
25%
20%
15%
10%
Percentageof Population 5%
0% Scotland Grampian Aberdeen City Aberdeenshire Moray 1999/2000 30% 27% 27% 26% 27% 2001/2002 28% 25% 27% 22% 27% 2003/2004 27% 25% 27% 24% 22% 2005/2006 26% 24% 23% 20% 23% 2007/2008 25% 24% 25% 20% 26% 2009/2010 24% 22% 23% 20% 28% 2012 23% 23% 23% 24% 23%
1. Scottish Government (2011) Scottish Household Survey local authority tables 2009/10 available from http://www.scotland.gov.uk/Topics/Statistics/16002/PublicationAnnual 2. ScotPHO (2011) Smoking Ready Reckoner available from http://www.scotpho.org.uk/publications/reports-and-papers/868-smoking-ready-reckoner
35
5.2 Reach of Smoking Cessation
Summary for NHS Grampian
The quit attempts made in Grampian in 2013 as a percentage of estimated adult smokers is 7.8% and is below the Scottish rate of 10.3%. The estimated percentage of pregnant smokers in Grampian attempting to quit using NHS cessation services in 2013 is 19.0% and is below the Scottish rate of 26.5%1. On this indicator NHS Grampian is at red, with three mainland boards performing less well.
Indicator Definition
Number of quit attempts made or quit dates set in 2013, as a percentage of adult smokers estimated from the Scottish Household Survey, 2012.
Estimated percentage of pregnant smokers attempting to quit using NHS cessation services in 2013, using SMR02 data for year ending March 2012 for numbers of pregnant smokers.
Rationale
Whilst NHS Grampian has the second highest quit rate (self reported at one month) of all the mainland boards1, there is concern at the relatively low percentage of quits attempts when expressed as a percentage of total smokers in Grampian.
The following measures have been adopted to reach and persuade pregnant smokers to attempt to quit:
• A smoking cessation pathway was developed through the maternity care collaborative, to ensure that all women attending booking have carbon monoxide levels tested and smokers are referred for smoking cessation support.
• Incentives were provided to encourage community pharmacies to engage pregnant women in smoking cessation services.
• A six-month advertising campaign using local radio and bus advertising.
It should be noted that smoking cessation is only one of many tobacco control measures set out in the national strategy2 and is not in itself a successful way to reduce smoking prevalence.
1 ISD (2014) NHS Smoking Cessation Services (Scotland) available at https://isdscotland.scot.nhs.uk/Health-Topics/Public-Health/Publications/2014-05-27/2014-05- 27-SmokingCessation-Report.pdf?55903261900 [accessed 04/07/2014]
2 Scottish Government (2013) Tobacco Control Strategy available from http://www.scotland.gov.uk/Publications/2013/03/3766
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Quit attempts made as a RAG Health Board Area Percentage of adult smokers 2013 2012 2013 Ayrshire & Arran 9.6% 7.2% A Borders 11.1% 10.5% G Dumfries & Galloway 12.1% 10.3% G Fife 8.8% 9.7% A Forth Valley 8.5% 8.7% A Grampian 9.9% 7.8% A Greater Glasgow & Clyde 13.3% 12.4% G Highland 9.4% 7.8% A Lanarkshire 14.6% 13.6% G Lothian 8.3% 9.8% A Orkney 4.7% 3.6% R Shetland 10.9% 6.3% A Tayside 12.0% 10.3% G Western Isles 4.2% 3.6% R Scotland 11.0% 10.3%
Percentage of pregnant smokers attempting to quit using NHS RAG Health Board Area cessation services 2013 2012 2013 Ayrshire & Arran 11.9% 12.5% R Borders 20.4% 21.2% R Dumfries & Galloway 33.8% 39.6% G Fife 16.0% 13.6% R Forth Valley 19.2% 14.6% R Grampian 18.3% 19.0% R Greater Glasgow & Clyde 39.3% 38.8% G Highland 30.6% 30.1% G Lanarkshire 28.9% 35.8% G Lothian 23.2% 24.5% A Orkney 3.7% 15.4% R Shetland 12.5% 34.6% G Tayside 40.1% 29.8% G Western Isles 26.7% 8.9% R Scotland 27.1% 26.5%
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6.1 Drinking Prevalence from Scottish Health Survey
Summary for NHS Grampian
In recent years the Scottish Health Survey1 findings on harmful and hazardous weekly drinkers tends to indicate that Grampian adults are no better or worse than the rest of Scotland, with a calculated prevalence in both Grampian and in Scotland of 21% in 2011. There is a marked difference between consumption in men and women: the average prevalence for the combined years 2008-2011 is 26% for men and 17% for women in Grampian.
Indicator Definition
Hazardous Harmful (including dependent) Men 22-49 units per week 50+ units per week Women 15-34 units per week 35+ units per week
The percentage of adults exceeding advised sensible limits for alcohol consumption which are up to 14 units per week for women and up to 21 units per week for men, with 2 alcohol-free days each week.
Rationale
Alcohol consumption in the UK has risen since the 1930s and more than doubled since 1950, with the rise most notable from the early 1990s to 2003.2,3
Men and women who consume alcohol above sensible drinking levels are described as either “hazardous” drinkers, meaning their drinking may cause harm in the future, or “harmful drinkers”, meaning that their drinking is at a level that is already causing physical, social or psychological harm.
It has been estimated that 62,000 men and 43,000 women in Grampian are either hazardous or harmful drinkers.4
The figures below show the percentage of men and women in Grampian exceeding the sensible weekly limits, compared to other health boards, and Scotland, for the combined years 2008-2011.1
38
Hazardous and Harmful Alcohol Consumption in Men by Health Board compared to Scotland 40 35 30 25 20 15 10
Percentage 5 0
Hazardous and Harmful Alcohol Consumption in Women by Health Board compared to Scotland 35 30 25 20 15 10 Percentage 5 0
1 The Scottish Government, 2012. The Scottish Health Survey, Volume 1: Adults. Edinburgh: National statistics for Scotland.
2 Theall KP et al. The Neighbourhood Alcohol Environment and Alcohol Related Morbidity. Alcohol and Alcoholism, 2009;44: 491-99.
3 Alcohol Focus Scotland (AFS)/Scottish Health Action on Alcohol Problems (SHAAP), 2011. Rethinking Alcohol Licensing: http://www.shaap.org.uk/UserFiles/File/Reports%20and%20Briefings/Re- thinking%20alcohol%20licensing,%20September%202011.pdf
4 NHS Grampian Substance Misuse Group (2014) Health Needs Assessment Alcohol and illicit drug use available from http://www.hi-netgrampian.org/hinet/3438.4.492.html
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6.2 Alcohol Brief Interventions
Summary for NHS Grampian
For April to December 2014 Grampian reached 69% of its annual target of 6054. GPs delivered 62% of the target, with Family Planning/GUM delivering 22% and A&E less than 1%.
Based on Scottish estimates, a potential £1.3 million saving could be achieved by NHS healthcare in Grampian in the first year if a 10% overall reduction in the average alcohol consumption could be achieved. This saving could amount to an estimated £19 million if the reduction in consumption was maintained over 10 years.1
Indicator Definition
Screening patients using the setting-appropriate screening tool, and appropriate alcohol brief intervention, in line with SIGN 74 guidelines.
Rationale
There is a known association between alcohol consumption and health and wellbeing, with increasing consumption associated with over fifty health conditions (physical and mental) and a range of negative social, legal, and economic outcomes. Brief interventions in primary and secondary care are effective at reducing alcohol consumption and associated harms. The inclusion of opportunistic delivery of brief interventions as a HEAT target was in recognition that alcohol is now a significant enough social problem to warrant being put to the top of the clinical agenda. 2,3
1 Dr Harry Burns (2011) Impact of health behaviours and health interventions on demand for and cost of NHS services Scottish Government Finance Committee Inquiry into preventative spending.
2 Kaner, EFS., Dickinson, HO., Beyer, FR. Et al. (2007) Effectiveness of brief alcohol interventions in primary care populations. The Cochrane library http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD004148.pub3/abstract [accessed 19.11.13]
3 McQueen, J., Howe, TE., Allan, L. et al (2011) Brief interventions for heavy alcohol users admitted to general hospital wards. The Cochrane Library. http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD005191.pub3/abstract [accessed 19.11.13]
40
41
6.3 Directly Attributable Alcohol Related Hospital Admissions
Summary for NHS Grampian
There has been an overall decrease in the rate of alcohol-related admissions to general acute hospitals in Grampian over the seven year period from 2006/07 to 2012/13 reflecting the national position. Throughout the seven year period Aberdeen City has continued to have a higher rate of alcohol-related admissions compared to Scotland (850 per 100,000 in 2012/13 compared to 693 per 100,000 for Scotland).1
Indicator Definition
General acute inpatient and day case admissions with an alcohol-related diagnosis in any position: 2006/07- 2012/13. Relates to conditions known to be a direct consequence of alcohol consumption.
Rationale
The acute or long term effects of excessive alcohol consumption are a major cause of avoidable hospital admissions. The short term effects of interventions aimed at reducing alcohol misuse may be monitored using more proximate measures (i.e. alcohol intake and surveys of drinking habits). However it is important to be able to demonstrate that successful interventions ultimately impact on health, both in the short term (e.g. alcohol related accidents) and longer term.
1200
1000
800
600
400
100,000 population 200 hospital admissionper rate European age standadrdised 0 2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13 Scotland 809 855 828 771 759 749 693 Aberdeen City 996 1074 1071 1051 920 960 850 Aberdeenshire 424 437 432 415 401 388 314 Moray 662 639 602 522 467 529 417
Grampian 676 710 696 669 603 622 530
1 ScotPHO Alcohol Profile Tool available at: https://scotpho.nhsnss.scot.nhs.uk/scotpho/profileSelectAction.do
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7.1 Child Obesity in Primary 1
Summary for NHS Grampian
In 2012/13 less than one in ten children in Grampian were found to be obese1 (9.1%), just below the Scottish obesity level (9.3%), and the fourth lowest of all health boards. This is an improvement from the previous year, where Grampian and Scotland were equal (9.8%). Aberdeen City and Aberdeenshire have levels significantly below Scotland and the higher percentage of obese children in Moray compared to Scotland is not significant at the 5% level.
A review2 of the information collected through annual school monitoring over 40 years commissioned through Aberdeen University, indicates a dramatic increase in obesity levels over a twenty year period between 1978 and 1998. For children born in 2000 onwards there has been a reducing trend. From nationally collated1 statistics, after an increase last year all three CHPs and therefore Grampian have followed the reduction seen in the Scotland level, although Moray continues to have a higher percentage than Scotland.
Indicator Definition
Height and weight measurements taken of children aged around 6 years. Obesity including morbid obesity determined by epidemiological measurement: greater than or equal to the 95th centile of the reference population. This excludes the overweight category. All categories are given in the table below.
Category Definition Underweight less than or equal to the 2nd centile Healthy Weight Greater than the 2nd centile and less than the 85th centile Overweight greater than or equal to 85th centile and less than the 95th centile Obese greater than or equal to 95th centile
Rationale
Obesity is a continuing, major public health challenge in Grampian. Direct healthcare costs to the NHS in Scotland as a result of obesity were an estimated £191 million in 2007-08 and the total cost to Scotland was in excess of £457 million.3
Notes/ Data Caveats
Prior to 2011/12, comparisons made with the prevalence of high BMI and low BMI in Scotland should be viewed with caution as, for example, NHS Greater Glasgow and Clyde only submitted 14% of reviews of children eligible for primary 1 in 2010/11. The percentage of obese children in each school cluster has not been displayed here due to the potential for disclosure of low numbers.
43
Percentage of obese Children in P1 in Health Board RAG 2012/2013 NHS Scotland 9.3% NHS Ayrshire & Arran A 11.0% NHS Borders G 8.3% NHS Dumfries & Galloway G 9.3% NHS Fife G 9.2% NHS Forth Valley G 8.3% NHS Grampian G 9.1% NHS Greater Glasgow & Clyde G 9.3% NHS Highland A 10.4% NHS Lanarkshire G 8.9% NHS Lothian G 8.9% NHS Orkney A 13.3% NHS Shetland A 11.9% NHS Tayside A 9.5% NHS Western Isles A 12.6%
Childhood Obesity in Grampian including Morbid Obesity by Year of Birth from 1970 to 2005 12%
10%
8%
6% Percentage
4%
2%
0%
Year of Birth
44
Obesity including Morbid Obesity by CHP and Grampian over Four Years By Year of Measurement 12
10
8
6
4
2 Percentageof Children
0 City Shire Moray Grampian Scotland 2009/10 2010/11 2011/12 2012/13
Obesity by School Cluster
There is a well-understood association between raised obesity levels and the most deprived areas.4 However, an analysis5 of the proportion of children with high BMI by cluster for the four years 2009/10 to 2013/14 combined, has found that the obesity level in most clusters is not significantly different from Scotland. There just are two clusters in Aberdeen City and three in Aberdeenshire that have significantly higher obesity levels than Scotland. Meanwhile, the number of clusters with significantly lower obesity levels than Scotland are: two in Aberdeen City, five in Aberdeenshire and one in Moray.
1 ISD (2014) Primary 1 Body Mass Index (BMI) Statistics: School Year 2012/13 Available at: https://isdscotland.scot.nhs.uk/Health-Topics/Child-Health/Publications/2014-02-25/2014-02- 25-P1-BMI-Statistics-Publication-2012-13-Report.pdf?69283694029
2 Turner S., Smith S., Craig L., McNeill G (2012). A Study of Trends in childhood Obesity in North East Scotland (STONES). Report submitted to NHS Grampian.
3 Finance Committee Inquiry into preventative spending (2010). Submission from Dr Harry Burns, Chief Medical Officer for Scotland http://archive.scottish.parliament.uk/s3/committees/finance/inquiries/preventative/cmo.pdf
4 Scottish Government (2012) Obesity Indicators http://www.scotland.gov.uk/Publications/2012/11/4673/0
5 ISD (2014) Primary 1 Body Mass Index (BMI) School Cluster Analysis for Combined School Years 2009/10 to 2012/13 (special request, for management information).
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7.2 Child Healthy Weight Interventions
Summary for NHS Grampian
Child Healthy Weight Interventions are delivered in Grampian by a school-based programme called “Grow Well” which advocates healthy lifestyle choices. The Scottish Government set the target for the number of interventions.
NHS Grampian exceeded the March 2014 target for all datazones by 10%, and the 40% most deprived datazones by 34%1. Over the three year period all boards either met or exceeded the target for all datazones.
Indicator Definition
The percentage of total target interventions to be delivered from April 2011 to March 2014, delivered by March 2014. The HEAT target was to achieve 1,556 completed child healthy weight interventions over the three years ending March 2014, for children aged 2 to 15, with 622 of these to be delivered in the 40% most deprived datazones.
Rationale
Obesity is a continuing, major public health challenge in Grampian. Direct healthcare costs to the NHS in Scotland as a result of obesity were an estimated £191 million in 2007-08 and the total cost to Scotland was in excess of £457 million2.
Data Caveats
There is a slight difference in the aggregate CHP totals shown below and the actual overall Grampian totals of 1706 all datazones and 835 for the 40% most deprived datazones. This is because the figures for Q3 and 4 in 2011/12 were originally (manually) reported to the Scottish Government using Business Objects reports. The CHP data has been sourced from ISD extracts which are now used to triangulate the data, not Business Objects.
Health Board Percentage of target interventions RAG delivered in all datazones NHS Ayrshire & Arran 113.2 G NHS Borders 108.8 G NHS Dumfries & Galloway 100.0 G NHS Fife 105.9 G NHS Forth Valley 130.0 G NHS Grampian 109.6 G NHS Greater Glasgow & Clyde 114.3 G NHS Highland 103.2 G NHS Lanarkshire 106.5 G NHS Lothian 116.0 G NHS Orkney 101.7 G NHS Shetland 102.9 G NHS Tayside 113.0 G
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NHS Western Isles 269.3 G NHS Scotland 112.8
Child Healthy Weight Interventions by CHP April 2011 - March 2014 800
700
600
500
400 Number of of Number
300 Completed Interventions 200
100
0 Aberdeen City Aberdeenshire Moray 40% Most Deprived 400 252 178 All Datazones 604 727 347
1 NHS Grampian Health Intelligence (2014) Overall Performance Report September 2014.
2 Finance Committee Inquiry into preventative spending (2010). Submission from Dr Harry Burns, Chief Medical Officer for Scotland http://archive.scottish.parliament.uk/s3/committees/finance/inquiries/preventative/cmo.pdf
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7.3 Adult Obesity
Summary for NHS Grampian
Adult obesity affects 9.5% of young adults and increases sharply with age, tripling to over 30% by the age of 35-44 years. Scottish statistics show a continuous increase with age until we reach the oldest age groups of 75+ when levels fall to just below 30%.
Indicator Definition
The percentage of adults who are obese as measured for the Scottish Health Survey1 in 2011. Obesity is defined as a body mass index (BMI) of greater than or equal to 30kg/m2, where BMI is a person’s weight in kilograms divided by the square of their height in metres.
Rationale
Obesity is a continuing, major public health challenge in Grampian. Direct healthcare costs to the NHS in Scotland as a result of obesity were an estimated £191 million in 2007-08 and the total cost to Scotland was in excess of £457 million.2
NHS Grampian – Grampian RAG Scotland Age Band Percentage obese Percentage obese 16-24 9.5 G 9.9 25-34 18.3 G 20.4 35-44 31.7 A 28.1 45-54 36.9 R 31.2 55-64 45.7 R 36.0 65-74 41.5 R 34.1 75+ 28.7 A 26.6 All Ages 29.9 A 26.7
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Adult Obesity (including Morbid Obesity) in Grampian (2012) 50
45
40
35
30
25 Grampian
Percentage Scotland 20
15
10
5
0 16-24 25-34 35-44 45-54 55-64 65-74 75+ Age Group
1 UK Data Service (2014) Scottish Health Survey 2011 data on obesity prevalence available from www.ukdataservice.ac.uk (with appropriate permission).
2 Finance Committee Inquiry into preventative spending (2010). Submission from Dr Harry Burns, Chief Medical Officer for Scotland http://archive.scottish.parliament.uk/s3/committees/finance/inquiries/preventative/cmo.pdf
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8.1 Child Activity Levels
Summary for NHS Grampian
In Grampian in 2012, two out of every three children appeared to meet the recommended levels of activity. This should be treated with caution, as other studies believe that this is an overestimate (see Data Caveats, below).
Indicator Definition
Parent-reported from the Scottish Health Survey (SHeS).1 High = meets recommendations of at least 60 minutes of activity on all 7 days in previous week; Medium = some activity 30 to 59 minutes of activity on all 7 days; and Low = lower level of activity.
Rationale
Described as ‘the best buy in public health’, physical activity can improve health and wellbeing, promote independence and quality of life.2 NHS Grampian is working with its partners, integrated through the Single Outcome Agreement, to make sure that more people in Grampian enjoy the benefits of having a physically active life.
Notes/ Data Caveats
Active Healthy Kids Scotland3 warn that the SHeS is parent-reported and assumes that all physical activity reported is of least moderate intensity, which they say is unrealistic as most physical activity is of light intensity. Therefore the following tables may overestimate the percentage of “high” and “medium” level activity.
Activity Level Grampian Boys RAG Scotland Boys in 2012 Percentage meeting the Percentage meeting recommended levels of the recommended activity levels of activity High 67.0 R 72.8 Medium 20.9 G 15.5 Low 12.1 A 11.8 Activity Level Grampian Girls RAG Scotland Girls In 2012 Percentage meeting the Percentage meeting recommended levels of the recommended activity levels of activity High 63.8 A 68.0 Medium 26.9 G 20.4 Low 9.4 G 11.6
50
Child Physical Activity Level 2012 80
70
60
50
40 Percentage
30
20
10
0 High Medium Low Boys Grampian Girls Grampian Boys Scotland Girls Scotland
Child Physical Activity Levels in Grampian 2008 to 2012 90
80
70
60
50
40 Percentage
30
20
10
0 High Medium Low High Medium Low Boys Girls 2008 2009 2010 2011 2012
1 UK Data Service (2014) Scottish Health Survey 2011 data on physical activity levels available from www.ukdataservice.ac.uk (with appropriate permission).
2 NHS Health Scotland (2008) Five Year Review of ‘Let's Make Scotland More Active’ - A Strategy for Physical Activity. Edinburgh. Available at http://paha.org.uk
3 Active Healthy Kids Scotland (2013) Report Card Long Version available from: http://www.activehealthykidsscotland.co.uk/
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8.2 Adult Activity Levels
Summary for NHS Grampian
Adult participation levels in physical activity declines with increasing age. Men are more likely than women to meet the recommended activity levels. Less than 20% of those over 65 reach minimum recommended levels. There is a clear relation between activity levels and household income, with those in higher income households more likely to meet recommended activity levels. The gradient is less apparent for Grampian men than Grampian women.
Indicator Definitions
From the Scottish Health Survey1: Participation in any activity is defined as any activity for at least 10 minutes in the four weeks prior to the survey.
Recommended level of activity (or high level): to accumulate at least 30 minutes of moderate activity on at least five days of the week, which can be accumulated in bouts of as little as 10 minutes.
Medium level of activity: 30 minutes or more on one to four days per week.
Low level of activity: fewer than 30 minutes of moderate or vigorous activity a week.
Rationale
Described as ‘the best buy in public health’, physical activity can improve health and wellbeing, promote independence and quality of life.2 NHS Grampian is working with its partners, integrated through the Single Outcome Agreement, to make sure that more people in Grampian enjoy the benefits of having a physically active life.
Participation in Any Activity
Age Grampian Men Percentage RAG Scotland Men Percentage Band engaging in any activity engaging in any activity 16-24 98.2 G 93.9 25-34 99 G 93.7 35-44 92.2 G 92.1 45-54 90.4 G 87.3 55-64 77.8 G 74.7 65-74 80.4 G 72.4 75+ 51.8 G 47.9 All 87.5 G 83.6 Ages
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Age Grampian Women RAG Scotland Women Band Percentage engaging in any Percentage engaging in activity any activity 16-24 98.1 G 86.1 25-34 88.2 A 91 35-44 94.5 G 89.4 45-54 91 G 86.9 55-64 77.7 A 80.1 65-74 79 G 65.7 75+ 55.1 G 40 All 84.7 G 79.5 Ages
Adult Participation in Any Physical Activity in 2011 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% Percentageparticipation in activity 0% 16-24 25-34 35-44 45-54 55-64 65-74 75+ Age Group
Men Grampian Women Grampian Men Scotland Women Scotland
Adult Activity in Scotland Meeting Recommended Levels 60%
50%
40%
30% 2008 2009 20% 2010
10%
Percentage Meeting Recommended Level 0% 16-24 25-34 35-44 45-54 55-64 65-74 75+ Age Group
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Grampian Adult Summary Activity Levels by sex and by equivalived annual household income quintile (2012) 100
80
60
High
Percentage Medium 40 Low
20
0 1st 2nd 3rd 4th 5th 1st 2nd 3rd 4th 5th (highest) (lowest) (highest) (lowest) Men Women
1 UK Data Service (2014) Scottish Health Survey 2012 data on physical activity levels available from www.ukdataservice.ac.uk (with appropriate permission).
2 NHS Health Scotland (2008) Five Year Review of ‘Let's Make Scotland More Active’ - A Strategy for Physical Activity. Edinburgh. Available at http://paha.org.uk
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9.1 No Obvious Decay P1 Pupils – (not updated)
Summary for NHS Grampian
Grampian has a higher percentage of P1 children with no obvious tooth decay than Scotland. Tables below tend to follow the pattern found nationally1, that the higher levels of no obvious decay occur in the least deprived areas, and the worst dental health is found in the most deprived areas.
Grampian’s performance over time is similar to Scotland1 which has seen a continuous improvement since 2003.
Indicator Definition
The percentage of children found on inspection in the school year 2011/12 to have “no obvious decay experience” in their primary teeth.
Rationale
Dental decay is almost totally preventable, but is the single most common reason to admit children to hospital in Scotland. Dental health is also widely used as an 'indicative measure' of children's general health. This is because it reflects a key 'outcome' of good parental care during the pre-school period. Children in Scotland have substantially higher levels of recorded decay than other European countries.2
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Percentage of primary 1 pupils with no obvious tooth Associated School Group or CHP decay RAG Community School Network 76.3% G Aberdeen Grammar ASG 69.2% G Bridge of Don ASG 69.3% G Bucksburn ASG 85.4% G Cults ASG 70.0% G Dyce ASG 74.6% G Harlaw ASG Aberdeen City 65.6% G Hazlehead ASG 58.6% R Kincorth ASG 51.5% R Northfield ASG 81.2% G Oldmachar ASG 56.4% R St Machar ASG 39.8% R Torry ASG 65.9% G Aberdeen City 75.9% G Aboyne CSN 77.4% G Alford CSN 83.5% G Banchory CSN 65.5% G Banff CSN 73.5% G Ellon CSN 58.2% R Fraserburgh CSN 65.1% A Huntly CSN 82.6% G Inverurie CSN 78.6% G Kemnay CSN Aberdeenshire 71.1% G Laurencekirk CSN 77.8% G Meldrum CSN 74.4% G Mintlaw CSN 63.8% A Peterhead CSN 76.1% G Portethen CSN 80.6% G Stonehaven CSN 68.3% G Turriff CSN 79.8% G Westhill CSN 73.5% G Aberdeenshire 64.8% A Buckie ASG 74.8% G Elgin Academy ASG 69.3% G Elgin High ASG 80.2% G Forres ASG Moray 63.6% A Keith ASG 77.7% G Lossiemouth ASG 67.6% G Milnes ASG 72.7% G Speyside ASG 72.2% G Moray
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Percentage of Primary 1 Pupils with No Obvious Tooth Decay by ASG/CSN in Grampian 2011/12
Cults ASG Banchory CSN Inverurie CSN Oldmachar ASG Stonehaven CSN Forres ASG Westhill CSN Kemnay CSN Meldrum CSN Lossiemouth ASG Alford CSN Aberdeen Grammar ASG Portethen CSN Aboyne CSN Elgin Academy ASG Harlaw ASG Mintlaw CSN Ellon CSN Speyside ASG Laurencekirk CSN Dyce ASG Elgin High ASG Bucksburn ASG Bridge of Don ASG Turriff CSN Milnes ASG Hazlehead ASG Banff CSN Huntly CSN Buckie ASG Peterhead CSN Keith ASG Kincorth ASG Fraserburgh CSN St Machar ASG Northfield ASG Torry ASG
0% 10% 20% 30% 40% 50% 60% 70% 80% 90%
Moray Aberdeenshire Aberdeen City
1 ISD (2012) Dental Care National Dental Inspection Programme available at: http://www.isdscotland.org/Health-Topics/Dental-Care/Publications/index.asp?ID=1162
2 Scottish Government (2013) Dental Health available at: http://www.scotland.gov.uk/Topics/Statistics/Browse/Health/TrendDentalHealth
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9.2 Decayed or Missing or Filled Teeth of P1 Pupils – (not updated)
Summary for NHS Grampian
Grampian P1 children have fewer decayed, missing and filled primary teeth per pupil inspected than Scotland as a whole. In 2011/12, Grampian was the third best performing mainland board.
Scotland1 has seen a steady decline in decayed, missing and filled primary teeth since 2003.
Indicator Definition
Mean number of decayed, missing and filled primary teeth, found in the 557 (i.e. 10.1% sample) pupils during the detailed inspection in the school year 2011/12.
Rationale
Dental decay is almost totally preventable, but is the single most common reason to admit children to hospital in Scotland. Dental health is also widely used as an 'indicative measure' of children's general health. This is because it reflects a key 'outcome' of good parental care during the pre-school period. Children in Scotland have substantially higher levels of recorded decay than other European countries.2
Notes/ Data Caveats
Mean Number of decayed, missing and filled primary teeth (2011/12) RAG Ayrshire & Arran 1.34 G Borders 1.05 G Dumfries & Galloway 1.38 A Fife 1.29 G Forth Valley 1.35 G Grampian 1.17 G Greater Glasgow & Clyde 1.63 R Highland 1.15 G Lanarkshire 1.51 R Lothian 1.21 G Orkney 0.79 G Shetland 1.07 G Tayside 1.42 R Western Isles 1.57 R Scotland 1.35
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Mean Number of Decayed, Missing or Filled Teeth 1.8 1.6 1.4 1.2 1.0
Teeth 0.8 0.6 0.4 0.2 0.0
1 ISD (2012) Dental Care National Dental Inspection Programme available at: http://www.isdscotland.org/Health-Topics/Dental-Care/Publications/index.asp?ID=1162
2 Scottish Government (2013) Dental Health available at: http://www.scotland.gov.uk/Topics/Statistics/Browse/Health/TrendDentalHealth
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10. Mental Health
The Mental Health and Wellbeing Report1 contains information and interpretation of a wide range of indicators on 18 subjects areas, of which two are repeated here.
10.1 Positive Mental Health: mean adult score on the Warwick-Edinburgh Mental Well-being Scale (WEMWBS) - (data not updated)
Summary for NHS Grampian
Mental wellbeing is measured using the Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS), where a higher score indicates more positive wellbeing. The average WEMWBS score for a four year combined period (2008-2011) for adults in Grampian was 50.3 (49.9 for Scotland). The average scores for Grampian men and women were not significantly different to Scotland.2
Indicator Definition
The mean WEMWBS score for a survey population pooled across 4 years. WEMWBS is used within the Scottish Health Survey to measure wellbeing. The mean WEMWBS score is used to monitor the national indicator ‘improve mental health.’ The score can range between 14 and 70. Mental wellbeing scores can be interpreted as follows: a score of 0-32 = very low, 32-40 = below average, 40-59 = average, 59-70 = above average. Therefore the higher the score the better the reported wellbeing.
Rationale
Mental wellbeing is a national priority and can be a key factor in determining physical wellbeing. Mental wellbeing can influence, as well as be influenced by, a range of social circumstances such as employment, participation within the community and relationships. There are a number of factors at individual, community and structural level that relate to mental wellbeing and having a sense of control over life situations.3
Mental well-being can be a key factor in determining physical well-being. In Scotland, men who assessed their general health as ‘bad’ or ‘very bad’ had were six times more likely to have low well-being; women were five times more likely.4
1. NHS Grampian (2014) Health Intelligence Mental Health and Wellbeing Report available from http://www.hi-netgrampian.org/hinet/secure_files/MHWellbeingJune14.pdf
2. Scottish Government (2012) SHeS Health Board Analysis 2008-2011. Available from: http://www.scotland.gov.uk/Topics/Statistics/Browse/Health/scottish-health- survey/Publications/HBAnalysis
3. Scottish Government (2013) Scotland Performs. Available at http://www.scotland.gov.uk/About/Performance/scotPerforms/indicator/wellbeing
4. Scottish Government (2012) Scottish Health Survey 2011 Volume 1 - Adults http://www.scotland.gov.uk/Publications/2012/09/7854 (pp 21-22)
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Mean Score Mean Score for NHS Board for Men RAG Women RAG Ayrshire & Arran 49.7 A 48.8 A Borders 50.6 G 51.0 G Dumfries & Galloway 50.2 G 50.3 G Fife 49.9 A 49.8 G Forth Valley 49.9 A 49.5 A Grampian 50.5 G 50.0 G Greater Glasgow & Clyde 49.8 A 49.2 A Highland 50.5 G 50.8 G Lanarkshire 49.9 A 48.8 A Lothian 50.5 G 50.2 G Orkney 50.3 G 51.1 G Shetland 51.0 G 50.6 G Tayside 50.4 G 49.6 A Western Isles 51.2 G 49.7 G Scotland 50.1 49.7
WEMWBS Mean Scores by Scottish Health Board - Men (2008-2011) Western Isles Shetland Borders Highland Grampian Lothian Tayside Orkney Dumfries & Galloway Scotland Forth Valley Fife Lanarkshire Greater Glasgow & Clyde Ayrshire & Arran
40 50 60 WEMWBS Mean Score
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WEMWBS Mean Scores by Scottish Health Board - Women (2008-2011) Orkney Borders Highland Shetland Dumfries & Galloway Lothian Grampian Fife Western Isles Scotland Tayside Forth Valley Greater Glasgow & Clyde Lanarkshire Ayrshire & Arran
40 50 60 WEMWBS Mean Score
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10.2 Suicide
Summary
The Grampian suicide rate for 2009-13 is not significantly different from the Scottish rate. At CHP level, only the rate for Aberdeenshire females is significantly different (lower) than the Scottish female rate.
Indicator Definition
The following International Statistical Classification of Diseases and Related Health Problems (ICD) codes: • intentional self-harm (ICD-9 codes E950-959; ICD-10 codes X60-X84 plus Y87.0, which is for sequelae of intentional self-harm); and • events of undetermined intent (ICD-9 codes E980-989; ICD-10 codes Y10- Y34 plus Y87.2, which is for sequelae of events of undetermined intent).
Rationale
In Grampian1 and in Scotland2, suicide is a leading cause of mortality among people aged 15-34 years. Suicide rates in Scotland are strongly related to deprivation level.2 The target was for the 2011–2013 rate in Scotland to be 20 percent less than the 2000–2002 rate. This target was not met in Scotland, and meanwhile the crude rate per 100,000 population in Grampian reduced by 19.4%.
The figure below illustrates European age-sex standardised (EAS) suicide rates by board for the five year period 2009-13. The Grampian rate of 13.3 per 100,000 population was below the Scottish rate of 14.5. ScotPHO3 surmise that no health board had a significantly different EAS suicide rate to the Scottish rate, as the 95% confidence intervals (not shown) around the rate for each board overlap with the Scottish rate.
European age-sex standardised Suicide Rate per 100,000 Population across Scotland 2009-2013 30
25
20
15
10
5 Suicides per 100,000 population 0 Shetland Highland Dumfries & Greater Borders Lothian Fife Lanarkshire Grampian Orkney Taysi de Western Ayr shire & Forth Valley Galloway Glasg ow & Isl es Arran Clyde EASR Scotland Rate
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It is standard procedure to group five years together to smooth out the year-on-year fluctuation. This has been done using ScotPHO EAS rates, and is displayed in the figure below.
European age-sex-standardised Suicide Rate per 100,000 Population 20 18 16 14 12 10 8 6 4 2
Number of Suicides per 100,000 population 100,000 per Number of Suicides 0 Grampian Aberdeen City Aberdeenshire Moray 1984-1988 17.4 15.7 17.8 19.1 1989-1993 14.4 13.3 14.5 16.0 1994-1998 17.4 17.0 16.8 19.5 1999-2003 16.1 16.7 14.2 19.8 2004-2008 14.1 15.9 12.8 14.3 2009-2013 * 13.3 12.3 12.0 19.8
*the 2009-2013 rate is calculated using the old coding rules to allow consistent comparison over time.
The pattern over time for Grampian and Aberdeen City are matched in so far as the peak occurred in 1994-98, with a reduction for each period since then. For Moray there is a reduction from 1994-98 to 2004-08, followed by an increase in the most recent period.
ScotPHO4 surmises that for 2009-13, no local authority had a significantly different EAS suicide rate to the Scottish rate, as the 95% confidence intervals around the rate for each local authority overlap with the Scottish rate. However, using the same method for females, the rates were significantly lower in East Dunbartonshire, Perth & Kinross and East Renfrewshire, and higher in Glasgow City than in Scotland as a whole.
1NHS Grampian Health Intelligence (2014) Local analysis from deaths files obtained from National Records of Scotland
2ScotPHO (2014) Suicide Key Points http://www.scotpho.org.uk/health-wellbeing-and-disease/suicide/key-points
3 ScotPHO (2014) Suicide Health Board Overview available at http://www.scotpho.org.uk/health-wellbeing-and-disease/suicide/data/nhs-board
4 ScotPHO (2014) Suicide Local Authority Overview available at http://www.scotpho.org.uk/health- wellbeing-and-disease/suicide/data/local-authority
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11. Sexual Health
11.1 Teenage Pregnancy under 16 years
Summary for NHS Grampian
During 2012, the annual rate of pregnancy per 1000 women aged 13 -15 in Grampian rate was 4.1, below the Scottish average of 5.6 per 1000 women1. Aberdeen City has had the highest rate of pregnancy (for combined years) of the three CHPs in Grampian since 2001/03.
Indicator Definition
Annual rate of teenage pregnancy in under 16 age group per 1,000 females aged 13 to 15 years inclusive including live and still births.
Rationale
Reproductive trends are inextricably and positively linked with socioeconomic development at both individual and societal levels. Sexual health outcomes have clear adverse gradients when matched to deprivation demographics, mirroring the situation for many other health outcomes.2
Scotland has one of the highest teenage pregnancy rates in Europe. There is a national target to reduce teenage pregnancy rates, with particular emphasis placed upon reducing pregnancies in the under 16 age group. The Scottish Government3 set a target to reduce the under 16 conception rate by 20% by 2010 i.e. from 8.5 in 1995, to 6.8 per 1,000 women aged 13–15 years in 2010, which Grampian did not meet.
Notes/ Data Caveats
Data suppressed by ISD for the island boards and Borders Health Board due to small numbers.
Rate per 1000 women Health Board Area (aged 13-15 years) 2011 (revised) 2012 RAG 2012 Ayrshire & Arran 4.2 6.4 R Dumfries & Galloway 7.7 6.8 R Fife 6.6 6.6 R Forth Valley 5.5 5.5 G Grampian 6.0 4.1 G Greater Glasgow & Clyde 4.9 5.9 R Highland 4.9 3.0 G Lanarkshire 6.5 5.8 A Lothian 5.6 5.5 G Tayside 6.0 7.8 R Scotland 5.6 5.6
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Under 16 Teenage Pregnancy Rate per 1,000 Population
12
10
8
6
4 Rate Per 1,000 Population
2
0 2002/04 2003/05 2004/06 2009/11 2010/12 2001/03 2005/07 2006/08 2007/09 2008/10
Aberdeen City CHP Aberdeenshire CHP Moray CHP Scotland
1 NHS National Services Scotland 2014 Teenage Pregnancy year ending 31st December 2012 https://isdscotland.scot.nhs.uk/Health-Topics/Sexual-Health/Publications/2014-06-24/2014- 06-24-TeenPreg-Report.pdf?7369631529
2 NHS Grampian (2014) Director of Public Health Annual Report 2013-14 available from http://nhsgintranet.grampian.scot.nhs.uk/depts/PublicHealth/Public%20Health%20Documents /DPH_Annual-Report2013-14.pdf
3 Scottish Government (2005) Respect and responsibility: Strategy and Action Plan for Improving Sexual Health Available from: http://www.scotland.gov.uk/Publications/2005/01/20603/content
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11.2 Abortion & Repeat Abortion
Summary for NHS Grampian
Abortion
Since 2009 the rate of abortion in Grampian has been relatively stable, around 12 cases per 1,000 women. At 12.0, NHS Grampian has the fourth highest rate in 2013 of any health board, and higher than the Scottish rate of 11.2 per 1,000 women aged 15-44 years.1
Repeat Abortion
Since 2004, the percentage of repeat abortion has been higher in Grampian than in Scotland.1 In 2013, Grampian had the third highest percentage (33.3%) of repeat abortions in Scotland, above the Scottish percentage of 30.7%.
Indicator Definition
The abortion rate is the rate per 1,000 women per year aged 15-44 years inclusive.
Repeat abortion percentage is the percentage of women in a given year who have had a least one previous abortion.
Rationale
Repeat abortion is a growing public health problem and indicates failures of strategies that are intended to prevent unintended pregnancies including uptake of post abortion contraceptives. Women who have had one or more repeat abortions are more likely to suffer a premature birth, foetal loss, have a low birth weight baby or an ectopic pregnancy.
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Annual Abortion Rate per 1000 women aged 15-44 RAG Health Board Area 1 years 2013 2012 (revised) 2013 Ayrshire & Arran 11.7 10.3 G Borders 10.2 9.5 G Dumfries & Galloway 10.4 9.3 G Fife 13.0 12.5 R Forth Valley 10.6 10.9 G Grampian 12.3 12.0 R Greater Glasgow & Clyde 11.4 10.5 G Highland 8.9 8.8 G Orkney, Shetland & Western Isles 5.6 5.2 G Lanarkshire 11.6 10.6 G Lothian 13.4 12.5 R Tayside 14.2 12.9 R Scotland 11.9 11.2
Abortion Rate by Scottish Health Board
Tayside
Lothian
Lanarkshire
Orkney Shetland & Wester Isles
Highland
Greater Glasgow & Clyde 2009 Grampian 2010 2011 Forth Valley 2012 Fife 2013 Dumfries & Galloway
Borders
Ayrshire & Arran
Scotland
0 5 10 15 20 Rate per 1000 women aged 15-44 year
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Percentage of repeat abortions by Scottish Health Board in 2012 & 2013
Percentage of abortions where the woman has had one or RAG Health Board Area 1 more previous abortions 2013 2012 2013 Ayrshire & Arran 27.9 32.7 R Borders 31.9 27.3 G Dumfries & Galloway 27.3 27.4 G Fife 26.9 27.5 G Forth Valley 29.2 34.2 R Grampian 34.8 33.3 R Greater Glasgow & Clyde 28.6 29.6 G Highland 28.1 27.6 G Orkney, Shetland & Western Isles 20.6 18.8 G Lanarkshire 27.5 25.0 G Lothian 33.5 33.1 R Tayside 36.8 34.3 R Scotland 30.7 30.7
Percentage of Abortions where the Woman has had one of more Previous Abortions by Health Board
Tayside Lothian Lanarkshire Orkney Shetland & Wester … Highland 2009 Greater Glasgow & Clyde 2010 Grampian 2011 Forth Valley 2012 Fife 2013 Dumfries & Galloway Borders Ayrshire & Arran Scotland
0 10 20 30 40 Percentage
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Abortion rate by age group for Grampian and Grampian council areas1.
Abortion Rate per 1000 women aged 15-44 year, by age group - 2013 15-19 yrs RAG 20-29 yrs RAG 30-44 yrs RAG Scotland 14.8 17.0 6.3 Grampian 12.9 G 18.2 R 7.2 R Aberdeen City 17.4 R 20.2 R 9.1 R Aberdeenshire 10.7 G 15.4 G 6.3 G Moray 8.8 G 15.8 G 5.1 G
Aberdeen City has the highest abortion rate of the Grampian CHPs, and the 20-29 year age group has the highest rate in each CHP and Scotland compared to other age groups.
1ISD (2013) Scotland Abortion Statistics, https://isdscotland.scot.nhs.uk/Health-Topics/Sexual- Health/Publications/2014-05-27/2014-05-27-Abortions2013-Report.pdf?21364992857 (last accessed 14/07/2014)
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11.3 Long Acting Reversible Contraceptive Uptake
Summary for NHS Grampian
During 2013/14, the rate of prescriptions per 1000 women aged 15-49 years of all very long acting reversible methods of contraception in Grampian was 61.8, below the rate in Scotland of 62.1. This was a decrease from 62.7 in 2012/13, and Grampian has the fifth lowest rate of all mainland boards. Despite this, NHS Grampian has the second highest rate for contraceptive implants distributed and dispensed in 2013/14, after NHS Greater Glasgow & Clyde.1
Indicator Definition
Rate per 1,000 women aged 15 to 49.
Rationale
Long-acting reversible methods of contraception (LARC) have a lower failure rate than alternative reversible methods (for example, the contraceptive pill or condoms). Current evidence suggest that increased uptake of long-acting methods would reduce unintended pregnancy and be cost-effective for the National Health Service. The Scottish Government strategy and action plan2 make clear that the full range of contraceptive methods should be available to all patients.
Rates of prescription of all very long acting methods by NHS boards from all sources, in 2012/3 and 2013/4 per 1000 per year
Rate in 2012/3 Rate in 2013/4 RAG
NHS Ayrshire & Arran 71.7 66.7 G NHS Borders 67 71.0 G NHS Dumfries & Galloway 75.7 67.6 G NHS Fife 52.9 53.3 R NHS Forth Valley 54.9 55.9 R NHS Grampian 62.7 61.8 A NHS Greater Glasgow & Clyde 71.7 68.1 G NHS Highland 70.1 67.0 G NHS Lanarkshire 48.2 49.8 R NHS Lothian 49.6 57.5 R NHS Orkney 85.8 114.4 G NHS Shetland 66.8 108.8 G NHS Tayside 69.3 67.7 G NHS Western Isles 46.8 59.4 A Scotland 61.9 62.1
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The figure below shows the trend in LARC uptake by Health Board in ascending order of rate for 2013/14.
LARC Uptake per 1,000 Women Aged 15 to 49 140
120
100
80
60 2009/10 Rate per 1,000 40 2010/11
20 2011/12 2012/13 0 2013/14
1. ISD (2014) Long Acting Reversible Contraceptive Key Clinical Indicator Available from: https://isdscotland.scot.nhs.uk/Health-Topics/Sexual-Health/Publications/2014-09-30/2014- 09-30-LARC-Report.pdf?17296999693
2. Scottish Government (2005) Respect and responsibility: Strategy and Action Plan for Improving Sexual Health Available from: http://www.scotland.gov.uk/Publications/2005/01/20603/content
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12. Immunisation
12.1 Primary Immunisation Uptake Rates by 12 months old and
12.2 Primary and Booster Immunisation Uptake Rates by 24 months old
Summary for NHS Grampian
According to figures published by ISD1, in Grampian in 2013, the uptake of vaccination at 12 months of age exceeded 95% for the primary course of immunisations in Aberdeenshire and Moray, but not in Aberdeen City. Uptake of the primary course and booster doses by age 24 months also remained high, although in Aberdeen City the 95% level was not achieved.
See the data caveats below for the findings of an investigation into the performance in Aberdeen City, which found shortcomings with the data recording processes, and evidence of uptake in excess of 95%.
Indicator definition
Uptake of vaccination against specific diseases expressed as a percentage of the cohort eligible to be offered vaccination during 2012. D = Diphtheria, T = Tetanus, P = Pertussis, IPV = Polio, Hib = Haemophilus influenza Group B infection, MenC = Meningococcal Group B infection, PCV = Pneumococcal infection, MMR = Measles, Mumps and Rubella.
Rationale
Immunisation provides effective protection against life-threatening infectious diseases. It is one of the most cost-effective health promoting interventions in existence. It provides individual protection and, if uptakes are high enough, herd immunity, which helps to protect those who are themselves unable to be vaccinated. Herd immunity to a disease is usually considered to be present when 95% of the population have been vaccinated against the condition.
Data Caveats
Nationally published reports do not appear to reflect the real uptake in Aberdeen City. This was confirmed by an investigation during 2014, which Dr Diane Webster reported2 to the Cross System Performance Review (sections quoted below).
“We requested patient specific data from ISD for all children included in the 4th quarter 2013 uptake report reported as having incomplete immunisations. Practices were then contacted by CHP managers and asked to confirm the vaccination status of each child.
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The ISD data showed 80 out of 695 eligible children as having incomplete vaccinations at age 12 months for one or more of the three recommended primary vaccination courses (DTP/Polio/Hib, MenC, and PCV). This gave an uptake of 93.8% for DTP/Polio/Hib, 88.2% for Men C, and 93.4% for PCV. However, when electronic GP patient records were reviewed by practice staff, it was confirmed that 65 of the 80 children were in fact fully vaccinated, giving an actual uptake of 97.8% for all three primary courses.”
Actions are being taken as a result of the investigation, to improve recording of vaccinations for children arriving from abroad in Aberdeen City.
Evaluation year: 01 January 2013 to 31 December 2013 for children born in 2012 % completed course by 12 months DTP/Pol/Hib MenC PCV Grampian 96.6 94.5 96.0 Aberdeen City 95.3 91.8 94.3 Aberdeenshire 97.8 96.7 97.5 Moray 96.9 96.0 96.6 Scotland 97.5 95.8 97.5
Evaluation year: 01 January 2013 to 31 December 2013 for children born in 2011 % completed booster by 24 % completed primary course by 24 months months DTP/Pol/Hib MenC PCV MMR1 Hib/MenC PCVB Grampian 97.9 95.0 95.8 94.9 94.4 93.8 Aberdeen City 96.7 92.5 94.1 94.1 92.8 92.2 Aberdeenshire 98.7 96.7 97.0 95.3 95.4 95.1 Moray 98.8 97.3 97.0 96.2 96.3 95.2 Scotland 98.3 96.2 97.0 95.4 95.7 95.6
1 ISD (2014) Childhood Immunisation available from http://isdscotland.org/Health- Topics/Child-Health/publications/data-tables.asp?id=1299#1299
2 NHS Grampian (2014) Childhood Immunisation Report for Cross System Performance Review, August 2014.
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12.3 Vaccination against Human Papilloma Virus
Summary for NHS Grampian
The uptake and completion of the three dose course of HPV vaccine is consistently high throughout all our CHPs, exceeding the overall uptake in Scotland as a whole. The uptake of the third dose has improved for each CHP when compared with 2011- 12.
Indicator definition
Uptake of HPV vaccine expressed as a percentage of the cohort of girls eligible to be offered vaccination during their S2 secondary school year in the 2012-2013 academic year.
Rationale
Human Papilloma Virus (HPV) vaccine is the first vaccine to be introduced in the UK aimed at the prevention of cancer. Once young women become sexually active they are at risk of HPV infection and a majority of women will have become infected with one or more strains of this common sexually transmitted virus by their early 20s. Whilst most overcome the infection naturally, with few untoward effects, a minority of women will remain chronically infected and it is these individuals who are at highest risk of going on to develop cervical cancer in later years. The HPV vaccine offers effective protection against infection with the strains of HPV that are the major cause of cervical cancer in women. To be most effective, girls need to be vaccinated before they become sexually active and exposed to HPV infection, so vaccination is offered in the S2 secondary school year. The vaccine is given as a three dose course of vaccinations over a period of around six months.
Human Papilloma Virus: HPV immunisation uptake for the S2 routine cohort by the end of the school year 2012-20131
Number in cohort % uptake of % uptake of % uptake of first dose second dose third dose NHS Grampian 2,835 93.7 93.3 92.3 Aberdeen City CHP 867 94.1 93.5 91.9 Aberdeenshire CHP 1,461 93.0 92.7 92.0 Moray CHSCP 485 95.5 94.8 94.0 Scotland 27,195 94.4 93.4 91.4
1 ISD (2014) HPV Immunisation Uptake Statistics available from http://www.isdscotland.org/Health- Topics/Child-Health/Publications/data-tables.asp?id=1144#1144 (accessed 30/9/2014)
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12.4 Seasonal Flu Vaccination
Summary for NHS Grampian
In autumn 2013, the uptake of flu vaccination1 amongst Grampian residents aged 65 years and older was 76.0%, exceeding the Scottish Government target of 75%. However, it was much lower (55.2%) amongst residents aged less than 65 years who are at increased risk of complications if they developed flu infection, with considerable variation in uptake between different risk groups (from 40.8% to 66.5%).
Indicator definition
Uptake of seasonal flu vaccine during the period from September 2013 to March 2014 expressed as a percentage of those in the eligible cohort.
Rationale
Annual flu vaccination is offered every autumn to all aged 65 years and older, and to everyone aged from six months to less than 64 years who is at increased risk of having a poor outcome following flu infection because of an underlying medical condition or pregnancy. The flu vaccine offers a valuable degree of protection against this infection, reducing the risk of severe illness and possible hospitalisation in those vaccinated.
The Scottish Government target flu vaccination uptake is 75% for both: • people aged 65 years and older was 75%, and • people at increased clinical risk aged 64 years or less.
Percentage uptake of flu vaccination People at risk NHS Grampian Scotland 2010/11 2011/12 2012/13 2013/14 2010/11 2011/12 2012/13 2013/14 Aged 65 yrs 75.9% 76.4% 76.1% 76.0% 75.4% 76.2% 76.8% 76.9% and older Aged 64 yrs 54.0% 55.6% 53.8% 55.2% 56.1% 56.4% 56.1% 57.5% or less and at increased clinical risk of complications from flu
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Flu Vaccination Uptake in people aged 64 years or less by individual clinical risk group
Percentage uptake of flu vaccination Clinical Risk Group NHS Grampian Scotland 2010/11 2011/12 2012/13 2013/14 2010/11 2011/12 2012/13 2013/14 Chronic respiratory 54.2% 55.7% 53.9% 54.9% 56.0% 55.8% 55.3% 56.7% disease
Chronic heart 58.2% 58.2% 57.2% 57.2% 59.7% 59.6% 59.5% 59.7% disease Chronic kidney 55.7% 62.7% 61.4% 61.7% 60.0% 63.5% 63.7% 63.8% disease Chronic liver 41.5% 44.4% 41.1% 40.8% 45.4% 47.7% 47.6% 48.3% disease Chronic 52.2% 54.1% 53.5% 53.1% 53.3% 53.8% 53.8% 54.9% neurological disease Diabetes 66.0% 67.0% 65.3% 66.5% 68.7% 68.8% 68.6% 69.3%
Immunosuppression 61.9% 63.7% 63.1% 64.6% 62.8% 64.6% 65.8% 66.5%
Pregnancy and at 72.3% 59.5% 65.5% 62.3% 74.8% 60.0% 68.7% 65.0% other clinical risk
Pregnancy and not 58.6% 42.4% 45.7% 42.4% 64.9% 39.6% 52.9% 47.9% at other clinical risk
1 Health Protection Scotland (2014) Seasonal Flu Vaccine Uptake Reporting Portal available from http:\\fluportal.hps.scot.nhs.uk (with appropriate permissions)
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13.1 Unintentional injuries in the home in the under 15 age group
Summary: Key Points from 2013 Report1
1. Aberdeen City residents have significantly higher admission rates from unintentional injury in the home than other council residents. There were 172 admissions in 2011, giving a rate of 526 per 100,000 population, or 1 in every 190 children resident in Aberdeen City. There is a possibility that some health boards outside Grampian may under-report home as the location of injury, but this is not the case in Grampian.
2. The deprivation gradient for admissions due to unintentional injury in the home during 2009-2011 is more apparent in Aberdeen City than in both Glasgow and Edinburgh, with more admissions the more deprived the area.
3. Admission rates for Aberdeen City residents have reduced at a faster rate than other councils, whether admission type or diagnosis codes are used to identify injury.
Summary of Admissions for Aberdeen City Children2
4. The under 5’s account for the vast majority of unintentional injuries in the home in Aberdeen City: 81% in 2000 and 75% in 2013. The admission rate for under 5’s reduced by 57.5% between 2000 and 2013 with a noticeable step change between 2009 and 2010.
5. The under 5’s also account for the vast majority of injuries inside the home, especially falls, where 84% were aged under 5. Admissions for falls amongst under 5’s decreased by 26% between 2002-04 and 2011-13 (see figure below).
Admissions for all injuries including burns, corrosions, poisonings and toxic effects, in the home for Aberdeen City residents
Main Secondary Diagnoses for Under 15s Injuries, Burns and Poisoning Related Hospital Admissions Inside the Home 300
250
200
150
100
Number of Admissions 50
0 Falls Exposure to Exposure to Accidental Intentional Falls Exposure to Exposure to Accidental Intentional Falls Exposure to Exposure to Accidental Intentional inanimate animate poisoning by self-harm inanimate animate poisoning by self-harm inanimate animate poisoning by self-harm mechanical mechanical and mechanical mechanical and mechanical mechanical and forces forces exposure to forces forces exposure to forces forces exposure to noxious noxious noxious substances substances substances
0-4 5-9 10-14 2002-04 2005-07 2008-10 2011-13 6. Significant negative correlations exist between admission rate and average Scottish Index of Multiple Deprivation (SIMD) datazone rank for each of the
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three age groups: i.e. the more deprived, the higher the admission rate, although outliers have been identified in the 0-4 and 5-9 year age groups (see the figures below).
Unintentional Injuries Admission Rates for 5-9 Year Olds v Deprivation Diagnosis Codes S00-S99, T00-T14 & T20-32
30
25
Oldmachar West
20
15
Admissions per 1000 Admissions per 1000 population per annum 10
Seaton
5
0 0 1000 2000 3000 4000 5000 6000 7000 Average Rank of Datazones in Intermediate Zone
7. There is a clear relationship between multiple admission rates and deprivation, with the most deprived areas having the highest rates of two or more admissions during the 14 year period.
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Rationale
The Health and Wellbeing at a glance scorecard3 noted that Aberdeen City residents have significantly higher rates of admission than the rest of Grampian for 2009-2011, despite reducing rates in Aberdeen City since 2000. This is of concern to Public Health and Aberdeen City Community Safety Partnership colleagues who requested further investigation.
Scope of Analysis
Admissions to hospital by council residents in Grampian and three other cities in Scotland over 12 years, and attendance at the Accident and Emergency (A&E) Departments in Grampian over seven years from April 2006 to March 2013.
Children from Aberdeen City who have been admitted over 14 years, by age group, intermediate zone, deprivation and GP Practice, including multiple admissions.
1 NHS Grampian Health Intelligence (2013) Hospitalisation of Children under 15 due to Unintentional Injuries in the Home
2 NHS Grampian Health Intelligence (2014) Hospitalisation of Children from Aberdeen City under 15 due to Unintentional Injuries in the Home
3 NHS Grampian Health Intelligence (2013) Health Improvement and Wellbeing at a Glance Scorecard
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