North Wales Profile 2011 Authors: Dr Rob Atenstaedt, Consultant in Public Health Medicine; Claire Jones, Public Health Intelligence Specialist; Claire Tiffany, Advanced Public Health Intelligence Analyst; Jo Charles, Associate Public Health Director; Siobhan Jones, Consultant in Public Health; Dr Rachel Andrew, Specialty Registrar in Public Health; Dr Julia Williams, Associate Public Health Director; Dr Angela Tinkler, Consultant in Public Health; Dr Peter Stevenson, Consultant in Public Health Medicine; Dr Stella Botchway, Specialty Registrar in Public Health Date: 13 th February 2012 Version: 1 Publication/ Distribution: Public (Internet) • NHS Wales (Intranet) • Public Health Wales (Intranet) Review Date: N/A Purpose and Summary of Document: This document has been put together to support Betsi Cadwaladr University Health Board and other partner agencies across North Wales. The document provides information and data from a range of sources, including the Public Health Wales Observatory. The profile describes the health and well being status of the North Wales population and the wider determinants of health, which can impact on individual’s health and well being. Work Plan reference: N/A Public Health Wales North Wales Profile 2011 Contents 1 INTRODUCTION 6 2 INFORMATION SOURCES 9 3 DATA ANALYSIS 10 3.1 Interpreting maps and charts 11 3.1.1 Interpreting Middle Super Output Area Maps 11 3.1.2 Interpreting Middle Super Output Area Charts 12 4 AGE, SEX & BIOLOGICAL FACTORS 13 4.1 Demography 14 4.1.1 Proportion of the population aged under 18 years 15 4.1.2 Proportion of the population aged 75 years and over 18 4.1.3 Proportion of the population aged 85 years and over 21 4.2 Population Density 23 4.3 Projected changes in total population, 2008 to 2033 24 4.4 General Fertility Rate 27 4.5 Low Birth Weight 30 4.6 Teenage Conceptions 34 4.6.1 Conceptions, under 16 year olds 34 4.6.2 Conceptions, under 18 year olds 36 4.7 Abortion Data 38 4.8 Black and Minority Ethnic Population 38 4.9 Overseas Migrant Population 39 4.10 Welsh Language 40 4.11 Religious Beliefs 41 4.12 Sexual Orientation 41 4.13 People living with a physical/sensory disability 42 5 MORTALITY 44 5.1 Life Expectancy 45 5.1.1 Inequalities in life expectancy 46 5.2 Infant Mortality 48 5.3 Mortality from all causes, all ages 50 5.3.1 Inequalities in all cause mortality, all ages 53 5.4 Mortality from all causes, persons aged under 75 55 5.4.1 Inequalities in all cause mortality, persons aged under 75 58 5.5 Mortality from cancers, all ages 60
Date: 13.02.12 Version: 1 Page 2 of 318 Public Health Wales North Wales Profile 2011 5.5.1 Inequalities in mortality from cancers 63 5.5.2 Cancer survival 66 5.6 Mortality from circulatory disease, all ages 68 5.6.1 Inequalities in mortality from circulatory disease 71 5.7 Mortality from circulatory disease, persons aged 74 under 75 5.8 Mortality from coronary heart disease, all ages 77 5.9 Mortality from respiratory disease, all ages 80 5.9.1 Inequalities in mortality from respiratory disease 83 6 MORBIDITY 86 6.1 Limiting Long Term Illness as reported by adults 86 6.2 Physical Component Summary Score 88 6.3 Dental Health 90 7 UNINTENTIONAL INJURIES 91 7.1 Unintentional injuries in children and young people 92 7.1.1 Unintentional injury related hospital admissions, 0 18 years 92 7.1.2 Unintentional injury related hospital admissions 0 5 years 97 7.2 Unintentional injury related mortality 98 7.3 Unintentional falls 98 7.3.1 Fractures 101 7.3.2 Public health strategies to counter falls and fractures 105 7.4 Road traffic casualties 105 8 MENTAL HEALTH 106 8.1 Prevalence of mental health conditions 107 8.2 Mental and physical health 111 8.3 Suicide 111 8.4 Mental health in children and young adults 115 8.5 Mental health in older people 118 8.6 Mental health service activity 119 9 LIFESTYLE 122 9.1 Nutrition 124 9.1.1 Nutrition & Children & Young People 125 9.1.2 Breastfeeding 126 9.2 Physical Activity 127 9.2.1 Physical Activity & Children & Young People 128 9.3 Overweight & Obesity 130
Date: 13.02.12 Version: 1 Page 3 of 318 Public Health Wales North Wales Profile 2011 9.3.1 Overweight or obese & children & young people 132 9.4 Tobacco 134 9.4.1 Smoking related mortality 135 9.4.2 Tobacco use & children & young people 136 9.4.3 Smoking in Pregnancy 137 9.4.4 Smoking Cessation Services 138 9.5 Alcohol 139 9.5.1 Alcohol use & children & young people 141 9.5.2 Alcohol related hospital admissions 141 9.5.3 Alcohol related mortality 142 9.5.4 Alcohol related crime 144 9.6 Illicit Drugs 145 9.6.1 British Crime Survey results of illicit drug use 145 9.6.2 Illicit drug related hospital admissions 146 9.6.3 Illicit drug use & children & young people 146 9.7 Sexual Behaviour 147 9.7.1 Sexually Transmitted Infections 148 10 FAMILY, FRIENDS & COMMUNITY 151 10.1 Carers 152 10.2 Household Composition 152 10.2.1 People living alone 153 10.2.2 Older people living alone 154 11 DEPRIVATION 155 11.1 Measurement of Deprivation 156 11.1.1 Townsend Index 157 11.1.2 Welsh Index of Multiple Deprivation 157 11.1.3 Free school meal entitlement 158 11.2 Measurement of Deprivation Results 158 11.2.1 Townsend Index 158 11.2.2 Welsh Index of Multiple Deprivation 2008 161 11.2.3 Welsh Index of Multiple Deprivation 2011 163 11.2.4 Comparisons between WIMD 2008 and WIMD 2011 166 11.2.5 Free school meal entitlement 166 11.3 Impact of Deprivation on health 167 11.3.1 National Public Health Service for Wales Report 167 11.4 Wider determinants of health 168
Date: 13.02.12 Version: 1 Page 4 of 318 Public Health Wales North Wales Profile 2011 11.4.1 Tobacco 168 11.4.2 Nutrition 168 11.4.3 Alcohol 169 11.4.4 Illicit drugs 169 11.4.5 Teenage conceptions 169 11.4.6 Work & unemployment 169 11.4.7 Transport 170 11.4.8 Crime 171 12 HEALTHCARE SERVICES & UTILISATION 172 12.1 Primary Care 173 12.1.1 General Medical Practitioners 173 12.1.2 NHS Dental Performers 176 12.1.3 Community Pharmacies 176 12.1.4 Opticians 177 12.2 Secondary Care 178 12.2.1 All hospital admissions, aged under 75 years 178 12.2.2 Emergency hospital admissions, aged under 75 years 182 12.2.3 Elective hospital admissions, aged under 75 years 185 13 IMMUNISATION 188 13.1 Childhood vaccines 189 13.2 Influenza vaccine 195 13.2.1 Seasonal influenza vaccination for pregnant women 196 14 SCREENING 197 14.1 Breast screening 198 14.2 Cervical screening 199 14.3 Bowel screening 200 14.4 Newborn hearing screening 200 15 ADDITIONAL RESOURCES 202 16 REFERENCES 203 17 APPENDICES 206
Date: 13.02.12 Version: 1 Page 5 of 318 Public Health Wales North Wales Profile 2011 1 Introduction Unitary authorities (UA), health boards (HB) and other partners are required to work in partnership to formulate and implement Health, Social Care and Well being (HSCWB) Strategies at the local level. These strategies should be informed by information and data on the health and well being status of the local population and on the wider determinants which can impact on an individual’s health and well being (Public Health Wales Observatory, 2010a). This information can also be used by HBs and UAs for planning services. When conducting a health needs assessment at the local level, it is important to know how health compares at a HB or a UA basis with other geographies in Wales. However, since HSCWB Strategies are required to plan, direct and prioritise health and social care activity within UAs, it is of at least equal importance to understand how health varies inside the local UA area. Sometimes, variation within a local area is greater than between areas (Public Health Wales Observatory, 2010a). A frequent source of frustration is that, often, the data that would be of most interest and relevance in determining health needs and associated priorities either does not exist or is not robust enough to support any firm conclusions. For example, there are not enough teenage conceptions to show meaningful variation within UA areas. Another source of difficulty, and sometimes confusion, is the plethora of geographies available at the sub unitary authority level. Frequently, these geographies vary over time, making the analysis of aggregate years’ data (often required to make analysis more robust) problematic. There are other geographies that may be useful at the local level but lack digitised boundary files with national coverage. There are others which are consistent and homogeneous across Wales but, sometimes, it is hard to relate them to real areas. To help overcome this, the Observatory has produced an Interactive Atlas of Geographies in Wales designed to give an overview of the different statistical and administrative geographies used in Wales (Public Health Wales Observatory, 2010a). People’s health is determined by the context of their lives and so blaming individuals for having poor health is inappropriate. People are unlikely to be able to directly control many of the determinants of their health. The ‘social determinants of health’ refers to both specific features of, and pathways by which, societal conditions affect health and that can potentially be altered by informed action. Most of the major health conditions and differences in their occurrence between groups and geographical areas are largely contributed to by these social factors. In the modified Dahlgren and Date: 13.02.12 Version: 1 Page 6 of 318 Public Health Wales North Wales Profile 2011 Whitehead model of health (Dahlgren and Whitehead, 1991) in Figure 1, a series of enveloping circles are seen radiating outwards from the individual. The person, possessing certain intrinsic characteristics (age, gender, ethnicity and genetics), is placed at the core. Surrounding them are layers of influences on health that could theoretically be modified, radiating out from lifestyle and behavioural factors (e.g. smoking and alcohol). At a wider level, the person is placed in a wider social world comprising social networks and social support that can also affect an individual’s health. A further layer of influence outside this relates to living and working environments and, finally, general socio economic, cultural and environmental factors are placed on the outside. These determinants have informed the structure of this profile of North Wales.
Date: 13.02.12 Version: 1 Page 7 of 318 Public Health Wales North Wales Profile 2011 Figure 1: Determinants of Health & Well being ENVIRONMENTAL, LIVING AND WORKING CONDITIONS ECONOMY EDUCATION HEALTHCARE & INCOME CRIME TRANSPORT WORK & FAMILY, FRIENDS AND COMMUNITY UNEMPLOYMENT COMMUNITY FAMILY LIFESTYLE FACTORS FRIENDS TOBACCO NUTRITION SEXUAL BEHAVIOUR SUBSTANCE MISUSE PHYSICAL ACTIVITY AGE, SEX AND BIOLOGICAL FACTORS Source: Dafydd Gwynne, Public Health Wales Adapted and used with permission
Date: 13.02.12 Version: 1 Page 8 of 318 Public Health Wales North Wales Profile 2011 2 Information Sources The guide below provides some brief definitions on the main information sources used in this profile. For more detailed information, please see the Public Health Wales Observatory’s Reference Guide (Public Health Wales Observatory, 2010b). Welsh Health The Welsh Health Survey provides information about the Survey health of people living in Wales, the way they use health services and their health related lifestyle. It is based on a representative sample of people living in private households in Wales. The survey collects information on households (through a short interview) and on individuals (through a self completion questionnaire). The results reflect people’s own understanding of their own health status and health related behaviours. It is now an annual survey. Census The Census is a count of all people and households in the country. It provides population statistics from a national to a neighbourhood level. The latest Census in England and Wales took place on 27 March 2011 and involved around 25 million households. As information is not yet available from this Census, the 2001 Census has been used. Health Behaviour The Health Behaviour in School Aged Children (HBSC) Survey in School Aged is a cross national study conducted in collaboration with the Children Survey World Health Organisation. The survey aims to provide an insight to, and increase understanding of, young people’s health and well being behaviours. The HBSC is a self reported survey therefore may not accurately reflect health and well being behaviour among children and young people. Office for The Annual District Death Extract (ADDE) data are based on National underlying cause of death. It is a legal requirement to register Statistics Annual a death; therefore the ADDE provides a reliable and complete District Death data source. Extract Office for The Annual District Births Extract (ADBE) data are based on National details from the birth certificate. It is a legal requirement to Statistics Annual register a birth; therefore the ADBE provides a reliable and District Births complete data source. Extract National NICE public health guidance provides recommendations on Institute for the promotion of good health and the prevention of ill health. Health & Clinical The guidance is for people working in the NHS, local Excellence authorities and the wider public, and private and voluntary (NICE) sectors. Although there is no specific requirement to implement NICE public health guidance in Wales, it provides a standard of high quality evidence based practice. Patient Episode The Patient Episode Database for Wales (PEDW) comprises Database for records of all episodes of inpatient and day case activity for Wales residents of Wales in NHS Wales hospitals and other UK NHS hospitals. Coding practices can vary, which makes regional
Date: 13.02.12 Version: 1 Page 9 of 318 Public Health Wales North Wales Profile 2011 comparisons more difficult to interpret.
Date: 13.02.12 Version: 1 Page 10 of 318 Public Health Wales North Wales Profile 2011 3 Data Analysis The guide below provides some brief definitions on the main data analyses used in this profile. For more detailed information, please see Public Health Wales Observatory’s Reference Guide (Public Health Wales Observatory, 2010b).
European Age The European Age Standardised Rate (EASR) represents the Standardised overall rate you would get if the population had the same Rate age structure as a theoretical European population. In order to calculate this we apply the rates which occur in each age band to the standard population structure. The measure only allows for comparison between the rates which have been standardised; it is not a proportion or risk of an event occurring and does not, itself, involve a comparison with rates across Europe. Confidence Confidence intervals are indications of the natural variation Intervals that would be expected around a rate. Confidence intervals must be considered when assessing or interpreting a rate. The 95% confidence interval represents a range which has the 95% probability of including the true population rate. The range of the confidence interval is dependent on the size of the population from which the events came. Rates based on small populations are likely to have wider confidence intervals and rates based on large populations are likely to have narrower confidence intervals. Confidence intervals cannot be used to assess the statistical significance of different areas. Super Output Super Output Areas (SOA) were developed by the Office for Areas National Statistics (ONS) to try to overcome some of the disadvantages of using Electoral Divisions (ED) for presenting data, such as frequent ED boundary changes and the variation in population sizes of EDs. The new SOA geographies are based on Census Output Areas and grouped together to form three levels of SOAs: lower (LSOA), middle (MSOA) and upper (USOA). LSOAs have a mean population of 1,500 and vary between approximately 1,000 and 3,500. MSOAs have a mean population of 7,200 and vary between 5,000 to 11,200. USOAs have a mean population of 31,000 and vary between 24,000 to 47,000.
Date: 13.02.12 Version: 1 Page 11 of 318 Public Health Wales North Wales Profile 2011 3.1 Interpreting Maps and Charts This profile incorporates a series of maps and charts published by the Public Health Wales Observatory (Public Health Wales Observatory, 2010a) for a number of indicators. These have then been plotted using maps and charts 3.1.1 Interpreting Middle Super Output Area Maps Maps are produced using Middle Super Output Areas (MSOA) and Unitary Authority (UA) boundaries. The maps show data by fifths of equal range within North Wales, and each MSOA is shaded according to which fifth it falls into. To aid interpretation, it is recommended that the maps be used alongside the charts showing individual MSOAs (Public Health Wales Observatory, 2010a). A list of MSOAsa and the respective Electoral Divisions which are related to them is provided in Appendix One. For full guidance on interpreting the maps, please see the Public Health Wales Observatory Reference Guide (Public Health Wales Observatory, 2010b). The following map has been produced with labels to aid interpretation:
Date: 13.02.12 Version: 1 Page 12 of 318 Public Health Wales North Wales Profile 2011 3.1.2 Interpreting Middle Super Output Area Charts The charts show rates or proportions for each of the indicators. Although they are based on whole populations rather than a sample, they are still regarded as estimates; this is because random variation can occur over time. Fewer numbers of events mean the effect of random variation is likely to be larger; to show this, 95% confidence intervals have been included. For comparative purposes, the charts also show UA, HB and all Wales averages for the indicator (Public Health Wales Observatory, 2010b). For full guidance on interpreting the charts, please see the Public Health Wales Observatory Reference Guide (Public Health Wales Observatory, 2010b). The following chart has been produced to aid interpretation:
MSOA age standardised rate (EASR per 100,000)
Value Point with 95% confidence interval
Ceredigion
010 591 MSOA names, e.g. 009 585 Ceredigion 005 002 578 005 535 (see Appendix 1 for EASR for local 003 location of MSOAs) 526 authority area 004 507 MSOA 006 496 Blue dotted line 001 475 Value 008 462 C eredigion EASR = 517 007 459 EASR per 100,000
EASR for health EASR for board area (green) Wales (red) Welsh language versions of key charts and maps produced by Public Health Wales Observatory are provided in Appendix Two.
Date: 13.02.12 Version: 1 Page 13 of 318 Public Health Wales North Wales Profile 2011 4 Age, Sex & Biological Factors Key Messages • In 2010, the population of North Wales was estimated to be 678,500. • North Wales has higher proportions of people aged 55 years and over and lower proportions of the population aged between 15 and 34 years, compared to Wales. • The proportion of the population aged under 18 years in North Wales is 20.7%; lower than 21% in Wales as a whole. • The proportion of people aged over 75 years in North Wales is higher than the average for Wales, 9.3% compared to 8.6%. There is variation across Unitary Authorities and Middle Super Output Areas. • The proportion of the population aged 85 years and over in North Wales is just above the average across Wales, 2.7% compared to 2.5%. There is variation across Unitary Authorities and Middle Super Output Areas. • The 65 years and over age group in North Wales is expected to increase by 60% between 2008 and 2033. Conwy is expected to experience the largest percentage increase in older people and Wrexham the smallest increase. • The General Fertility Rate (GFR) for North Wales is just above the average for Wales, 61 per 1,000 compared to 60 per 1,000. • The proportion of low birth weight babies in North Wales is lower than the average across Wales, 5.5% compared to 5.8%. There is considerable variation across Middle Super Output Areas in North Wales. MSOA Denbighshire 006 (Rhyl South West) has the highest proportion of low birth weight babies, 8.2%. MSOA Conwy 003 (Llandrillo yn Rhos, Penrhyn) has the lowest proportion, 2.9%. • The teenage conception rates (15 to 17 year olds) across North Wales, with the exception of Flintshire, are higher than the average for Wales. • The abortion rates in Unitary Authorities across North Wales, with the exception of Flintshire, are higher than the average for Wales. Date: 13.02.12 Version: 1 Page 14 of 318 Public Health Wales North Wales Profile 2011 • The Black and Ethnic Minority population in North Wales is lower than the average for Wales, 1.0% compared to 2.1%. • Overseas migration data are based on National Insurance Registrations, although this is deemed to be an underestimation of the true figure. Data show that Wrexham has had the highest number of registrations since 2002/03. • In North Wales, 37.2% of people aged over three years are able to speak Welsh. There is wide variation across North Wales from 70.5% in Gwynedd to 17% in Wrexham. 4.1 Demography North Wales is a geographical area of approximately 2,500 square miles. There are six unitary authorities (UA) within this region – Isle of Anglesey, Gwynedd, Conwy, Denbighshire, Flintshire and Wrexham, and one Health Board (HB) – Betsi Cadwaladr University Health Board (BCU HB). In 2010, the approximate population of North Wales was 678,500. Flintshire in the North East has the largest population of 149,700 and Anglesey in the North West has the smallest population, 68,600; this is shown in Table 1. Table 1: Mid year population estimates, 2010 Thousands Wales 300.6 North Wales 678.5 Isle of Anglesey 68.6 Gwynedd 119.0 Conwy 110.9 Denbighshire 96.7 Flintshire 149.7 Wrexham 133.6 Source: Welsh Government/StatsWales Around 700,560 individuals with a Welsh residence are registered with a BCU HB general practice; a further 6,780 individuals with an English residence are also registered with a HBs general practice. A further 8,310 Welsh residents are registered with an English general practice (Betsi Cadwaladr University Health Board, 2011a). The registered population is higher than the resident population due, in the main, to practice list inflation which occurs when people move
Date: 13.02.12 Version: 1 Page 15 of 318 Public Health Wales North Wales Profile 2011 to a new practice but do not notify their old practice of the move (National Public Health Service & Wales Centre for Health, 2009). Figure 2 below shows that North Wales has higher proportions of people aged 55 years and over and lower proportions of the population aged between 15 and 34 years compared to Wales. This reflects older people moving into North Wales for retirement and younger people moving out of North Wales for education or employment. Figure 2: Proportion of population by age and sex Betsi Cadwaladr University Health Board: 2009 Produced by the Public Health Wales Observatory using data from 2009 mid year population estimates, Office for National Statistics
Betsi Cadwaladr females Betsi Cadwaladr males Wales females Wales males
85+ 80 84 75 79 70 74 65 69 60 64 55 59 50 54 45 49 40 44 35 39 30 34 25 29 20 24 15 19 10 14 05 09 00 04
1210 8 6 4 2 0 2 4 6 8 1012 Proportion (%) of population Further Information • Public Health Wales Observatory: UA population pyramids 4.1.1 Proportion of the population aged under 18 years In North Wales, 20.7% of the population is under the age of 18 years, compared with 21.0% in Wales as a whole. Figures 3 and 4 show how this varies across North Wales, with the highest proportion of under 18s in Flintshire UA (21.4%) and MSOA Wrexham 010 (Cartrefle, Queensway, Wynnstay) at 29.4%, and the lowest proportion of under 18s residing in Conwy UA at 20.0% and
Date: 13.02.12 Version: 1 Page 16 of 318 Public Health Wales North Wales Profile 2011 MSOA Gwynedd 001 at 10.2% (Deiniol, Hirael, Marchog, Menai Bangor). Figure 5 shows the variation by UA across Wales. Figure 3: Percentage of population aged under 18 in Betsi Cadwaladr University Health Board area, 2009 Produced by the Public Health Wales Observatory using data from ONS (MYE) Gwynedd MSOA 002 23.4 003 23.3 0.0Local Authority 5.0 006 23.2 Wales (21.0%) 003 748 004 22.9 Health Board (20.7%) 006 22.6 005 22.7 008 22.2 Isle of Anglesey 009 22.1 003 24.5 007 21.5 006 22.6 011 21.3
007 21.4 MSOA 015 20.7 009 21.1 012 20.0 001 20.8 016 18.7 MSOA 004 18.9 010 18.7 008 18.8 014 Isle of Anglesey 18.2 005 17.9 013 17.8 % = 20.6 Gwynedd 002 17.8 017 16.4 % = 20.2 % under 18 001 10.2 % under 18 Conwy Denbighshire 009 23.8 006 29.3 007 22.8 002 22.6 008 22.6 008 22.3 002 22.2 011 22.3 011 21.3 012 21.4 005 21.3 005 21.1 014 20.6 015 21.0 013 20.0 009 20.9
MSOA 015 19.7 007 20.6 MSOA 003 19.5 001 20.3 012 19.0 014 19.6 010 17.7 013 19.0 006 17.4 004 Conwy % 18.8 004 15.5 = 20.0 010 18.7 Denbighshire 001 14.8 003 17.1 % = 20.6 % under 18 016 16.8 % under 18 Flintshire Wrexham 004 23.7 007 23.2 010 29.4 003 23.1 017 23.3 010 23.0 003 23.1 009 22.4 004 23.0 005 22.3 005 22.8 015 22.2 006 22.5 013 22.0 015 22.2 018 21.9 013 22.2 012 21.9 001 21.6 002 21.9 009 21.2 MSOA
008 21.8 MSOA 014 20.6 016 21.2 019 20.6 011 20.7 016 20.5 017 20.3 018 20.1 014 19.7 012 19.5 020 19.7 002 18.9 001 19.6 Flintshire % = 008 17.3 Wrexham % 019 21.4 19.4 007 17.1 = 21.2 006 18.3 011 16.6 % under 18 % under 18
Date: 13.02.12 Version: 1 Page 17 of 318 Public Health Wales North Wales Profile 2011 Figure 4:
Figure 5: Percentage of population aged under 18 by local authority, 2009 Produced by Public Health Wales Observatory, using data from ONS (MYE)
Wales = 21.0% 23.2% 22.4% 22.3% 22.2% 21.8% 21.5% 21.5% 21.4% 21.4% 21.4% 21.2% 21.1% 20.8% 20.6% 20.7% 20.6% 20.3% 20.2% 20.2% 19.9% 19.6% 17.6% Powys Cardiff Conwy Torfaen Newport Bridgend Flintshire Swansea Gwynedd Wrexham Caerphilly Ceredigion Denbighshire Merthyr Tydfil Pembrokeshire Blaenau Gwent Monmouthshire Isle of Anglesey Carmarthenshire Neath Port Talbot
Areas ordered geographically from north west to south east Rhondda Cynon Taff
The Vale of Glamorgan
Date: 13.02.12 Version: 1 Page 18 of 318 Public Health Wales North Wales Profile 2011 4.1.2 Proportion of the population aged 75 years and over In North Wales, the proportion of the population aged 75 years and over is 9.3%, which is higher than the proportion in Wales as a whole, at 8.6%. Again, there are variations across North Wales. Figures 6 and 7 show that the highest proportion of the 75s and over reside in Conwy UA at 11.9% and MSOA Conwy 004 (Llandrillo yn Rhos) at 20.4%, and the lowest proportion in Flintshire UA (7.5%) and MSOA Denbighshire 006 (Rhyl South West) at 5.3%. Figure 8 shows the variation by UA across Wales.
Date: 13.02.12 Version: 1 Page 19 of 318 Public Health Wales North Wales Profile 2011 Figure 6: Percentage of population aged 75 and over in Betsi Cadwaladr University Health Board area, 2009 Produced by Public Health Wales Observatory, using data from ONS (MYE) Gwynedd
MSOA 017 14.3 014 13.6 0.0Local Authority 2.0 010 12.3 Wales (8.6%) 005 748 013 11.6 002 11.4 Health Board (9.3%) 012 11.4 Isle of Anglesey 011 11.4 016 11.1 005 12.5 007 9.8 002 11.4 009 9.2
008 10.7 MSOA 015 9.1 004 9.9 006 8.4 006 9.1 008 8.2 MSOA 001 8.8 002 8.2 007 8.7 Isle of Anglesey 005 7.8 009 8.7 % = 9.6 004 7.3 003 7.4 Gwynedd 003 6.7 % = 9.7 % 75 and over 001 5.6 % 75 and over Conwy Denbighshire 004 20.4 004 12.9 010 15.8 014 12.9 003 15.7 003 12.7 001 15.4 016 12.4 006 15.3 001 12.1 002 12.0 002 11.8 008 10.5 010 11.2 007 10.5 007 10.3
MSOA 012 9.9 005 9.6 MSOA 005 9.8 012 9.6 015 9.2 013 9.5 013 9.1 009 9.0 011 8.9 011 Conwy 7.8 009 8.1 % = 11.9 008 7.5 Denbighshire 014 7.9 015 7.4 % = 10.2 % 75 and over 006 5.3 % 75 and over Flintshire Wrexham 016 9.9 004 9.9 009 12.6 020 9.5 002 11.4 006 8.5 008 10.7 017 7.9 007 10.1 019 7.8 019 9.5 011 7.8 015 8.9 001 7.7 018 8.7 013 7.7 014 7.8 009 7.4 017 7.4 014 7.1 001 7.3 MSOA
003 7.1 MSOA 006 7.1 002 6.9 011 6.9 012 6.9 016 6.9 015 6.4 012 6.7 008 6.3 010 6.5 018 6.1 005 6.4 Flintshire 005 6.0 013 6.1 Wrexham 010 % = 7.5 5.8 003 6.0 % = 7.9 007 5.7 004 5.4 % 75 and over % 75 and over
Date: 13.02.12 Version: 1 Page 20 of 318 Public Health Wales North Wales Profile 2011 Figure 7:
Figure 8: Percentage of population aged 75 and over by local authority, 2008 Produced by Public Health Wales Observatory, using data from ONS ( MYE)
Wales = 8.6% 11.7% 10.3% 10.2% 9.7% 9.7% 9.6% 9.6% 9.5% 9.4% 9.0% 8.9% 8.7% 8.4% 8.2% 7.9% 7.9% 7.9% 7.8% 7.6% 7.3% 7.3% 6.9% … Powys Cardiff Conwy Torfaen Newport Swansea Bridgend Flintshire Gwynedd Wrexham Caerphilly Ceredigion The Vale of Denbighshire Merthyr Tydfil Blaenau Gwent Pembrokeshire Monmouthshire Isle of Anglesey Carmarthenshire Neath Port Talbot Areas ordered geographically from north west to south east Rhondda Cynon Taff
Date: 13.02.12 Version: 1 Page 21 of 318 Public Health Wales North Wales Profile 2011 4.1.3 Proportion of the population aged 85 years and over In North Wales, 2.7% of the population are aged 85 years and over, which is slightly higher than the average of 2.5% across Wales. Figures 9 and 10 show that the highest proportion of 85 year olds and over reside in Conwy UA, 3.5% and MSOA Conwy 004 (Llandrillo yn Rhos), 6.8%. The lowest proportions live in Flintshire UA 2.1% and MSOA Wrexham 013 (Minera, Penycae, Penycae & Ruabon South), 1.2%.
Date: 13.02.12 Version: 1 Page 22 of 318 Public Health Wales North Wales Profile 2011 Figure 9: Percentage of population aged 85 and over in Betsi Cadwaladr University Health Board area, 2009 Produced by Public Health Wales Observatory, using data from ONS (MYE) Gwynedd MSOA 014 3.9 0.0 Health Board (2.7%)2.0 011 3.9 Wales (2.5%) 017 748 3.7 010 3.7 3.5 Local Authority 013 3.2 Isle of Anglesey 016 3.0 012 2.9 008 3.7 007 2.6 005 3.5 005 2.5 002 3.2 MSOA 002 2.4 004 2.7 006 2.2 007 2.5 015 2.1 MSOA 006 2.4 009 2.0 001 2.4 Isle of Anglesey 008 2.0 009 2.3 % = 2.7 001 1.9 003 Gwynedd 1.8 004 1.9 % 85 and over % = 2.6 003 1.6 % 85 and over Conwy Denbighshire 004 6.8 004 5.1 001 5.4 014 4.5 003 5.3 002 4.4 010 4.5 016 4.2 006 4.3 010 4.0 008 3.7 003 3.7 002 3.6 001 3.5 007 3.6 012 3.3
MSOA 013 2.7 007 2.7 MSOA 015 2.6 005 2.7 012 2.4 009 2.6 005 2.2 008 2.5 014 2.1 013 Conwy 2.4 011 2.0 % = 3.5 011 2.1 Denbighshire 009 2.0 015 1.9 % = 3.3 % 85 and over 006 1.3 % 85 and over Flintshire Wrexham 020 2.8 016 2.8 009 4.0 004 2.7 002 3.8 006 2.6 015 3.2 013 2.5 008 2.9 017 2.4 019 2.7 005 2.2 007 2.5 009 2.1 018 2.3 019 2.1 012 2.3 003 2.0 001 2.3 011 2.0 006 2.2 MSOA
002 1.8 MSOA 011 2.1 015 1.8 005 2.0 014 1.7 016 1.9 001 1.7 017 1.8 008 1.6 010 1.8 018 1.6 014 1.8 007 1.5 Flintshire 004 1.6 Wrexham 012 % = 2.1 1.5 003 1.6 % = 2.3 010 1.3 013 1.2 % 85 and over % 85 and over
Date: 13.02.12 Version: 1 Page 23 of 318 Public Health Wales North Wales Profile 2011
Figure 10:
4.2 Population Density Population density provides a measure of the concentration of people living in an area. It is calculated by dividing the population by the geographical area in square kilometres. Population density varies across North Wales, with Wrexham and Flintshire being the most densely populated areas. Denbighshire, Conwy and Anglesey are more sparsely populated and Gwynedd has the most sparsely distributed population in North Wales. Table 2 shows the population density across the region. Table 2: Population density: persons per square km, 2010 Persons per km 2 Wales 144.7 Isle of Anglesey 96.0 Gwynedd 46.7 Conwy 98.1 Denbighshire 115.4 Flintshire 342.0 Wrexham 265.1 Source: Welsh Government/STATSWales Date: 13.02.12 Version: 1 Page 24 of 318 Public Health Wales North Wales Profile 2011 North Wales has 62 areas which are classed as ‘urban’ (that is, an area with a minimum population of 1,500). 40 of these areas have populations of less than 5,000 people and 14 areas have populations of 10,000 people or more (Table 3). It should be noted that this data is now 10 years old and we are awaiting results from the 2011 Census. Table 3: Main urban areas in North Wales, 2001 UA Area Resident population Wrexham, Wrexham 42,576 Colwyn Bay Conwy 30,269 Rhyl Denbighshire 25,390 Shotton (inc. Hawarden) Flintshire 24,751 Prestatyn Denbighshire 18,496 Buckley Flintshire 18,268 Brymbo/Gwersyllt Wrexham 17,912 Abergele Conwy 17,574 Connah’s Quay Flintshire 16,526 Bangor Gwynedd 15,280 Llandudno Conwy 14,872 Rhosllanerchrugog Wrexham 13,246 Flint Flintshire 11,936 Holyhead Anglesey 11,237 Source: Census 2001 4.3 Projected changes in total population from 2008 to 2033 Figure 11 shows that the 65 year old and over age group in North Wales is predicted to increase by 60% between 2008 and 2033. The proportion aged 75 years and over (Figure 12) is projected to increase around 7% and 8% per cent in Flintshire and Wrexham to around 15% and 14% respectively during this period. In Conwy, the proportion is projected to rise from around 12% to 18%. The percentage aged 85 years and over (Figure 13) is projected to double from around 2% to 3.5% to around 5.5% to 7% by 2033 (Public Health Wales Observatory, 2011). It is important to note that population projections provide estimates of the size of the future population, and are based on assumptions about births, deaths and migration. The assumptions are based on past trends. Projections only indicate what may happen should the recent trends continue. Projections done in this way do not make allowances for the effects of local or central government policies on
Date: 13.02.12 Version: 1 Page 25 of 318 Public Health Wales North Wales Profile 2011 future population levels, distribution and change (National Public Health Service & Wales Centre for Health, 2009). Figure 11:
2008 based population projections for Betsi Cadwaladr University Health Board, persons: 2008 to 2033 Produced by the Public Health Wales Observatory, using data from the Welsh Assembly Government
0 15 16 24 25 44 45 64 65+ 70
60
50
40
30
20
10
0 Percentage change from 2008 10
20 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 Figure 12:
Projected population, 2008 2033, % aged 75 and over Produced by Public Health Wales Observatory, using data from the Welsh Assembly Government Isle of Anglesey Gwynedd Conwy Denbighshire Flintshire Wrexham Wales 20
18
16
14 %
12
10
8
6 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 * Y axis is truncated
Date: 13.02.12 Version: 1 Page 26 of 318 Public Health Wales North Wales Profile 2011 Figure 13:
Projected population, 2008 2033, % aged 85 and over Produced by Public Health Wales Observatory, using data from the Welsh Assembly Government Isle of Anglesey Gwynedd Conwy Denbighshire Flintshire Wrexham Wales 8
7
6
5 %
4
3
2 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 * Y axis is truncated Further Information • Public Health Observatory Wales: Population Projections http://www.wales.nhs.uk/sitesplus/888/document/150184 • Public Health Observatory Wales: Population estimates and projection resources http://howis.wales.nhs.uk/sitesplus/922/page/36662 Date: 13.02.12 Version: 1 Page 27 of 318 Public Health Wales North Wales Profile 2011 4.4 General Fertility Rate The general fertility rate (GFR) is defined as the total number of live births born to females who are of childbearing age in a population, i.e. those aged between 15 and 44 years. This rate provides a useful indicator when studying population growth and change. Across Wales and the UK, the GFR fell between 1998 and 2001/2002. Figure 14 shows it has been slowly rising since 2001/2002. It has been postulated that this upturn has been largely driven by increasing birth rates among older women. The North Wales GFR is slightly higher than the Wales rate (61 per 1,000 compared to 60 per 1,000), but closely reflects the Welsh pattern. Figure 14:
General fertility rate (GFR) trend, Wales and Betsi Cadwaladr University LHB, 1998 to 2007
Data source: Office for National Statistics (Annual District Births Extract, Mid-year Po pulation Estim ates) 8 0
Betsi Cadwaladr University LHB W ales
6 0
4 0
2 0
Livebirths per 1000females aged 15-44 Error bars show 95% C onfidence Intervals
0 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 Further Information • Public Health Wales Observatory: UA level trend data http://www.wales.nhs.uk/sitesplus/888/document/150194 Figures 15 and 16 show that the GFR for 2006 8 is highest in Wrexham UA (64 per 1,000) and MSOA Wrexham 010 (Cartrefle, Queensway, Wynnstay) at 93 per 1,000 and lowest in Gwynedd UA (58 per 1,000) and MSOA Gwynedd 001 (Deiniol, Marchog, Hirael, Menai [Bangor]), 21 per 1,000; rates are particularly low in parts of Bangor where there is a large student population. Figure 17 shows how GFR varies in UAs across Wales.
Date: 13.02.12 Version: 1 Page 28 of 318 Public Health Wales North Wales Profile 2011 Figure 15: General fertility rate per 1,000 in Betsi Cadwaladr University Health Board area, females aged 15 44, 2006 08 Produced by Public Health Wales Observatory, using data from ONS (ADBE, MYE) MSOA GFR with 95% Gwynedd confidence interval 006 77 Local Authority 009 71 0 20 012 68 Wales (GFR = 60) 003 748 008 68 Health Board (GFR = 61) 001 68 004 68 007 67 Isle of Anglesey 003 67 003 74 011 64 001 68 015 64
006 68 MSOA 002 63 004 62 005 60 007 62 016 57 MSOA 009 60 010 54 002 58 013 Isle of Anglesey 54 008 52 014 51 GFR = 63 Gwynedd 005 52 017 49 GFR = 58 GFR 001 21 GFR Conwy Denbighshire 007 84 004 84 010 71 006 84 002 69 011 72 009 67 001 69 005 66 007 68 004 63 014 58 015 61 003 57 014 61 010 56
MSOA 013 60 012 56 MSOA 001 58 008 55 008 56 015 55 011 55 013 53 003 53 005 53 006 51 Conwy 009 52 GFR = 62 Denbighshire 012 51 016 47 GFR = 61 GFR 002 46 GFR Flintshire Wrexham 004 74 003 73 010 93 002 71 012 76 007 69 005 73 009 67 015 73 008 67 017 72 015 66 003 70 013 61 004 69 016 58 006 68 005 58 013 62 017 58 019 61 MSOA
011 54 MSOA 014 61 012 52 001 59 018 52 016 58 010 52 008 55 014 51 011 51 020 51 018 48 006 50 007 48 Flintshire Wrexham 019 48 GFR = 60 009 47 GFR = 64 001 45 002 47 GFR GFR
Date: 13.02.12 Version: 1 Page 29 of 318 Public Health Wales North Wales Profile 2011 Figure 16:
Figure 17: General fertility rate per 1,000, by local authority, 2006 08 95% confidence Produced by Public Health Wales Observatory, using data from ONS (ADBE, MYE) interval
Wales = 59.7 66.0 64.3 64.2 62.8 62.8 62.3 62.0 61.5 61.0 60.4 60.3 60.2 59.9 59.8 59.8 59.4 58.5 58.2 57.9 57.5 56.9 41.3 Powys Cardiff Conwy Torfaen Newport Swansea Bridgend Flintshire Gwynedd Wrexham Caerphilly Ceredigion Denbighshire Merthyr Tydfil Pembrokeshire Blaenau Gwent Monmouthshire Isle of Anglesey Carmarthenshire Neath Port Talbot Rhondda Cynon Taff Areas ordered geographically from north west to south east The Vale of Glamorgan Date: 13.02.12 Version: 1 Page 30 of 318 Public Health Wales North Wales Profile 2011 4.5 Low Birth Weight Birth weight is measured to identify children who are most at risk of dying young or suffering health related problems in childhood. There is a strong correlation between social deprivation and low birth weight. Figure 18 shows that the percentage of low birth weight births is smaller in North Wales (5.5%), compared to 5.8% in Wales as a whole. Figures 18 and 19 show that within North Wales, the highest percentage of low birth weight babies is in Conwy and Denbighshire UAs (6%), and the lowest in Gwynedd UA (5%). There is considerable variation across MSOAs; the MSOA with the highest proportion of low birth weight babies is Denbighshire 006 (Rhyl South West) at 8.2% and the MSOA with the lowest is Conwy OO3 (Llandrillo yn Rhos, Penrhyn) at 2.9%. Figure 20 illustrates the variation in low birth weight in UAs across Wales. Figure 21 shows trends in low birth weight for the six UAs in North Wales between 2001 and 2009.
Date: 13.02.12 Version: 1 Page 31 of 318 Public Health Wales North Wales Profile 2011 Figure 18: Low birth weight in Betsi Cadwaladr University Health Board area, percentage of singleton live births, 1998 2007 Produced by Public Health Wales Observatory, using data from ONS (ADBE, MYE)
MSOA % with 95% Gwynedd confidence interval 006 7.5 Local Authority 0.0 2.0 003 6.8 Wales (5.8%) 008 6.0 003 748 001 Health Board (5.5%) 5.3 005 6.0 009 5.1 Isle of Anglesey 011 5.0 007 4.9 003 6.8 010 4.7 005 6.0 005 4.6
001 5.7 MSOA 012 4.5 006 5.6 017 4.4 008 5.2 014 4.2 MSOA 002 5.0 002 4.2 007 4.8 Isle of Anglesey 015 3.6 004 4.4 %LBW = 5.4 013 3.6 Gwynedd 009 4.3 004 3.5 %LBW = 5.0 % low birth weight 016 3.4 % low birth weight Conwy Denbighshire 010 7.3 006 8.2 007 7.2 004 7.4 013 7.1 003 6.7 005 7.0 005 6.6 001 6.7 011 6.3 002 6.5 009 6.2 009 6.3 008 5.9 004 6.0 001 5.8
MSOA 006 5.5 016 5.8 015 5.3 MSOA 010 5.6 014 5.2 007 5.4 011 5.0 015 5.3 012 4.7 Conwy 002 4.7 008 4.4 %LBW = 6.0 014 4.6 003 2.9 Denbighshire 012 4.2 %LBW = 6.0 % low birth weight 013 4.1 % low birth weight Flintshire Wrexham 007 8.1 009 7.4 010 7.5 015 5.8 005 7.0 017 5.8 012 6.1 004 5.7 004 5.8 001 5.6 011 5.8 020 5.4 014 5.6 016 5.4 017 5.5 005 5.2 002 5.5 006 5.1 003 5.4 014 4.9 015 5.4 MSOA
003 4.8 MSOA 006 5.2 013 4.7 013 4.9 002 4.7 007 4.9 008 4.6 009 4.8 011 4.3 008 4.7 012 4.2 019 4.4 018 4.1 001 4.3 Flintshire Wrexham 010 3.8 016 4.1 %LBW = 5.3 %LBW = 5.4 019 3.7 018 3.0 % low birth weight % low birth weight
Date: 13.02.12 Version: 1 Page 32 of 318 Public Health Wales North Wales Profile 2011 Figure 19:
Numbers on map indicate MSOAs with a rate statistically significantly higher than the all Wales rate. Figure 20: Low birth weight by local authority, percentatge of singleton live 95% confidence births, 1998 2007 interval Produced by Public Health Wales Observatory, using data from ONS (ADBE, MYE)
Wales = 5.8% 7.8% 7.6% 6.8% 6.5% 6.2% 6.1% 6.0% 6.0% 6.0% 5.7% 5.7% 5.6% 5.5% 5.5% 5.5% 5.4% 5.4% 5.3% 5.0% 5.0% 4.9% 4.4% Powys Cardiff Conwy Torfaen Newport Swansea Bridgend Flintshire Gwynedd Wrexham Caerphilly Ceredigion Denbighshire Merthyr Tydfil Blaenau Gwent Pembrokeshire Monmouthshire Isle of Anglesey Carmarthenshire Neath Port Talbot Rhondda Cynon Taff
Areas ordered geographically from north west to south east The Vale of Glamorgan
Date: 13.02.12 Version: 1 Page 33 of 318 Public Health Wales North Wales Profile 2011 Figure 21: Percentage of singleton live births with a low birth weight (less than 2500g), 3 year rolling average, 2001/03 2007/09, Betsi Cadwaladr University Health Board area local authorities and Wales Produced by Public Health Wales Observatory, using ADBE (ONS) 95% confidence Local authority Wales interval Isle of Anglesey Gwynedd 9 8 7 6 5 4 3 2 1 0
Conwy Denbighshire 9 8 7 6 5 4 3 2 1 0
Flintshire Wrexham 9 8
Percentage (%) of singleton live births 7 6 5 4 3 2 1 0 03 04 05 06 07 08 09 03 04 05 06 07 08 09 2001 2002 2003 2004 2005 2006 2007 2001 2002 2003 2004 2005 2006 2007
Date: 13.02.12 Version: 1 Page 34 of 318 Public Health Wales North Wales Profile 2011 4.6 Teenage Conceptions Teenage pregnancy is a known cause of health inequality and childhood poverty. Evidence has shown that teenage pregnancy is related to poor maternal and child health outcomes. There is an increased risk of teenage mothers failing to complete their education, suffering from post natal depression and other mental health issues and of living in poverty. There is a 60% increase in the ‘Infant Mortality Rate’ in comparison to older mothers (Department of Health, 2010). Children of teenage mothers are at risk of poor health, poor housing, low educational attainment and lower rates of economic activity in adult life (Department of Health, 2010). NICE Guidance • Prevention of sexually transmitted infections and under 18 conceptions http://guidance.nice.org.uk/PH3 4.6.1 Conceptions, under 16 year olds There are around 100 conceptions to females aged 13 to 15 years each year in North Wales. This equates to a conception rate of 7.6 per 1,000 females aged 13 to 15 years. Table 4 shows that the rate for Wrexham is just above the average for Wales, 8.6 compared to 8.3 per 1,000 females aged 13 to 15 years. Conwy has the second highest rate in North Wales, 8.2 per 1,000; the Isle of Anglesey has the lowest rate, 4.8 per 1,000 females aged 13 to 15 years. Table 4: Conception rate per 1,000 females aged 13 to 15 years, 2008 Rate per 1,000 Wales 8.3 Isle of Anglesey 4.8 Gwynedd 6.8 Conwy 8.2 Denbighshire 6.5 Flintshire 5.7 Wrexham 8.6 Source: ONS
Date: 13.02.12 Version: 1 Page 35 of 318 Public Health Wales North Wales Profile 2011 Figure 22 shows trends in teenage conceptions for females aged 13 to 15 years for the six UAs in North Wales. Figure 22: Under 16 conceptions, rate per 1,000 females aged 13 15, Betsi Cadwaladr University Health Board local authority areas, 1999 to 2008 Produced by Public Health Wales Observatory, using Conceptions data (WG) 95% confidence Local authority Wales interval Isle of Anglesey Gwynedd 20
15
10
5
0
Conwy Denbighshire 20
15
10
5
0
Flintshire Wrexham 20
Rate per 1,000 females aged 13 15 15
10
5
0 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 Date: 13.02.12 Version: 1 Page 36 of 318 Public Health Wales North Wales Profile 2011 4.6.2 Conceptions, under 18 year olds Table 5 shows that there are over 500 conceptions to women aged 15 to 17 years in North Wales per annum. Table 5: Number of conceptions, females aged 15 to 17 years, 2001 2009 Numbers 2001 2002 2003 2004 2005 2006 2007 2008 2009 p
Wales 2,529 2,601 2,609 2,605 2,521 2,598 2,622 2,578 2,293 North Wales 479 518 526 566 575 581 572 550 524 Isle of Anglesey 46 44 44 43 41 55 51 58 62 Gwynedd 88 95 70 79 85 91 106 82 94 Conwy 74 82 104 99 100 110 85 93 85 Denbighshire 64 73 79 92 82 80 95 95 84 Flintshire 109 116 101 107 115 100 124 106 92 Wrexham 98 108 128 146 152 145 111 116 107
Source: Office for National Statistics (ONS) p provisional In 2009 conception rates per 1,000 young women aged 15 to 17 years in England were 38.2; the Wales rate was higher at 40.1 per 1,000 females aged 15 to 17 years. Table 6 shows that in 2009, Anglesey has the highest rate of conceptions among 15 to 17 year olds. Flintshire has the lowest rate in North Wales. Teenage conception rates (15 to 17 year olds) in UAs across North Wales, with the exception of Flintshire, are higher than the average for Wales. Table 6: Conception rate per 1,000 females aged 15 to 17 years, 2001 2009 Rate per 1,000 2001 2002 2003 2004 2005 2006 2007 2008 2009 p
Wales 45.5 46.0 45.7 45.0 43.6 45.0 44.9 44.3 40.1 Isle of Anglesey 36.0 34.8 34.0 32.5 31.1 40.9 36.8 41.5 46.8 Gwynedd 44.1 47.0 34.6 38.0 40.5 43.3 49.3 38.1 42.6 Conwy 38.3 41.5 53.4 49.3 49.4 52.6 40.2 43.4 41.0 Denbighshire 37.3 40.8 42.8 50.5 44.7 42.6 49.8 48.6 43.6 Flintshire 38.7 40.4 35.5 37.5 40.5 34.2 41.2 35.8 32.3 Wrexham 40.6 44.9 55.8 62.2 62.5 58.8 43.9 46.9 44.2
Source: Office for National Statistics (ONS) p provisional
Date: 13.02.12 Version: 1 Page 37 of 318 Public Health Wales North Wales Profile 2011 Figure 23 shows trends in under 18 conceptions for the six UAs in North Wales. Figure 23: Under 18 conceptions, rate per 1,000 females aged 15 17, Betsi Cadwaladr University Health Board local authority areas, 2000 to 2009 Produced by Public Health Wales Observatory, using Conceptions data (ONS) & (WG) 95% confidence Local authority Wales interval Isle of Anglesey Gwynedd 80
60
40
20
0
Conwy Denbighshire 80
60
40
20
0
Flintshire Wrexham 80
Rate per 1,000 females aged 15 17 60
40
20
0 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Date: 13.02.12 Version: 1 Page 38 of 318 Public Health Wales North Wales Profile 2011 4.7 Abortion Data Table 7 shows that abortion rates within North Wales vary from 15.1 per 1,000 females aged 15 to 44 years in Flintshire to 20.7 per 1,000 females aged 15 to 44 years in Conwy. All the rates are higher than the Wales rate with the exception of Flintshire. Table 7: Abortion rates per 1,000 females aged 15 44 years, 2010 Rate per 1,000 Wales 15.2 Isle of Anglesey 17.4 Gwynedd 17.2 Conwy 20.7 Denbighshire 18.3 Flintshire 15.1 Wrexham 18.0 Source: Department of Health 4.8 Black and Minority Ethnic Population
In North Wales, the Black and Minority Ethnic (BME) population is approximately 1.0%. Table 8 shows that, at UA level, there is little variation, with figures varying from 0.7% in Anglesey to 1.2% in Gwynedd and Denbighshire respectively (National Public Health Service & Wales Centre for Health, 2009). Table 8: Percentage of people who are non white, 2001 Percentage Wales 2.1 North Wales 1.0 Isle of Anglesey 0.7 Gwynedd 1.2 Conwy 1.1 Denbighshire 1.2 Flintshire 0.8 Wrexham 1.1 Source: Census 2001 It should be noted that this data is now 10 years old and we are awaiting results from the 2011 Census. Further Information • Public Health Wales: A report on the health/health promotion needs of the black and minority ethnic communities in North Wales http://nww2.nphs.wales.nhs.uk:8080/vulnerableadultsdocs.nsf • Stats Wales: Ethnicity (Equality) Date: 13.02.12 Version: 1 Page 39 of 318 Public Health Wales North Wales Profile 2011 http://www.statswales.wales.gov.uk/ReportFolders/reportFolders.aspx 4.9 Overseas Migrant Population It is very difficult to estimate the migrant population from overseas in North Wales, but an indication can be obtained from the number of National Insurance Number Registrations, shown in Table 9 and Figure 24. This is likely to be an underestimate of the overseas migrant population, however, as some migrants may have registered elsewhere. The data shows that Wrexham has had the highest number of registrations since 2002/3. Migrant workers are not asylum seekers or refugees. They may or may not have unmet needs but are not included in legislation or services for asylum seekers (National Public Health Service, 2009). Table 9: National Insurance Number Registrations to adult overseas nationals entering the UK by year of registration and LA, 2002/03 2008/09 Thousands 2002/03 2003/04 2004/05 2005/06 2006/07 2007/08 2008/09 2009/10 Isle of Anglesey 0.07 0.1 0.15 0.23 0.17 0.16 0.13 0.1 Gwynedd 0.22 0.3 0.49 0.74 0.62 0.7 0.67 0.5 Conwy 0.14 0.23 0.36 0.56 0.48 0.4 0.35 0.26 Denbighshire 0.14 0.23 0.27 0.52 0.44 0.25 0.26 0.15 Flintshire 0.14 0.14 0.27 0.74 0.73 0.65 0.44 0.33 Wrexham 0.26 0.46 0.95 1.45 1.17 1.13 0.82 0.76
Source: Department of Work & Pensions Figure 24: National Insurance Number Registrations to adult overseas nationals entering the UK by year of registration and LA, 2002/03 2009/10 Source: Department of Work & Pensions
Further Information • National Public Health Service. Guidance on healthcare issues for asylum seekers in Wales: 2009. http://nww2.nphs.wales.nhs.uk:8080/VulnerableAdultsDocs.nsf/Public/83F97 989DCAF729B8025755900570C8C/$file/WASHRAGJan09%20(2).doc?OpenEle
Date: 13.02.12 Version: 1 Page 40 of 318 Public Health Wales North Wales Profile 2011 ment 4.10 Welsh Language Table 10 shows data on the proportion of people over three years of age who can speak welsh by UA area. This data is taken from the 2010 Welsh Assembly Government Annual Population Survey (Welsh Assembly Government, 2010a). It can be seen that with 37.2% of the population able to speak welsh; North Wales has a much higher proportion of welsh speakers than the Wales average of 24.8%. Gwynedd has the highest proportion of welsh speakers at 70.5%, followed by Anglesey at 60.9%. Wrexham has the lowest proportion of welsh speakers at 17%. Table 10: People over age of three years who say they can speak welsh, 2009 Percentage Wales 24.8 North Wales 37.2 Isle of Anglesey 60.9 Gwynedd 70.5 Conwy 33.3 Denbighshire 30.4 Flintshire 25.3 Wrexham 17.0 Source: WAG/Annual Population Survey Further Information • Welsh Assembly Government (2010) Local Area Summary Statistics Heritage: Welsh speaking http://wales.gov.uk/topics/statistics/publications/localarea/?lang=en Date: 13.02.12 Version: 1 Page 41 of 318 Public Health Wales North Wales Profile 2011 4.11 Religious Beliefs According to the 2001 census, over three quarters of North Wales residents are Christian, with the second highest group being those who profess no religion. Table 11 shows the distribution by county. Table 11: Percentage of people who state their religion as specified, 2001 Percentage Other No Religion Christian Buddhist Hindu Jewish Muslim Sikh religions religion not stated Isle of Anglesey 79.38 0.13 0.04 0.03 0.13 0.02 0.27 13.55 6.46 Gwynedd 74.54 0.22 0.10 0.04 0.29 0.02 0.32 16.53 7.94 Conwy 77.72 0.19 0.09 0.08 0.25 0.02 0.24 14.00 7.43 Denbighshire 77.81 0.20 0.13 0.07 0.26 0.02 0.17 13.38 7.96 Flintshire 79.21 0.12 0.06 0.06 0.13 0.02 0.13 12.92 7.34 Wrexham 77.30 0.13 0.13 0.04 0.27 0.03 0.10 14.50 7.50 Source: C ensus, 2001 It should be noted that this data is now 10 years old and we are awaiting results from the 2011 Census. 4.12 Sexual Orientation According to the charity Stonewall Cymru, a figure of five to seven per cent for the proportion of the population who are lesbian, gay and bisexual people is a reasonable estimate. However, there is no robust data on the number of lesbians, gay men and bisexuals in the UK as no national census has ever asked people to define their sexuality. Various sociological/commercial surveys have produced a wide range of estimates, but there is no definitive figure available. According to Stonewall Cymru, information on the health of the lesbian and gay population in Wales is hard to determine. Using research evidence gathered from health surveys conducted in England, it notes that individuals who are lesbian or gay can: • Consult late with medical practitioners because of the fear of intrusive and judgmental questioning; • Experience higher levels of emotional and physical vulnerability when admitted into hospital or receiving healthcare; • Exhibit to a greater proportion than the general population, many of the illnesses and diseases associated with being discriminated against by others; • Be vulnerable to experiencing higher levels of mental health issues; • Lack the social structures to promote wellbeing and good health.
Date: 13.02.12 Version: 1 Page 42 of 318 Public Health Wales North Wales Profile 2011 In Wales, Stonewall Cymru believes that among the lesbian and gay population there is no reason to suspect these health factors are any different from across the rest of the UK. However the demographic nature of the lesbian and gay community can mean that such considerations are exacerbated by rural isolation, economic inactivity and peer group oppression. Stonewall Cymru has published a report exploring the health needs of lesbian, gay and bisexual people in North and Mid Wales – Inside Out Project (Stonewall, 2007). This made the following recommendations: • All health care staff should receive training on sexual orientation issues both in health care and equality of treatment. • Health care agencies should improve the recognition, acknowledgement and treatment of same sex sexual orientation issues both in health care and equality of treatment. • NHS Wales to increase access to specific sexual health services for lesbian, gay and bisexual people. • Health care staff to accept the right of a patient to nominate their same sex partner/family of choice member as their first point of contact or primary carer (often referred to as ‘next of kin’). • Statutory bodies to provide sustainable funding and support to the participation of lesbian, gay and bisexual community researchers/interacters in creating an access point and dialogue with this ‘hard to reach’ community. 4.13 People living with a physical/sensory disability In October 2010, the Equality Act 2010 replaced most of the Disability Discrimination Act. The new Act defines a person as having a disability if they have a physical or mental impairment which has a substantial and long term adverse effect on their ability to perform normal day to day activities. The Act also considers progressive conditions to be a disability. People with Human Immunodeficiency Virus (HIV), cancer or multiple sclerosis are protected by the Act from the point of diagnosis, as are people with some visual impairments (Home Office, 2010a). Levels of disability are an indicator of population health at all ages. Although not an inevitable consequence of ageing, increasing age is commonly associated with increasing disability and loss of independence, with function impairments such as loss of mobility, sight and hearing. A range of health conditions lead to physical
Date: 13.02.12 Version: 1 Page 43 of 318 Public Health Wales North Wales Profile 2011 disability such as congenital conditions, injury, stroke, diabetes, vascular disease, arthritis and neurological conditions. Sensory impairment, for example hearing and sight problems, can be related to congenital conditions, diabetes, cataracts, glaucoma, and age. Table 12 provides data on the number of people of working age in North Wales who report having a disability. The data is taken from the Annual Population Survey, which is carried out by the Office for National Statistics. The numbers include DDA disabled, that is persons whose health problem is covered under the Disability Discrimination Act 1995, and work limiting disabled, which covers those people whose problem affects the kind or quantity of paid work they can do (Welsh Assembly Government, 2009a). Table 12: People of working age with disabilities, 2009 Number of Percentage disabled of persons population
Wales 387,800 21.7 North Wales 78,600 19.8 Isle of Anglesey 8,900 22.7 Gwynedd 14,300 20.9 Conwy 13,500 22.0 Denbighshire 11,800 21.3 Flintshire 15,000 16.4 Wrexham 15,100 18.6
Source: Welsh Government (StatsWales)
Date: 13.02.12 Version: 1 Page 44 of 318 Public Health Wales North Wales Profile 2011 5 Mortality Key Messages • Life expectancy at birth in North Wales is slightly higher than the average for Wales. For males, life expectancy at birth in North Wales is 78 years compared to 77 years across Wales. Females in North Wales and Wales have a life expectancy of 82 years. • There are inequalities in life expectancy at birth in North Wales. Life expectancy for males living in the least deprived areas within North Wales is six years longer than males living in the most deprived areas. The life expectancy of females living in the least deprived areas of North Wales is five years longer than females living in the most deprived areas. • The all cause mortality rate in North Wales (all ages) is lower than the average for Wales, 617 compared to 635 per 100,000; however there is variation at MSOA level. MSOA Wrexham 004 (Gwersyllt North, Gwersyllt West) is 1,016 per 100,000 compared to 427 per 100,000 in MSOA Wrexham 018 (Bronington, Overton). Small area mortality rates do not take into account unusual demography, such as high numbers of residents in nursing homes, which might alter the expected pattern of mortality. • The all cause mortality rate for males (all ages) living in the most deprived fifths in North Wales is 930 per 100,000 compared to 591 in the least deprived fifths. The rate for females living in the most deprived fifth within North Wales is 635 per 100,000 compared to 410 per 100,000 in the least deprived. These inequalities are also reflected for the conditions below. • All cause mortality in under 75 year olds has declined in North Wales and in Wales as a whole between 2000 and 2009. This is largely due to reductions in circulatory diseases subsequent to improved lifestyle, for example reductions in smoking, and improved healthcare such as use of statin drugs. • Mortality data for 2004 8 show the mortality rate for under 75 year olds in North Wales to be considerably lower than the average for Wales, 320 per 100,000 compared with 331 per 100,000. • Mortality for all cancers (excluding non melanoma skin cancer) in North Wales is just above the average for Wales, 187 compared to 186 per 100,000. The highest cancer mortality rates in North Date: 13.02.12 Version: 1 Page 45 of 318 Public Health Wales North Wales Profile 2011 Wales are in Wrexham, 191 per 100,000 and MSOA Wrexham 010 (Cartrefle, Queensway, Wynnstay), 272 per 100,000 population. The lowest rates are recorded in Denbighshire, 184 per 100,000 and MSOA Wrexham 018 (Bronington, Overton) at 124 per 100,000. • Mortality from circulatory disease in North Wales is lower than the average across Wales, 210 compared with 214 per 100,000. The highest mortality rates are found in Wrexham, 216 per 100,000 and MSOA Wrexham 004 (Gwersyllt North, Gwersyllt West), 378 per 100,000. The lowest rates are recorded in Anglesey, 194 per 100,000 and MSOA Anglesey 008 (Braint, Cadnant, Gwyngyll, Tysilio), 136 per 100,000. • The mortality rate from coronary heart disease (CHD) in North Wales is just below the average for Wales, 106 compared with 108 per 100,000. The highest rates are recorded in Wrexham, 119 per 100,000 and MSOA Wrexham 004 (Gwersyllt North, Gwersyllt West), 226 per 100,000. The lowest rates are recorded in Anglesey. 94 per 100,000 and MSOA Anglesey 008 (Braint, Cadnant, Gwyngyll, Tysilio), 59 per 100,000. • Mortality from respiratory disease in North Wales is lower than the all Wales rate, 74 compared to 77 per 100,000. The highest rates are recorded in Wrexham, 93 per 100,000 and MSOA Wrexham 010 (Cartrefle, Queensway, Wynnstay), 152 per 100,000. The lowest rates are recorded in Conwy, 63 per 100,000 and MSOA Anglesey 002 (Brynteg, Llanddyfnan, Llaneilian, Moelfre), 42 per 100,000. 5.1 Life Expectancy Life expectancy at birth is defined as the number of years a newborn baby would expect to live should they experience an area’s current age specific mortality rates throughout their lifetime. The average life expectancy at birth is a broad indicator of overall population health. Data for the population of North Wales show that life expectancy is slightly higher than that of the Wales average. Life expectancy at birth for males in North Wales is 78 years compared to 77 years across Wales. For females in North Wales and Wales, life expectancy at birth is 82 years. Data at Unitary Authority level can be found from the links below.
Date: 13.02.12 Version: 1 Page 46 of 318 Public Health Wales North Wales Profile 2011 Further Information • Public Health Wales Observatory: Trends in life expectancy http://www.wales.nhs.uk/sitesplus/922/page/58379 • Public Health Wales Observatory: Measuring Inequalities , life expectancy, healthy life expectancy & disability free life expectancy http://www.wales.nhs.uk/sitesplus/922/page/58379 NICE Guidance • Identifying and supporting people most at risk of dying prematurely http://guidance.nice.org.uk/PH15 5.1.1 Inequalities in life expectancy The social gradient in health, that is the lower a person’s social position, the worse his or her health (Marmot Review, 2010), is well recognised. These inequalities are highlighted in the charts and tables below. Life expectancy: males The life expectancy for males living in least deprived areas within North Wales is six years longer than males living within the most deprived areas within North Wales, for the period 2007 09 shown in Figure 25 and Table 13. Figure 25:
Life expectancy at birth, males, Betsi Cadwaladr UHB and Wales, 2001 09 Produced by Public Health Wales Observatory, using ADDE/MYE (ONS), WIMD 2008 (WAG)
Most deprived within Betsi Cadwaladr Life expectancy (Wales) Least deprived within Betsi Cadwaladr Betsi Cadwaladr overall
85
80
75
70
Axis truncated 65 2001 03 2002 04 2003 05 2004 06 2005 07 2006 08 2007 09
Date: 13.02.12 Version: 1 Page 47 of 318 Public Health Wales North Wales Profile 2011 Table 13:
Life expectancy at birth, males, Betsi Cadwaladr UHB and Wales, 2001 09
Betsi Cadwaladr Least and most deprived within Betsi Wales overall Cadwaladr
Life exectancy LE in least LE in most Life at birth deprived deprived Ratio* expectancy (95% CI) (95% CI) (95% CI) (Wales)
2001 03 76 (76 76) 79 (78 79) 72 (72 73) 1.09 75 2002 04 76 (76 77) 79 (78 79) 72 (71 73) 1.09 76 2003 05 77 (76 77) 79 (79 80) 73 (72 73) 1.09 76 2004 06 77 (77 77) 80 (79 80) 73 (72 74) 1.09 77 2005 07 77 (77 77) 80 (79 81) 73 (73 74) 1.09 77 2006 08 77 (77 78) 80 (79 80) 73 (73 74) 1.08 77 2007 09 78 (77 78) 80 (79 80) 74 (73 74) 1.08 77
Produced by Public Health Wales Observatory, using ADDE/MYE (ONS), WIMD 2008 (WAG) *Life expectancy in least deprived divided by most deprived Life expectancy: females The life expectancy for females living in least deprived areas within North Wales is five years longer than females living within the most deprived areas within North Wales for the period 2007 09, shown in Figure 26 and Table 14. Figure 26:
Life expectancy at birth, females, Betsi Cadwaladr UHB and Wales, 2001 09 Produced by Public Health Wales Observatory, using ADDE/MYE (ONS), WIMD 2008 (WAG)
Most deprived within Betsi Cadwaladr Life expectancy (Wales) Least deprived within Betsi Cadwaladr Betsi Cadwaladr overall
90
85
80
75
70
Axis truncated 65 2001 03 2002 04 2003 05 2004 06 2005 07 2006 08 2007 09
Date: 13.02.12 Version: 1 Page 48 of 318 Public Health Wales North Wales Profile 2011 Table 14:
Life expectancy at birth, females, Betsi Cadwaladr UHB and Wales, 2001 09
Betsi Cadwaladr Least and most deprived within Betsi Wales overall Cadwaladr
Life exectancy LE in least LE in most Life at birth deprived deprived Ratio* expectancy (95% CI) (95% CI) (95% CI) (Wales)
2001 03 80 (80 81) 82 (82 83) 77 (77 78) 1.06 80 2002 04 81 (80 81) 83 (82 84) 78 (78 79) 1.06 80 2003 05 81 (81 81) 83 (83 84) 78 (78 79) 1.06 81 2004 06 81 (81 81) 84 (83 84) 79 (78 79) 1.06 81 2005 07 81 (81 82) 84 (83 84) 79 (78 79) 1.06 81 2006 08 82 (81 82) 84 (83 85) 79 (79 80) 1.06 81 2007 09 82 (81 82) 84 (83 85) 79 (78 80) 1.06 82
Produced by Public Health Wales Observatory, using ADDE/MYE (ONS), WIMD 2008 (WAG) *Life expectancy in least deprived divided by most deprived Further Information • Public Health Wales Observatory: Inequalities in life expectancy http://www.wales.nhs.uk/sitesplus/922/page/58379 • Welsh Assembly Government (2010) Local Area Summary Statistics: Life Expectancy http://wales.gov.uk/topics/statistics/publications/localarea/?lang=en 5.2 Infant Mortality Worldwide, infant mortality rates are used to gauge the population’s health (Reidpath & Allotey, 2003). In the UK mortality rates are comparatively low. Rates of infant mortality have been shown to be significantly higher in areas with high levels of deprivation. Figure 27 shows infant mortality rate trends for the six UAs in North Wales.
Date: 13.02.12 Version: 1 Page 49 of 318 Public Health Wales North Wales Profile 2011 Figure 27: Infant mortality (those aged less than one year), rate per 1,000 live births, Betsi Cadwaladr University Health Board local authority areas, 2001 05 to 2005 09 Produced by Public Health Wales Observatory, using data from ONS (ADDE, ADBE) 95% confidence Local authority Wales interval Isle of Anglesey Gwynedd 9 8 7 6 5 4 3 2 1 0
Conwy Denbighshire 9 8 7 6 5 4 3 2 1 0 Rate per 1,000 live births Flintshire Wrexham 9 8 7 6 5 4 3 2 1 0 2001 05 2002 06 2003 07 2004 08 2005 09 2001 05 2002 06 2003 07 2004 08 2005 09
Date: 13.02.12 Version: 1 Page 50 of 318 Public Health Wales North Wales Profile 2011 5.3 Mortality from all causes, all ages Indicators derived from mortality (death) rates provide a good picture of overall population health. The all cause mortality rate for North Wales (617 per 100,000) is lower than the all Wales rate (635 per 100,000). Figure 28 and Figure 29 show that all cause mortality varies across UAs and MSOAs. The highest all cause mortality rate in North Wales is in Wrexham UA (645 per 100,000) and MSOA Wrexham 004 (Gwersyllt North, Gwersyllt West) at 1,016 per 100,000 and the lowest in Anglesey UA (597 per 100,000) and MSOA Wrexham 018 (Bronington, Overton) at 427 per 100,000 population. Small area mortality rates do not take into account unusual demography, such as high numbers of residents in nursing homes, which might alter the expected pattern of mortality. Figure 30 shows how all cause mortality varies in UAs across Wales.
Date: 13.02.12 Version: 1 Page 51 of 318 Public Health Wales North Wales Profile 2011 Figure 28: All cause mortality in Betsi Cadwaladr University Health Board area, all persons, 2004 08, European age standardised rates per 100,000 Produced by Public Health Wales Observatory, using data from ONS (ADDE, MYE) MSOA EASR with 95% Gwynedd confidence interval 003 710 Local Authority 009 699 Wales (EASR = 635) 001 669 003 748 Health Board (EASR = 617) 008 664 007 675 012 634 014 Isle of Anglesey 632 002 630 003 748 006 621 007 675 017 605
009 639 MSOA 004 605 001 634 005 599 006 614 007 596 MSOA 004 604 011 590 005 511 Isle of Anglesey 015 586 008 477 EASR = 597 016 579 Gwynedd 002 475 010 573 EASR = 612 EASR per 100,000 013 518 EASR per 100,000 Conwy Denbighshire 005 789 004 941 007 778 006 736 001 715 011 675 004 639 005 656 008 633 010 626 013 626 002 585 002 623 009 581 015 619 007 576
MSOA 009 595 013 575 MSOA 014 582 012 564 006 574 016 554 010 563 014 549 011 558 001 539 003 522 Conwy 015 530 EASR = 620 Denbighshire 012 519 008 523 EASR = 611 EASR per 100,000 003 494 EASR per 100,000 Flintshire Wrexham 003 814 009 806 004 1016 007 778 010 887 004 755 012 813 005 715 015 750 011 683 017 750 001 656 006 738 020 654 011 687 017 635 009 656 002 632 013 644 014 603 008 634 MSOA
006 581 MSOA 019 610 008 580 005 608 012 556 003 581 016 549 001 566 019 538 014 522 010 524 016 521 015 521 002 512 Flintshire Wrexham 013 456 EASR = 620 007 477 EASR = 645 018 448 018 427 EASR per 100,000 EASR per 100,000
Date: 13.02.12 Version: 1 Page 52 of 318 Public Health Wales North Wales Profile 2011 Figure 29:
Numbers on map indicate MSOAs with a rate statistically significantly higher than the all Wales rate. Figure 30:
Date: 13.02.12 Version: 1 Page 53 of 318 Public Health Wales North Wales Profile 2011 All cause mortality by local authority, all persons, 2004 08, European 95% confidence age standardised rates per 100,000 interval Produced by Public Health Wales Observatory, using data from ONS (ADDE, MYE)
Wales = 635.1 751.9 741.7 708.5 697.9 684.2 666.7 651.7 644.7 636.6 636.2 636.1 635.3 620.0 619.7 618.5 611.8 611.3 597.0 595.6 550.3 533.2 516.6 Powys Cardiff Conwy Torfaen Newport Swansea Bridgend Flintshire Gwynedd Wrexham Caerphilly Ceredigion Denbighshire Merthyr Tydfil Pembrokeshire Blaenau Gwent Monmouthshire Isle of Anglesey Carmarthenshire Neath Port Talbot
Areas ordered geographically from north west to south east Rhondda Cynon Taff The Vale of Glamorgan 5.3.1 Inequalities in all cause mortality, all ages All cause mortality: males, all ages The all cause mortality rate for males in North Wales (706 per 100,000) is lower than the average for Wales (730 per 100,000) in the period 2007 9. The all cause mortality rate for males living in the most deprived fifths within North Wales is 932 per 100,000 compared to 591 per 100,000 in the least deprived fifth in the period 2007 9, shown in Figure 31 and Table 15. Figure 31:
Date: 13.02.12 Version: 1 Page 54 of 318 Public Health Wales North Wales Profile 2011
All cause mortality, all ages, males, European age standardised rate (EASR) per 100,000, Betsi Cadwaladr UHB and Wales, 2001 09 Produced by Public Health Wales Observatory, using ADDE/MYE (ONS), WIMD 2008 (WAG)
Most deprived within Betsi Cadwaladr Wales EASR Least deprived within Betsi Cadwaladr Betsi Cadwaladr overall 1200
1000
800
600
400
200 Rate Ratio most deprived divided by least deprived 1.6 1.6 1.6 1.6 1.7 1.6 1.6 0 2001 03 2002 04 2003 05 2004 06 2005 07 2006 08 2007 09 Table 15:
All cause mortality, all ages, males, European age standardised rate (EASR) per 100,000, Betsi Cadwaladr UHB and Wales, 2001 09
Betsi Cadwaladr Least and most deprived within Betsi Wales overall Cadwaladr
Annual EASR in least EASR in most EASR Rate Wales average deprived deprived (95% CI) ratio* EASR deaths (95% CI) (95% CI)
2001 03 3643 811 (795 827) 680 (649 713) 1056 (1015 1098) 1.6 853 2002 04 3631 796 (780 811) 672 (641 704) 1044 (1004 1086) 1.6 831 2003 05 3611 777 (762 792) 634 (604 664) 1025 (985 1066) 1.6 807 2004 06 3554 751 (736 766) 602 (573 631) 976 (937 1016) 1.6 770 2005 07 3523 727 (713 741) 579 (551 607) 962 (924 1002) 1.7 757 2006 08 3561 718 (703 732) 596 (568 625) 950 (912 989) 1.6 743 2007 09 3582 706 (693 720) 591 (564 620) 932 (894 970) 1.6 730
Produced by Public Health Wales Observatory, using ADDE/MYE (ONS), WIMD 2008 (WAG) *EASR in most deprived divided by EASR in least deprived
Date: 13.02.12 Version: 1 Page 55 of 318 Public Health Wales North Wales Profile 2011
All cause mortality: females, all ages The all cause mortality rate for females in North Wales (508 per 100,000) is slightly below the average for Wales (512 per 100,000) in the period 2007 9, shown in Figure 32 and Table 16. The all cause mortality rate for females living in the most deprived fifth within North Wales is 635 per 100,000 compared to 410 per 100,000 in the least deprived fifth in the period 2007 9. Figure 32:
All cause mortality, all ages, females, European age standardised rate (EASR) per 100,000, Betsi Cadwaladr UHB and Wales, 2001 09 Produced by Public Health Wales Observatory, using ADDE/MYE (ONS), WIMD 2008 (WAG)
Most deprived within Betsi Cadwaladr Wales EASR Least deprived within Betsi Cadwaladr Betsi Cadwaladr overall 800 700 600 500 400 300 200 Rate Ratio most deprived divided by least deprived 100 1.5 1.5 1.5 1.6 1.6 1.5 1.5 0 2001 03 2002 04 2003 05 2004 06 2005 07 2006 08 2007 09 Table 16:
All cause mortality, all ages, females, European age standardised rate (EASR) per 100,000, Betsi Cadwaladr UHB and Wales, 2001 09
Betsi Cadwaladr Least and most deprived within Betsi Wales overall Cadwaladr
Annual EASR in least EASR in most EASR Rate Wales average deprived deprived (95% CI) ratio* EASR deaths (95% C I) (95% CI)
2001 03 4280 573 (562 584) 488 (465 511) 715 (686 745) 1.5 586 2002 04 4197 556 (545 567) 452 (431 474) 685 (657 714) 1.5 576 2003 05 4136 548 (537 559) 443 (422 464) 683 (655 712) 1.5 563 2004 06 4026 527 (517 538) 422 (401 443) 659 (631 687) 1.6 541 2005 07 3988 519 (508 529) 423 (402 444) 659 (631 687) 1.6 531 2006 08 3960 509 (498 519) 413 (393 434) 636 (609 663) 1.5 522 2007 09 3967 508 (497 518) 410 (390 431) 635 (608 663) 1.5 512
Produced by Public Health Wales Observatory, using ADDE/MYE (ONS), WIMD 2008 (WAG) *EASR in most deprived divided by EASR in least deprived
Date: 13.02.12 Version: 1 Page 56 of 318 Public Health Wales North Wales Profile 2011 Further Information • Public Health Wales Observatory: Measuring Inequalities all cause mortality all ages http://www.wales.nhs.uk/sitesplus/922/page/58379 5.4 Mortality from all causes, persons aged under 75 years Figure 33 shows that all cause mortality has declined in North Wales and in Wales as a whole between 2000 and 2009. This is largely due to reductions in circulatory diseases subsequent to improved lifestyle, for example reductions in smoking, and improved healthcare such as use of statin drugs. Figure 33: All cause mortality rate trend for Betsi Cadwaladr University Health Board, persons aged under 75: 2000 to 2009 Produced by the Public Health Wales Observatory, using data from ONS (ADDE, MYE)
Betsi Cadwaladr University Health Board Wales 500
400
300
200
100 EASR per 100,000 population
0 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 Mortality data for 2004 08 (Figure 34) show the mortality rate for under 75 year olds in North Wales to be considerably lower than the average for Wales, 320 per 100,000 compared with 331 per 100,000. Conwy has the highest mortality rate in North Wales, 332 per 100,000. The lowest mortality rates can be found in Anglesey, 310 per 100,000. The highest all cause mortality rate for under 75 year olds in North Wales at MSOA level is in MSOA Denbighshire 004 (Rhyl East, Rhyl West), 584 per 100,000 and the lowest in MSOA Wrexham 018 (Bronington, Overton) at 201 per 100,000
Date: 13.02.12 Version: 1 Page 57 of 318 Public Health Wales North Wales Profile 2011 Figure 36 shows variation in all cause mortality across UAs in Wales. Figure 34: All cause mortality in Betsi Cadwaladr University Health Board area, persons aged under 75 years, 2004 08, European age standardised rates per 100,000 Produced by Public Health Wales Observatory, using data from ONS (ADDE, MYE) MSOA EASR with 95% Gwynedd confidence interval 009 391 0Health Board (EASR = 320) 10 20 001 389 003 377 003 Wales (EASR = 331) 748 012 375 007 Local Authority 367 002 336 016 Isle of Anglesey 329 008 320 003 444 011 318 007 367 007 317 006 346 MSOA 006 305 001 329 017 301 009 321 005 301 MSOA 004 303 015 298 002 240 013 298 005 226 Isle of Anglesey 014 297 EASR = 310 008 214 010 276 Gwynedd EASR = 319 EASR per 100,000 004 259 EASR per 100,000 Conwy Denbighshire 001 445 007 444 004 584 005 384 006 415 008 356 005 354 004 340 011 347 002 339 010 341 013 339 014 315 015 318 002 306
MSOA 011 317 007 303 009 311 001 299 MSOA 012 296 009 280 010 292 016 275 006 286 015 273 014 276 Conwy EASR 012 247 003 249 = 332 008 236 EASR per 100,000 013 233 Denbighshire 003 225 EASR = 318 Flintshire EASR per 100,000 009 474 Wrexham 007 463 010 530 003 451 004 470 004 446 012 461 001 360 015 441 011 355 006 408 017 335 017 383 002 301 019 356 008 293 003 331 005 292 013 328 MSOA 012 287 005 327 006 287 009 322 020 279 MSOA 008 322 016 270 011 317 014 262 014 256 015 255 016 245 010 238 007 244 019 229 Flintshire 001 220 018 229 EASR = 312 002 206 Wrexham 013 216 018 201 EASR = 330 EASR per 100,000 EASR per 100,000 Date: 13.02.12 Version: 1 Page 58 of 318 Public Health Wales North Wales Profile 2011 Figure 35:
Figure 36:
All cause mortality by local authority, persons aged under 75 years, 95% confidence 2004 08, European age standardised rates per 100,000 interval Produced by Public Health Wales Observatory, using data from ONS (ADDE, MYE)
Wales = 331 416 404 380 373 352 349 346 342 332 331 331 330 327 319 318 317 312 310 296 269 263 262 Powys Cardiff Conwy Torfaen Newport Swansea Bridgend Flintshire Gwynedd Wrexham Caerphilly Ceredigion Denbighshire Merthyr Tydfil Pembrokeshire Blaenau Gwent Monmouthshire Isle of Anglesey Carmarthenshire Neath Port Talbot Rhondda Cynon Taff Areas ordered geographically from north west to south east The Vale of Glamorgan Date: 13.02.12 Version: 1 Page 59 of 318 Public Health Wales North Wales Profile 2011 5.4.1 Inequalities in all cause mortality, persons aged under 75 years All cause mortality: males, under 75 years The all cause mortality rate for males under 75 years in North Wales (376 per 100,000) is lower than the average for Wales (394 per 100,000). The all cause mortality rate for males under 75 years living in the most deprived areas within North Wales is 563 per 100,000 compared to 294 per 100,000 in the least deprived in the period 2007 09, shown in Figure 37 and Table 17. Figure 37:
All cause mortality, under 75, males, European age standardised rate (EASR) per 100,000, Betsi Cadwaladr UHB and Wales, 2001 09 Produced by Public Health Wales Observatory, using ADDE/MYE (ONS), WIMD 2008 (WAG)
Most deprived within Betsi Cadwaladr Wales EASR Least deprived within Betsi Cadwaladr Betsi Cadwaladr overall 800 700 600 500 400 300 200 100 2.1 2.0 2.1 2.1 2.1 2.0 1.9 0 2001 03 2002 04 2003 05 2004 06 2005 07 2006 08 2007 09 Table 17:
All cause mortality, under 75, males, European age standardised rate (EASR) per 100,000, Betsi Cadwaladr UHB and Wales, 2001 09
Betsi Cadwaladr Least and most deprived within Betsi Wales overall Cadwaladr
Annual EASR in least EASR in most EASR Rate Wales average deprived deprived (95% CI) ratio* EASR deaths (95% CI) (95% CI)
2001 03 1550 423 (410 435) 305 (282 329) 626 (592 661) 2.1 456 2002 04 1550 420 (407 432) 311 (288 335) 636 (601 672) 2.0 443 2003 05 1528 409 (397 421) 292 (270 316) 625 (591 660) 2.1 429 2004 06 1524 404 (392 416) 289 (267 313) 598 (565 633) 2.1 413 2005 07 1504 391 (380 403) 279 (258 302) 588 (555 622) 2.1 408 2006 08 1504 385 (374 397) 293 (271 316) 581 (548 614) 2.0 401 2007 09 1489 376 (365 388) 294 (272 317) 563 (532 596) 1.9 394
Produced by Public Health Wales Observatory, using ADDE/MYE (ONS), WIMD 2008 (WAG) *EASR in most deprived divided by EASR in least deprived
Date: 13.02.12 Version: 1 Page 60 of 318 Public Health Wales North Wales Profile 2011
All cause mortality: females, under 75 years The all cause mortality rate for females under 75 years in North Wales is the same as the average for Wales (251 per 100,000). The all cause mortality rate for females under 75 years living in the most deprived fifth within North Wales is 354 per 100,000 compared to 179 in the least deprived fifth in the period 2007 09, shown in Figure 38 and Table 18. Figure 38:
All cause mortality, under 75, females, European age standardised rate (EASR) per 100,000, Betsi Cadwaladr UHB and Wales, 2001 09 Produced by Public Health Wales Observatory, using ADDE/MYE (ONS), WIMD 2008 (WAG)
Most deprived within Betsi Cadwaladr Wales EASR Least deprived within Betsi Cadwaladr Betsi Cadwaladr overall 450 400 350 300 250 200 150 100 50 1.8 1.9 2.0 2.0 2.0 1.9 2.0 0 2001 03 2002 04 2003 05 2004 06 2005 07 2006 08 2007 09 Table 18:
All cause mortality, under 75, females, European age standardised rate (EASR) per 100,000, Betsi Cadwaladr UHB and Wales, 2001 09
Betsi Cadwaladr Least and most deprived within Betsi Wales overall Cadwaladr
Annual EASR in least EASR in most EASR Rate Wales average deprived deprived (95% CI) ratio* EASR deaths (95% C I) (95% CI)
2001 03 1109 279 (269 289) 217 (199 237) 397 (371 424) 1.8 284 2002 04 1064 265 (256 275) 192 (175 211) 371 (346 397) 1.9 277 2003 05 1064 263 (254 273) 187 (169 205) 374 (349 400) 2.0 269 2004 06 1024 250 (241 260) 177 (160 195) 353 (329 379) 2.0 261 2005 07 1031 249 (240 259) 182 (165 200) 358 (334 384) 2.0 258 2006 08 1029 246 (238 255) 180 (163 197) 345 (321 370) 1.9 255 2007 09 1061 251 (242 260) 179 (162 196) 354 (330 379) 2.0 251
Produced by Public Health Wales Observatory, using ADDE/MYE (ONS), WIMD 2008 (WAG) *EASR in most deprived divided by EASR in least deprived Date: 13.02.12 Version: 1 Page 61 of 318 Public Health Wales North Wales Profile 2011 Further Information • Public Health Wales Observatory: Measuring Inequalities all cause mortality (under 75 year olds) http://www.wales.nhs.uk/sitesplus/922/page/58379 • Public Health Wales Observatory: UA level mortality trends http://www.wales.nhs.uk/sitesplus/888/document/150193 5.5 Mortality from cancers, all ages Cancers are a large group of different diseases. The four most common cancers – breast, lung, colorectal and prostate – account for more than half of the new cases of malignant cancer (excluding non melanoma skin cancer) registered every year. Over one in four people die from cancer. Cancer accounts for about 30% of all deaths in males and 25% in females. The cancer mortality rate in North Wales (187 per 100,000) in 2004 8 is just above the Wales rate (186 per 100,000). Figure 39 and Figure 40 show the variation in cancer rates across UAs and also MSOAs. The highest cancer mortality rates in North Wales are in Wrexham UA (191 per 100,000) and MSOA Wrexham 010 (Cartrefle, Queensway, Wynnstay) at 272 per 100,000 and the lowest cancer rates are recorded in Denbighshire UA (184 per 100,000) and MSOA Wrexham 018 (Bronington, Overton) at 124 per 100,000 population.
Figure 41 shows the variation in cancer mortality rate for UAs across Wales.
Further Information • Welsh Cancer Intelligence Surveillance Unit: Cancer Incidence in Wales http://www.wales.nhs.uk/sites3/page.cfm?orgid=242&pid=51358
Date: 13.02.12 Version: 1 Page 62 of 318 Public Health Wales North Wales Profile 2011 Figure 39: Mortality from all cancers in Betsi Cadwaladr University Health Board area, all persons, 2004 08, European age standardised rates per 100,000 Produced by Public Health Wales Observatory, using data from ONS (ADDE, MYE)
MSOA EASR with 95% Gwynedd confidence interval 002 223 Local Authority 009 216 Wales (EASR = 186) 012 210 007 748 Health Board (EASR = 187) 001 207 003 217 016 207 Isle of Anglesey 005 205 008 201 007 223 010 189 003 217 003 187
006 215 MSOA 017 185 001 193 011 173 004 189 014 171 MSOA 002 174 007 170 005 173 Isle of Anglesey 015 166 009 171 EASR = 190 006 166 Gwynedd 008 160 013 165 EASR = 187 EASR per 100,000 004 159 EASR per 100,000 Conwy Denbighshire 007 209 006 247 015 207 004 234 005 206 011 216 011 203 005 206 001 201 001 203 004 196 009 194 002 193 007 193 008 190 014 192
MSOA 006 185 015 190 MSOA 013 180 012 168 012 177 010 162 014 176 016 161 003 168 002 161 010 167 Conwy 013 155 EASR = 186 Denbighshire 009 160 003 153 EASR = 184 EASR per 100,000 008 146 EASR per 100,000 Flintshire Wrexham 007 262 003 257 010 272 009 237 012 257 004 229 015 242 012 212 006 232 008 208 017 217 005 206 013 211 020 199 004 199 001 191 009 194 006 190 011 193 014 185 005 193 MSOA
002 181 MSOA 007 186 017 179 016 186 011 178 008 184 016 169 019 175 015 164 014 171 019 150 001 159 018 148 003 154 Flintshire Wrexham 013 146 EASR = 189 002 137 EASR = 191 010 142 018 124 EASR per 100,000 EASR per 100,000
Date: 13.02.12 Version: 1 Page 63 of 318 Public Health Wales North Wales Profile 2011 Figure 40:
Numbers on map indicate MSOAs with a rate statistically significantly higher than the all Wales rate. Figure 41: Mortality from all cancers by local authority, all persons, 2004 08, 95% confidence European age standardised rates per 100,000 interval Produced by Public Health Wales Observatory, using data from ONS (ADDE, MYE)
Wales = 185.5 215.4 202.8 195.5 195.0 193.6 193.2 193.4 192.2 191.2 189.6 189.2 187.2 186.4 186.3 184.5 184.1 184.3 176.9 174.4 162.2 157.4 154.2 Powys Cardiff Conwy Torfaen Newport Swansea Bridgend Flintshire Gwynedd Wrexham Caerphilly Ceredigion Denbighshire Merthyr Tydfil Blaenau Gwent Pembrokeshire Monmouthshire Isle of Anglesey Carmarthenshire Neath Port Talbot Rhondda Cynon Taff
Areas ordered geographically from north west to south east The Vale of Glamorgan Date: 13.02.12 Version: 1 Page 64 of 318 Public Health Wales North Wales Profile 2011 5.5.1 Inequalities in mortality from cancers Mortality from cancers: males, all ages The mortality rate from cancer for males in North Wales (219 per 100,000) is just above the average for Wales (218 per 100,000) in 2007 9. The mortality rate from cancers for males living in the most deprived fifth within North Wales is 276 per 100,000 compared to 200 per 100,000 in the least deprived fifth in 2007 9, shown in Figure 42 and Table 19. Figure 42:
Mortality from cancers (excl. other skin), all ages, males, European age standardised rate (EASR) per 100,000, Betsi Cadwaladr UHB and Wales, 2001 09 Produced by Public Health Wales Observatory, using ADDE/MYE (ONS), WIMD 2008 (WAG)
Most deprived within Betsi Cadwaladr Wales EASR Least deprived within Betsi Cadwaladr Betsi Cadwaladr overall 350
300
250
200
150
100
50 Rate Ratio most deprived divided by least deprived 1.4 1.3 1.5 1.4 1.5 1.4 1.4 0 2001 03 2002 04 2003 05 2004 06 2005 07 2006 08 2007 09
Date: 13.02.12 Version: 1 Page 65 of 318 Public Health Wales North Wales Profile 2011 Table 19:
Mortality from cancers (excl. other skin), all ages, males, European age standardised rate (EASR) per 100,000, Betsi Cadwaladr UHB and Wales, 2001 09
Betsi Cadwaladr Least and most deprived within Betsi Wales overall Cadwaladr
Annual EASR in least EASR in most EASR Rate Wales average deprived deprived (95% CI) ratio* EASR deaths (95% C I) (95% CI)
2001 03 1028 228 (220 237) 202 (185 220) 286 (265 308) 1.4 233 2002 04 1052 230 (222 238) 209 (192 227) 280 (259 302) 1.3 230 2003 05 1067 228 (220 237) 197 (181 215) 287 (266 309) 1.5 226 2004 06 1108 233 (225 241) 197 (181 214) 278 (257 299) 1.4 223 2005 07 1094 225 (217 233) 191 (176 208) 282 (261 303) 1.5 222 2006 08 1122 224 (217 232) 198 (182 214) 283 (263 304) 1.4 222 2007 09 1120 219 (212 227) 200 (184 216) 276 (256 297) 1.4 218
Produced by Public Health Wales Observatory, using ADDE/MYE (ONS), WIMD 2008 (WAG) *EASR in most deprived divided by EASR in least deprived Mortality from cancers: females, all ages The cancer mortality rate for females in North Wales (158 per 100,000) is just above the average for Wales (156 per 100,000) in 2007 9. The cancer mortality rate for females living in the most deprived fifth within North Wales is 195 per 100,000 compared to 131 in the least deprived in 2007 9, shown in Figure 43 and Table 20. Figure 43:
Date: 13.02.12 Version: 1 Page 66 of 318 Public Health Wales North Wales Profile 2011
Mortality from cancers (excl. other skin), all ages, females, European age standardised rate (EASR) per 100,000, Betsi Cadwaladr UHB and Wales, 2001 09 Produced by Public Health Wales Observatory, using ADDE/MYE (ONS), WIMD 2008 (WAG)
Most deprived within Betsi Cadwaladr Wales EASR Least deprived within Betsi Cadwaladr Betsi Cadwaladr overall 250
200
150
100
50 Rate Ratio most deprived divided by least deprived 1.4 1.4 1.5 1.5 1.5 1.4 1.5 0 2001 03 2002 04 2003 05 2004 06 2005 07 2006 08 2007 09 Table 20:
Mortality from cancers (excl. other skin), all ages, females, European age standardised rate (EASR) per 100,000, Betsi Cadwaladr UHB and Wales, 2001 09
Betsi Cadwaladr Least and most deprived within Betsi Wales overall Cadwaladr
Annual EASR in least EASR in most EASR Rate Wales average deprived deprived (95% CI) ratio* EASR deaths (95% C I) (95% CI)
2001 03 1032 172 (165 179) 155 (141 169) 212 (195 230) 1.4 165 2002 04 1005 165 (159 172) 140 (127 153) 202 (186 219) 1.4 162 2003 05 1012 165 (159 172) 136 (124 150) 205 (188 222) 1.5 161 2004 06 991 160 (154 167) 130 (118 143) 196 (180 213) 1.5 160 2005 07 983 158 (152 165) 133 (121 146) 201 (184 218) 1.5 160 2006 08 986 158 (152 164) 135 (122 148) 192 (176 209) 1.4 158 2007 09 1001 158 (152 165) 131 (119 144) 195 (179 212) 1.5 156
Produced by Public Health Wales Observatory, using ADDE/MYE (ONS), WIMD 2008 (WAG) *EASR in most deprived divided by EASR in least deprived Further Information • Public Health Wales Observatory: Measuring Inequalities, mortality from cancer http://www.wales.nhs.uk/sitesplus/922/page/58379 5.5.2 Cancer Survival Relative survival is the most widely used method in population studies. It is the ratio of the survival observed in the group of cancer patients to the survival that would be expected if they were
Date: 13.02.12 Version: 1 Page 67 of 318 Public Health Wales North Wales Profile 2011 subject to the same overall mortality rates by age, sex and calendar period as the general population. The expected probabilities are obtained from life tables for Wales that provide the life expectancy of persons for a given year by age and sex. The problems arising with crude survival are therefore overcome. It enables one to measure variations in cancer survival (or its complement, mortality) independently of variations in expected (background) mortality associated with various factors (age and sex in these analyses).The regional data for Wales indicate a steady improvement in one year relative survival for both males and females (Public Health Wales Observatory, 2011). Figures 44 and 45 show on year relative survival for all cancers (excluding non melanoma skin cancer) in males and females respectively from 1994/6 to 2006/8. These show that relative survival has improved during this period for both males and females. Figure 44: One year relative survival, all cancer (excluding non melanoma skin cancer), males, Wales regions, 1994/6 2006/8 Produced by the Welsh Cancer Intelligence and Surveillance Unit
100
95
90
85
80
75
70 One yearOnerelative survival (%) 65
60
55
50 1994-1996 1997-1999 2000-2002 2003-2005 2006-2008 Wales 53.07 56.24 60.98 64.45 66.93 North Wales 54.26 56.20 62.52 65.26 68.74 South Wales 52.69 56.26 60.46 64.19 66.34 Figure 45: One year relative survival, all cancer (excluding non melanoma skin cancer), females, Wales regions, 1994/6 2006/8 Produced by the Welsh Cancer Intelligence and Surveillance Unit
Date: 13.02.12 Version: 1 Page 68 of 318 Public Health Wales North Wales Profile 2011
100
95
90
85
80
75
70 One year Onerelative survival (%) 65
60
55
50 1994-1996 1997-1999 2000-2002 2003-2005 2006-2008 Wales 62.00 64.20 66.21 68.65 70.18 North Wales 62.01 64.06 64.97 68.36 71.61 South Wales 61.99 64.25 66.61 68.74 69.71 The site specific one and five year relative survival figures given in Table 21 indicate that there are no statistically significant differences between Betsi Cadwaladr UHB and Wales as a whole (Public Health Wales Observatory, 2011). Table 21: One year and five year relative survival, by cancer site Betsi Cadwaladr University Health Board area, males and females, 2000 2004 (95% confidence intervals) Produced by the Welsh Cancer Intelligence and Surveillance Unit Male 1 year relative survival Cancer Site Betsi Cadwaladr All Wales Prostate 89.37 (87.66, 90.85) 88.80 (87.95, 89.59) Lung 24.02 (21.75, 26.35) 22.84 (21.71, 24.00) Colorectal 73.70 (70.89, 76.28) 71.51 (70.12, 72.85) Bladder 88.17 (84.93, 90.75) 86.10 (84.51, 87.53) All malignancies (excl NMSC) 63.14 (62.08, 64.19) 62.11 (61.57, 62.63) 5 year relative survival Cancer Site Betsi Cadwaladr All Wales Prostate 77.81 (75.10, 80.27) 77.17 (75.83, 78.45) Lung 6.14 (4.87, 7.60) 5.36 (4.73, 6.04) Colorectal 52.99 (49.52, 56.33) 48.59 (46.91, 50.24) Bladder 73.96 (69.14, 78.14) 72.34 (70.04, 74.50) All malignancies (excl NMSC) 46.39 (45.17, 47.60) 45.39 (44.79, 45.99) Female 1 year relative survival Cancer Site Betsi Cadwaladr All Wales Breast 93.08 (91.84, 94.14) 93.41 (92.83, 93.94) Lung 25.46 (22.63, 28.38) 25.53 (24.09, 26.99) Colorectal 67.11 (63.82, 70.17) 68.80 (67.19, 70.36) Date: 13.02.12 Version: 1 Page 69 of 318 Public Health Wales North Wales Profile 2011 Ovary 60.38 (55.00, 65.32) 63.92 (61.50, 66.24) Corpus Uteri 90.11 (85.89, 93.12) 89.83 (87.90, 91.46) All malignancies (excl NMSC) 66.40 (65.32, 67.45) 67.24 (66.71, 67.76) 5 year relative survival Cancer Site Betsi Cadwaladr All Wales Breast 82.54 (80.66, 84.25) 82.06 (81.14, 82.94) Lung 9.56 (7.64, 11.72) 6.85 (6.00, 7.76) Colorectal 48.10 (44.41, 51.68) 49.18 (47.31, 51.01) Ovary 35.97 (30.73, 41.22) 39.29 (36.78, 41.80) Corpus Uteri 79.39 (73.65, 84.02) 77.77 (75.02, 80.25) All malignancies (excl NMSC) 52.95 (51.74, 54.14) 52.76 (52.17, 53.36) Significantly higher than Wales Significantly lower than Wales Excl NSCM: Excluding non melanoma skin cancer Further Information • Welsh Cancer Surveillance and Intelligence Unit Cancer Survival http://www.wales.nhs.uk/sites3/home.cfm?OrgID=242
Date: 13.02.12 Version: 1 Page 70 of 318 Public Health Wales North Wales Profile 2011 5.6 Mortality from circulatory disease, all ages Circulatory diseases (which include heart disease and stroke) have remained the most common cause of death in England and Wales over the last 90 years among both males and females, with the exception of 1918 to 1919. Mortality from circulatory disease is lower in North Wales (210 per 100,000) compared to all Wales (214 per 100,000). Figure 46 and Figure 47 show the variation in circulatory mortality disease rates across UAs and MSOAs in North Wales. The highest mortality rates from circulatory disease are recorded in Wrexham UA (216 per 100,000) and in MSOA Wrexham 004 (Gwersyllt North, Gwersyllt West) at 378 per 100,000. The lowest mortality rates are recorded in Anglesey UA (194 per 100,000) and in MSOA Anglesey 008 (Braint, Cadnant, Gwyngyll, Tysilio) at 136 per 100,000 population. Figure 48 shows how mortality from circulatory disease varies in UAs across Wales. Figure 49 shows trends in circulatory disease mortality rates for the six UAs in North Wales. NICE Guidance • Prevention of cardiovascular disease http://guidance.nice.org.uk/PH25
Date: 13.02.12 Version: 1 Page 71 of 318 Public Health Wales North Wales Profile 2011 Figure 46: Mortality from circulatory disease in Betsi Cadwaladr University Health Board area, all persons, 2004 08, European age standardised rates per 100,000 Produced by Public Health Wales Observatory, using data from ONS (ADDE, MYE)
MSOA EASR with 95% Gwynedd confidence interval 009 259 0 50 100 Local Authority 003 247 003 748Wales (EASR = 214) 006 233 007 232Health Board (EASR = 210) 007 224 009 008 221 014 Isle of Anglesey 219 017 216 003 252 002 205 007 232 012 205
009 205 MSOA 001 199 006 205 004 199 001 203 010 198 MSOA 004 180 011 197 005 176 Isle of Anglesey 015 191 002 154 EASR = 194 005 185 Gwynedd 008 136 016 174 EASR = 207 EASR per 100,000 013 164 EASR per 100,000 Conwy Denbighshire 005 278 004 333 007 262 006 235 002 232 010 227 001 227 012 217 009 223 013 217 004 213 007 213 013 212 009 213 014 210 016 207
MSOA 006 203 002 205 MSOA 015 199 005 202 010 196 008 186 008 192 003 183 003 186 011 182 011 179 Conwy 001 175 EASR = 210 Denbighshire 012 174 015 172 EASR = 212 EASR per 100,000 014 166 EASR per 100,000 Flintshire Wrexham 005 285 004 281 004 378 003 278 012 278 007 256 017 266 009 255 010 235 011 252 015 232 002 229 006 231 008 216 013 228 017 214 009 218 014 212 011 216 001 205 019 213 MSOA
006 205 MSOA 003 211 020 198 005 205 010 196 008 202 019 191 001 193 015 185 018 173 016 183 002 169 013 182 014 166 Flintshire Wrexham 012 154 EASR = 215 007 165 EASR = 216 018 144 016 148 EASR per 100,000 EASR per 100,000
Date: 13.02.12 Version: 1 Page 72 of 318 Public Health Wales North Wales Profile 2011 Figure 47:
Numbers on map indicate MSOAs with a rate statistically significantly higher than the all Wales rate. Figure 48: Mortality from circulatory disease by local authority, all persons, 2004 95% confidence 08, European age standardised rates per 100,000 interval Produced by Public Health Wales Observatory, using data from ONS (ADDE, MYE)
Wales = 213.9 259.6 251.0 239.4 238.8 234.5 225.9 218.9 215.9 215.6 215.5 213.0 212.3 210.4 210.0 207.1 203.8 197.9 194.1 191.1 189.9 177.5 176.3 Powys Cardiff Conwy Torfaen Newport Swansea Bridgend Flintshire Gwynedd Wrexham Caerphilly Ceredigion Denbighshire Merthyr Tydfil Pembrokeshire Blaenau Gwent Monmouthshire Isle of Anglesey Carmarthenshire Neath Port Talbot Rhondda Cynon Taff
Areas ordered geographically from north west to south east The Vale of Glamorgan Date: 13.02.12 Version: 1 Page 73 of 318 Public Health Wales North Wales Profile 2011 Figure 49: Mortality from circulatory disease, European age standardised rate per 100,000 persons, Betsi Cadwaladr University Health Board local authorities, 2000 2009 Produced by Public Health Wales Observatory, using ADDE/MYE (ONS) 95% confidence Local authority Wales interval Isle of Anglesey Gwynedd 160 140 120 100 80 60 40 20 0
Conwy Denbighshire 160 140 120 100 80 60 40 20 0
Flintshire Wrexham 160 140 120 100 80 60 European age standardised rate per 100,000 persons 40 20 0 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
5.6.1 Inequalities in mortality from circulatory disease Mortality from circulatory disease: males, all ages The circulatory disease mortality rate for males in North Wales (241 per 100,000) is slightly above the average for Wales (239 per 100,000) in 2007 09. The circulatory disease mortality rate for males living in the most deprived fifth within North Wales is 320 per 100,000 compared to 195 per 100,000 living in the least deprived fifth in 2007 09, shown in Figure 50 and Table 22.
Date: 13.02.12 Version: 1 Page 74 of 318 Public Health Wales North Wales Profile 2011 Figure 50:
Mortality from circulatory disease, all ages, males, European age standardised rate (EASR) per 100,000, Betsi Cadwaladr UHB and Wales, 2001 09 Produced by Public Health Wales Observatory, using ADDE/MYE (ONS), WIMD 2008 (WAG)
Most deprived within Betsi Cadwaladr Wales EASR Least deprived within Betsi Cadwaladr Betsi Cadwaladr overall 500 450 400 350 300 250 200 150 100 Rate Ratio most deprived divided by least deprived 50 1.4 1.5 1.6 1.7 1.7 1.6 1.6 0 2001 03 2002 04 2003 05 2004 06 2005 07 2006 08 2007 09 Table 22:
Mortality from circulatory disease, all ages, males, European age standardised rate (EASR) per 100,000, Betsi Cadwaladr UHB and Wales, 2001 09
Betsi Cadwaladr Least and most deprived within Betsi Wales overall Cadwaladr
Annual EASR in least EASR in most EASR Rate Wales average deprived deprived (95% CI) ratio* EASR deaths (95% C I) (95% CI)
2001 03 1539 331 (321 341) 289 (269 310) 409 (384 435) 1.4 339 2002 04 1462 308 (299 317) 261 (242 280) 395 (371 420) 1.5 318 2003 05 1416 292 (283 301) 237 (219 255) 380 (356 405) 1.6 301 2004 06 1313 264 (256 273) 209 (193 226) 345 (323 369) 1.7 277 2005 07 1292 254 (246 263) 201 (185 217) 336 (314 359) 1.7 265 2006 08 1280 247 (239 255) 202 (187 218) 322 (301 345) 1.6 251 2007 09 1273 241 (233 249) 195 (180 211) 320 (299 342) 1.6 239
Produced by Public Health Wales Observatory, using ADDE/MYE (ONS), WIMD 2008 (WAG) *EASR in most deprived divided by EASR in least deprived
Mortality from circulatory disease: females, all ages The mortality rate for circulatory disease among females in North Wales and Wales is 154 per 100,000 in 2007 09. The circulatory disease mortality rate for females living in the most deprived fifth within North Wales is 188 compared to 131 in the least deprived in 2007 09, shown in Figure 51 and Table 23.
Date: 13.02.12 Version: 1 Page 75 of 318 Public Health Wales North Wales Profile 2011 Figure 51:
Mortality from circulatory disease, all ages, females, European age standardised rate (EASR) per 100,000, Betsi Cadwaladr UHB and Wales, 2001 09 Produced by Public Health Wales Observatory, using ADDE/MYE (ONS), WIMD 2008 (WAG)
Most deprived within Betsi Cadwaladr Wales EASR Least deprived within Betsi Cadwaladr Betsi Cadwaladr overall 300
250
200
150
100
50 Rate Ratio most deprived divided by least deprived 1.4 1.5 1.6 1.6 1.5 1.5 1.4 0 2001 03 2002 04 2003 05 2004 06 2005 07 2006 08 2007 09 Table 23:
Mortality from circulatory disease, all ages, females, European age standardised rate (EASR) per 100,000, Betsi Cadwaladr UHB and Wales, 2001 09
Betsi Cadwaladr Least and most deprived within Betsi Wales overall Cadwaladr
Annual EASR in least EASR in most EASR Rate Wales average deprived deprived (95% CI) ratio* EASR deaths (95% C I) (95% CI)
2001 03 1805 209 (203 215) 180 (168 192) 259 (243 275) 1.4 215 2002 04 1723 199 (193 205) 165 (153 177) 250 (234 266) 1.5 204 2003 05 1644 189 (183 194) 153 (142 164) 237 (222 253) 1.6 193 2004 06 1563 178 (173 184) 141 (131 152) 222 (207 237) 1.6 180 2005 07 1531 172 (166 177) 140 (130 151) 207 (193 221) 1.5 170 2006 08 1466 161 (156 167) 134 (124 145) 197 (183 211) 1.5 161 2007 09 1417 154 (149 160) 131 (121 141) 188 (175 202) 1.4 154
Produced by Public Health Wales Observatory, using ADDE/MYE (ONS), WIMD 2008 (WAG) *EASR in most deprived divided by EASR in least deprived Further Information • Public Health Wales Observatory: Measuring Inequalities, mortality from circulatory disease http://www.wales.nhs.uk/sitesplus/922/page/58379 Date: 13.02.12 Version: 1 Page 76 of 318 Public Health Wales North Wales Profile 2011 5.7 Mortality from circulatory disease, persons aged under 75 years In those aged under 75, the mortality rate from circulatory disease in North Wales (82 per 100,000) is below the all Wales rate (90 per 100,000). Figure 52 and Figure 53 show the variation across North Wales. The highest mortality rate is recorded in Wrexham UA (87 per 100,000) and MSOA Denbighshire 004 (Rhyl East and Rhyl West) at 183 per 100,000 and the lowest in Anglesey UA (77 per 100,000) and MSOAs Anglesey 008 (Braint, Cadnant, Gwyngyll, Tysilio), Gwynedd 004 (Bethel, Llanrug, Y Felinheli) and Wrexham 002 (Gresford East & West, Marford & Hoseley), all at 47 per 100,000 population. Figure 54 shows the variation in circulatory disease mortality in the under 75s in UAs across Wales.
Date: 13.02.12 Version: 1 Page 77 of 318 Public Health Wales North Wales Profile 2011 Figure 52: Mortality from circulatory disease in Betsi Cadwaladr University Health Board area, all persons aged under 75, 2004 08, European age standardised rates per 100,000 Produced by Public Health Wales Observatory, using data from ONS (ADDE, MYE) MSOA EASR with 95% Gwynedd confidence interval 009 108 0Local Authority 50 100 003 101 003 748 Wales (EASR = 90) 006 96 007 99 Health Board (EASR = 82) 011 87 012 86 Isle of Anglesey 007 85 002 81 003 128 008 81 007 99 016 78
006 86 MSOA 001 76 009 85 014 75 001 75 010 68 MSOA 004 74 017 68 005 52 Isle of Anglesey 015 68 002 51 EASR = 77 013 64 008 Gwynedd 47 005 62 EASR = 79 EASR per 100,000 004 47 EASR per 100,000 Conwy Denbighshire 007 112 004 183 001 111 006 109 005 102 002 87 002 95 010 83 009 88 007 81 004 84 016 81 012 79 005 71 008 77 012 69
MSOA 013 76 009 69 MSOA 010 74 014 66 003 71 015 64 006 70 011 64 015 69 013 63 011 68 Conwy 003 59 EASR = 82 Denbighshire 014 61 008 57 EASR = 81 EASR per 100,000 001 56 EASR per 100,000 Flintshire Wrexham 004 137 003 127 004 171 007 120 012 124 011 110 010 122 009 103 003 110 005 95 019 108 017 88 015 103 002 87 017 101 006 82 006 96 001 81 005 94 020 78 009 84 MSOA
015 73 MSOA 013 81 008 73 007 80 014 71 008 73 013 71 018 67 019 71 016 59 010 66 001 53 016 64 011 53 Flintshire Wrexham 018 62 EASR = 85 014 49 EASR = 87 012 58 002 47 EASR per 100,000 EASR per 100,000
Date: 13.02.12 Version: 1 Page 78 of 318 Public Health Wales North Wales Profile 2011 Figure 53:
Numbers on map indicate MSOAs with a rate statistically significantly higher than the all Wales rate.
Date: 13.02.12 Version: 1 Page 79 of 318 Public Health Wales North Wales Profile 2011 Figure 54: Mortality from circulatory disease by local authority, all persons aged 95% confidence under 75, 2004 08, European age standardised rates per 100,000 interval Produced by Public Health Wales Observatory, using data from ONS (ADDE, MYE)
Wales = 89.5 123.3 116.9 112.3 112.2 96.0 94.5 91.4 91.5 89.9 87.6 87.1 87.0 86.7 85.1 81.8 81.4 78.7 77.5 72.9 72.1 71.0 66.5 Powys Cardiff Conwy Torfaen Newport Swansea Bridgend Flintshire Gwynedd Wrexham Caerphilly Ceredigion Denbighshire Merthyr Tydfil Blaenau Gwent Pembrokeshire Monmouthshire Isle of Anglesey Carmarthenshire Neath Port Talbot Rhondda Cynon Taff Areas ordered geographically from north west to south east The Vale of Glamorgan 5.8 Mortality from coronary heart disease, all ages In order to work properly, the heart needs a constant supply of oxygen. Oxygen is carried in the blood, which flows through the heart's blood vessels (coronary arteries) to the heart muscle. Coronary heart disease (CHD) is the term used to describe what happens when this supply is blocked or interrupted. This is caused by a build up of fatty substances (arteriosclerosis or atheroma or plaque) in the arteries. If the coronary arteries become partially blocked, this can lead to chest pains called angina. These pains most commonly occur during exertion and subside at rest. This is called ‘stable angina’. If however they occur at rest this is known as ‘unstable angina’ and need urgent investigation. If the arteries become completely blocked, this can lead to a heart attack (myocardial infarction). Coronary thrombosis (clotting of the blood within a coronary artery) happens when blood turns from liquid form to solid in one of the heart's arteries. This creates a clot in one of the coronary arteries and stops blood supply to the heart muscle causing a heart attack.
Date: 13.02.12 Version: 1 Page 80 of 318 Public Health Wales North Wales Profile 2011 The mortality rate from coronary heart disease in North Wales (106 per 100,000) is slightly below the all Wales rate (108 per 100,000). Figure 55 and Figure 56 show how the rate varies across UAs and MSOAs. The highest rates of coronary heart disease mortality are recorded in Wrexham UA (119 per 100,000) and MSOA Wrexham 004 (Gwersyllt North, Gwersyllt West) at 226 per 100,000. The lowest rates are recorded in Anglesey UA (94 per 100,000) and MSOA Anglesey 008 (Braint, Cadnant, Gwyngyll, Tysilio) at 59 per 100,000 population. Figure 57 shows the variation in coronary heart disease mortality in UAs across Wales. Figure 55: Mortality from coronary heart disease in Betsi Cadwaladr University Health Board area, all persons, 2004 08, European age standardised rates per 100,000 Produced by Public Health Wales Observatory, using data from ONS (ADDE, MYE)
Date: 13.02.12 Version: 1 Page 81 of 318 Public Health Wales North Wales Profile 2011
MSOA EASR with 95% Gwynedd confidence interval 009 127 0Local Authority 50 100 006 122 003 748Wales (EASR = 108) 003 111 006 119 Health Board (EASR = 106) 015 109 007 112 002 105 Isle of Anglesey 008 103 007 102 003 128 014 101 006 119 012 99
007 112 MSOA 005 97 009 101 001 96 004 96 011 96 MSOA 001 93 004 91 005 71 Isle of Anglesey 017 89 002 63 EASR = 94 010 81 008 Gwynedd 59 013 76 EASR = 97 EASR per 100,000 016 72 EASR per 100,000 Conwy Denbighshire 005 151 004 176 007 120 007 121 009 119 006 116 014 115 009 114 001 106 010 112 013 103 013 101 002 102 012 101 004 102 005 100
MSOA 010 96 002 100 MSOA 006 95 016 99 012 93 001 94 008 89 003 94 003 88 015 88 011 88 Conwy 011 84 EASR = 102 Denbighshire 015 82 014 79 EASR = 105 EASR per 100,000 008 79 EASR per 100,000 Flintshire Wrexham 004 172 003 152 004 226 005 144 017 170 007 141 012 148 009 134 015 131 011 131 009 128 019 123 003 128 001 121 006 124 017 119 013 124 008 118 019 121 020 111 011 119 MSOA
002 110 MSOA 008 114 016 108 005 112 014 105 010 109 010 103 001 106 006 98 018 89 015 97 014 86 012 84 007 85 Flintshire Wrexham 013 80 EASR = 116 002 80 EASR = 119 018 71 016 77 EASR per 100,000 EASR per 100,000
Date: 13.02.12 Version: 1 Page 82 of 318 Public Health Wales North Wales Profile 2011 Figure 56:
Numbers on map indicate MSOAs with a rate statistically significantly higher than the all Wales rate.
Date: 13.02.12 Version: 1 Page 83 of 318 Public Health Wales North Wales Profile 2011 Figure 57: Mortality from coronary heart disease by local authority, all persons, 95% confidence 2004 08, European age standardised rates per 100,000 interval Produced by Public Health Wales Observatory, using data from ONS (ADDE, MYE)
Wales = 108.4 142.1 134.6 130.1 128.7 118.9 117.9 115.7 112.9 111.7 111.3 106.7 106.3 105.5 97.7 97.4 101.9 94.6 93.7 93.5 92.0 87.7 86.8 Powys Cardiff Conwy Torfaen Newport Swansea Bridgend Flintshire Gwynedd Wrexham Caerphilly Ceredigion Denbighshire Merthyr Tydfil Pembrokeshire Blaenau Gwent Monmouthshire Isle of Anglesey Carmarthenshire Neath Port Talbot Rhondda Cynon Taff Areas ordered geographically from north west to south east The Vale of Glamorgan 5.9 Mortality from respiratory disease, all ages Within this category is chronic obstructive pulmonary disease (COPD), including chronic bronchitis and emphysema. It is almost always caused by smoking and can be made worse by air pollution. It develops in smokers usually after the age of 40 and is currently more common in older men. It is a common and important chronic disease that can cause severe shortness of breath, which can severely limit mobility, and contributes to mortality. Chest infections are more common and can be severe. It is a common reason for being off work and flare up (‘exacerbations’) of COPD is a common reason for GP consultations and emergency hospital admission. Social inequalities in COPD prevalence and mortality reflect the higher smoking prevalence in more deprived communities. Mortality from respiratory disease is lower in North Wales (74 per 100,000) compared to all Wales (77 per 100,000). Figure 58 and Figure 59 show variation across Unitary Authorities and MSOAs. The highest mortality rates from respiratory disease are recorded in Wrexham UA (93 per 100,000) and MSOA Wrexham 010 (Cartrefle, Queensway, Wynnstay) at 152 per 100,000. The lowest mortality rates from respiratory disease are recorded in Conwy UA (63 per
Date: 13.02.12 Version: 1 Page 84 of 318 Public Health Wales North Wales Profile 2011 100,000) and MSOA Anglesey 002 (Brynteg, Llanddyfnan, Llaneilian, Moelfre) at 42 per 100,000 population. Figure 60 shows the variation in respiratory disease mortality in UAs across Wales. Figure 58: Mortality from respiratory disease in Betsi Cadwaladr University Health Board area, all persons, 2004 08, European age standardised rates per 100,000 Produced by Public Health Wales Observatory, using data from ONS (ADDE, MYE)
Date: 13.02.12 Version: 1 Page 85 of 318 Public Health Wales North Wales Profile 2011 MSOA EASR with 95% Gwynedd confidence interval 003 96 0Local Authority 50 100 004 79 003 748 Wales (EASR = 77) 008 78 009 95 Health Board (EASR = 74) 001 77 004 002 75 Isle of Anglesey 006 73 005 70 003 112 007 69 009 95 009 67
004 86 MSOA 015 65 001 86 013 60 006 68 010 59 MSOA 007 65 014 59 005 48 Isle of Anglesey 012 57 008 45 EASR = 71 017 55 002 Gwynedd 42 011 54 EASR = 65 EASR per 100,000 016 46 EASR per 100,000 Conwy Denbighshire 005 97 004 126 013 91 006 108 007 78 013 87 010 70 005 85 011 64 002 79 009 63 010 77 001 63 016 65 004 62 011 63
MSOA 015 57 009 60 MSOA 002 56 008 60 014 55 001 59 008 49 003 57 006 48 015 57 012 48 Conwy 012 57 EASR = 63 Denbighshire 003 46 007 56 EASR = 73 EASR per 100,000 014 47 EASR per 100,000 Flintshire Wrexham 003 117 009 107 010 152 020 93 004 146 005 92 012 124 016 92 017 114 011 89 011 112 019 87 006 111 017 86 015 105 007 82 001 105 002 80 009 93 004 78 005 88 MSOA
012 72 MSOA 003 85 010 71 014 84 014 67 013 82 001 65 008 80 006 63 019 79 008 62 002 73 015 61 016 60 Flintshire Wrexham 013 60 EASR = 79 007 47 EASR = 93 018 54 018 47 EASR per 100,000 EASR per 100,000 Figure 59:
Date: 13.02.12 Version: 1 Page 86 of 318 Public Health Wales North Wales Profile 2011
Numbers on map indicate MSOAs with a rate statistically significantly higher than the all Wales rate. Figure 60:
Mortality from respiratory disease by local authority, all persons, 95% confidence 2004 08, European age standardised rates per 100,000 interval Produced by Public Health Wales Observatory, using data from ONS (ADDE, MYE)
Wales = 77.0 99.1 97.7 94.9 93.5 89.8 85.5 85.1 81.7 79.5 77.7 77.5 76.7 74.3 72.9 71.4 71.1 64.8 64.0 62.9 58.7 55.1 54.2 Powys Cardiff Conwy Torfaen Newport Swansea Bridgend Flintshire Gwynedd Wrexham Caerphilly Ceredigion Denbighshire Merthyr Tydfil Pembrokeshire Blaenau Gwent Monmouthshire Isle of Anglesey Carmarthenshire Neath Port Talbot Rhondda Cynon Taff Areas ordered geographically from north west to south east The Vale of Glamorgan 5.9.1 Inequalities in mortality from respiratory disease, all ages Date: 13.02.12 Version: 1 Page 87 of 318 Public Health Wales North Wales Profile 2011 Mortality from respiratory disease: males, all ages The respiratory disease mortality rate for males in North Wales (83 per 100,000) is just below the average for Wales (89 per 100,000) in 2007 09 The respiratory disease mortality rate for males in the most deprived fifth within North Wales is 118 per 100,000 population compared to 63 per 100,000 in the least deprived fifth in 2007 09, shown in Figure 61 and Table 24. Figure 61:
Mortality from respiratory disease, all ages, males, European age standardised rate (EASR) per 100,000, Betsi Cadwaladr UHB and Wales, 2001 09 Produced by Public Health Wales Observatory, using ADDE/MYE (ONS), WIMD 2008 (WAG)
Most deprived within Betsi Cadwaladr Wales EASR Least deprived within Betsi Cadwaladr Betsi Cadwaladr overall 160 140 120 100 80 60 40 Rate Ratio most deprived divided by least deprived 20 1.8 1.8 1.6 1.8 1.7 1.7 1.9 0 2001 03 2002 04 2003 05 2004 06 2005 07 2006 08 2007 09 Table 24:
Mortality from respiratory disease, all ages, males, European age standardised rate (EASR) per 100,000, Betsi Cadwaladr UHB and Wales, 2001 09
Betsi Cadwaladr Least and most deprived within Betsi Wales overall Cadwaladr
Annual EASR in least EASR in most EASR Rate Wales average deprived deprived (95% CI) ratio* EASR deaths (95% CI) (95% CI)
2001 03 442 93 (88 98) 72 (62 83) 132 (118 147) 1.8 100 2002 04 447 92 (87 97) 75 (65 85) 133 (120 148) 1.8 101 2003 05 451 90 (86 96) 77 (68 88) 126 (113 141) 1.6 99 2004 06 422 82 (78 87) 65 (57 75) 115 (102 129) 1.8 93 2005 07 425 81 (76 85) 66 (58 76) 112 (100 125) 1.7 90 2006 08 434 81 (76 85) 65 (57 75) 114 (102 128) 1.7 89 2007 09 454 83 (78 87) 63 (55 72) 118 (106 132) 1.9 89
Produced by Public Health Wales Observatory, using ADDE/MYE (ONS), WIMD 2008 (WAG) *EASR in most deprived divided by EASR in least deprived Mortality from respiratory disease: females, all ages
Date: 13.02.12 Version: 1 Page 88 of 318 Public Health Wales North Wales Profile 2011 The respiratory disease mortality rate for all females in North Wales (67 per 100,000) is just above the average for Wales (66 per 100,000) in 2007 09. The respiratory disease mortality rate for all females living in the most deprived fifths within North Wales is 97 per 100,000 compared to 46 per 100,000 in the least deprived fifth in 2007 09, shown on Figure 62 and Table 25. Figure 62:
Mortality from respiratory disease, all ages, females, European age standardised rate (EASR) per 100,000, Betsi Cadwaladr UHB and Wales, 2001 09 Produced by Public Health Wales Observatory, using ADDE/MYE (ONS), WIMD 2008 (WAG)
Most deprived within Betsi Cadwaladr Wales EASR Least deprived within Betsi Cadwaladr Betsi Cadwaladr overall 120
100
80
60
40
20 Rate Ratio most deprived divided by least deprived 1.6 1.7 1.7 1.9 2.0 2.1 2.1 0 2001 03 2002 04 2003 05 2004 06 2005 07 2006 08 2007 09 Table 25:
Mortality from respiratory disease, all ages, females, European age standardised rate (EASR) per 100,000, Betsi Cadwaladr UHB and Wales, 2001 09
Betsi Cadwaladr Least and most deprived within Betsi Wales overall Cadwaladr
Annual EASR in least EASR in most EASR Rate Wales average deprived deprived (95% CI) ratio* EASR deaths (95% CI) (95% C I)
2001 03 578 68 (65 72) 55 (48 62) 89 (80 99) 1.6 72 2002 04 593 69 (66 73) 55 (48 62) 91 (82 101) 1.7 72 2003 05 604 71 (67 75) 57 (51 65) 99 (89 109) 1.7 72 2004 06 588 67 (64 71) 52 (46 59) 98 (88 108) 1.9 68 2005 07 589 68 (64 71) 51 (45 58) 101 (91 112) 2.0 67 2006 08 600 67 (64 71) 46 (40 53) 95 (86 105) 2.1 66 2007 09 606 67 (64 71) 46 (40 52) 97 (87 107) 2.1 66
Produced by Public Health Wales Observatory, using ADDE/MYE (ONS), WIMD 2008 (WAG) *EASR in most deprived divided by EASR in least deprived
Date: 13.02.12 Version: 1 Page 89 of 318 Public Health Wales North Wales Profile 2011 Further Information • Public Health Wales Observatory: Measuring Inequalities , mortality from respiratory disease http://www.wales.nhs.uk/sitesplus/922/page/58379
Date: 13.02.12 Version: 1 Page 90 of 318 Public Health Wales North Wales Profile 2011 6 Morbidity Key Messages • Morbidity (ill health) status is influenced by a range of factors, some of which an individual can have a reasonable degree of control over (i.e. lifestyle, keeping up to date with immunisations and screening opportunities). Other factors, such as social circumstances, may be more difficult to control, particularly at an individual level. • One measure of ill health status is limiting long term illness (LLTI), which can be mental, physical or both. The percentage of adults reporting LLTI in North Wales is 25%, which is lower than the average for Wales, 27%. There is variation across the region but no Unitary Authority has a percentage above Wales. • Physical well being can have an impact on how an individual functions on a daily basis. The Welsh Health Survey includes questions that, when analysed, give a score of perceived physical and mental measures. For North Wales, self reported physical health, reported through the Physical Component Summary score, is more favourable than Wales. • The average number of decayed, missing and filled teeth in children aged five years in North Wales ranges from 1.43 in Anglesey to 2.13 in Denbighshire. 6.1 Limiting Long Term Illness as reported by adults As well as mortality, it is important to include various measures of ill health (mental and physical) and well being. One measure is limiting long term illness (LLTI), which is defined as adults who report having any limiting long term illness, health problem or disability which limits their daily activities or the work they can do; this includes any problems due to old age. Figure 63 shows that the highest percentage of adults with LLTI in North Wales is in Anglesey, 27%, and the lowest percentage in Conwy, 23%.
Date: 13.02.12 Version: 1 Page 91 of 318 Public Health Wales North Wales Profile 2011 Figure 64 shows trends in LLTI for the six UAs in North Wales. Figure 63: Adults who reported having a limiting long term illness by local authority and health board, age standardised percentage, 2008 2009 Produced by Public Health Wales Observatory using data from the Welsh Health Survey, 2008 and 2009
Wales = 27
33 31 31 32 31 30 30 30 29 29 29 29 27 28 28 25 25 26 26 26 26 26 26 25 24 23 24 24 24 Powys Powys Cardiff Conwy Torfaen Newport Cwm Taf Swansea Bridgend Flintshire Gwynedd Wrexham Caerphilly Hywel Dda Ceredigion Denbighshire Merthyr Tydfil Aneurin Bevan Pembrokeshire Blaenau Gwent Monmouthshire Betsi Cadwaladr Isle of Anglesey Carmarthenshire Neath Port Talbot Rhondda Cynon Taf The Vale of Glamorgan Cardiff & Vale University Abertawe Bro Morgannwg
Areas ordered geographically from north west to south east Fi
Date: 13.02.12 Version: 1 Page 92 of 318 Public Health Wales North Wales Profile 2011 gure 64: Persons aged 16+ with a limiting long term illness, age standardised %, Betsi Cadwaladr University Health Board local authority areas, 2004 to 2010 Produced by Public Health Wales Observatory, using WHS (WG) Local authority Wales
Isle of Anglesey Gwynedd 40
30
20
10
0
Conwy Denbighshire 40
30
20
10
Age standardised % 0
Flintshire Wrexham 40
30
20
10
0 2004 06 2005 07 2007 08 2008 09 2009 10 2004 06 2005 07 2007 08 2008 09 2009 10 6.2 Physical Component Summary Score The Welsh Health Survey adult questionnaire includes a standard set of 36 health status questions known as SF 36 (version 2). SF 36 questions ask respondents about their own perception of their physical and mental health and the impact it has on their daily lives. The SF 36 questions include a question asking respondents to rate their own general health on a five point scale ranging from excellent to poor. Responses can be combined to produce eight scores for the following aspects of health and well being: • physical functioning • role physical • bodily pain • general health • vitality • social functioning • role emotional • mental health
Date: 13.02.12 Version: 1 Page 93 of 318 Public Health Wales North Wales Profile 2011 The eight components can be combined to produce two summary measures of physical and mental health the Physical Component Summary (PCS) and Mental Component Summary (MCS) scores. Higher scores indicate better health. The results for the North Wales PCS are shown in Figure 65. The results for the MCS are shown in the Mental Health section of this profile. Physical Component Summary scores for North Wales are higher than the average across Wales. Flintshire has the highest score in North Wales. Figure 65: Mean SF 36 Physical component summary score by local authority and health board, age standardised rate, 2008 2009 Produced by Public Health Wales Observatory using data from the Welsh Health Survey, 2008 and 2009
Wales = 48.8 50.3 50.2 49.9 49.8 49.7 49.7 49.7 49.7 49.6 49.5 49.3 49.3 49.2 49.1 49.0 49.0 48.6 48.4 48.2 48.2 48.1 48.1 48.1 48.0 47.7 47.7 47.5 47.4 47.0 Powys Powys Cardiff Conwy Torfaen Newport Cwm Taf Swansea Bridgend Flintshire Gwynedd Wrexham Caerphilly Hywel Dda Ceredigion Denbighshire Merthyr Tydfil Aneurin Bevan Pembrokeshire Blaenau Gwent Monmouthshire Betsi Cadwaladr Isle of Anglesey Carmarthenshire Neath Port Talbot Rhondda Cynon Taf The Vale of Glamorgan Cardiff & Vale University Abertawe Bro Morgannwg
Areas ordered geographically from north west to south east * Y axis is truncated to 45
Date: 13.02.12 Version: 1 Page 94 of 318 Public Health Wales North Wales Profile 2011 6.3 Dental Health Dental caries are associated with a variety of factors including poor nutrition, social deprivation and lifestyle factors (Welsh Assembly Government, 2006a). Table 26 shows that across North Wales over two thirds of adults report using a dentist within the last 12 months. Table 26: Percentage of adults who reported using a dentist in past 12 months, 2008 + 2009 Percentage Wales 70 North Wales 72 Isle of Anglesey 75 Gwynedd 72 Conwy 72 Denbighshire 73 Flintshire 71 Wrexham 69 Source: Welsh Health Survey In UAs across North Wales, the number of decayed, missing and filled teeth in five year olds is lower than the average for Wales, with the exception of Denbighshire (1.98 compared with 2.13). The 2007/08 dental health survey was the first year to use positive consent; therefore figures cannot be compared with survey data from previous years. Table 28: Number of decayed, missing & filled teeth (dmft) in 5 year olds, 2007/08 Number Wales 1.98 Isle of Anglesey 1.43 Gwynedd 1.59 Conwy 1.45 Denbighshire 2.13 Flintshire 1.56 Wrexham 1.76 Source: Welsh Oral Health Information Unit *Dmft Decayed, missing and filled teeth Further information • Welsh Oral Health Information Unit http://www.cardiff.ac.uk/dentl/research/themes/appliedclinicalresearch/epide miology/oralhealth/index.html
Date: 13.02.12 Version: 1 Page 95 of 318 Public Health Wales North Wales Profile 2011 7 Unintentional Injuries Key Messages • Boys are more likely than girls to report having had an injury in the past year. • Emergency admission rates for injury and poisoning among children and young people aged 18 years and younger in Anglesey and Gwynedd are significantly higher than the average for Wales. The rate for Wrexham is significantly lower than the average for Wales. • In 2009, 833 children aged 0 to 5 years in North Wales were admitted to hospital with an unintentional injury. • Hospitalisation rates for falls in North Wales are similar to all Wales rates. Females have much higher rates of hospitalisation as a result of falls than males, around 2,400 per 100,000 compared to 1,550 per 100,000 population. • The number of the population aged 65 years and over admitted to hospital due to a fall is predicted to almost double between 2011 and 2030. • North Wales seems to have much higher mortality rates from unintentional falls than all Wales for all ages and people aged 65 years and over. • Rates of hip fractures in North Wales in people aged 65 years and over are slightly lower than the all Wales rates. • Rates of hip fractures in females are around double that of males, 520 per 100,000 compared to 270 per 100,000 population; this is likely due to the higher risk of osteoporosis in women. Injuries and their consequences produce a heavy burden on society in terms of short and long term disability, mortality, economic loss and health care costs. Whilst unintentional injuries account for only about three per cent of total deaths in Wales, the distribution of the age of death in those dying is very different from most other causes of death with a high proportion of deaths occurring in the young. After the age of one injury is the first or second leading cause of death in most European countries, including Wales.
Date: 13.02.12 Version: 1 Page 96 of 318 Public Health Wales North Wales Profile 2011 7.1 Unintentional Injuries in Children & Young People Boys of all age groups are more likely than girls to report having had an injury in the past year (Welsh Assembly Government, 2011a). In North Wales, 49% of boys report experiencing one or more injuries in the past 12 months compared to 39% of girls (Welsh Assembly Government, 2011a), giving a combined figure of 44% as shown in Figure 66. Figure 66: Percentage of 11 to 16 year olds reporting one or more injuries in the past twelve months, 2009 Source: Health Behaviour in School aged Children Survey, 2009/2010
Wales average = 45% 47 46
44 44 44 44
41
Abertawe Aneurin Betsi Cardiff & Cwm Taf Hywel Dda Powys BMU Bevan Cadwaladr Vale Teaching 7.1.1 Unintentional injury related hospital admissions in 0 to 18 year olds Figure 67 and Table 28 show the emergency admission rate for injury and poisoning among children and young people aged 0 to 18 years in Wales. Rates for Anglesey and Gwynedd are significantly higher than the average for Wales. The rate for Wrexham is significantly lower than the average for Wales. Figures 68 and 69 show the same data by MSOA. The highest rate is seen in Gwynedd 001(Deiniol, Hirael, Marchog and Menai Bangor) at 38 per 100,000 and the lowest in Conwy 004 (Llandrillo yn Rhos) at 7 per 100,000. Figure 70 shows the trends in this indicator for the six UAs in North Wales. Date: 13.02.12 Version: 1 Page 97 of 318 Public Health Wales North Wales Profile 2011 Figure 67:
Emergency admissions for injury & poisoning, European age standardised rate (EASR) per 100,000, Local Authorities, all persons aged 0 18, 2008 Produced by Public Health Wales Observatory using MYE (ONS), PEDW (HSW)
95% confidence EASR Crude rate interval for EASR 3000
2500
2000
Wales EASR = 1550 1500
1000 Rate per 100,000
500
0 Cardiff Powys Conwy Torfaen Newport Bridgend Flintshire Swansea Gwynedd Wrexham Caerphilly Ceredigion Denbighshire Merthyr Tydfil Pembrokeshire Blaenau Gwent Monmouthshire Isle of Anglesey Carmarthenshire Neath Port Talbot Vale of Glamorgan
Rhondda Cynon Taff
Date: 13.02.12 Version: 1 Page 98 of 318 Public Health Wales North Wales Profile 2011 Table 28:
Emergency admissions for injury & poisoning, European age standardised rate (EASR) per 100,000, Local Authorities, all persons aged 0 18, 2008
All rates shown are per 100,000 population EASR EASR Health Board / Local Crude Compared Count EASR 95% 95% Authority rate to Wales LCL UCL
Isle of Anglesey 279 1850 1870 1660 2110 Sig. high Gwynedd 449 1750 1780 1610 1950 Sig. high Conwy 343 1450 1450 1300 1620 No sig. dif. Denbighshire 360 1680 1700 1520 1880 No sig. dif. Flintshire 499 1450 1440 1310 1570 No sig. dif. Wrexham 405 1350 1330 1200 1470 Sig. low Powys 354 1230 1250 1120 1390 Sig. low Ceredigion 191 1290 1330 1140 1530 Sig. low Pembrokeshire 437 1610 1620 1470 1780 No sig. dif. Carmarthenshire 524 1310 1310 1200 1430 Sig. low Swansea 954 1960 1970 1840 2100 Sig. high Neath Port Talbot 514 1680 1690 1540 1840 No sig. dif. Bridgend 387 1260 1250 1130 1380 Sig. low The Vale of Glamorgan 364 1220 1250 1130 1390 Sig. low Cardiff 1025 1410 1420 1340 1510 Sig. low Rhondda Cynon Taff 966 1780 1790 1680 1910 Sig. high Merthyr Tydfil 316 2390 2390 2140 2680 Sig. high Caerphilly 620 1500 1510 1400 1640 No sig. dif. Blaenau Gwent 269 1680 1660 1470 1880 No sig. dif. Torfaen 320 1500 1490 1330 1660 No sig. dif. Monmouthshire 282 1410 1390 1230 1560 No sig. dif. Newport 548 1580 1570 1440 1700 No sig. dif. Wales 10406 1540 1550 1520 1580 Produced by Public Health Wales Observatory using MYE (ONS), PEDW (HSW)
No sig. dif. = no significant difference
Date: 13.02.12 Version: 1 Page 99 of 318 Public Health Wales North Wales Profile 2011 Figure 68: Emergency hospital admission rates due to injury, European age standardised rate per 1,000 persons aged 18 years and under, 2008 2009 MSOA EASR with 95% Gwynedd confidence interval 001 38 Health Board (EASR = 16) 748 006 27 25 Wales (EASR = 16) 002 21 Local Authority 005 19 23 013 17 Isle of Anglesey 009 17 003 17 006 27 012 16 007 25 007 16 003 23 MSOA 011 16 005 21 004 15 008 20 010 15
MSOA 001 19 008 15 009 17 014 14 004 16 Isle of Anglesey 016 14 Gwynedd 002 14 EASR = 21 017 14 EASR = 18 EASR per 1,000 015 13 EASR per 1,000 Conwy Denbighshire 007 21 006 25 013 20 004 24 010 19 007 21 005 19 011 20 002 18 009 18 014 16 001 17 001 14 015 17 009 14 002 16
MSOA 011 13 005 15 006 MSOA 13 008 15 015 12 010 15 012 11 014 12 008 10 Conwy 013 12 003 EASR = 15 10 016 11 Denbighshire 004 7 003 10 EASR = 16 EASR per 1,000 012 9 EASR per 1,000 Flintshire Wrexham 004 23 011 23 012 20 009 20 010 19 015 18 015 18 007 17 017 17 008 16 004 14 003 15 014 14 002 15 011 14 017 14 013 14 001 13 005 13 018 13 006 13 MSOA
005 13 MSOA 019 12 013 13 008 12 006 12 009 12 010 11 018 12 019 10 016 12 012 10 003 11 Flintshire 016 9 002 10 Wrexham EASR = 14 EASR = 14 014 8 001 9 020 8 007 8 EASR per 1,000 EASR per 1,000 Date: 13.02.12 Version: 1 Page 100 of 318 Public Health Wales North Wales Profile 2011 Figure 69:
Date: 13.02.12 Version: 1 Page 101 of 318 Public Health Wales North Wales Profile 2011 Figure 70: Emergency hospital admissions for injury or poisoning in all persons aged 18 and under, European age standardised rate (EASR) per 1,000 population, Betsi Cadwaladr University Health Board local authority areas, 2000 09 Produced by Public Health Wales Observatory, using PEDW (NWIS) & MYE (ONS) 95% confidence Local authority Wales interval Isle of Anglesey Gwynedd 30 25 20 15 10 5 0
Conwy Denbighshire 30 25 20 15 10
EASR per 1,000 5 0
Flintshire Wrexham 30 25 20 15 10 5 0 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
7.1.2 Unintentional injury related hospital admissions among 0 to 5 year olds The most common type of injury resulting in accident and emergency attendances for the five years and under age group include poisoning/overdose, lacerations/wounds and scalds. Data relating to the location of injuries shows that the 0 to five year age group are at the highest risk of injury in the home (National Institute for Health and Clinical Excellence 2010). In 2009, 833 children aged 0 to five years in North Wales were admitted to hospital with an injury, shown in Table 29. Table 29: Emergency hospital admissions for injuries, children aged 0 to 5 years, North Wales, 2009
Date: 13.02.12 Version: 1 Page 102 of 318 Public Health Wales North Wales Profile 2011 Number of admissions Crude rate per 100,000 North Wales 833 1,856 Isle of Anglesey 116 2,573 Gwynedd 166 2,220 Conwy 134 1,975 Denbighshire 128 2,094 Flintshire 178 1,720 Wrexham 111 1,151 Produced by Public Health Wales Observatory using PEDW (NWIS) NICE Guidance • Strategies to prevent unintentional injuries among under 15s http://guidance.nice.org.uk/PH29 • Preventing unintentional road injuries among under 15s: road design http://guidance.nice.org.uk/PH31 • Preventing unintentional injuries among under 15s in the home http://guidance.nice.org.uk/PH30 Further Information • Health Behaviour in School aged Children Survey, Wales http://wales.gov.uk/topics/health/research/research/behaviour/?lang=en 7.2 Unintentional injury related mortality Table 30 shows the European age standardised rates for unintentional injury mortality in North Wales between 2000 and 2009. In 2009, Anglesey had the highest mortality rate from unintentional injuries, 42 per 100,000 compared to 30.3 per 100,000 in Flintshire. Table 30: Mortality from unintentional injuries, all persons, North Wales, European age standardised rate per 100,000 2000 2009
Date: 13.02.12 Version: 1 Page 103 of 318 Public Health Wales North Wales Profile 2011 EASR per 100,000 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Wales 32.5 32.3 30.4 33.0 30.9 30.4 29.0 30.7 29.0 29.7 North Wales 35.2 29.9 30.5 30.7 38.2 37.8 33.7 30.6 33.2 33.8 Isle of Anglesey 23.7 19.9 23.8 29.9 38.7 28.6 20.0 32.3 34.7 42.0 Gwynedd 33.3 25.3 25.9 28.8 39.2 34.8 30.8 25.9 31.1 34.3 Conwy 40.0 35.9 42.7 36.5 45.5 48.3 42.8 36.6 41.3 36.0 Denbighshire 46.6 44.3 41.6 32.2 39.1 50.7 47.3 30.9 34.4 34.5 Flintshire 37.2 27.7 24.4 26.0 34.8 32.4 32.7 29.0 30.0 30.3 Wrexham 30.1 26.2 26.3 33.2 33.9 33.6 28.7 31.9 31.3 32.2
Source: eHealthShow 7.3 Unintentional Falls Increasing age is associated with frailty, disability and loss of independence which can lead to an increase in the risks associated with unintentional falls. Tables 31 to 36 show hospitalisation numbers and rates in North Wales, by local authority, for all persons aged 65 years and over, and then for females and males separately. In 2007 there were over 3,200 hospital discharges as a result of unintentional falls in people aged 65 and over in North Wales (a rate of around 2,000 per 100,000 population). It can be seen that rates in North Wales are similar to all Wales rates and that females have much higher rates of hospitalisation as a result of falls than males (around 2,400 per 100,000 compared to 1,550 per 100,000 in 2007). Table 31: Unintentional falls, hospital discharge numbers, all persons aged 65 years and over, North Wales, 2001 2007 Numbers 2001 2002 2003 2004 2005 2006 2007
Wales 10,943 11,230 11,573 12,184 12,410 12,520 12,702 North Wales 2,753 3,072 3,492 3,248 3,234 3,184 3,292 Isle of Anglesey 189 224 241 233 307 329 368 Gwynedd 358 399 471 421 460 561 598 Conwy 713 783 859 852 758 669 674 Denbighshire 583 714 846 655 595 579 548 Flintshire 522 504 619 621 662 571 624 Wrexham 388 448 456 466 452 475 480
Source: eHealthShow Date: 13.02.12 Version: 1 Page 104 of 318 Public Health Wales North Wales Profile 2011 Table 32: Unintentional falls, hospital discharge EASR per 100,000 population, all persons aged 65 years and over, North Wales, 2001 2007 EASR per 100,000 2001 2002 2003 2004 2005 2006 2007
Wales 1,822 1,847 1,880 1,953 1,960 1,946 1,959 North Wales 1,835 2,010 2,277 2,094 2,056 2,010 2,073 Isle of Anglesey 1,251 1,454 1,555 1,436 1,842 2,026 2,189 Gwynedd 1,349 1,465 1,728 1,556 1,645 1,953 2,156 Conwy 2,116 2,332 2,572 2,530 2,284 1,975 1,987 Denbighshire 2,443 2,900 3,411 2,588 2,334 2,260 2,127 Flintshire 2,000 1,911 2,294 2,293 2,362 2,054 2,200 Wrexham 1,584 1,774 1,826 1,830 1,765 1,809 1,823
Source: eHealthShow Table 33: Unintentional falls, hospital discharge numbers, females aged 65 years and over, North Wales, 2001 2007 Numbers 2001 2002 2003 2004 2005 2006 2007
Wales 8,077 8,309 8,451 8,859 8,891 9,157 8,980 North Wales 2,032 2,274 2,568 2,362 2,340 2,345 2,358 Isle of Anglesey 136 172 176 167 224 243 262 Gwynedd 276 308 361 323 336 417 457 Conwy 545 577 628 623 557 498 493 Denbighshire 421 512 617 491 411 413 395 Flintshire 376 378 456 418 483 410 425 Wrexham 278 327 330 340 329 364 326
Source: eHealthShow Table 34: Unintentional falls, hospital discharge EASR per 100,000 population, females aged 65 years and over, North Wales, 2001 2007
Date: 13.02.12 Version: 1 Page 105 of 318 Public Health Wales North Wales Profile 2011 EASR per 100,000 2001 2002 2003 2004 2005 2006 2007
Wales 2,117 2,157 2,166 2,268 2,253 2,314 2,268 North Wales 2,102 2,323 2,623 2,424 2,359 2,377 2,401 Isle of Anglesey 1,425 1,775 1,793 1,660 2,177 2,476 2,550 Gwynedd 1,629 1,782 2,036 1,894 1,867 2,278 2,665 Conwy 2,436 2,733 2,947 2,932 2,671 2,379 2,404 Denbighshire 2,754 3,117 3,886 3,091 2,573 2,570 2,436 Flintshire 2,263 2,273 2,707 2,469 2,759 2,418 2,458 Wrexham 1,780 2,008 2,061 2,132 2,023 2,184 1,931
Source: eHealthShow Table 35: Unintentional falls, hospital discharge numbers, males aged 65 years and over, North Wales, 2001 2007 Numbers 2001 2002 2003 2004 2005 2006 2007
Wales 2,866 2,917 3,121 3,325 3,519 3,363 3,721 North Wales 721 796 924 886 894 839 934 Isle of Anglesey 53 52 65 66 83 86 106 Gwynedd 82 91 110 98 124 144 141 Conwy 168 206 231 229 201 171 181 Denbighshire 162 202 229 164 184 166 153 Flintshire 146 125 163 203 179 161 199 Wrexham 110 120 126 126 123 111 154
Source: eHealthShow Table 36: Unintentional falls, hospital discharge EASR per 100,000 population, males aged 65 years and over, North Wales, 2001 2007 EASR per 100,000 2001 2002 2003 2004 2005 2006 2007
Wales 1,335 1,331 1,400 1,455 1,493 1,383 1,493 North Wales 1,370 1,484 1,704 1,573 1,551 1,415 1,554 Isle of Anglesey 959 934 1,141 1,061 1,280 1,363 1,639 Gwynedd 899 970 1,137 994 1,262 1,379 1,392 Conwy 1,484 1,721 1,955 1,861 1,643 1,334 1,386 Denbighshire 1,911 2,422 2,679 1,826 1,988 1,755 1,618 Flintshire 1,542 1,295 1,643 2,094 1,709 1,515 1,745 Wrexham 1,275 1,364 1,438 1,334 1,302 1,159 1,580
Source: eHealthShow Table 37 provides a prediction for the population of North Wales aged 65 years and over likely to be admitted to hospital due to a fall. It can be seen that there is predicted to be an almost doubling
Date: 13.02.12 Version: 1 Page 106 of 318 Public Health Wales North Wales Profile 2011 in the number of admissions between 2011 and 2033, reflecting the ageing population in North Wales. Table 37: Population aged 65 years and over predicted to be admitted to hospital due to a fall Numbers 2011 2015 2020 2025 2030
North Wales 3,514 3,889 4,424 5,202 5,983 Anglesey 384 434 501 600 696 Gwynedd 108 121 121 114 121 Conwy 109 121 125 123 134 Denbighshire 550 606 687 817 949 Flintshire 735 837 975 1,176 1,369 Wrexham 520 581 668 782 903
Source: Welsh Government Statistical Directorate (Daffodil) 7.3.1 Fractures Fractures are an important cause of pain, disability and death. The vast majority of fractures and injuries in older people are the result of falls. Osteoporosis, which is a disease characterised by a reduction in bone mass and density, increases the risk of fracture when an older person falls. Osteoporotic fractures occur most commonly in the hip, spine and wrist. Vertebral fractures due to osteoporosis can cause loss of height, curvature of the spine and chronic back pain. One in two women and one in five men over 50 will experience an osteoporotic fracture in their lifetime. Over 12,000 osteoporotic fractures occur in Wales each year, 4,200 of which are hip fractures. Hip (neck of femur) fracture is the most common serious injury related to falls in older people. In Wales, hip fractures lead to a total cost to health and social services of £84 million each year. One third of this cost is for acute care, and two thirds for social and medical aftercare necessary in the first two years after the injury. 7% of people die within a month of this injury, with 25% dying within the following year. Half of survivors fail to regain their pre fracture level of independence. (Welsh Assembly Government, 2006b). Tables 38 to 43 show hospitalisation numbers and rates for hip fractures in those aged 65 years and over, all persons, and females and males separately in North Wales, by UA. It can be seen that rates of hip fracture in this group in North Wales are slightly below the all Wales rates. In 2007 around 430 per 100,000 persons aged 65 and over were discharged from hospital with a fractured neck of
Date: 13.02.12 Version: 1 Page 107 of 318 Public Health Wales North Wales Profile 2011 femur in North Wales, compared to 500 per 100,000 in Wales. Rates of hip fracture in females are around double that of males (520 per 100,000 compared to 270 per 100,000 in North Wales in 2007). This is likely due to the higher risk of osteoporosis in women. Table 38: Hospital discharge numbers due to fractured neck of femur in North Wales, all persons aged 65 years and over, 2011 2007 Numbers 2001 2002 2003 2004 2005 2006 2007
Wales 2,766 3,223 3,333 3,206 3,361 3,432 3,444 North Wales 590 769 754 712 710 752 729 Isle of Anglesey 41 48 37 53 49 58 59 Gwynedd 72 76 87 73 90 98 89 Conwy 136 171 162 171 144 165 137 Denbighshire 103 151 158 126 98 113 132 Flintshire 114 140 121 152 205 161 191 Wrexham 124 183 189 137 124 157 121
Source: eHealthShow Table 39: Hospital discharges due to fractured neck of femur in North Wales, all persons aged 65 years and over, 2001 2007, European age standardised rate per 100,000 EASR per 100,000 2001 2002 2003 2004 2005 2006 2007
Wales 452 511 522 498 513 512 504 North Wales 385 487 489 456 435 459 428 Isle of Anglesey 267 314 225 328 287 348 333 Gwynedd 261 268 317 276 307 347 300 Conwy 398 494 486 512 419 465 365 Denbighshire 425 569 660 497 371 431 486 Flintshire 430 521 455 556 715 552 634 Wrexham 491 703 724 512 456 573 434
Source: eHealthShow Table 40: Hospital discharge numbers due to fractured neck of femur in North Wales, females aged 65 years and over, 2011 2007
Date: 13.02.12 Version: 1 Page 108 of 318 Public Health Wales North Wales Profile 2011 Numbers 2001 2002 2003 2004 2005 2006 2007
Wales 2,223 2,573 2,657 2,563 2,642 2,688 2,638 North Wales 485 596 590 565 572 604 560 Isle of Anglesey 29 37 28 37 39 50 48 Gwynedd 56 60 69 61 69 78 71 Conwy 111 130 127 128 119 134 112 Denbighshire 85 124 123 104 83 89 98 Flintshire 96 113 89 122 161 119 141 Wrexham 108 132 154 113 101 134 90
Source: eHealthShow Table 41: Hospital discharges due to fractured neck of femur in North Wales, females aged 65 years and over, 2001 2007, European age standardised rate per 100,000 EASR per 100,000 2001 2002 2003 2004 2005 2006 2007
Wales 575 643 655 634 647 647 629 North Wales 495 595 588 578 556 586 523 Isle of Anglesey 286 411 272 372 367 499 435 Gwynedd 327 328 390 378 371 456 394 Conwy 489 599 604 614 547 589 483 Denbighshire 553 708 761 654 513 554 564 Flintshire 563 680 519 728 891 646 735 Wrexham 681 783 892 646 584 756 519
Source: eHealthShow Table 42: Hospital discharge numbers due to fractured neck of femur in North Wales, males aged 65 years and over, 2001 2007 Numbers 2001 2002 2003 2004 2005 2006 2007
Wales 543 646 676 643 719 744 806 North Wales 105 170 164 147 138 148 169 Isle of Anglesey 12 11 9 16 10 8 11 Gwynedd 16 16 18 12 21 20 18 Conwy 25 41 35 43 25 31 25 Denbighshire 18 27 35 22 15 24 34 Flintshire 18 25 32 30 44 42 50 Wrexham 16 50 35 24 23 23 31
Source: eHealthShow
Date: 13.02.12 Version: 1 Page 109 of 318 Public Health Wales North Wales Profile 2011 Table 43: Hospital discharges due to fractured neck of femur in North Wales, males aged 65 years and over, 2001 2007, European age standardised rate per 100,000 EASR per 100,000 2001 2002 2003 2004 2005 2006 2007
Wales 250 296 302 275 299 300 313 North Wales 195 320 313 256 233 250 270 Isle of Anglesey 214 198 155 245 153 128 172 Gwynedd 172 166 192 116 198 186 171 Conwy 212 347 312 359 196 258 170 Denbighshire 203 310 433 241 151 246 343 Flintshire 200 271 339 295 426 391 450 Wrexham 183 593 413 253 241 240 301
Source: eHealthShow Fracture incidence and costs will rise by over 1% per annum simply as a result of the ageing of the Welsh population. Figure 71 shows the forecast demand for hip fracture related hospital treatment to 2025, by age group. Figure 71: Forecast demand for hip fracture related hospital treatment to 2025, by age group. Application of current level of hospital activity to population projections, number of people having at least one hip fracture, North Wales resident population, all persons source: PEDW, NPHS 1600 1400 1200 1000 800 600
Number of Numberpeople 400 200 0 Baseline 2009 2012 2015 2018 2021 2024 2027 (average of 2004- 06) 00-14 15-64 65-74 75-84 85+ 7.3.2 Public health strategies to counter falls and fractures
Date: 13.02.12 Version: 1 Page 110 of 318 Public Health Wales North Wales Profile 2011 Public health strategies aim to reduce the incidence and the impact of falls. These include actions to encourage appropriate weight bearing and strength enhancing physical activity, to promote healthy eating (including adequate intake of calcium) and to reduce smoking in the general population. Access to regular sight and eye health checks are also important as poor vision is often a factor in falls (Welsh Assembly Government, 2006b). 7.4 Road traffic casualties In 2010 there were 2,470 road casualties recorded in North Wales; the highest number occurred in Flintshire. Table 44: Police recorded road casualties, 2010 Numbers 2005 2006 2007 2008 2009 2010
North Wales 2,684 3,052 2,778 2,840 2,610 2,470 Isle of Anglesey 198 240 203 164 225 158 Gwynedd 514 556 534 544 478 508 Conwy 424 523 460 512 497 394 Denbighshire 376 441 464 500 408 406 Flintshire 630 696 663 651 541 572 Wrexham 542 596 454 469 461 432
Source: Welsh Government 2010
Date: 13.02.12 Version: 1 Page 111 of 318 Public Health Wales North Wales Profile 2011 8 Mental Health
Key Messages • The mental health component summary score for North Wales is just above the average for Wales, indicating better mental health. • People in North Wales report lower rates of mental illness requiring treatment compared to Wales as a whole. • The number of adults in North Wales reporting current treatment for a mental health problem is predicted to increase from just under 19,500 in 2011 to 21,500 by 2030. • Welsh Health Survey data show that people with mental health problems also report higher levels of physical health problems. • In North Wales, suicide rates among males are statistically significantly higher in Denbighshire and Conwy compared to the Wales average. Suicide rates among females in Conwy are statistically significantly higher than the average for Wales. • During the period 2005 to 2009, North Wales had the second highest rate of paediatric admissions for mental disorders in Wales. • Just under 10,000 older people in North Wales have dementia; the prevalence is expected to almost double by 2030.
Mental health is an important aspect of health and well being. Mental illness can have a detrimental effect on the functioning of the individual and the community in which they live. Psychological distress is a contributing factor to unemployment, homelessness, social exclusion, crime, and substance misuse and vice versa. For example, in North Wales, an estimated 71,503 people received incapacity benefit in 2010 due to mental illness (Office for National Statistics, 2011). Date: 13.02.12 Version: 1 Page 112 of 318 Public Health Wales North Wales Profile 2011 8.1 Prevalence of mental health conditions Mental health is difficult to measure as information on the incidence and prevalence of psychiatric illness is limited. Different sources of data can be used to estimate the prevalence of mental illness, although caution is needed when drawing conclusions from these data. For example, diagnostic labels attached to a group of symptoms can be misleading, as psychiatric morbidity may be a continuum of psychological states as opposed to discrete entities. For every patient that presents to health care services for mental health problems, there will be several more in the community who are undiagnosed . The Welsh Health Survey is a continuous survey that collects information about the health of people living in Wales. It comprises of an interview followed by a self completion questionnaire (Welsh Government, 2011b). The Welsh Health Survey gives a picture of how the people of North Wales rate their own mental health. The SF 36 questionnaire is a self completed questionnaire commonly used as a measure of functioning and health. The mental component summary score (MHS) gives an indication of the presence of psychiatric symptoms. A higher score indicates better mental health. Table 45 shows that the MHS for North Wales is slightly better than Wales as a whole. Table 45: Mental health component summary score, adults aged 16 years and over, North Wales 2009/2010 Percentage Wales 49.9 North Wales 50.8 Isle of Anglesey 50.6 Gwynedd 51.0 Conwy 51.1 Denbighshire 50.6 Flintshire 51.3 Wrexham 50.2 Source: Welsh Health Survey * Higher score indicates better health
Date: 13.02.12 Version: 1 Page 113 of 318 Public Health Wales North Wales Profile 2011 Data from the Welsh Health Survey can also be used to estimate how many people in North Wales may be suffering from a mental health problem, and how these numbers may change over time. The Welsh Health Survey asks participants whether they are currently being treated for a mental illness. Figure 72 shows that the age standardised percent of adults who report being currently treated for a mental illness in North Wales was 9% in 2009/10; this compares to 10% for the whole of Wales. Therefore, people living in North Wales report lower rates of mental illness requiring treatment compared to Wales as a whole.
Figure 72: Adults who report being currently treated for a mental illness, 2009/10 Source: Welsh Health Survey 2009/10
11 10 10 9 9 9 8 7 Wrexham Conwy Wales Betsi Cadwaladr Gwynedd Isle of Anglesey Flintshire Denbighshire University
Data from the Welsh Health Survey can be used to see how numbers change over time. Figure 73 was generated from prevalence rates from the Welsh Health Survey and applied to population projections to 2030. It shows that the number of adults in North Wales with a mental health problem is predicted to increase to almost 21,500 by 2030.
Date: 13.02.12 Version: 1 Page 114 of 318 Public Health Wales North Wales Profile 2011 Figure 73 : Population aged 16 years and over predicted to have a mental health problem, North Wales, 2011 2030 Source: Welsh Government Statistical Directorate (Daffodil)
The Quality and Outcomes Framework can provide very rough estimates of the prevalence of important psychiatric disorders. This data is likely to underestimate the true prevalence because it relies on the patient presenting to a GP for treatment, receiving a diagnosis from the GP, and being entered onto a disease register. There will be many patients in the community with symptoms of a psychological disorder who do not have an encounter with their GP. In addition, many patients are not put onto a register despite being treated for a mental health condition. This is particularly true of mental illnesses, as patients and healthcare workers may be wary of the continuing stigma attached to ill mental health. Therefore, it is important to interpret these estimates with caution. Table 50 shows the number of patients in North Wales on relevant QoF disease registers. Table 46: Number of people on QoF disease registers, North Wales, 2010 11 Condition Number on register
Depression 01 (patients on the diabetes mellitus 56,869 and/or coronary heart disease register)
Depression 02 (patients diagnosed with 61,549 depression ever, where ‘depression resolved’ has not been recorded following the latest diagnosis)
Dementia (patients diagnosed with dementia ever) 3,957
Mental Health (patients diagnosed with 5,250 schizophrenia, bipolar disorder or other psychosis; or patients currently being treated with lithium) Source: QoF/StatWales Date: 13.02.12 Version: 1 Page 115 of 318 Public Health Wales North Wales Profile 2011 The Adult Psychiatric Morbidity Survey 2007 was a comprehensive survey conducted to estimate the prevalence of mental health disorders from a representative sample of households in England (McManus & Meltzer, 2011). Although this survey did not include participants from Wales, the previous survey conducted in 2000 showed that the methodology has good applicability to Wales. Therefore, data from this survey can be used to estimate the prevalence of common psychiatric disorders in North Wales, shown in Table 47. Prevalences determined by the survey were applied to the ONS 2010 mid year population estimates for North Wales for those aged 16 and above. Table 47: Estimated numbers of adults in North Wales suffering from mental health problems Estimated number of Estimated people affected in Condition Prevalence North Wales aged 16 and above At least one of the common mental 16.2% 88,960 disorders Mixed anxiety and depressive disorder 9% 50,040
Generalised anxiety disorder 4.4% 24,460
Major depressive episode 2.3% 12,790
Phobias 1.4% 7,780
Obsessive Compulsive Disorder 1.1% 6,116
Panic disorder 1.1% 6,116
Source: Adult Psychiatric Morbidity Survey 2007/ONS 2010 The estimated prevalence of a common mental disorder as generated by the Adult Psychiatric Morbidity Survey and the Welsh Health Survey is over twice the estimate of people who report being treated for a mental health problem. This suggests that there could be many affected people in the population who are not seeking help for various reasons. Date: 13.02.12 Version: 1 Page 116 of 318 Public Health Wales North Wales Profile 2011 8.2 Mental and Physical Health Physical ill health is associated with mental ill health. Those with poorer physical health are at risk from suffering from a mental illness and vice versa. Figure 74 shows that those with mental health problems also have higher levels of physical health problems (Thomas, 2011). Figure 74: Self reported chronic conditions in people with and without mental health problems, Wales 2005 Source: Welsh Health Survey 2005 from Public Health Wales Cwm Taf Mental Health Needs Epidemiology, 2011 Percentage
8.3 Suicide The Office of National Statistics defines suicide as a death caused by intentional self harm or caused by injury or poisoning of undetermined intent (Welsh Government, 2011b). In England and Wales, it has been customary to assume that most injuries and poisonings of undetermined intent are caused where the harm was self inflicted but there was insufficient evidence to prove that the deceased deliberately intended to kill themselves. For comparability, this definition of undetermined intent has been used across all countries of the UK.
Date: 13.02.12 Version: 1 Page 117 of 318 Public Health Wales North Wales Profile 2011 The causes of suicide are complex. A summary of evidence on suicide prevention cited a number of factors associated with an increased risk of suicide including gender (male); age (15 to 44 year olds); socio economic deprivation; psychiatric illness including major depression; bipolar disorder; anxiety disorders; physical illness such as cancer; a history of self harm and family history of suicide. It is important that recognition is given to the fact that suicides are an uncommon occurrence. Small area analyses should be interpreted with caution, as rates can vary dramatically due to a small number of cases; suicide data is also subject to a number of caveats. Suicide rates in Wales rank amongst the lowest when compared with other Organisation for Economic Co operation and Development (OECD) countries, in both males and females. However, suicide rates in Wales are higher than the UK average in both sexes. There were approximately 280 deaths from suicide per year in Wales in the period 2001 2009. In Wales, suicide rates peaked among males between the ages 20 and 39; there was a secondary peak among elderly males in the same period. In females, the highest rates were seen among those aged 40 to 54. Suicide rates have decreased among young men (age 15 to 24 years) in Wales between 2001 to 2009. Figure 75 shows that within North Wales, rates for suicide among men registered between 1996 and 2006 were statistically significantly higher in Denbighshire and Conwy compared to the Wales average.
Date: 13.02.12 Version: 1 Page 118 of 318 Public Health Wales North Wales Profile 2011 Figure 75: European age standardised rates, suicide or event of undetermined intent, males aged 15 years and over, 1996 2006
Date: 13.02.12 Version: 1 Page 119 of 318 Public Health Wales North Wales Profile 2011 Figure 76 shows rates for suicide among women registered between 1996 and 2006 in Conwy were statistically significantly higher compared to the Welsh average. Figure 76 : European age standardised rates, suicide or event of undetermined intent, females aged 15 years and over, 1996 2006
Further Information • National Public Health Service: Suicide in Wales Briefing document to Bridgend Local Health Board http://nww2.nphs.wales.nhs.uk:8080/HIATDocs.nsf/Public/A2A71FA69F7B00B6802573 E60047DD41/$file/Suicide_brief_Bridgend_LHB_v2.doc?OpenElement Date: 13.02.12 Version: 1 Page 120 of 318 Public Health Wales North Wales Profile 2011 8.4 Mental health in children and young adults One in ten children in the UK have a mental health disorder (Department of Health, 2004a). There are many factors that can increase the vulnerability of young people to psychiatric illness, including contact with social services, illicit substance abuse and a family history of suicide or psychiatric disorder. Reasons for children calling the helpline Childline gives an indication of issues that contribute towards psychological distress in children. Table 48: Calls to Childline, top ten reasons UK, 2010 o Family relationship
o Bullying
o Physical abuse
o General content
o Sexual abuse
o Facts of life
o Depression/mental health
o Other
o Problem with friends
o Partner relationship It is possible to estimate the prevalence of mental health problems in children using a previous ONS survey, Prevalence of psychiatric disorders by sex and age, 1999. Figure 77 estimates the number of children in North Wales with mental health problems. Date: 13.02.12 Version: 1 Page 121 of 318 Public Health Wales North Wales Profile 2011 Figure 77: Estimated number of children with any mental health problem in North Wales, 2011 Source: Welsh Government Statistical Directorate (Daffodil) 6,000
5,000
4,000
3,000
2,000
1,000
0 Males, Males, Males, Females, Females, Females, 5 10 11 15 5 15 5 10 11 15 5 15 years years years years years years Table 49 shows the estimated number of children in North Wales suffering from different mental health disorders, obtained by applying prevalences obtained from the survey Mental Health of Children and Young People in Great Britain, 2004 (Department of Health, 2004a), to mid year population estimates for 2010 from ONS. Table 49: Estimated numbers of children in North Wales suffering from mental health problems Condition Estimated Prevalence Number of children Emotional disorder 4% 4,900 Conduct disorder 6% 7,300 Hyperkinetic disorder 2% 2,500 Other disorder* 1% 1,250 More than one disorder 2% 2,500 Source: Department of Health & Office for National Statistics *Includes autism and anorexia nervosa Most children with mental health problems who present to health services will be treated by their GPs or in outpatients. However, sometimes, children need to be admitted to hospital for treatment; anorexia nervosa, post traumatic stress disorder, bipolar disorder and depression are the commonest reasons leading to hospital admissions in children (Thomas, 2011). Figure 78 shows that in 2005 9, North Wales had the second highest rate of paediatric hospital admissions for mental health disorders in Wales.
Date: 13.02.12 Version: 1 Page 122 of 318 Public Health Wales North Wales Profile 2011 Figure 78: Rate of Hospital admissions where the primary diagnosis was a mental health disorder, all persons aged 0 17 years, 2005 2009 Source: Public Health Wales Observatory
19.4
16.7
12.1 11.3 10.4 9.2 7.4
4.7
Cwm Taf Powys Abertawe Aneurin Cardiff & Wales* Betsi Hywel Dda Teaching BMU Bevan Vale Cadwalader
Date: 13.02.12 Version: 1 Page 123 of 318 Public Health Wales North Wales Profile 2011 8.5 Mental health in older people Older people are vulnerable to experiencing mental health problems. Older people are at risk of social exclusion, reduced income, age related degeneration and poor physical health, which are all risk factors for poor mental health. Dementia is an important mental health condition of old age, as it is a significant cause of morbidity, mortality and health care use. As people live longer, the prevalence of dementia is likely to increase. It is estimated that there are currently 9,800 number of people aged 65 and over in North Wales with dementia (Welsh Government Statistical Directorate, 2011). It is possible to predict the likely future burden of dementia by calculating projections. Figure 79 shows that the prevalence of dementia in North Wales is expected to almost double by 2030. Figure 79: Estimated number of people in North Wales suffering with dementia, 2011 2030 Source: Welsh Government Statistical Directorate (Daffodil)
Date: 13.02.12 Version: 1 Page 124 of 318 Public Health Wales North Wales Profile 2011 8.6 Mental Health Service Activity A fifth of the NHS expenditure for Wales is on mental health services. Many services are involved in treated patients with mental health problems. A large proportion of attendances to A&E and general admissions to hospital are related to mental health problems. North Wales has several units and facilities for people with mental health needs. Figure 80 shows that North Wales has approximately 0.4 mental illness inpatient beds per 1,000 adult population, which is in the middle of the range in Wales. It has about the same number of old age psychiatry inpatient beds, which is the second lowest provision in Wales. Figure 80: Mental illness inpatient beds Source: Welsh Health Survey 2005 from Public Health Wales Cwm Taf Mental Health Needs Epidemiology, 2011
Date: 13.02.12 Version: 1 Page 125 of 318 Public Health Wales North Wales Profile 2011 Figure 81: Old age psychiatry beds Source: Welsh Health Survey 2005 from Public Health Wales Cwm Taf Mental Health Needs Epidemiology, 2011
Based on estimated adult population to be 61% of total population (2009 ONS midyear) OAP = Old Age Psychiatry CHC = Continuing Health Care Figure 82 shows that since 2006, total admissions to mental health facilities in BCU have been increasing. Figure 82: Total admissions to mental health facilities in Betsi Cadwaladr University Health Board, 2005 2010 Source: Public Health Wales Observatory
Date: 13.02.12 Version: 1 Page 126 of 318 Public Health Wales North Wales Profile 2011 Figure 83 shows that the vast majority of admissions to mental health facilities in North Wales, as with the rest of Wales, are on an informal basis. Figure 83: Source: Welsh Health Survey 2005 from Public Health Wales Cwm Taf Mental Health Needs Epidemiology, 2011
Community mental health teams support patients outside of the hospital environments. Local authorities provide care and support for people with mental illnesses in the community. Residential care, day services and outreach teams are an important part of psychiatric care.
Date: 13.02.12 Version: 1 Page 127 of 318 Public Health Wales North Wales Profile 2011 9 Lifestyle Key Messages • There are other measures, interventions, lifestyle factors and activities of daily living that will have an influence on health, well being and risks associated with experiencing and managing ill health. Many of these risks can be modified through lifestyle changes coupled with timely support and health promoting policies at local and national levels. • Lifestyle indicators in North Wales are generally better than, or similar to, the Wales average. However, the Welsh Health Survey and European School Survey show that adults and young people are not meeting the recommended levels for a healthy lifestyle. • The consequences of an unhealthy diet and a sedentary lifestyle are well documented. Through the results shown in this section from the Welsh Health Survey and European School Survey reported below, we can conclude that in North Wales nearly two thirds of the adult and school age population (older children) do not meet recommended guidelines for diet and physical activity. • The above are important factors in relation to risks associated with being overweight or obese. Over half the adult population (54%) in North Wales are overweight or obese, 34% of children are estimated to be overweight or obese, with 19% estimated to be obese. • Breastfeeding has proven benefits for both mother and baby. Exclusive breastfeeding is recommended up to six months of age. Routine data show that the proportion of babies breastfed at birth is around 50%; the figure then rapidly declines. The 2010 Infant Feeding Survey found a clear association between breastfeeding and socio economic status; incidence of breastfeeding is lowest in the most deprived groups. • Smoking is a major cause of health inequalities and poor health outcomes. 37% of the population smoke in the most deprived areas of Wales compared to 14% in the least deprived areas. Although recent trends have seen a decline in smoking rates across Wales, nearly one in four adults continue to smoke, (range is 22% in Anglesey, Conwy and Flintshire to 26% in Wrexham), and compared to the rest of Europe our rates remain too high.
Date: 13.02.12 Version: 1 Page 128 of 318 Public Health Wales North Wales Profile 2011 • The percentage of young people reporting smoking weekly or more in North Wales is 7% compared to 6% across Wales. • Smoking levels before or during pregnancy are highest in Wales at 16% compared to 12% across the UK. • In North Wales, smoking attributable death rates for males and females are highest in Wrexham. • Alcohol and substance misuse contribute to ill health and premature death. According to the Welsh Health Survey nearly 44% of the population of North Wales report drinking alcohol above recommended guidelines; 27% report binge drinking on at least one day of the previous week at the time of the survey. • The percentage of young people reporting drinking one or more alcoholic drinks weekly in North Wales is 17% compared to 16% across Wales. • Alcohol related hospital admissions are increasing and Anglesey has the highest rate for males, with Conwy and Denbighshire having the highest rate of admissions for females. • Anglesey hospital admission rates for males due to illicit drug use (331 per 100,000) is nearly double the rate for North Wales (173 per 100,000). • The percentage of young people reporting using drugs in the last 12 months in North Wales and across Wales is 9%. • There has been a continued upward trend in the reporting of sexually transmitted infections, this may be partly attributable to increased awareness and improved diagnostic techniques, i.e. for Chlamydia. A healthy lifestyle is an important achievable goal for all sectors of society. Lifestyle includes a number of modifiable risk factors for health and has been recognised as an important area within public health as outlined by the strategic report Our Healthy Future (Welsh Assembly Government, 2009a). Lifestyle indicators in North Wales are generally better than, or similar to, the Wales average (Public Health Wales Observatory, 2011).
Date: 13.02.12 Version: 1 Page 129 of 318 Public Health Wales North Wales Profile 2011 9.1 Nutrition A healthy balanced diet is important for good health; it is also an essential requisite for healthy growth and development in children and adolescents (Welsh Assembly Government, 2006a). NICE Guidance • Maternal and child nutrition : guidance on improving nutrition and breastfeeding in low income households http://guidance.nice.org.uk/PH11 According to Figure 84, just over one third of the population (36%) in Wales self report eating the recommended levels of fruit and vegetables daily (five portions a day). In North Wales, the level is slightly higher at 37%; Gwynedd has the highest percentage, 42% and Wrexham has the lowest, 31%. Figure 84: Adults who reported eating five/more portions fruit/veg the previous day by local authority/health board, age standardised percentage, 2008 2009 Produced by Public Health Wales Observatory using data from the Welsh Health Survey, 2008 and 2009
Wales = 36
42 41 39 39 39 39 39 39 40 37 37 37 37 38 37 38 35 34 33 33 33 33 31 32 32 29 29 28 29 Powys Powys Cardiff Conwy Torfaen Newport Cwm Taf Swansea Bridgend Flintshire Gwynedd Wrexham Caerphilly Hywel Dda Ceredigion Denbighshire Merthyr Tydfil Aneurin Bevan Pembrokeshire Blaenau Gwent Monmouthshire Betsi Cadwaladr Isle of Anglesey Carmarthenshire Neath Port Talbot Rhondda Cynon Taf The Vale of Glamorgan Cardiff & Vale University Abertawe Bro Morgannwg
Areas ordered geographically from north west to south east
Date: 13.02.12 Version: 1 Page 130 of 318 Public Health Wales North Wales Profile 2011 9.1.1 Nutrition & Children in Young People In Wales, slightly more girls than boys report eating fruit on a daily basis (Welsh Assembly Government, 2011a). The proportion of 11 to 16 year olds eating fruit regularly declines with age (Welsh Assembly Government, 2011a). Children from the most affluent families are more likely than those from middle and low affluence groups to eat fruit daily (Welsh Assembly Government, 2011a). In North Wales, 29% of boys and girls aged 11 to 16 years report eating fruit on a daily basis (Welsh Assembly Government, 2011a), shown in Figure 85. Figure 85: Percentage eating fruit daily, persons aged 11 to 16 year olds, by Health Board area, 2009 Source: Health Behaviour in School aged Children Survey, 2009/2010
39 Wales average = 31% 35 33 28 29 29 28
Abertawe Aneurin Betsi Cardiff & Cwm Taf Hywel Dda Powys BMU Bevan Cadwaladr Vale Teaching Further Information • Health Behaviour in School aged Children Survey, Wales http://wales.gov.uk/topics/health/research/research/behaviour/?lang=en Date: 13.02.12 Version: 1 Page 131 of 318 Public Health Wales North Wales Profile 2011 9.1.2 Breastfeeding Breastfeeding can have a positive impact on the health of women and children. Within Wales, around 50% of mothers initiate breastfeeding but unfortunately levels rapidly decline and only a third of mothers remain breastfeeding by two months (Welsh Assembly Government 2009b). Data from the National Community Child Health Database (NCCHD) show that breastfeeding rates for low birth weight babies, babies of low gestational age at birth and multiple births are lower than average (Welsh Assembly Government 2009b). Table 50 shows breastfeeding rates in North Wales as highest in Conwy and lowest in Flintshire. Table 50: Breastfeeding status at birth, 2010 Breastfeeding Not breastfeeding Breastfeeding not stated Live births Number % Number % Number %
Wales 36,033 17,983 49.9 14,524 40.3 3,526 9.8 North Wales 7,635 3,959 51.9 2,785 36.5 891 11.7 Anglesey 792 422 53.3 274 34.6 96 12.1 Gwynedd 1,243 671 54.0 407 32.7 165 13.3 Conwy 1,126 655 58.2 408 36.2 63 5.6 Denbighshire 1,040 534 51.3 412 39.6 94 9.0 Flintshire 1,750 835 47.7 657 37.5 258 14.7 Wrexham 1,684 842 50.0 627 37.2 215 12.8
Source: STATS Wales The 2010 Infant Feeding Survey found 71% of mothers in Wales reported breast feeding compared to 81% across the UK. As with previous years, the 2010 Survey found a clear association between breastfeeding and socio economic status. Incidence of breastfeeding remains highest in the least deprived groups (NHS Information Centre 2011). Further information • National Community Child Health Database http://wales.gov.uk/topics/statistics/headlines/health2011/110713/?lang=en • Public Health Wales Observatory: Health eating and obesity resources http://howis.wales.nhs.uk/sitesplus/922/page/43920
Date: 13.02.12 Version: 1 Page 132 of 318 Public Health Wales North Wales Profile 2011 9.2 Physical Activity People who have a physically active lifestyle have approximately 50% less risk of developing coronary heart disease (CHD), stroke and type 2 diabetes mellitus (DM) compared to those who have a sedentary lifestyle, and can reduce their risk of premature death by about 20 to 30 per cent. (Department of Health, 2004b). NICE Guidance • Physical activity and the environment http://wales.gov.uk/topics/statistics/headlines/health2011/110713/?lang=en • Four commonly used methods to increase physical activity http://guidance.nice.org.uk/PH17 • Promoting physical activity in children and young people http://guidance.nice.org.uk/PH17 • Promoting physical activity in the workplace http://guidance.nice.org.uk/PH13 Within Wales, 34% of the population are classed as sedentary (i.e. not achieving 30 minutes of physical activity on any day of the week). The Welsh Health Survey shows the percentage of adults in North Wales who are currently meeting physical activity guidelines (those adults who do at least 30 minutes of moderate intensity physical activity on five or more days a week) currently stands at 31% (Table 51). Although this is 2% more than the all Wales average, there is no room for complacency as conversely this means that the majority of people in North Wales do not meet the guidelines and there is subsequently a need for many more people in both North Wales and at an all Wales level to be, and remain, physically active. Table 51: Percentage of adults who meet physical activity guidelines* Percentage 2003/05 2004/06 2005/07 2007/08 2008/09
Wales 29 30 30 30 29 North Wales 31 33 33 32 31 Anglesey 33 32 33 33 30 Gwynedd 35 37 36 35 34 Conwy 31 32 31 31 33 Denbighshire 32 35 34 34 33 Flintshire 30 29 30 30 30 Wrexham 25 32 36 30 28 Source: Welsh Health Survey *Guidelines recommend adults do at least 30 minutes of at least moderate intensity physical activity on five or more days a week. Respondents were asked to include physical activity which is part of their job Date: 13.02.12 Version: 1 Page 133 of 318 Public Health Wales North Wales Profile 2011 Figure 86 shows variation in UAs across Wales. Figure 86: Adults who reported meeting physical activity guidelines in the past week by local authority/health board, age standardised percentage, 2008 2009 Produced by Public Health Wales Observatory using data from the Welsh Health Survey, 2008 and 2009
Wales = 29
39 39 36 34 33 33 33 34 31 31 30 30 30 30 30 29 28 28 27 28 27 27 28 28 28 26 25 26 26 Powys Powys Cardiff Conwy Torfaen Newport Cwm Taf Swansea Bridgend Flintshire Gwynedd Wrexham Caerphilly Hywel Dda Ceredigion Denbighshire Merthyr Tydfil Aneurin Bevan Blaenau Gwent Pembrokeshire Monmouthshire Isle of Anglesey Betsi Cadwaladr Carmarthenshire Neath Port Talbot Rhondda Cynon Taf The Vale of Glamorgan Cardiff & Vale University Abertawe Bro Morgannwg
Areas ordered geographically from north west to south east 9.2.1 Physical Activity & Children in Young People The consequences of a sedentary lifestyle in childhood include overweight and obesity. Often these lifestyle behaviours, set down in childhood and adolescence can determine health outcomes behaviours in adult life (Welsh Assembly Government, 2006a). The Health Behaviour in School Aged Children Survey (HBSC) is undertaken across Europe every four years. The survey shows the proportion of young people meeting recommended activity levels declines between the ages of 11 and 15 years in Wales (World Health Organisation, 2006). Rates of physical activity vary substantially between girls and boys. Around one in three girls report doing 60 minutes five days a week
Date: 13.02.12 Version: 1 Page 134 of 318 Public Health Wales North Wales Profile 2011 compared to more than half of boys (Welsh Assembly Government, 2011a). Rates of physical activity decline slightly with age (Welsh Assembly Government, 2011a). Children from the highest income groups are slightly more likely to do regular exercise than those from the middle and lowest income groups (Welsh Assembly Government, 2011a). In North Wales, 45% of children aged 11 to 16 years report being physically active for 60 minutes or more, five days or more per week (Figure 87). Over half (53%) of boys in North Wales reported doing regular physical activity compared to 35% of girls in the region (Welsh Assembly Government, 2011a). Figure 87: Percentage of 11 to 16 year olds reporting being physically active for 60 minutes or more five days or more per week, by Health Board area, 2009 Source: Health Behaviour in School aged Children Survey, 2009/2010
Wales average = 44%
46 46 45 44 45 41 41
Abertawe Aneurin Betsi Cardiff & Cwm Taf Hywel Dda Powys BMU Bevan Cadwaladr Vale Teaching Further Information • Public Health Wales Observatory: Physical activity resources http://howis.wales.nhs.uk/sitesplus/922/page/36317 • Health Behaviour in School aged Children Survey, Wales http://wales.gov.uk/topics/health/research/research/behaviour/?lang=en Date: 13.02.12 Version: 1 Page 135 of 318 Public Health Wales North Wales Profile 2011 9.3 Overweight & Obesity Being overweight or obese significantly increases an individual’s risk of cardio vascular disease, diabetes mellitus and stroke (Department of Health, 2004b). Figure 88 shows that 57% of adults in Wales are overweight or obese. All areas in North Wales are lower than, or equal to, the average for Wales, however more than 50% of the population in North Wales are still overweight or obese. Figure 88: Adults who were overweight or obese by local authority and health board, age standardised percentage, 2008 2009 Produced by Public Health Wales Observatory using data from the Welsh Health Survey, 2008 and 2009
Wales = 57
62 63 59 60 59 60 61 60 60 60 59 61 60 58 56 57 55 56 56 57 55 55 55 54 52 53 52 54 53 Powys Powys Cardiff Conwy Torfaen Newport Cwm Taf Swansea Bridgend Flintshire Gwynedd Wrexham Caerphilly Hywel Dda Ceredigion Denbighshire Merthyr Tydfil Aneurin Bevan Blaenau Gwent Pembrokeshire Monmouthshire Isle of Anglesey Betsi Cadwaladr Carmarthenshire Neath Port Talbot Rhondda Cynon Taf The Vale of Glamorgan Cardiff & Vale University Abertawe Bro Morgannwg
Areas ordered geographically from north west to south east Figure 89 shows trends in overweight and obesity for the six UAs in North Wales.
Date: 13.02.12 Version: 1 Page 136 of 318 Public Health Wales North Wales Profile 2011 Figure 89: Persons aged 16+ who are overweight or obese (BMI 25+), age standardised %, Betsi Cadwaladr University Health Board local authority areas, 2004 to 2010 Produced by Public Health Wales Observatory, using WHS (WG) Local authority Wales
Isle of Anglesey Gwynedd 80
60
40
20
0
Conwy Denbighshire 80
60
40
20
Age standardised % 0
Flintshire Wrexham 80
60
40
20
0 2004 06 2005 07 2007 08 2008 09 2009 10 2004 06 2005 07 2007 08 2008 09 2009 10 Table 52 shows that 21% of adults in Wales report being obese. In North Wales, Anglesey has the highest percentage of obese adults, 20%, followed by Gwynedd, 19%. Table 52: Percentage of adults who reported being obese*, North Wales, 2008 + 2009 Percentage Wales 21 North Wales 18 Isle of Anglesey 20 Gwynedd 19 Conwy 17 Denbighshire 17 Flintshire 18 Wrexham 16 Source: Welsh Health Survey 2005/07 *Reported BMI of 30+
Date: 13.02.12 Version: 1 Page 137 of 318 Public Health Wales North Wales Profile 2011 Figure 90 shows trends in obesity for the six UAs in North Wales. Figure 90: Persons aged 16+ who are obese (BMI 30+), age standardised %, Betsi Cadwaladr University Health Board local authority areas, 2004 to 2010 Produced by Public Health Wales Observatory, using WHS (WG) Local authority Wales
Isle of Anglesey Gwynedd 25
20
15
10
5
0
Conwy Denbighshire 25
20
15
10
5
Age standardised % 0
Flintshire Wrexham 25
20
15
10
5
0 2004 06 2005 07 2007 08 2008 09 2009 10 2004 06 2005 07 2007 08 2008 09 2009 10
9.3.1 Overweight or Obese and Children in Young People The Welsh Health Survey (2009) noted that 34% of children in Wales were estimated to be overweight or obese, including 19% obese (Welsh Assembly Government 2010b). Figures for UAs are not available. The Health Behaviour in School Aged Children (HBSC) Survey is undertaken every four years and is a self reported study of the health behaviours of school children across Europe (Welsh Assembly Government, 2011a).
Date: 13.02.12 Version: 1 Page 138 of 318 Public Health Wales North Wales Profile 2011 Initial findings from the 2009/2010 HBSC Survey show that just under one in five secondary school students in Wales is overweight or obese (Welsh Assembly Government, 2011a). Figure 91 shows that rates of overweight and obesity are slightly higher in boys than in girls, but do not vary significantly by age or family affluence (Welsh Assembly Government, 2011a). Figure 91: Percentage of 11 to 16 year olds* reporting being overweight or obese, by Health Board area, 2009 Source: Health Behaviour in School aged Children Survey,
21 19
16
Total Girls Boys 2009/2010 *only includes respondents who gave valid height and weight measurements NICE Guidance • Weight management before, during and after pregnancy http://guidance.nice.org.uk/PH27 Further Information • Welsh Assembly Government Local Area Summary Statistics: Adult Obesity http://guidance.nice.org.uk/PH13 • Public Health Wales Observatory: Measuring childhood heights and weights in Wales http://www2.nphs.wales.nhs.uk:8080/PubHObservatoryProjDocs.nsf • Public Health Wales Observatory: Healthy eating and obesity • Health Behaviour in School aged Children Survey, Wales http://wales.gov.uk/topics/health/research/research/behaviour/?lang=en
Date: 13.02.12 Version: 1 Page 139 of 318 Public Health Wales North Wales Profile 2011 9.4 Tobacco Smoking causes almost 90% of deaths from lung cancer, around 80% of deaths from bronchitis and emphysema, and around 17% of deaths from heart disease (ASH, 2007). 37% of the population from the most deprived areas of Wales smoke compared to 14% from the least deprived areas. These differences are believed to be a major cause of health inequalities. Reducing smoking levels across Wales is a public health priority (Welsh Assembly Government, 2009a). NICE Guidance In terms of evidence on what interventions work, NICE has published the following guidance relevant to smoking: • Preventing the uptake of smoking in children and young people http://guidance.nice.org.uk/PH14 • Quitting smoking in pregnancy and following childbirth http://guidance.nice.org.uk/PH26 • School based interventions to prevent the uptake of smoking amongst children http://guidance.nice.org.uk/PH23 • Workplace interventions to promote smoking cessation http://guidance.nice.org.uk/PH5 • Brief interventions and referral for smoking cessation http://guidance.nice.org.uk/PH14 In 1978, an estimated 35% of people in Wales were smokers; this fell to 24% in 2008, although the decline has been slower in recent years. Generally there has been a downward smoking prevalence trend across North Wales, as shown in Figure 92. Figure 92: Adult current smokers by Local Authority, age standardised, Wales: 2004/05 to 2008/09 Data Source: Public Health Wales Observatory from WAG (Welsh Health Survey)
Isle of Anglesey Gwynedd Conwy Denbighshire Flintshire Wrexham Wales
32
30
28
26
24
22
20 2004/05 2005/06 2006/07 2007/08 2008/09
Date: 13.02.12 Version: 1 Page 140 of 318 Public Health Wales North Wales Profile 2011 Despite this decline of recent years, almost one in four adults in North Wales continue to smoke; prevalence rates range from 22% in Anglesey, Conwy and Flintshire to 26% in Wrexham (Figure 93). The prevalence rates in North Wales are the same as the average for Wales but still this level remains too high when compared to the best in the UK or Europe. Figure 93: Adults who reported being a current smoker by local authority and health board, age standardised percentage, 2008 2009 Produced by Public Health Wales Observatory using data from the Welsh Health Survey, 2008 and 2009
Wales = 24
30 26 27 26 26 24 25 25 24 24 25 24 25 24 24 24 22 22 22 22 22 23 22 22 23 23 23 23 20 Powys Powys Cardiff Conwy Torfaen Newport Cwm Taf Swansea Bridgend Flintshire Gwynedd Wrexham Caerphilly Hywel Dda Ceredigion Denbighshire Merthyr Tydfil Aneurin Bevan Blaenau Gwent Pembrokeshire Monmouthshire Isle of Anglesey Betsi Cadwaladr Carmarthenshire Neath Port Talbot Rhondda Cynon Taf The Vale of Glamorgan Cardiff & Vale University Abertawe Bro Morgannwg
Areas ordered geographically from north west to south east 9.4.1 Smoking related mortality The number of deaths caused by smoking within North Wales has been estimated at 1,300 annually. These numbers are based on a calculation of how many deaths from different diseases can be attributed to smoking. Table 53 shows that the highest male death rates attributable to smoking are seen in Wrexham and Denbighshire, both being higher than the all Wales rate. Conwy has a statistically significantly lower rate than Wales but this still represents a potentially preventable 301 male deaths per 100,000 population. The highest female smoking attributable death rates are found in Wrexham, Denbighshire and Flintshire; again these rates are higher than the
Date: 13.02.12 Version: 1 Page 141 of 318 Public Health Wales North Wales Profile 2011 all Wales rate. Gwynedd has a statistically significantly lower death rate in women than Wales. Table 53: Mortality from smoking, EASR per 100,000 population, North Wales, 2007 08 EASR per 100,000 Males Females
Wales 340 155 Betsi Cadwaladr 329 150 Isle of Anglesey 334 135 Gwynedd 312 131 Conwy 301 140 Denbighshire 341 161 Flintshire 329 161 Wrexham 367 173 Source: Welsh Health Survey, 2008 ONS 2007 Further Information • Public Health Wales Observatory: Measuring Inequalities, smoking attributable mortality aged 35 and over http://www.wales.nhs.uk/sitesplus/922/page/58379 9.4.2 Tobacco use in Children & Young People Smoking is generally more common in younger people. More than twice as many 16 to 24 year olds are smokers (24%) compared to people aged 65 years and over (10%) (World Health Organisation 2006). Figure 94 shows the percentage of 11 to 16 year olds in North Wales reporting smoking weekly or more is just above the average for Wales.
Date: 13.02.12 Version: 1 Page 142 of 318 Public Health Wales North Wales Profile 2011 Figure 94: Percentage of 11 to 16 year olds reporting smoking weekly or more, by Health Board area, 2009 Source: Health Behaviour in School aged Children Survey, 2009/2010
7 7 Wales average = 6% 6 6 6
5
4
Abertawe Aneurin Betsi Cardiff & Cwm Taf Hywel Dda Powys BMU Bevan Cadwaladr Vale Teaching NICE • School based interventions to prevent smoking (PH23) http://guidance.nice.org.uk/PH23 Further Information • Health Behaviour in School aged Children Survey, Wales http://wales.gov.uk/topics/health/research/research/behaviour/?lang=en 9.4.3 Smoking in Pregnancy In 2010, around a quarter (26%) of mothers in the UK smoked directly before or during their pregnancy. Smoking levels before or during pregnancy were highest in Wales (33%) and lowest in England (26%). Across the UK, one in eight mothers (12%) continued to smoke throughout pregnancy, and were still smoking after the baby was born. Mothers in Wales were most likely to smoke throughout their pregnancy (16%) (NHS Information Centre 2011). NICE Guidance • Smoking cessation services in primary care, local authorities and workplaces, particularly for manual workers groups, pregnancy, women and heard to reach communities http://www.nice.org.uk/PH10 • How to stop smoking in pregnancy and following child birth http://www.nice.org.uk/nicemedia/live/13023/49345/49345.pdf
Date: 13.02.12 Version: 1 Page 143 of 318 Public Health Wales North Wales Profile 2011 9.4.4 Smoking Cessation Services Engagement with NHS Stop Smoking Services increases the likelihood of a smoker successfully quitting smoking. Evidence shows that smoking cessation services are cost effective (Smoke Free London & World Health Organisation, 2001). NICE Guidance • Smoking cessation services http://guidance.nice.org.uk/PH10 The target for NHS Stop Smoking Services is to treat 5% of the estimated local population of people who smoke or use tobacco in any form each year. During 2010/11, Stop Smoking Wales made contact with 2,409 smokers in Wales, of which 1,292 became treated smokers. At four week follow up, 61.5% self reported that they had successfully quit smoking. Just over 40% of treated smokers were verified as not smoking at four week follow up by carbon monoxide monitoring (Stop Smoking Wales, 2011). Data from Stop Smoking Wales and the Pharmacy Level Three Enhanced Smoking Cessation Service will be used to measure progress against the target. Further Information • Welsh Assembly Government Local Area Summary Statistics: Adult smoking rate http://wales.gov.uk/topics/statistics/publications/localarea/?lang=en • Public Health Wales Observatory: Smoking resources http://howis.wales.nhs.uk/sitesplus/922/page/43928 • Stop Smoking Wales: Annual Report 2010/11 http://www.stopsmokingwales.com/sitesplus/documents/1006/SSW%20Annu al%20Report%20Final%202010 11%20ENGLISH.pdf Date: 13.02.12 Version: 1 Page 144 of 318 Public Health Wales North Wales Profile 2011 9.5 Alcohol Alcohol is a major preventable cause of death and illness in Wales. Around 1,000 deaths are due to alcohol per year in Wales. NICE Guidance • Preventing harmful drinking http://guidance.nice.org.uk/PH24 • School based interventions on alcohol http://guidance.nice.org.uk/PH7 Table 54 shows that the percentage of adults (aged 16 and over) in North Wales who reported drinking alcohol above guidelines is lower than the average for Wales, but 44% of adults (aged 16 years and over) drink alcohol above national guidelines (21 units per week for men and 14 units per week for women). Gwynedd has the highest level of excess alcohol ingestion within North Wales (47%). Table 54: Percentage of adults who drink alcohol above guidelines, 2008 + 2009 Percentage Wales 45 North Wales 44 Isle of Anglesey 43 Gwynedd 47 Conwy 42 Denbighshire 43 Flintshire 46 Wrexham 43 Source: Welsh Health Survey, 2008 *Above guidelines means men drinking more than 4 units a day and women drinking more than 3 units a day Binge drinking has declined over the last few years in young adults aged 16 to 24 years in Great Britain. This is an encouraging trend but levels are still high. Binge drinking is defined as men drinking more than eight units and women drinking more than six units of alcohol on any one day. Figure 95 shows that in North Wales, 27% of adults aged 16 and over reported binge drinking on at least one day in the past week.
Date: 13.02.12 Version: 1 Page 145 of 318 Public Health Wales North Wales Profile 2011 Figure 95: Adults who reported binge drinking on at least one day in the past week by local authority and health board, age standardised percentage, 2008 2009 Produced by Public Health Wales Observatory using data from the Welsh Health Survey, 2008 and 2009
Wales = 28
31 32 31 29 30 30 29 29 29 29 29 29 27 27 28 27 27 28 28 28 28 27 26 25 25 23 23 22 23 Powys Powys Cardiff Conwy Torfaen Newport Cwm Taf Swansea Bridgend Flintshire Gwynedd Wrexham Caerphilly Hywel Dda Ceredigion Denbighshire Merthyr Tydfil Aneurin Bevan Blaenau Gwent Pembrokeshire Monmouthshire Isle of Anglesey Betsi Cadwaladr Carmarthenshire Neath Port Talbot Rhondda Cynon Taf The Vale of Glamorgan Cardiff & Vale University Abertawe Bro Morgannwg
Areas ordered geographically from north west to south east
Date: 13.02.12 Version: 1 Page 146 of 318 Public Health Wales North Wales Profile 2011 9.5.1 Alcohol Use in Children & Young People Results from the Health Behaviour in School aged Children Survey show that 17% of 11 to 16 year olds report drinking one or more alcohol beverages weekly; this is just below the average for Wales (Welsh Assembly Government, 2011a), shown in Figure 96. Figure 96: Percentage of 11 to 16 year olds reporting drinking one or more alcohol beverages weekly, by Health Board area, 2009 Source: Health Behaviour in School aged Children Survey, 2009/2010
Wales average = 16% 21
18 17 17 16 15
12
Abertawe Aneurin Betsi Cardiff & Cwm Taf Hywel Dda Powys BMU Bevan Cadwaladr Vale Teaching Further Information • Health Behaviour in School aged Children Survey, Wales http://wales.gov.uk/topics/health/research/research/behaviour/?lang=en 9.5.2 Alcohol related hospital admissions The Wales trend for both alcohol related and alcohol attributable hospital admission rates is upwards, with rates approximately twice as high for males than females (Public Health Wales Observatory, 2010c). In 2008, there were 12,230 alcohol related hospital admissions in North Wales; just over 60% of these were males. Table 55 shows that the hospital admission rate due to alcohol for males is statistically significantly worse on Anglesey than the average for Wales (2,064 compared to 1,940). In Conwy and Denbighshire, the rates are statistically significantly worse for Date: 13.02.12 Version: 1 Page 147 of 318 Public Health Wales North Wales Profile 2011 females compared with the average for Wales (1,154 and 1,141 compared to 1,073). Table 55: Hospital admissions due to alcohol, EASR per 100,000 population, all persons, North Wales, 2008 EASR per 100,000 Males Females
Wales 1,940 1,073 North Wales 1,855 1,057 Isle of Anglesey 2,064 1,059 Gwynedd 1,959 1,103 Conwy 1,974 1,154 Denbighshire 1,911 1,141 Flintshire 1,817 1,006 Wrexham 1,588 937 Source: PEDW, 2008 9.5.3 Alcohol related mortality The alcohol related mortality rate for males almost doubled in the period of 1991 1993 to 2004 2006, although the trend has been levelling out in the latest UK rates released. The rate for persons in Wales in 2007 was slightly higher than the rate for England, but just over half the rate for Scotland (Public Health Wales Observatory 2010c). In 2008, there were 260 deaths from alcohol in North Wales; 65% of these were males. Table 56 shows that within North Wales, the areas with the highest male death rate from alcohol are Conwy and Denbighshire, and these are statistically significantly worse than the all Wales rate. The area with the highest death rate from alcohol for females within North Wales is Gwynedd (Public Health Wales Observatory, 2010d).
Date: 13.02.12 Version: 1 Page 148 of 318 Public Health Wales North Wales Profile 2011 Table 56: Mortality from alcohol, EASR per 100,000 population, North Wales, 2008 EASR per 100,000 Males Females
Wales 43 17 North Wales 43 19 Isle of Anglesey 40 18 Gwynedd 41 23 Conwy 50 19 Denbighshire 48 18 Flintshire 42 19 Wrexham 41 19 Source: PEDW, 2008 Substantial inequalities in alcohol attributable deaths are found between the most deprived and least deprived communities. The most deprived areas experience alcohol related mortality rates more than twice as high as the least deprived areas (Public Health Wales Observatory 2010c), shown in Figure 97. Figure 97: Alcohol-attributable deaths, European age- standardised rate (EASR) per 100,000, WIMD 5ths, persons, 2002-06 Source: ONS (ADBE, MYE); WAG (WIMD 2005) 95% confidence intervals are shown around the EASR EASR Crude rate 50
40
30 Wales EASR = 28.8
20 Rate per 100,000 per Rate
10
0 1 - least 2 3 4 5 - most deprived deprived Further Information • Public Health Wales Observatory: Measuring Inequalities, mortality due to alcohol
Date: 13.02.12 Version: 1 Page 149 of 318 Public Health Wales North Wales Profile 2011 9.5.4 Alcohol related crime The British Crime Survey 2009 10 reported that victims believed offenders to be under the influence of alcohol in half of all violent crimes (Home Office, 2010b). Further Information • Wales Centre for Health & National Public Health Service: Profile of Alcohol in Wales http://howis.wales.nhs.uk/sitesplus/922/page/36972 • Public Health Wales Observatory: Alcohol misuse resources http://howis.wales.nhs.uk/sitesplus/922/page/43911 • Welsh Assembly Government (2010) Local Area Summary Statistics: Rate of individuals referred to treatment for alcohol misuse http://wales.gov.uk/topics/statistics/publications/localarea/?lang=en
Date: 13.02.12 Version: 1 Page 150 of 318 Public Health Wales North Wales Profile 2011 9.6 Illicit drugs Over the last five years, the total number of drug related deaths in Wales has increased by over 30%. Hospital admissions for mental and behavioural disorders due to opioids and cocaine have also increased (Public Health Wales Observatory 2010c). NICE Guidance • Interventions to reduce substance misuse among vulnerable young people http://guidance.nice.org.uk/PH4 9.6.1 British Crime Survey results of illicit drug use The British Crime Survey 2009/10 reports that in one in five (20%) violent incidents, the victim believed the offender(s) to be under the influence of drugs (Home Office, 2010b). The same data source shows that overall illicit drug use among 16 to 59 year olds decreased from 11.1% in 1996 to 10.1% in 2008/09, due in part to successive declines in the use of cannabis between 2003/04 and 2007/08 (Home Office, 2010b). Estimates from the British Crime Survey 2010/11 show that around one in three adults aged 16 to 59 in England and Wales (36.3%) had ever used illicit drugs in their lifetime; almost 8.8% of 16 to 59 year olds reported using an illicit drug in the last year. Levels of any drug use are at around the lowest that they have been since measurement of drug prevalence began in the 1996 British Crime Survey (Home Office, 2011). The British Crime Survey reports that drug prevalence is greater amongst younger adults than for the adult population as a whole. Around two in five young people aged 16 to 24 years had ever used illicit drugs in their lifetime and one in five young people had used illicit drugs in the last year. Figures from the British Crime Survey show that more men than women had used any illicit drug and a Class A drug in the last year. The level of any illicit drug use among men was twice as high as that for women, 12% compared to 5.7%. Men were also more than twice as likely as women to have used a Class A drug in the last year, 4.2% compared to 1.8%. Date: 13.02.12 Version: 1 Page 151 of 318 Public Health Wales North Wales Profile 2011 9.6.2 Illicit drug related hospital admissions There were 590 hospital admissions due to illicit drug use in North Wales in 2008; over half of these were males. Table 57 shows that this equates to a male rate of 173 per 100,000 population and a female rate of 125 per 100,000 population. In comparison the Anglesey admission rate of males due to illicit drugs is nearly double that of North Wales. The highest female admission rates are seen in Gwynedd and Wrexham, both of which are statistically significantly worse than the all Wales rate. Table 57: Hospital admissions due to drugs, EASR per 100,000, males & females, North Wales, 2008 Males Females
Wales 171 112 North Wales 173 125 Isle of Anglesey 331 131 Gwynedd 197 160 Conwy 184 114 Denbighshire 166 106 Flintshire 105 102 Wrexham 162 143 Source: PEDW, 2008 9.6.3 Illicit Drug Use in Children & Young People There are up to 17,500 children and young people in Wales living in families affected by parental drug misuse (Public Health Wales Observatory, 2010c). The Health Behaviour in School aged Children Survey found that 9% of 11 to 16 year olds in North Wales report using drugs in the last 12 months; this is equal to the average across Wales (Welsh Assembly Government, 2011a), shown in Figure 98.
Date: 13.02.12 Version: 1 Page 152 of 318 Public Health Wales North Wales Profile 2011 Figure 98: Percentage of 11 to 16 year olds reporting using drugs in the last 12 months, by Health Board area, 2009 Source: Health Behaviour in School aged Children Survey, 2009/2010
9 9 9 Wales average = 9% 8 8 8 7
Abertawe Aneurin Betsi Cardiff & Cwm Taf Hywel Dda Powys BMU Bevan Cadwaladr Vale Teaching Further Information • Health Behaviour in School aged Children Survey, Wales http://wales.gov.uk/topics/health/research/research/behaviour/?lang=en • STATSWales: Substance misuse http://www.statswales.wales.gov.uk/ReportFolders/reportFolders.aspx • Wales Centre for Health & National Public Health Service for Wales: Profile of Alcohol in Wales http://howis.wales.nhs.uk/sitesplus/888/page/34017 • National Public Health Service for Wales: Needs Assessment Substance Misuse http://www.wales.nhs.uk/sitesplus/888/page/43654 9.7 Sexual behaviour Girls having sex under 16 years of age are three times more likely to become pregnant than those who first have sex over 16 years of age (Department for Education and Skills, 2006). The Health Behaviour in School aged Children Survey found that 33% of Year 11 students in Wales report having had sexual intercourse. Girls were more likely to report having had sexual intercourse than boys (Welsh Assembly Government, 2011), shown in Figure 99.
Date: 13.02.12 Version: 1 Page 153 of 318 Public Health Wales North Wales Profile 2011 Figure 99: Percentage of Year 11 students reporting having had sexual intercourse, Wales, 2009 Source: Health Behaviour in School aged Children Survey, 2009/2010 38
33
28
Total Girls Boys Further Information • Health Behaviour in School aged Children Survey, Wales http://wales.gov.uk/topics/health/research/research/behaviour/?lang=en 9.7.1 Sexually Transmitted Infections Key trends in sexually transmitted infections (STIs) in Wales include (Public Health Wales, 2011a): • The prevalence of HIV/AIDS in Wales continued to increase; in 2009 there were 1,193 Welsh residents receiving treatment for HIV/AIDS (40 per 100,000 population). This represents a 10% increase in the number of patients receiving treatment in 2008, and more than double the number in 2002. • The Health Protection Agency (HPA) reported 142 new cases of HIV infection in Wales in 2009. This represents a decrease from the previous year which saw the highest number of new cases in Wales since the start of the epidemic. • Between 2008 and 2009 the numbers of new cases of gonorrhoea diagnosed in genitourinary medicine (GUM) clinics in Wales increased. • The number of cases of infectious syphilis reported to the Enhanced Syphilis Surveillance Scheme decreased significantly, with just 55 cases reported in 2009 compared to 119 in 2008.
Date: 13.02.12 Version: 1 Page 154 of 318 Public Health Wales North Wales Profile 2011 • The number of episodes of uncomplicated chlamydia infection diagnosed in GUM in 2009 remains unchanged compared with 2008. NICE Guidance • Prevention of sexually transmitted infections http://www.nice.org.uk/PHI003 Chlamydia : is the most commonly diagnosed bacterial STI in the UK. Highest rates are seen in young people, especially men and women aged under 24 years (Public Health Wales, 2011a). Figure 100 shows how rates have climbed in Wales since 1991. Figure 100: Number of episodes and rates of uncomplicated chlamydia reported to GUM clinics in Wales: 1991 2009 Source: KC60 Data
Following an increase in the number of uncomplicated chlamydia infections in North Wales since 2002 (which may partly reflect the increased awareness and improved diagnostic techniques), numbers have begun to decline since 2005 (Table 58). Table 58: Episodes of uncomplicated chlamydia infection, North Wales, 2002 2009 Numbers 2002 2003 2004 2005 2006 2007 2008 2009
North Wales 611 649 739 1,348 1,148 1,104 963 919 Source: KC60 data Date: 13.02.12 Version: 1 Page 155 of 318 Public Health Wales North Wales Profile 2011 Figure 101 shows the rise in reports of uncomplicated chlamydia in Wales between 1994 and 2009 in those aged 15 to 19 years. Figure 101: Reports of uncomplicated Chlamydia, Wales, 1994 2009 Source: KC60 Data
Syphilis : there were 51 episodes of primary and secondary infectious syphilis reported in North Wales GUM clinics between 2002 and 2009, an average of 6.4 cases per year. In 2009, episodes of primary and secondary infectious syphilis in Wales were most frequently reported in men aged 20 to 24 years. In women, primary and secondary infectious syphilis was also most frequently reported in those aged 20 to 24 years (Public Health Wales, 2011a). Gonorrhoea : is the second most common bacterial STI in the UK (after chlamydia).The number of episodes of uncomplicated gonorrhoea in North Wales has declined since 2004. In Wales, the number of cases of uncomplicated gonorrhoea reported by GUM clinics in 2009 was higher than in 2008; this is the first increase in reported cases since the general decline in 2004 (Public Health Wales, 2011a), shown in Table 63. Table 59: Episodes of post pubertal uncomplicated gonorrhoea, North Wales 2002 2009 Numbers 2002 2003 2004 2005 2006 2007 2008 2009
North Wales 64 82 96 67 67 47 43 48 Source: KC60 data Further Information • Public Health Wales: HIV & STI trends in Wales http://nww2.nphs.wales.nhs.uk:8080/CommunitySurveillanceDocs.nsf/3dc046 69c9e1eaa880257062003b246b/3c401826e20f106e8025786900356115/$FIL E/HIV%20and%20STI%20trends%20in%20Wales%20Report%202009 Date: 13.02.12 Version: 1 Page 156 of 318 Public Health Wales North Wales Profile 2011 10_v1b%20201.pdf
Date: 13.02.12 Version: 1 Page 157 of 318 Public Health Wales North Wales Profile 2011 10 Family, Friends & Community Key Messages • “Social cohesion” – i.e. high levels of participation in community and public affairs; membership of community groups; and strong family networks – is associated with improved health for both individuals and communities. • Physical environments play an important role in supporting the development of social cohesion. Increased risks of unintentional injuries and falls are related both to aspects of social cohesion and physical environments, and are thus included in this section. • In North Wales, just over 38% of people aged 16 years and over live alone and 43% of 75 year olds and over. The impact of social networks such as friends and family, and the wider community are known important determinants of health and wellbeing (Dahlgren & Whitehead 1991). Social support is defined as ‘resources provided by other persons’. Belonging to a social network has a strong protective effect on health. Thus, people who receive less social and emotional support from others are more likely to experience a lower degree of well being, more depression, higher rates of pregnancy complications and disability from chronic diseases. Evidence has shown that those individuals with the fewest social connections (lack of participation in organisations, few friends and not being married) also have the highest mortality rate. Social support can have direct effects on health or can act as a buffer by moderating the impact of acute and chronic stressors. Social integration also has a positive effect on the whole community. There is increasing evidence that those communities with high levels of social cohesion (high levels of participation in communal and public affairs and high levels of membership of community groups) have better health than those communities with low levels. For example, social cohesion is related to community coronary heart disease rates. Social capital can be broadly defined as the resources within a community that create family and social organisation. These include civic engagement, trust, social relationships, formal and informal social networks and reciprocity. The physical environment, in particular transport and planning, play an important part in developing supportive environments within communities where people feel free to walk, cycle, use local Date: 13.02.12 Version: 1 Page 158 of 318 Public Health Wales North Wales Profile 2011 facilities and talk with each other. It has been recognised that the design of buildings and groups of building, their layout and the way in which buildings relate to one another may help to encourage or discourage neighbourliness and hence may have effects on health. ‘Semi private’ space is important in allowing people to make informal social contacts in a non threatening communal setting. This section describes data on a number of aspects which are important in developing and strengthening communities, and supporting self reliance and independence. 10.1 Carers Unpaid carers, that is, family, friends and neighbours provide around 70% of care in the community. Societal changes such as increases in single person households, lone parent families and mobility among family members are likely to reduce the availability of informal care. A decline in informal carers is likely to increase the demand for statutory health and social care services (Welsh Assembly Government, 2007). Further Information • Welsh Assembly Government, Welsh Health Survey 2008: Health of Carers http://wales.gov.uk/docs/statistics/2010/100224sb92010en.pdf 10.2 Household Composition Table 65 shows data on household composition for North Wales, based on census data from 2001. At the North Wales level, 30% of households are one person households, 37% are married couple households, 8% are cohabiting couples and 10% are lone parent households. Table 60 shows Conwy has the highest proportion of one person households as a proportion of total households at 33% and Wrexham has the lowest at 29%. Flintshire has the highest proportion of married couple households at 42% and Conwy has the lowest at 33%. Anglesey has the highest proportion of lone parent households at 11% and Conwy has the lowest at 9%. It should be noted that this data is now 10 years old and we are awaiting results from the 2011 Census. Date: 13.02.12 Version: 1 Page 159 of 318 Public Health Wales North Wales Profile 2011 Table 60: Household composition in North Wales, UA, 2001 Conwy Anglesey Flintshire Gwynedd Wrexham North Wales Denbighshire Total 28,356 49,237 48,062 39,892 60,539 53,226 279,312 Households One person 8,289 15,897 15,739 12,866 16,068 15,227 84,086 households Married couple 10,589 16,876 16,075 13,849 25,547 20,966 103,902 households Cohabiting couple 1,979 3,778 3,444 3,069 5,027 4,692 21,989 households Lone parent 2,998 4,838 4,252 3,836 5,860 5,171 26,955 households All other households 4,501 7,848 8,552 6,272 8,037 7,170 42,380 Source: Census 2001 Further Information • Welsh Assembly Government Local Area Summary Statistics: Housing http://wales.gov.uk/topics/statistics/publications/localarea/?lang=en 10.2.1 People living alone Table 61 shows data from the 2001 Census on the percentage of people aged over 16 years living alone. Gwynedd has the highest proportion of people living alone. It should be noted that this data is now 10 years old and will be updated when the results from the 2011 Census are published. Table 61: Persons aged over 16 years living alone, North Wales, 2001 Persons aged over 16 Persons living alone Persons living alone years (number) (%)
North Wales 523,123 200,910 38.4 Isle of Anglesey 53,150 20,396 38.4 Gwynedd 91,249 37,473 41.1 Conwy 87,200 33,420 38.3 Denbighshire 72,997 28,535 39.1 Flintshire 117,012 42,274 36.1 Wrexham 101,515 38,812 38.2
Source: Census 2001
Date: 13.02.12 Version: 1 Page 160 of 318 Public Health Wales North Wales Profile 2011 10.2.2 Older People Living Alone Table 62 shows data from the 2001 Census on the percentage of people aged 75 and over living alone. In North Wales, 43.2% of older people live alone compared to 43.0% in Wales as a whole. At the UA level, figures vary from 41.2% in Anglesey to 45.1% in Wrexham. Once again it should be noted that this data is now 10 years old and will be updated when the results from the 2011 Census are published. Table 62: Percentage of people aged 75 and over living alone, 2001 Percentage Wales 43.0 North Wales 43.2 Isle of Anglesey 41.2 Gwynedd 42.9 Conwy 41.4 Denbighshire 44.1 Flintshire 44.1 Wrexham 45.1 Source: Census 2001 Further Information • Welsh Assembly Government Local Area Summary Statistics: Older people supported in the community http://wales.gov.uk/topics/statistics/publications/localarea/?lang=en
Date: 13.02.12 Version: 1 Page 161 of 318 Public Health Wales North Wales Profile 2011 11 Deprivation Key Messages • The influence of social circumstances on health, well being and length and quality of life has long been recognised and described. • The most up to date deprivation measure, and the one recommended for use locally, is the Welsh Index of Multiple Deprivation (WIMD) 2011 at Lower Super Output Area (LSOA) level. • Denbighshire has the highest percentage of LSOAs in the most deprived 10% in Wales, the Isle of Anglesey the highest percentage in the most deprived 20%, Wrexham the highest percentage in the most deprived 30% and the Isle of Anglesey the highest percentage in the most deprived 50%. • Denbighshire has the highest percentage of people living in the most deprived 10% of LSOAs, Conwy the highest percentage in the most deprived 20%, Wrexham the highest percentage in the most deprived 30% and the Isle of Anglesey the highest percentage living in the most deprived 50%. • Denbighshire has the most number of people living in the most deprived 10% of LSOAs, and Wrexham has the most number of people living in the most deprived 20%, 30% and 50% of LSOAs in Wales. • LSOAs Rhyl West 2, Rhyl West 1 and Queensway 1 are in the top ten most deprived areas in Wales. • Free school meal entitlement is a potentially important indicator of deprivation. The highest levels of free school meal entitlement are in Anglesey for primary schools and Wrexham for secondary schools. • Higher proportions of children attending special schools are entitled to free school meals compared to those attending mainstream schools. Date: 13.02.12 Version: 1 Page 162 of 318 Public Health Wales North Wales Profile 2011 The influence of social circumstances on health, well being and length and quality of life has long been recognised and described. The recently published Marmot Review “Fair Society, Healthy Lives” is of particular importance in this respect (The Marmot Review 2010). Inequalities in health arise because of inequalities in society – through differences in which individuals are born, grow, live work and age. Although inequalities are most commonly described in terms of the socio economic deprivation in the areas in which people live, classifying individuals by their level of education, occupation or housing conditions will also reveal similar gradients in their health. As Marmot notes:
Social and economic differences in health status reflect, and are caused by, social and economic inequalities in society. The main mechanism that links the socio economic environment and poor health is likely to be psychosocial stress. Poor socio economic circumstances lead to anxiety, insecurity, low self esteem, social isolation and lack of control over work and home life. They also increase risk taking behaviour such as smoking, alcohol misuse, drug taking and unsafe sex. The socio economic environment also determines the level of exposure to physical environment hazards, such as poor housing and road traffic. 11.1 Measurement of Deprivation A number of indicators are used to measure and report deprivation. The different indices use a variety of data and, as a consequence, can produce slightly different conclusions. On the whole however, the same communities will be identified as most deprived whichever indicator is used. For completeness, this report will describe the different measures of deprivation and the geographical levels at which the data is available. However, the most up to date deprivation measure, and the one recommended for use locally, is the Welsh Index of Multiple Deprivation (WIMD) 2011 at Lower Super Output Area (LSOA) level. Date: 13.02.12 Version: 1 Page 163 of 318 Public Health Wales North Wales Profile 2011 11.1.1 Townsend Index The Townsend Index is a summary score providing an indicator of small area deprivation. It is calculated from four 2001 census based variables: • proportion of households with no car; • proportion of households not owner occupied; • proportion of unemployed economically active persons aged 16 to 59 years (females) and 16 to 64 years (males); • proportion of households overcrowded. Although now largely superseded by the WIMD, Townsend is still used for analyses when the unit of measurement is not the LSOA level e.g. GP practice based deprivation. 11.1.2 Welsh Index of Multiple Deprivation
The Welsh Index of Multiple Deprivation (WIMD) is a geographically based deprivation measure which can be used to show inequalities in health and suggest areas likely to most need measures to improve health and manage ill health. As with all area based measures, it has to be noted that not everyone living in a deprived area is necessarily living in deprived circumstances and, equally, some people living in an area classed as least deprived may experience deprivation.
WIMD is the official measure of relative deprivation for small areas in Wales. It is produced at Lower Super Output Area (LSOA), one of the statistical geographies used to report Census output. LSOAs have an average of 1500 people within them, and this inevitably means that the geographical size of the areas varies. There are 1896 LSOAs in Wales (425 in North Wales). The Index was originally developed to ensure that funding, policy and programmes can be effectively focussed on the most disadvantaged communities. It is important to note that deprivation is a wider concept than poverty, since poverty is usually considered to be a lack of money, whereas deprivation includes a lack of the opportunities and resources we would expect all citizens to have access to. Eight types of deprivation – domains – are included within the Index: • Employment • Income • Education • Health • Community safety
Date: 13.02.12 Version: 1 Page 164 of 318 Public Health Wales North Wales Profile 2011 • Geographical access to services • Housing • Physical environment The domains are weighted with income and employment having the highest weight. Each domain is made up of a number of different indicators. The indicators used within the health domain are cancer incidence, all cause death rate, percentage Low Birth Weights, and long term limiting illness (from census). It is also important to note that lack of deprivation is not necessarily the same as affluence. The ranks used within the Index are a relative system of measurement; it describes those areas which are more (or less) deprived than others, but does not measure by how much areas are more (or less) deprived. The Welsh Index of Multiple Deprivation (WIMD) has been updated for 2011. However, as a number of analyses have used 2008 based data, information on both the 2008 WIMD and 2011 WIMD is included in this report. 11.1.3 Free school meal entitlement Free school meal entitlement is a potentially important indicator of deprivation, and although the relationships between socio economic deprivation and educational attainment are complex, this indicator is a useful proxy measure of potential health inequalities. 11.2 Measurement of Deprivation Results 11.2.1 Townsend Index Across Wales, electoral wards have been grouped from worst to best into fifths (quintiles). On an all Wales basis, 705,118 people are recorded as residing within the most deprived wards. 122,181 people are recorded as living within such wards which are located within North Wales (i.e. approx 17% of the total population living within the most deprived wards in Wales). Table 63 shows that the highest percentage of people living in the most deprived wards in the region are in Gwynedd and the lowest in Flintshire, on the basis of applying Townsend to electoral wards.
Date: 13.02.12 Version: 1 Page 165 of 318 Public Health Wales North Wales Profile 2011 Table 63: Percentage of population resident in the most deprived fifth (Townsend index applied to wards), 2001 Number Percentage
Isle of Anglesey 11,622 17 Gwynedd 32,900 28 Conwy 18,849 17 Denbighshire 12,335 13 Flintshire 17,931 12 Wrexham 28,544 22 Source: NPHS/Census 2001 There is a difference between deprivation measures at ward level compared to LSOA level. The idea of creating deprivation scores at LSOA level is to identify ‘pockets’ of deprivation which may often be hidden in larger geographies, such as wards. Table 64 shows the same results when LSOAs are used. The distribution of deprivation has been divided into five groups (four cut points) for the analysis. The cut points for the groups have been defined so that each fifth has an equal number of LSOAs. By this method, the county with the highest percentage of its population living in the most deprived fifth is Conwy and the lowest is Flintshire. Table 64: Percentage of population resident in the most deprived fifth (Townsend index applied to LSOAs), 2001 Population in most Percentage of deprived fifth population in most deprived fifth
Wales 583,128 20.1 North Wales 100,361 15.1 Isle of Anglesey 9,972 14.9 Gwynedd 16,629 14.2 Conwy 23,377 21.3 Denbighshire 15,140 16.3 Flintshire 13,272 8.9 Wrexham 21,971 17.1 Source: NPHS / Census 2001 Figure 102 shows the fifths of deprivation into which LSOAs in North Wales fall when the Townsend Index is used. It is apparent that pockets of deprivation are often found in urban centres, for example Rhyl, Bangor, Blaenau Ffestiniog and Wrexham. Rural deprivation is also an important issue in North Wales.
Date: 13.02.12 Version: 1 Page 166 of 318 Public Health Wales North Wales Profile 2011 Figure 102: Lower Super Output Areas by fifths of deprivation, Townsend Deprivation Score, North Wales
N.B. In this map, the 1896 LSOAs in Wales have been split into five equal groups based on deprivation scores. The figures in brackets show the number of LSOAs across the whole of Wales in each fifth. Crown copyright material is reproduced with the permission of the Controller of HMSO and the Queen’s Printer for Scotland
Date: 13.02.12 Version: 1 Page 167 of 318 Public Health Wales North Wales Profile 2011 11.2.2 Welsh Index of Multiple Deprivation 2008 Figure 103 shows the level of deprivation in the health board in comparison to the rest of Wales using WIMD 2008 data. Figure 103: Lower Super Output Areas by fifths of deprivation, Overall Welsh Index of Multiple Deprivation, North Wales, 2008
In North Wales, 49 out of the 425 LSOAs are in the most deprived fifth in Wales. By this methodology, the county with the highest percentages in the most deprived fifth in Wales is Denbighshire and the lowest is Gwynedd (Table 65). However, it is important to note that not all deprived people live in the most deprived areas. This means that whilst it is true to say that deprivation is more concentrated in some areas, many deprived people will live outside these areas.
Date: 13.02.12 Version: 1 Page 168 of 318 Public Health Wales North Wales Profile 2011 Table 65: Percentage of Lower Super Output Areas in most deprived fifth in Wales, 2008 Percentage Wales 20 North Wales 12 Isle of Anglesey 11 Gwynedd 5 Conwy 13 Denbighshire 16 Flintshire 11 Wrexham 14 Source: WAG Table 66 identifies those LSOAs in North Wales which fall into the most deprived 10% in Wales according to WIMD 2008. Rhyl West 2, Queensway 1, Rhyl West 1 and Rhyl S West 2 are all in the top 10 most deprived LSOAs in Wales. Table 66: North Wales Lower Super Output Areas in most deprived 10% in Wales, 2008 Lower Super Output Area Local Authority WIMD 2008 Rank
Rhyl West 2 Denbighshire 1 Queensway 1 Wrexham 3 Rhyl West 1 Denbighshire 4 Rhyl S West 2 Denbighshire 5 Wynnstay Wrexham 32 Plas Madoc Wrexham 34 Glyn 2 Conwy 44 Rhyl West 3 Denbighshire 67 Peblig (Caernarfon) Gwynedd 82 Hermitage 2 Wrexham 83 Shotton Higher 2 Flintshire 85 Rhyl S West 1 Denbighshire 87 Queensway 2 Wrexham 95 Tudno 2 Conwy 117 Morawelon Anglesey 119 Abergele Pensarn Conwy 120 Rhiw 3 Conwy 143 Holywell Central Flintshire 145 Rhyl East 3 Denbighshire 152 Greenfield 1 Flintshire 165 Mold West 1 Flintshire 166 Flint Castle Flintshire 171 Marchog 1 Gwynedd 176 Marchog 2 Gwynedd 178 Cartrefle 2 Wrexham 184 Tudur Anglesey 187
Date: 13.02.12 Version: 1 Page 169 of 318 Public Health Wales North Wales Profile 2011 Source: WAG 11.2.3 Welsh Index of Multiple Deprivation 2011 Figure 104 shows the level of deprivation in BCU HB compared to the rest of Wales using WIMD 2011 data. Figure 104: Lower Super Output Areas by fifths of deprivation, Overall Welsh Index of Multiple Deprivation, North Wales, 2011
The summary data for the North Wales Local Authorities is in Tables 67 to 69. According to Table 67, Denbighshire has the highest percentage of LSOAs in the most deprived 10% in Wales, the Isle of Anglesey the highest percentage in the most deprived 20%, Wrexham the highest percentage in the most deprived 30% and the Isle of Anglesey the highest percentage in the most deprived 50%.
Date: 13.02.12 Version: 1 Page 170 of 318 Public Health Wales North Wales Profile 2011 Table 67: Percentage of small areas (LSOAs) in each local authority in North Wales which are in the most deprived 10% (ranks 1 190), 20% (ranks 1 380), 30% (ranks 1 570) and 50% (ranks 1 950) of LSOAs in Wales, WIMD 2011 % LSOAs in % LSOAs in % LSOAs in % LSOAs in Number of most deprived most deprived most deprived most deprived LSOAs in local 10% 20% 30% 50% Local authority authority ranks 1 190 ranks 1 380 ranks 1 570 ranks 1 950 Isle of Anglesey 44 2.3 15.9 20.5 54.5 Gwynedd 75 4.0 4.0 6.7 32.0 Conwy 71 2.8 14.1 22.5 43.7 Denbighshire 58 10.3 15.5 19.0 46.6 Flintshire 92 4.3 10.9 17.4 31.5 Wrexham 85 5.9 14.1 29.4 43.5 North Wales 425 4.9 12.0 19.3 40.5 Wales 1,896 10 20 30 50 Produced by Public Health Wales Observatory, using WIMD 2011 (WG) According to Table 68, Denbighshire has the highest percentage of people living in the most deprived 10% of LSOAs, Conwy the highest percentage in the most deprived 20%, Wrexham the highest percentage in the most deprived 30% and the Isle of Anglesey the highest percentage living in the most deprived 50%. Table 68: Percentage of people in each local authority in North Wales who live in the most deprived 10%, 20%, 30% and 50% of LSOAs in Wales, WIMD 2011 Percent of Percent of Percent of Percent of people living in people living in people living in people living in most deprived most deprived most deprived most deprived Total 10% of LSOAs 20% of LSOAs 30% of LSOAs 50% of LSOAs Local authority Population ranks 1 190 ranks 1 380 ranks 1 570 ranks 1 950 Isle of Anglesey 68,592 2.1 15.2 21.1 53.8 Gwynedd 119,007 4.1 4.1 7.4 33.5 Conwy 110,863 2.6 15.3 24.0 44.3 Denbighshire 96,731 9.6 14.1 17.4 46.3 Flintshire 149,709 3.9 10.1 17.2 31.8 Wrexham 133,559 5.8 14.8 29.8 44.0 North Wales 678,461 4.7 11.9 19.5 40.8 Wales 3,006,430 9.5 19.2 29.2 49.2 Produced by Public Health Wales Observatory, using WIMD 2011 (WG), MYE 2010 (ONS) Lastly, Table 69 shows the actual number of people who live in the most deprived LSOAs. Denbighshire has the most number of people living in the most deprived 10% of LSOAs, and Wrexham has the most number of people living in the most deprived 20%, 30% and 50% of LSOAs in Wales.
Date: 13.02.12 Version: 1 Page 171 of 318 Public Health Wales North Wales Profile 2011 Table 69: Number of people in each local authority in North Wales who live in the most deprived 10%, 20%, 30% and 50% of LSOAs in Wales, WIMD 2011 Number of Number of Number of Number of people living in people living in people living in people living in most deprived most deprived most deprived most deprived Total 10% of LSOAs 20% of LSOAs 30% of LSOAs 50% of LSOAs Local authority Population ranks 1 190 ranks 1 380 ranks 1 570 ranks 1 950 Isle of Anglesey 68,592 1,465 10,448 14,497 36,894 Gwynedd 119,007 4,932 4,932 8,774 39,902 Conwy 110,863 2,855 16,941 26,570 49,107 Denbighshire 96,731 9,270 13,662 16,844 44,811 Flintshire 149,709 5,876 15,109 25,723 47,570 Wrexham 133,559 7,687 19,791 39,864 58,735 North Wales 678,461 32,085 80,883 132,272 277,019 Produced by Public Health Wales Observatory, using WIMD 2011 (WG), MYE 2010 (ONS) Table 70 identifies those LSOAs in North Wales which fall into the most deprived 10% in Wales according to WIMD 2011. LSOAs Rhyl West 2, Rhyl West 1 and Queensway 1 are in the top ten most deprived areas in Wales. Table 70: Lower Super Output Areas in the most deprived 10% in Wales for WIMD 2011, North Wales Lower Super Output Area Local Authority WIMD 2011 rank Rhyl West 2 Denbighshire 1 Rhyl West 1 Denbighshire 7 Queensway 1 Wrexham 9 Rhyl South West 2 Denbighshire 12 Plas Madoc Wrexham 24 Wynnstay Wrexham 26 Rhyl West 3 Denbighshire 34 Glyn (Conwy) 2 Conwy 50 Shotton Higher 2 Flintshire 83 Queensway 2 Wrexham 88 Rhyl South West 1 Denbighshire 96 Tudno 2 Conwy 116 Peblig (Caernarfon) Gwynedd 119 Cartrefle 2 Wrexham 123 Marchog 1 Gwynedd 136 Marchog 2 Gwynedd 143 Morawelon Isle of Anglesey 146 Connah's Quay Golftyn 4 Flintshire 153 Holywell Central Flintshire 155 Denbigh Upper/Henllan 1 Denbighshire 160 Mold West 1 Flintshire 184 Date: 13.02.12 Version: 1 Page 172 of 318 Public Health Wales North Wales Profile 2011 Produced by Public Health Wales Observatory, using WIMD 2011 (WG) 11.2.4 Comparisons between WIMD 2008 and WIMD 2011 Comparisons between WIMD 2008 and 2011 show the following: • LSOA Rhyl West 2 remains the most deprived LSOA in Wales. • LSOA Rhyl West 1 is the seventh most deprived in Wales in 2011 compared to third most deprived in 2008. • Queensway 1 is the ninth most deprived in Wales in 2011 compared to the second most deprived in 2008. • Rhyl South West 2 is the 12 th most deprived in 2011 compared to the fifth most deprived in 2008. Further Information • Public Health Wales Observatory: Measuring Inequalities, deprivation fifths http://www.wales.nhs.uk/sitesplus/922/page/58379 11.2.5 Free School Meal Entitlement The figures in Table 71 suggest that the highest level of entitlement is in the Isle of Anglesey for primary schools and special schools, and in Wrexham for secondary schools. Notably higher proportions of children attending special schools are entitled to free school meals. The table also gives a comparison between counties in North Wales, Wales, England and Scotland. However, it should be noted that the criteria for receiving free school meals may be slightly different across countries, and can change from year to year. For this reason, these figures may not be directly comparable.
Date: 13.02.12 Version: 1 Page 173 of 318 Public Health Wales North Wales Profile 2011 Table 71: Percentage of pupils entitled to free school meals, North Wales local authorities, Wales, England and Scotland 2010/11 Primary Secondary Special Local authority Schools* Schools Schools Isle of Anglesey 18.8 13.8 47.9 Gwynedd 13.0 10.8 38.2 Conwy 17.1 14.4 36.7 Denbighshire 18.5 14.9 37.1 Flintshire 14.2 11.1 33.5 Wrexham 16.4 16.3 47.3 Wales 18.9 15.8 41.9 England 17.3 14.2 33.3 Scotland 19.8 14.4 53.4
* Percentages for England include Nursery and Primary Schools Produced by Public Health Wales Observatory, using data from: Welsh Government, Department for Education (England), Scottish Government 11.3 Impact of Deprivation on Health 11.3.1 National Public Health Service for Wales Report In 2006, the National Public Health Service (NPHS) produced a series of reports which analysed routine datasets at Electoral Division level, in order to compare outcomes between those in the most and least deprived fifths of the population across Wales, using the Townsend Index. The reports show whether health and associated indicators are statistically different in the most deprived fifth compared with the least deprived fifth. Although the analysis was undertaken at an all Wales level, we can reasonably expect people living in the most deprived areas in North Wales to have statistically significantly higher levels of ill health and a greater exposure to the major risk factors affecting health (National Public Health Service, 2006). Table 72 shows indicators from the NPHS report that are relevant to the Upstream Prevention and Well being priority area, with rate ratios which indicate the comparison between the most and least deprived areas.
Date: 13.02.12 Version: 1 Page 174 of 318 Public Health Wales North Wales Profile 2011 Table 72: Rate Ratios and Significance for indicators Rate ratio Significant difference? Lifestyle Health Determinants Physical inactivity 2.08 Yes Smoking (daily or occasional) 1.64 Yes Obesity 1.47 Yes Alcohol consumption (excessive) 1.05 No Healthy diet* 0.65 Yes Health Status SF 36 mental component 0.95 Yes summary** Illness & Injury Pedestrian injury 2.15 Yes Mental illness 1.90 Yes Deaths Unintentional falls 1.21 Yes Road traffic injury* 0.96 No Suicide 1.51 Yes Source: NPHS *Where the ratio is less than one, this means that the most deprived group exhibit a lower level for that particular indicator. For example, the rate ratio of 0.65 for healthy diet means that people living in the most deprived fifth of wards are about a third less likely to have a healthy diet than their counterparts in the least deprived fifth or wards. **The rate ratio is reserved in this case, due to the way in which the SF36 is scored. The rate ratio of 0.95 shows that people living in the most deprived fifth of wards rate their health significantly more poorly than people living in the least deprived fifth of wards. 11.4 Wider Determinants of Health 11.4.1 Tobacco There are strong links between smoking and deprivation, with more than one in three people smoking in the most deprived areas of Wales, compared to around one in seven in the least deprived areas (Welsh Assembly Government, 2008b). These differences are believed to be a major cause of health inequalities. 11.4.2 Nutrition People living in the most deprived areas of Wales are less likely to eat five or more portions of fruit and vegetables a day (30%) than those living in the least deprived areas (39%) (Welsh Assembly Government, 2008b). Date: 13.02.12 Version: 1 Page 175 of 318 Public Health Wales North Wales Profile 2011 11.4.3 Alcohol Self reported measures of drinking above guidelines and binge drinking are as common in the most deprived as in the least deprived communities. Alcohol attributable mortality rates, however, show substantial inequalities with rates more than twice as high in the most deprived areas compared to the least deprived (Gartner et al, 2009). 11.4.4 Illicit drugs Illicit drug use leads to a range of problems in society which can pull communities into a downward spiral of fear and deprivation. These deprived communities are already at greater risk (Welsh Assembly Government, 2008a). 11.4.5 Teenage Conceptions Generally, teenage mothers and their children suffer poor social, economic and health outcomes. Higher rates tend to be found in areas of greatest deprivation, and the risk of becoming a teenage mother for girls whose families are in Social Class V is almost ten times higher compared with girls whose families are in Social Class I (National Public Health Service, 2006). 11.4.6 Work and Unemployment There is an important cyclical relationship between health and the economy in that not only are healthy populations better able to support economic development, but strong economic conditions also promote better health by giving more people in the population access to well paid jobs. Healthy people not only make fewer demands upon the health and social care systems, they are also more productive. In this sense, resources devoted to securing health improvement are not a cost, but rather an investment in economic and social prosperity. Economic development that is not sustainable can have overall negative health and well being effects for people, especially for less affluent social groups. Whilst being in general employment is healthier than unemployment, there is a legacy of ill health associated with occupation in a number of areas across North Wales. This relates particularly to respiratory conditions associated with work in the Slate and Mining Industries in North West and North East Wales. Conditions most likely to be associated with modern day occupations and working patterns include musculoskeletal disorders, and work related stress, depression and anxiety. Psychosocial stress
Date: 13.02.12 Version: 1 Page 176 of 318 Public Health Wales North Wales Profile 2011 in the workplace, particularly related to low autonomy at work and ‘high effort – low reward’ work has been implicated as a key determinant of ill health. Even after allowing for social class and health status before unemployment, unemployment is closely linked with a number of ill health conditions and premature deaths. The Welsh Health Survey demonstrates that for each of heart disease, cancers, respiratory illness, mental illness, arthritis, back pain, long term illness, physical and mental component scores, eyesight and hearing problems, and visiting the dentist for a check up within the last twelve months, health status was worse for unemployed people. NICE Guidance • Management of long term sickness and incapacity for work http://guidance.nice.org.uk/PH19 • Promoting mental wellbeing at work http://guidance.nice.org.uk/PH22 11.4.7 Transport The key road transport links in North Wales are the A55 Expressway (which also acts as the North Wales section of Euro Route 22), the A5, A483, A487 and A470. The A55 Expressway (which has four road tunnels) experiences the highest volume of traffic, which increases significantly during the summer months owing to the flow of tourists into the region. Car ownership can have significant advantages to an individual and household. Owning a car can improve access to services such as healthcare, employment and leisure activities. Conwy and Wrexham have the highest proportion of households in North Wales with no car or van, 24%, although they are below the average for Wales, 26%, shown in Table 73. It should be noted that this data is now 10 years old and we are awaiting results from the 2011 Census. Table 73: Percentage of population with no car or van ownership, 2001 Percentage
Anglesey 20.9 Conwy 24.2 Denbighshire 23.7 Flintshire 19.1 Gwynedd 23.9 Wrexham 24.7 Date: 13.02.12 Version: 1 Page 177 of 318 Public Health Wales North Wales Profile 2011 Source: Census, 2001 Further information • Welsh Assembly Government Local Area Summary Statistics: Transport http://wales.gov.uk/topics/statistics/publications/localarea/?lang=en 11.4.8 Crime The causes of crime are largely the same socio economic factors that determine health and well being. A safe environment, free of crime, contributes significantly to people’s sense of well being. If the social environment becomes unsafe, mental health status is jeopardised; fear of crime is associated with increased anxiety and higher blood pressure, and is significantly associated with poor self rated health. Violent crime against the person is clearly an important health determinant, but so too is crime against property. Poor design of built environments creates opportunities for crime and decreases residents’ willingness to use local space. Deprived neighbourhoods with vacant properties, unmaintained housing, graffiti and visible signs of criminal activity are strongly related to the fear of crime. Further information • StatsWales: Crime http://www.statswales.wales.gov.uk/ReportFolders/reportFolders.aspx
Date: 13.02.12 Version: 1 Page 178 of 318 Public Health Wales North Wales Profile 2011 12 Healthcare Services & Utilisation Key Messages • Adults in North Wales generally report using health services less often than the average across Wales. • The inpatient admissions rate for persons aged under 75 years (planned and emergency) in North Wales is lower than the average for Wales, 139 per 1,000 compared to 145 per 1,000 population. Inpatient admission rates for under 75 year olds are higher in Anglesey and MSOA Denbighshire 004 (Rhyl East & Rhyl West) than the average for Wales. • The emergency inpatient admission rate for people aged under 75 years in North Wales is lower than the average for Wales, 65 per 1,000 compared to 68 per 1,000 population. Again, rates in Anglesey and MSOA Denbighshire 004 (Rhyl East & Rhyl West) are higher than the average for Wales. • The elective inpatient admission rate for under 75 year olds in North Wales is lower than the average for Wales, 65 per 1,000 compared to 68 per 1,000 population. The rate for Anglesey is 86 per 1,000 population compared to 64 per 1,000 in Wrexham. The MSOAs which have significantly higher rates than Wales are in Anglesey, Gwynedd and Conwy; this may suggest a difference of coding practices between hospital sites. As highlighted in the Determinants of Health and Well being diagram (Figure 1) which informs this profile, the provision of, and access to, healthcare services has an important role in determining the health inequalities experienced in society. High quality accessible services – particularly those provided in the primary and community care settings with a strong focus on illness prevention and the promotion of robust physical and mental health can play a significant role in mitigating the negative effects of social deprivation. The information presented below profiles the numbers and geographical distribution of key healthcare services.
Date: 13.02.12 Version: 1 Page 179 of 318 Public Health Wales North Wales Profile 2011 12.1 Primary Care Table 74 shows the percentage of people reporting use of primary care services are broadly just below those for Wales, with the exception of visits to a dentist in the past 12 months. This may be related to access issues associated with rural areas of the region (Public Health Wales, 2011a) Table 74: Betsi Cadwaladr University Health Board adults who reported particular service use, Welsh Health Survey 2008 & 2009
Age Observed standardised Wales per cent percent per cent Health service use Family doctor (GP) in the past two weeks 17 17 18 In the past three months: Accident, injury or poisoning needing 4 4 5 hospital treatment or a visit to casualty In the past twelve months: Pharmacist 67 67 70 Dentist 72 72 70 Optician 47 46 49
Unweighted base (i) All aged 16+ 8,047 8,047 29,331
Source: Welsh Health Survey 2008 + 2009 (i) Bases vary: those shown are for the whole sample. Age standardised rate is standardised to the Wales population. 12.1.1 General Medical Practitioners Table 75 shows the number of practitioners in North Wales, excluding GP Registrars, Retainers and Locums. Table 75: Number of General Practitioners, North Wales, 2009 Numbers North Wales 438 Isle of Anglesey 44 Gwynedd 95 Conwy 75 Denbighshire 59 Flintshire 80 Wrexham 85 Source: Stats Wales Date: 13.02.12 Version: 1 Page 180 of 318 Public Health Wales North Wales Profile 2011 Table 76 shows the rate of GPs per 10,000 population in North Wales. The rate for North Wales is just below the average for Wales. Gwynedd has the highest rate per 10,000 population which, in part, reflects the geography and sparse population distribution of the county. Table 77 shows the Welsh language ability of GPs in North Wales and Figure 105 shows the location of the main GP surgeries. Table 76: GP rate per 10,000 population, North Wales, 2009 GPs per 10,000 population Wales 6.5 North Wales 6.4 Isle of Anglesey 6.3 Gwynedd 7.7 Conwy 6.1 Denbighshire 5.5 Flintshire 5.3 Wrexham 6.1 Source: Stats Wales Table 77: Welsh language ability* amongst GPs in Wales, 2010 Rate per 10,000 Rate per 10,000 population Welsh speaking population Wales 1.0 4.9 North Wales 1.6 5.0 Isle of Anglesey 2.2 3.9 Gwynedd 4.2 6.4 Conwy 1.3 4.5 Denbighshire 1.3 5.5 Flintshire 0.3 1.9 Wrexham 0.8 5.5 Source: Business Services Centre, 2009/WAG * Any mention of Welsh ability on Medical Performers List
Date: 13.02.12 Version: 1 Page 181 of 318 Public Health Wales North Wales Profile 2011 Figure 105: Location of Main GP Surgeries
Date: 13.02.12 Version: 1 Page 182 of 318 Public Health Wales North Wales Profile 2011 12.1.2 NHS Dental Performers Table 78 shows the total number of NHS dental performers in North Wales. A performer is a dentist named on a contract who will or might be carrying out the work agreed in the contract. A provider performer is a provider that holds a contract with a LHB and also performs NHS dentistry on the contract. This shows the number of providing performers who have any NHS activity recorded against them at any time in the year. Performers and provider performers are counted in every LHB area where they have a contract and therefore can be counted more than once. Table 78: Number of NHS dental performers, North Wales, 2010 Total Performer Provider only only North Wales 295 206 89 Isle of Anglesey 27 16 11 Gwynedd 48 25 23 Conwy 79 64 15 Denbighshire 56 48 8 Flintshire 67 41 26 Wrexham 63 53 10 Source: StatsWales 12.1.3 Community Pharmacies Table 79 and Figure 106 show the number and location of community pharmacies across North Wales. Table 79: Number of community pharmacies, North Wales, 2009 10 Numbers North Wales 153 Isle of Anglesey 13 Gwynedd 30 Conwy 28 Denbighshire 24 Flintshire 28 Wrexham 30 Source: StatsWales
Date: 13.02.12 Version: 1 Page 183 of 318 Public Health Wales North Wales Profile 2011 Figure 106: Population per Community Pharmacy, Wales, 2009
12.1.4 Opticians Table 80 shows the number of opticians practising in North Wales. Table 80: Number of opticians practising in North Wales, 2008/09 Numbers North Wales 265 Isle of Anglesey 10 Gwynedd 38 Conwy 45 Denbighshire 47 Flintshire 56 Wrexham 69 Date: 13.02.12 Version: 1 Page 184 of 318 Public Health Wales North Wales Profile 2011 Source: StatsWales 12.2 Secondary Care Whilst access to hospital care is influenced by a complex range of factors, analysis of admissions data in those under the age of 75 can be helpful, as a proportion of these may be potentially avoidable. It is important to note that admissions for those under 75 only represent a relatively small proportion of total admissions to hospital in respect of both emergency and planned care. The maps and accompanying charts in Figures 107 to 115, describe rates of hospital admissions for 2009 for all those under the age of 75 and resident within the Betsi Cadwaladr Health Board area. The data source used – the Patient Episode Database for Wales (PEDW) – also includes admissions for Welsh residents to hospitals outside Wales. The analysis used European Age Standardised Rates (EASR) takes into account the different age distributions across North Wales, and thus some comparison of the rates is appropriate. As noted above however, many other factors influence patterns of hospital use, and these need to be taken into account in interpreting the information presented. Although processes are now increasingly standardised across Wales, the potential impact of different approaches to coding hospital activity data can be significant. 12.2.1 All Hospital Admissions, aged under 75 years Here all inpatient admissions for persons aged under 75 years, both those which are planned including surgery and admissions for investigation or treatment and those which are emergency or unplanned are included. For the Betsi Cadwaladr Health Board area, the rate of admission is lower than that for Wales overall (Wales 145 per 1,000; BCUHB area 139 per 1,000 population). Figure 107 demonstrates the Isle of Anglesey has the highest rate across North Wales, with an EASR of 157 per 1,000 population, which is higher than the Wales rate. The highest individual rate is 187 per 1,000 for the Denbighshire MSOA which includes the electoral divisions of Rhyl West and Rhyl East. The map in Figure 108 suggests that close proximity to acute hospital facilities in Bangor, Bodelwyddan, and Chester is related to higher admission rates, but this effect is less clear from the map in relation to Wrexham. Evidence from a number of studies has illustrated that hospital utilisation is heavily influenced by distance, with those living further away less likely to use acute facilities.
Date: 13.02.12 Version: 1 Page 185 of 318 Public Health Wales North Wales Profile 2011 The figures suggest an association between high admission rates and the highest areas of socio economic deprivation, with the most deprived areas of each of the six UA areas having significantly higher EASRs than Wales overall. Lastly, Figure 109 shows variation in hospital admissions for under 75 year olds in UAs across North Wales.
Date: 13.02.12 Version: 1 Page 186 of 318 Public Health Wales North Wales Profile 2011 Figure 107: Hospital admissions in Betsi Cadwaladr University Health Board area, persons aged under 75, 2009, European age standardised rates per 1,000 Produced by Public Health Wales Observatory, using data from NWIS (PEDW), ONS (MYE) Gwynedd MSOA EASR with 95% 006 178 confidence interval 002 157 Health Board (EASR = 139) 003 748 001 157 Wales (EASR = 145) 005 154 006 169 004 150 009 Local Authority 162 009 150 Isle of Anglesey 007 149 012 003 174 146 003 006 169 145
MSOA 008 009 162 141 001 161 011 138 005 153 013 135 010 MSOA 007 153 133 004 148 015 122 008 139 Isle of Anglesey 016 122 Gwynedd EASR = 141 002 138 EASR = 157 014 119 EASR per 1,000 017 116 EASR per 1,000 Conwy Denbighshire 007 162 004 187 005 159 006 180 002 159 007 169 001 158 011 158 013 155 005 142 010 151 001 138 009 144 010 137 011 143 003 136
MSOA 012 140 008 136
014 MSOA 139 009 136 004 138 002 131 006 136 014 123 015 136 Conwy EASR 016 122 008 = 146 134 012 122 Denbighshire 003 128 015 120 EASR = 141 EASR per 1,000 013 108 EASR per 1,000 Flintshire Wrexham 004 164 007 156 010 172 011 154 009 141 009 153 006 141 017 150 004 138 003 144 015 138 015 141 012 136 014 136 013 135 008 136 005 134 016 135 017 133 013 134 003 128 MSOA
002 134 MSOA 007 124 010 130 011 123 012 130 008 123 005 128 016 122 001 126 019 121 019 124 014 120 Flintshire 006 121 018 Wrexham EASR = 137 108 020 118 001 107 EASR = 128 018 116 002 104 EASR per 1,000 EASR per 1,000
Date: 13.02.12 Version: 1 Page 187 of 318 Public Health Wales North Wales Profile 2011 Figure 108:
Figure 109: Hospital admissions by local authority, persons aged under 75, 2009, 95% confidence European age standardised rates per 1,000 interval Produced by Public Health Wales Observatory, using data from NWIS (PEDW), ONS (M YE)
Wales = 145.1 175.5 167.7 162.5 159.2 156.8 155.2 152.0 150.0 148.2 147.5 145.8 145.5 145.0 144.8 141.4 141.9 141.0 138.7 137.6 137.1 128.0 125.7 Powys Cardiff Conwy Torfaen Newport Bridgend Flintshire Swansea Gwynedd Wrexham Caerphilly Ceredigion Denbighshire Merthyr Tydfil Pembrokeshire Blaenau Gwent Monmouthshire Isle of Anglesey Carmarthenshire Neath Port Talbot Rhondda Cynon Taff Areas ordered geographically from north west to south east The Vale of Glamorgan Date: 13.02.12 Version: 1 Page 188 of 318 Public Health Wales North Wales Profile 2011 12.2.2 Emergency hospital admissions aged under 75 years The BCU Health Board rate of emergency admissions is just under the overall Wales rate, 65 per 1,000 compared to 68 per 1,000 population. Again rates for the Isle of Anglesey (71 per 1,000 population), shown in Figure 110, are the highest across North Wales and higher than the Wales rate. The highest individual rate is again for the Denbighshire MSOA covering Rhyl West and Rhyl East, and is far in excess of all other areas of North Wales at 105 per 1,000 population. This is shown in Figure 110 and 111. The relationship between proximity to the acute hospital sites and emergency admission rates is clearer here than with all admissions, but the overall association between emergency admission rates and the most deprived areas is slightly less obvious, although a number of the most deprived areas again have significantly higher emergency admission rates than the overall Wales rate. Admission rates for Gwynedd (63 per 1,000 population) and Wrexham (61 per 1,000 population) are in general lower than both the Wales rate and also the rates in the other four counties of North Wales. Figure 112 shows variation in emergency hospital admissions by UAs across Wales.
Date: 13.02.12 Version: 1 Page 189 of 318 Public Health Wales North Wales Profile 2011 Figure 110: Emergency hospital admissions in Betsi Cadwaladr University Health Board area, persons aged under 75, 2009, European age standardised rates per 1,000 Produced by Public Health Wales Observatory, using data from NWIS (PEDW), ONS (MYE) MSOA EASR with 95% Gwynedd confidenc interval 006 87 Health Board (EASR = 65) 006 748 001 80 Wales (EASR = 68) 002 001 78 75 007 68 009 Local Authority 77 004 67 Isle of Anglesey 005 67 009 66 006 78 012 64 001 78 003 62 009 77 MSOA 010 62 003 76 008 59 005 71 011 57 MSOA 007 67 015 57 004 65 016 55 002 61 Isle of Anglesey 014 55 Gwynedd 008 60 EASR = 71 013 55 EASR = 63 EASR per 1,000 017 45 EASR per 1,000 Conwy Denbighshire 007 80 004 105 005 79 006 99 010 75 007 85 001 72 011 82 002 71 005 69 013 69 008 67 009 68 003 64 014 65 001 64
MSOA 011 63 009 62 006 MSOA 62 002 60 008 62 010 60 012 61 016 58 004 60 Conwy EASR 015 56 015 = 67 60 014 53 Denbighshire 003 52 012 50 EASR = 68 EASR per 1,000 013 45 EASR per 1,000 Flintshire Wrexham 004 85 007 77 010 93 011 76 012 71 009 72 004 70 017 71 015 67 003 70 009 67 001 65 006 65 015 65 017 64 008 62 011 64 016 62 005 64 014 61 013 62 MSOA
002 60 MSOA 008 59 013 59 003 59 012 58 016 57 006 57 014 55 005 57 007 54 019 54 019 52 Flintshire 010 54 018 51 Wrexham EASR = 64 EASR = 61 018 53 002 48 020 48 001 45 EASR per 1,000 EASR per 1,000
Date: 13.02.12 Version: 1 Page 190 of 318 Public Health Wales North Wales Profile 2011 Figure 111:
Figure 112:
Emergency hospital admissions by local authority, persons aged under 95% confidence 75, 2009, European age standardised rates per 1,000 interval Produced by Public Health Wales Observatory, using data from NWIS (PEDW), ONS (M YE)
Wales = 68.5 97.8 86.4 85.0 83.4 76.9 76.0 75.4 71.2 70.9 68.8 68.1 67.2 66.8 65.2 63.5 63.4 62.3 61.1 60.5 59.6 55.3 53.8 Powys Cardiff Conwy Torfaen Newport Bridgend Flintshire Swansea Gwynedd Wrexham Caerphilly Ceredigion Denbighshire Merthyr Tydfil Pembrokeshire Blaenau Gwent Monmouthshire Isle of Anglesey Carmarthenshire Neath Port Talbot
Areas ordered geographically from north west to south east Rhondda Cynon Taff
The Vale of Glamorgan Date: 13.02.12 Version: 1 Page 191 of 318 Public Health Wales North Wales Profile 2011 12.2.3 Elective hospital admissions aged under 75 years The elective hospital admission rate for under 75 year olds in North Wales is lower than the overall rate for Wales, 73 per 100,000 compared to 77 per 100,000 population. Figures 113 and 114 show that at UA level there are some striking differences across North Wales, with Anglesey again displaying very high admission rates (86 per 1,000 population) and Wrexham having a rate considerably lower (64 per 1,000 population) than the rest of North Wales and Wales overall. This disparity, and fact that all those MSOA areas which have significantly higher rates than Wales overall are in Anglesey, Gwynedd or Conwy is worthy of further examination, as it may be suggestive of a difference in coding practices between the hospital sites. The relationships between admission rates and both proximity to acute facilities and levels of deprivation are much less clear in respect of planned admissions. Figure 115 shows variation in elective hospital admissions in UAs across Wales. Figure 113:
Date: 13.02.12 Version: 1 Page 192 of 318 Public Health Wales North Wales Profile 2011 Figure 114: Elective hospital admissions in Betsi Cadwaladr University Health Board area, persons aged under 75, 2009, European age standardised rates per 1,000 Produced by Public Health Wales Observatory, using data from NWIS (PEDW), ONS (MYE) Gwynedd MSOA EASR with 95% confidence interval 006 93 005 91 003 748 Health Board (EASR = 73) 002 87 006 Wales (EASR = 77) 89 004 85 Local Authority 009 87 003 83 Isle of Anglesey 001 83 009 82 003 96 007 82 006 89 011 82 009 87 MSOA 012 81 001 85 013 80 004 85 008 77 MSOA 007 84 010 72 005 84 014 62 008 79 Isle of Anglesey 016 61 Gwynedd 002 78 EASR = 86 017 61 EASR = 78 EASR per 1,000 015 60 EASR per 1,000 Conwy Denbighshire 013 87 007 84 001 87 006 81 002 86 011 79 011 82 005 78 005 79 010 76 006 77 009 76 012 76 004 75 007 75 001 73
MSOA 003 75 003 71 004 MSOA 74 014 70 010 73 012 69 014 73 002 69 015 73 Conwy EASR 008 66 009 = 77 72 015 64 Denbighshire 008 71 016 62 EASR = 72 EASR per 1,000 013 60 EASR per 1,000 Flintshire Wrexham 011 80 017 79 006 72 015 77 013 70 004 77 007 70 009 76 010 69 014 76 009 69 007 75 005 68 010 75 003 68 002 74 015 67 008 74 004 66 013 74 017 65 MSOA
003 73 MSOA 012 65 016 70 019 64 019 68 008 64 005 68 016 62 012 68 014 61 020 67 011 58 Flintshire 006 63 001 57 Wrexham EASR = 72 EASR = 64 018 63 002 55 001 62 018 55 EASR per 1,000 EASR per 1,000
Date: 13.02.12 Version: 1 Page 193 of 318 Public Health Wales North Wales Profile 2011 Figure 115: Elective hospital admissions by local authority, persons aged under 75, 95% confidence 2009, European age standardised rates per 1,000 interval Produced by Public Health Wales Observatory, using data from NWIS (PEDW), ONS (M YE)
Wales = 76.9 86.6 86.0 84.4 83.7 82.8 81.5 81.6 79.5 79.9 79.2 77.9 77.8 77.4 77.4 77.2 76.9 73.2 72.2 71.7 71.6 68.6 63.9 Powys Cardiff Conwy Torfaen Newport Bridgend Flintshire Swansea Gwynedd Wrexham Caerphilly Ceredigion Denbighshire Merthyr Tydfil Pembrokeshire Blaenau Gwent Monmouthshire Isle of Anglesey Carmarthenshire Neath Port Talbot
Areas ordered geographically from north west to south east Rhondda Cynon Taff The Vale of Glamorgan
Date: 13.02.12 Version: 1 Page 194 of 318 Public Health Wales North Wales Profile 2011 13 Immunisation Key Messages • Immunisation is one of the most important ways of protecting individuals and the wider community from serious illness. In North Wales significant progress has been made towards reaching the level of protection (95% coverage) recommended for childhood immunisation. There is further work to do to increase and sustain uptake across North Wales, particularly in relation to both doses of MMR (MMR1 and MMR2) and the 4 in 1 vaccine. • Uptake of the HPV vaccine in young girls, which offers protection against a virus that is attributable to 70% of cervical cancers, is relatively high in North Wales (81.2% for 3 doses). • Uptake of the seasonal flu vaccine in the 65 years and over age group in North Wales is 68.2%, which is lower than the national target of 70%. Uptake in the under 65 at risk groups, including those with asthma and diabetes, is 52%. Immunisation is one of the most important ways of protecting individuals and the community from serious illness. It is the responsibility of BCU HB, in collaboration with its partners, to ensure adequate provision of immunisation cover to the local population. Children who miss immunisations for any reason remain without protection against serious childhood diseases. The term “herd immunity” is used to describe a level of vaccination high enough to protect those who have not been vaccinated. As long as sufficient numbers of children are immunised against a specific disease, the protection can extend to everyone; it is normally set at 95% and above. Uptake of immunisations is affected by a number of factors including socio economic factors, lay beliefs about the procedure, media, religious and moral beliefs and advice received from health professionals. NICE Guidance • Reducing differences in the uptake of immunisations http://guidance.nice.org.uk/PH21 Further Information • Public Health Wales: Vaccine Preventable Disease Programme http://www.wales.nhs.uk/sitesplus/888/page/43510 Date: 13.02.12 Version: 1 Page 195 of 318 Public Health Wales North Wales Profile 2011
Date: 13.02.12 Version: 1 Page 196 of 318 Public Health Wales North Wales Profile 2011 13.1 Childhood vaccines The following section provides information on childhood immunisation uptake rates in North Wales between July and September 2011 (Public Health Wales, 2011b). 5 in 1 : The DTaP/IPV/Hib vaccine protects babies against five different diseases: diphtheria, tetanus, pertussis, polio and Haemophilus Influenzae Type B. Diphtheria is an infection of the upper respiratory tract. Tetanus, commonly known as lockjaw, is caused by a bacteria which can be found in soil or manure and can be picked up through a scratch or wound. Pertussis (whooping cough) is a highly infectious disease, which ranges from a mild condition to one which could result in death. Poliomyelitis is an acute viral infection of the nervous system which is spread faeco orally. Haemophilus Influenzae Type B (Hib) is a bacteria responsible for a range of infections, primarily in young children (4 and under) including meningitis and septicaemia. During July to September 2011, Anglesey UA (98.6%) had the highest uptake of the 5 in 1 vaccine in North Wales and Conwy UA (94.7%) the lowest uptake (Public Health Wales, 2011b). MenC : One of the most serious conditions that can afflict children is meningitis. Meningococcal meningitis and meningococcal septicaemia are infections caused by the bacteria Neisseria meningitidis . The majority of meningococcal infections occur in infants less than five years of age, with a peak incidence in those under one year of age. There is a smaller, secondary peak in incidence in young adults aged between 15 to 19 years of age. Most disease in the UK is caused by serogroups B and C. However, the number of cases caused by serogroup C has been significantly reduced since routine vaccination was introduced in those age groups targeted for vaccination (i.e. under 18 year olds) in 1999. During July to September 2011, Conwy UA (98.6%) had the highest uptake in North Wales and Denbighshire UA (94.7%) had the lowest uptake (Public Health Wales, 2011b). MMR1 (first dose) : Measles, mumps and rubella vaccines are all components of the MMR vaccine. Measles is an acute highly infectious viral illness transmitted via droplet infection. Almost all who are infected develop symptoms. Mumps is an acute viral illness transmitted by direct contact with saliva or droplets from the saliva of an infected person. Humans are the only known host of the mumps virus. For most people rubella is a mild infectious disease, although it can have serious consequences for pregnant women. During July to September 2011, Flintshire UA (95.1%) had the highest uptake in North Wales and Conwy UA (91.6%) had the lowest uptake (Public Health Wales, 2011b).
Date: 13.02.12 Version: 1 Page 197 of 318 Public Health Wales North Wales Profile 2011 MMR2 (booster) : During July to September 2011, Anglesey UA (94.7%) had the highest uptake in North Wales; Gwynedd UA (87.3%) had the lowest uptake rate (Public Health Wales, 2011b). 4 in 1 : The DTaP/IPV (or dTaP/IPV) vaccine boosts a child's protection against four different diseases: diphtheria, tetanus, pertussis and polio. During July to September 2011, Anglesey UA (96.7%) had the highest uptake in North Wales; Denbighshire UA (89.0%) had the lowest uptake (Public Health Wales, 2011b). Figures 116 to 123 show uptake for individual childhood vaccines for North Wales and for each individual county between 2004 and 2011. In general, vaccine uptake has improved during this period. Figure 116: Routine childhood immunisation Betsi Cadwaladr University Health Board area, trends 2004 2011 Produced by Public Health Wales Vaccine Preventable Disease Programme, from the Public Health Wales COVER reports 100
90
80 % uptake %
70 5 in 1 at 1yr MMR 1 at 2yrs MMR2 at 5yrs 4 in 1 at 5 yrs Men C at 1 yr 95% target 60 2011 1 2011 2004 1 2004 2 2004 3 2004 4 2004 1 2005 2 2005 3 2005 4 2005 1 2006 2 2006 3 2006 4 2006 1 2007 2 2007 3 2007 4 2007 1 2008 2 2008 3 2008 4 2008 1 2009 2 2009 3 2009 4 2009 1 2010 2 2010 3 2010 4 2010 Cover quarter
Date: 13.02.12 Version: 1 Page 198 of 318 Public Health Wales North Wales Profile 2011 Figure 117: Routine childhood immunisation Betsi Cadwaladr University Health Board area, July to September 2011 Produced by Public Health Wales Vaccine Preventable Disease Programme, from the Public Health Wales COVER reports
Figure 118: Routine childhood immunisation Isle of Anglesey local authority area, trends 2004 2011 Produced by Public Health Wales Vaccine Preventable Disease Programme, from the Public Health Wales COVER reports
Date: 13.02.12 Version: 1 Page 199 of 318 Public Health Wales North Wales Profile 2011 Figure 119: Routine childhood immunisation Conwy local authority area, trends 2004 2011 Produced by Public Health Wales Vaccine Preventable Disease Programme, from the Public Health Wales COVER reports
Figure 120: Routine childhood immunisation Denbighshire local authority area, trends 2004 2011 Produced by Public Health Wales Vaccine Preventable Disease Programme, from the Public Health Wales COVER reports
Date: 13.02.12 Version: 1 Page 200 of 318 Public Health Wales North Wales Profile 2011 Figure 121: Routine childhood immunisation Flintshire local authority area, trends 2004 2011 Produced by Public Health Wales Vaccine Preventable Disease Programme, from the Public Health Wales COVER reports
Figure 122: Routine childhood immunisation Gwynedd local authority area, trends 2004 2011 Produced by Public Health Wales Vaccine Preventable Disease Programme, from the Public Health Wales COVER reports
Date: 13.02.12 Version: 1 Page 201 of 318 Public Health Wales North Wales Profile 2011 Figure 123: Routine childhood immunisation Wrexham local authority area, trends 2004 2011 Produced by Public Health Wales Vaccine Preventable Disease Programme, from the Public Health Wales COVER reports
Human Papillomavirus Vaccine : On 26 th October 2007 the Welsh Assembly Government and other UK Health Departments announced that all 12 to 13 year old girls (School Year 8) would be offered vaccination against two human papillomavirus (HPV) types that cause 70% of cervical cancer. On 28 th October 2008 an extension of the first year programme to include 17 to 18 year olds was announced. On the 17 th March 2009 an announcement was made that the HPV catch up vaccination campaign was to be accelerated in Wales. All girls and young women in Wales born between 1 st September 1991 and 31 st August 1995 will be offered the HPV vaccine during school year 2009 10. The latest results of the immunisation programme are shown in Tables 81 and 82. Table 81: HPV Vaccine uptake in girls reaching their 13th birthday between 01/09/2010 and 31/08/2011 and resident on 01/05/2010 Percentage 1 dose 2 doses 3 doses
North Wales 87.9 87.1 84.3 Anglesey 90.6 89.4 86.2 Conwy 86.9 86.6 82.7 Denbighshire 85.7 84.7 82.3 Flintshire 89.5 88.5 83.6 Gwynedd 86.7 86.4 85.6 Wrexham 87.9 86.9 86.1 Source: Public Health Wales Date: 13.02.12 Version: 1 Page 202 of 318 Public Health Wales North Wales Profile 2011 Table 82: HPV Vaccine uptake in girls reaching their 14 th birthday between 01/09/2010 and 31/08/2011 and resident on 01/05/2010 Percentage 1 dose 2 doses 3 doses
North Wales 85.5 84.7 83.4 Anglesey 85.5 84.0 81.2 Conwy 85.9 85.7 84.9 Denbighshire 82.4 82.0 80.1 Flintshire 89.0 88.3 86.6 Gwynedd 82.6 82.2 81.2 Wrexham 86.4 84.5 84.2 Source: Public Health Wales Further information • Public Health Wales: Childhood Immunisations COVER data http://howis.wales.nhs.uk/sites3/page.cfm?orgid=474&pid=21302#2 13.2 Influenza vaccine Influenza, more commonly known as the flu, is a respiratory illness, affecting the lungs and airways, and is the result of an infection caused by an influenza virus. There are three types of influenza virus, known as A, B and C. The characteristic symptoms of flu, which usually come on suddenly, are fever, chills, headache, cough, body aches and fatigue. The flu virus is usually spread in the small droplets of saliva coughed or sneezed into the atmosphere by an infected person. Direct contact with hands contaminated with the virus can also spread infection. As influenza circulates each year in the UK during the winter months (October to April), it is often called seasonal flu and results from slight changes to the virus from the previous year which means that some people who encounter the new virus may no longer be fully immune. A vaccine (the 'flu jab') is developed for each season which is offered free to everyone over 65 and people in certain 'at risk' groups who are more likely to develop complications as a result of having flu. Table 83 shows that immunisation rates for influenza in North Wales in the 65 years and over population are below the national uptake target of 70%. In 2010/11, Wrexham had the highest uptake rate (71.2%) and Anglesey had the lowest (64.5%). In North Wales, uptake in people aged under 65 years in one or more clinical risk groups during 2010/11 was 52%. The highest Date: 13.02.12 Version: 1 Page 203 of 318 Public Health Wales North Wales Profile 2011 uptake was in Wrexham (56.1%) and the lowest in Denbighshire (49.4%). Table 83: Uptake of seasonal influenza immunisation in Betsi Cadwaladr University Health Board, 2010/2011 Produced by Public Health Wales Vaccine Preventable Disease Programme, data source: Audit + Patients aged 65y and over Patients aged under 65y at risk Total Patients Total Patients Uptake (%) Uptake (%) patients immunised patients immunised Anglesey 14,460 9,322 64.5 6,720 3,356 49.9 Conwy 27,377 18,460 67.4 10,990 5,624 51.2 Denbighshire 20,964 14,288 68.2 10,469 5,167 49.4 Flintshire 25,879 18,247 70.5 14,830 7,960 53.7 Gwynedd 24,471 16,164 66.1 11,058 5,479 49.5 Wrexham 24,635 17,535 71.2 13,502 7,579 56.1 UHB total 137,786 94,016 68.2 67,569 35,165 52.0 13.2.1 Seasonal Influenza vaccination for pregnant women Pregnant women have recently been identified as a group at risk of developing complications from seasonal flu infection. If a pregnant woman were to develop complications the health of the unborn baby can also be affected (Public Health Wales, 2011). Table 88 shows uptake of influenza immunisation among pregnant women in North Wales. Table 84: Uptake of influenza immunisation, pregnant women, North Wales, 2010/11 Percentage North Wales 43.1 Anglesey 39.7 Conwy 44.6 Denbighshire 45.7 Flintshire 46.5 Gwynedd 44.6 Wrexham 37.7 Source: Public Health Wales Further Information • Public Health Wales: Flu immunisation uptake http://howis.wales.nhs.uk/sites3/page.cfm?orgid=474&pid=21303 14 Screening Key Messages • Uptake of breast screening by women aged 50 to 70 years in North Wales (73.3%) is lower than the average for Wales Date: 13.02.12 Version: 1 Page 204 of 318 Public Health Wales North Wales Profile 2011 (76.2%). Uptakes rates are lowest in Conwy (64.3%), and highest in Anglesey (78.8%). • Uptake of cervical screening in North Wales (76.5%) is similar to the average for Wales (76.2), but is below the target coverage (80%). • Bowel screening uptake in North Wales (54.1%) is lower than the average for Wales (55.3%). Uptake rates in North Wales range from 48.2% in Wrexham to 59.3% in Anglesey. • Coverage rates for newborn hearing screening are consistently high across North Wales at either 100% or just under. Screening is a process of identifying apparently healthy people who may be at increased risk of a disease or condition. They can then be offered information, further tests and appropriate treatment to reduce their risk and/or any complications arising from the disease or condition. In the context of screening programmes: Uptake is the proportion of people routinely invited for screening for who a screening test result is recorded within the same invitation episode. Uptake is an important measure of the acceptability of a screening programme. There are minimum uptake standards and targets set for each of the programmes. Coverage is the proportion of people resident and eligible at a particular point in time who have been screened at least once in a defined time period (dependent on the screening interval of the different programmes). Further Information • Public Health Wales Screening Services http://www.screeningservices.org.uk/
Date: 13.02.12 Version: 1 Page 205 of 318 Public Health Wales North Wales Profile 2011 14.1 Breast Screening Breast Test Wales (BTW), part of Public Health Wales, provides the NHS Breast Screening Programme in Wales. All women resident in Wales aged between 50 and 70 are invited to attend for screening once every three years. In addition, women aged over 70 are encouraged to request screening. Women under the age of 50 assessed as being at increased risk of breast cancer (as a result of their family history, or previous treatment with mantle radiotherapy for Hodgkin’s disease) are also offered mammographic surveillance. Currently around 100,000 women per year are screened for breast cancer throughout Wales; the figure for North Wales is around 20,000 per year. The number of women screened each year is increasing because of the increase in the population in older age groups (approximately 2% per annum), reduction in programme slippage, the invitation of women up to the age of 67 from 2003, and the introduction of the service for women referred from the Genetics Service from 2001 onwards. From January 2006, the upper age for automatic invitation to screening was raised to 70 years across Wales. Wales is considered to have an excellent breast screening programme, which exceeds all the national cancer detection standards. Breast screening standards have been set at 70% for each of the measures, but a target of 80% is desired. As coverage will always be lower than uptake (by around 5% because of the women in the 50 to 52 year age band who will be waiting for invitation), an uptake of at least 75% is needed to ensure coverage of 70%. A reduction in breast cancer mortality is likely at this rate. 99.4% of all screens are negative. Breast cancer incidence (new cases) has continued to rise since the 1970s, but mortality (death) rates are falling. As North Wales has generally reported relatively high levels of breast cancer incidence and mortality, continuous improvement in uptake is desirable. Table 89 shows breast screening coverage in North Wales. The highest coverage level is in Anglesey (78.8%) and the lowest in Conwy (64.3%).
Date: 13.02.12 Version: 1 Page 206 of 318 Public Health Wales North Wales Profile 2011 Table 85: Uptake of breast screening programme by 50 to 70 year olds, North Wales, 1 st April 2009 to 31 st March 2010 Percentage Wales 76.2 North Wales 73.3 Anglesey 78.8 Gwynedd 74.0 Conwy 64.3 Denbighshire 72.2 Flintshire 71.1 Wrexham 71.3 Source: Screening Division, Public Health Wales Further Information • Breast Test Wales http://www.screeningservices.org/btw/reports/reports.asp 14.2 Cervical Screening Cervical Screening Wales (CSW) operates the call and recall system which covers the target population of women between the ages of 20 and 64 years. Screening is offered once every three years in Wales. The target coverage in Wales is 80%. CSW report that uptake of cervical screening is low and falling in the 20 to 24 age group. Table 86 shows the uptake of cervical screening in North Wales. The highest uptake rates are found in Flintshire (78%) and the lowest in Gwynedd (74.6%) Table 86: Uptake of cervical screening programme by 20 to 64 year olds, North Wales, 1 st April 2009 to 31 st March 2010 Percentage Wales 76.2 North Wales 76.5 Anglesey 76.8 Gwynedd 74.6 Conwy 76.3 Denbighshire 76.3 Flintshire 78.0 Wrexham 76.9 Source: Screening Division, Public Health Wales Further Information • Cervical Screening Wales Date: 13.02.12 Version: 1 Page 207 of 318 Public Health Wales North Wales Profile 2011 • http://www.screeningservices.org/csw/prof/reports/ 14.3 Bowel Screening Bowel cancer is the third most common cancer in Wales. It is more common in people aged over 50 years; around one in twenty people aged over 50 years will develop bowel cancer. However, if it is detected early it is one of the most treatable types of cancer. Table 91 shows the uptake across North Wales. Table 87: Uptake of bowel screening by 60 to 69 year olds, North Wales, 1 st April 2009 to 31 st March 2010 Percentage Wales 55.3 North Wales 54.1 Anglesey 59.3 Gwynedd 57.2 Conwy 54.5 Denbighshire 53.7 Flintshire 53.9 Wrexham 48.2 Source: Screening Division, Public Health Wales Further Information • Bowel Screening Wales http://www.wales.nhs.uk/sites3/home.cfm?orgid=747 14.4 Newborn hearing screening Wales has a national newborn hearing screening programme in place, the aim of which is to identify babies with hearing impairment and intervene with appropriate help and support which will enable the child to develop better language and communication skills (Betsi Cadwaladr University Health Board, 2011). The coverage rates for Newborn Hearing are consistently high across North Wales, shown in Table 88.
Date: 13.02.12 Version: 1 Page 208 of 318 Public Health Wales North Wales Profile 2011 Table 88: Uptake of newborn hearing screening, North Wales, 1 st April 2009 to 31 st March 2010 Percentage Wales 99.7 North Wales 99.9 Anglesey 100.0 Gwynedd 100.0 Conwy 100.0 Denbighshire 99.9 Flintshire 99.9 Wrexham 99.8 Source: Screening Division, Public Health Wales Further Information • Newborn Hearing Screening Wales http://www.screeningservices.org/nbhsw/index.asp
Date: 13.02.12 Version: 1 Page 209 of 318 Public Health Wales North Wales Profile 2011 15 Additional Resources Betsi Cadwaladr University Health Board: Executive Director of Public Health, Annual Report, 2011 http://www.wales.nhs.uk/sitesplus/documents/861/Annual%20Report%20 %20Executive%20Director%20of%20Public%20Health%202011.pdf Public Health Wales Observatory: Measuring Inequalities, 2011 http://www.wales.nhs.uk/sitesplus/922/page/58379 Public Health Wales Observatory: Health Needs Assessment Support, 2010 http://www.wales.nhs.uk/sitesplus/922/page/49835 Public Health Wales Observatory: Public Health Topics http://www.wales.nhs.uk/sitesplus/922/page/49879 Welsh Government: StatsWales http://statswales.wales.gov.uk/index.htm Local Government Data Unit: Data Unit Wales http://www.dataunitwales.gov.uk/Home.asp?lang=en
Date: 13.02.12 Version: 1 Page 210 of 318 Public Health Wales North Wales Profile 2011 16 References ASH (Action for Smoking and Health) 2007. Facts at a glance Smoking and Disease . ASH. http://www.ash.org.uk./ [Accessed 04.01.12].
Betsi Cadwaladr University Health Board 2011a. Exeter System, December 2011
Betsi Cadwaladr University Health Board 2011b. Executive Director of Public Health, Annual Report, 2011 . http://www.wales.nhs.uk/sitesplus/documents/861/Annual%20Report%2 0 %20Executive%20Director%20of%20Public%20Health%202011.pdf [Accessed 05.01.12]
Dahlgren G. & Whitehead M. 1991. Policies and Strategies to Promote Social Equality in Health. Stockholm, Institute of Further Studies.
Department for Education and Skills 2006. Teenage pregnancy: accelerating the strategy to 2010 . London:DfES. https://www.education.gov.uk/publications/standard/publicationDetail/Pa ge1/DFES 03905 2006 [Accessed 04.01.12]
Department of Health 2004a. The Mental Health of Children and Adolescents in Great Britain: Summary Report.
Department of Health 2004b. At least five a week: Evidence on the impact of physical activity and its relationship to health. A report from the Chief Medical Officer . London 2004. http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/Publicatio nsPolicyAndGuidance/DH_4080994 [Accessed 04.01.12]
Department of Health 2010. ‘Teenage pregnancy strategy: Beyond 2010’ . Department of children, schools and families. Department of Health. London. http://www.education.gov.uk/consultations/downloadableDocs/4287_Teen age%20pregnancy%20strategy_aw8.pdf [Accessed 04.01.12].
Gartner A, Cosh H, Gibbon R, Lester N. 2009. A profile of alcohol and health in Wales . Cardiff: Wales Centre for Health. http://www.wales.nhs.uk/sites3/Documents/568/Alcohol%20and%20Heal th%20in%20Wales_WebFinal_E.pdf [Accessed 04.01.12]
Home Office 2010a. Equality Act 2010 . http://www.homeoffice.gov.uk/equalities/equality act/ [Accessed 04.01.12]
Home Office 2010b. Crime in England and Wales, 2009/2010 . http://webarchive.nationalarchives.gov.uk/20110218135832/http:/rds.ho meoffice.gov.uk/rds/pdfs10/hosb1210.pdf [Accessed 04.01.11]
Date: 13.02.12 Version: 1 Page 211 of 318 Public Health Wales North Wales Profile 2011
Home Office 2011. Drug Misuse Declared: Findings from the 2010/11 British Crime Survey, England and Wales . http://www.homeoffice.gov.uk/publications/science research statistics/research statistics/crime research/hosb1211/hosb1211?view=Binary [Accessed 04.01.12]
McManus S, Meltzer H. Adult psychiatric morbidity in England, 2007. Results of a household survey. The NHS Information Centre for Health and Social care; 2011
National Institute for Clinical Excellence 2010. Strategies to prevent unintentional injuries among under 15s: guidance . http://www.nice.org.uk/nicemedia/live/13272/51621/51621.pdf [Accessed 05.01.12]
National Public Health Service & Wales Centre for Health 2009. Betsi Cadwaladr University Health Board: Demography Profile . http://www.wales.nhs.uk/sitesplus/922/page/49844 [Accessed 04.01.12]
National Public Health Service 2006. Deprivation & Health: LHB Summary Reports . http://howis.wales.nhs.uk/sitesplus/888/page/33533 [Accessed 04.01.12]
National Public Health Service 2009. Guidance on healthcare issues for asylum seekers in Wales: 2009. Welsh Asylum Seeker and Refugee Health Advisory Group . http://nww2.nphs.wales.nhs.uk:8080/VulnerableAdultsDocs.nsf/Public/83 F97989DCAF729B8025755900570C8C/$file/WASHRAGJan09%20(2).doc? OpenElement [Accessed 04.01.12]
NHS Information Centre 2011. Infant Feeding Survey 2010: Early Results http://www.ic.nhs.uk/pubs/infantfeeding10 [Accessed 04.01.12]
Office of National Statistics 2011. Official Labour Market Statistics.
Public Health Wales 2011a HIV and STI trends in Wales Surveillance Report , March 2011 http://nww2.nphs.wales.nhs.uk:8080/CommunitySurveillanceDocs.nsf/3d c04669c9e1eaa880257062003b246b/3c401826e20f106e80257869003561 15/$FILE/HIV%20and%20STI%20trends%20in%20Wales%20Report%20 2009 10_v1b%20201.pdf [Accessed 04.01.12]
Public Health Wales 2011b. Vaccine Uptake in Children in Wales. July to September 2011. COVER 100: Wales November 2011 . http://nww2.nphs.wales.nhs.uk:8080/VaccinationsImmunisationProgsDoc s.nsf/3dc04669c9e1eaa880257062003b246b/aa3def6f3faf4cc3802579530 0558dce/$FILE/Cov11q3%20(report100).pdf [Accessed 05.01.12]
Date: 13.02.12 Version: 1 Page 212 of 318 Public Health Wales North Wales Profile 2011 Public Health Wales 2011c. Seasonal Influenza vaccine uptake in Wales Winter 2010/11 . http://howis.wales.nhs.uk/sites3/page.cfm?orgid=474&pid=21303#2010 11_report [Accessed 05.01.12]
Public Health Wales Observatory 2010a. Health needs assessment support 2010: key small area indicators . http://howis.wales.nhs.uk/sitesplus/888/page/36939 [Accessed 04.01.12].
Public Health Wales Observatory 2010b. Health needs assessment support 2010: key small area indicator. Reference Guide . http://nww2.nphs.wales.nhs.uk:8080/PubHObservatoryProjDocs.nsf/85c5 0756737f79ac80256f2700534ea3/cc9035281b8cd9278025775e00539766 /$FILE/20100712_HNA_ReferenceGuide_nl_v2a.doc [Accessed 04.01.12]
Public Health Wales Observatory 2010c. Lifestyle and health, Wales and its health boards . http://nww2.nphs.wales.nhs.uk:8080/PubHObservatoryProjDocs.nsf/85c5 0756737f79ac80256f2700534ea3/a1e8a36c3d05ab5c802576f5005054eb/ $FILE/Lifestyle_Wales_Final_E.pdf [Accessed 04.01.12]
Public Health Wales Observatory 2010d. Lifestyle and health. Betsi Cadwaladr University Health Board . http://www2.nphs.wales.nhs.uk:8080/PubHObservatoryProjDocs.nsf/85c5 0756737f79ac80256f2700534ea3/4c097ec28880d085802576f500518064/ $FILE/Lifestyle_Betsi_Final_E.pdf [Accessed 04.01.12]
Public Health Wales Observatory 2011. Director of Public Health Annual Report Chart Book: Betsi Cadwaladr University Health Board.
Reidpath D.D. Allotey P. 2003. Infant mortality rate as an indicator of population health. Journal of Epidemiology & Community Health Vol.57 pp.344 346.
Smoke free London and WHO 2001. The case for commissioning smoking cessation services . Smoke free London and World Health Organisation. http://www.ash.org.uk/files/documents/ASH_414.pdf [Accessed 04.01.12]
Stonewall Cymru 2007. Inside Out Project . http://www.stonewall.org.uk/cymru/english/what_we_do/research_and_p olicy/insideout_project/default.asp#executive_summary [Accessed 04.01.12]
Stop Smoking Wales 2011. Annual Report 2010/11 . http://www.stopsmokingwales.com/sitesplus/documents/1006/SSW%20A nnual%20Report%20Final%202010 11%20ENGLISH.pdf [Accessed 04.01.12]
The Marmot Review 2010. Fair Society Healthy Lives. http://www.instituteofhealthequity.org/projects/fair society healthy lives the marmot review [Accessed 04.01.12]
Date: 13.02.12 Version: 1 Page 213 of 318 Public Health Wales North Wales Profile 2011 Thomas K. 2011. Cwm Taf mental health needs: epidemiology. Public Health Wales; 2011.
Welsh Assembly Government 2006a. Food and fitness – promoting healthy eating and physical activity for children and young people in Wales. 5 year Implementation Plan . WAG: Cardiff. http://www.physicalactivityandnutritionwales.org.uk/Documents/740/food fitness implement e.pdf [Accessed 04.01.12]
Welsh Assembly Government 2006b. National Service Framework for older people in Wales. http://www.wales.nhs.uk/sites3/documents/439/NSFforOlderPeopleInWal esEnglish.pdf [Accessed 04.01.11]
Welsh Assembly Government 2007. Carers Strategy for Wales Action Plan 2007 . http://wales.gov.uk/topics/health/publications/socialcare/carers/carersacti onplan?lang=en [Accessed 04.01.12]
Welsh Assembly Government 2008a. Working together to reduce harm. The substance misuse strategy for Wales 2008 – 2018. Welsh Assembly Government. Cardiff. Wales. http://wales.gov.uk/topics/housingandcommunity/safety/publications/stra tegy0818/?lang=en [Accessed 04.01.12]
Welsh Assembly Government 2008b. Welsh Health Survey . Cardiff: WAG. http://wales.gov.uk/topics/statistics/headlines/health2009/hdw20090521 1/?lang=en [Accessed 04.01.12]
Welsh Assembly Government 2009a. Our Healthy Future Welsh Assembly Government. Cardiff. Wales. Available at: www.wales.gov.uk . [Accessed 05/07/10]
Welsh Assembly Government 2009b. Births in Wales 2008: Data from the National Community Child Health Database . Welsh Assembly Government: Cardiff. http://wales.gov.uk/docs/statistics/2009/090708sdr1062009en.pdf [Accessed 04.01.12]
Welsh Assembly Government 2010a. Annual Population Survey 2010 . http://wales.gov.uk/topics/statistics/headlines/economy2011/110623/?lan g=en [Accessed 04.01.12]
Welsh Assembly Government 2010b. Welsh Health Survey 2009: Initial Headline Results . http://wales.gov.uk/docs/statistics/2010/100525sdr742010en.pdf [Accessed 04.01.12]
Welsh Assembly Government 2011a. Health Behaviour in School aged Children: initial findings from the 2009/10 survey in Wales. http://wales.gov.uk/docs/caecd/research/110328healthbehaviouren.pdf [Accessed 04.01.12]
Date: 13.02.12 Version: 1 Page 214 of 318 Public Health Wales North Wales Profile 2011
Welsh Government 2011b. StatsWales . http://www.statswales.wales.gov.uk/ReportFolders/ReportFolders.aspx?C S_referer=&CS_ChosenLang=en [Accessed 04.01.12]
Welsh Government 2011c. Welsh Health Survey . http://wales.gov.uk/topics/statistics/theme/health/health survey/results/?lang=en [Accessed 04.01.12]
Welsh Government Statistical Directorate 2011. Daffodil . http://www.daffodilcymru.org.uk/index.php [Accessed 04.01.12]
World Health Organisation 2006. Health Behaviour in School aged Children Survey 2005/06 . http://www.hbsc.org/ [Accessed 04.01.12]
Date: 13.02.12 Version: 1 Page 215 of 318 Public Health Wales North Wales Profile 2011 17 Appendix One: North Wales Middle Super Output Areas (MSOA)/Electoral Divisions To aid interpretation of the information presented as maps, the tables which follow list Middle Super Output Areas (MSOAs) and the respective Electoral Divisions which are related to them. As can be seen, these do not always fit neatly with some Electoral Divisions split between MSOAs. Isle of Angelsey MSOA Electoral Division Isle of Anglesey 001 Amlwch Port Llannerch y medd Amlwch Rural Mechell Llanbadrig Isle of Anglesey 002 Brynteg Llaneilian Llanddyfnan Moelfre Isle of Anglesey 003 Holyhead Town Maeshyfryd Kingsland Morawelon London Road Porthyfelin Isle of Anglesey 004 Llanfaethlu Trearddur Parc a'r Mynydd Valley Isle of Anglesey 005 Beaumaris Llangoed Cwm Cadnant Pentraeth Llanbedrgoch Isle of Anglesey 006 Bodffordd Cyngar Cefni Tudur Isle of Anglesey 007 Aberffraw Llanfair yn Neubwll Bryngwran Isle of Anglesey 008 Braint Gwyngyll Cadnant Tysilio Isle of Anglesey 009 Bodorgan Llanidan Llanfihangel Ysceifiog Rhosyr
Date: 13.02.12 Version: 1 Page 216 of 318 Public Health Wales North Wales Profile 2011 Gwynedd MSOA Electoral Division Gwynedd 001 Deiniol Marchog Hirael Menai (Bangor)
Gwynedd 002 Dewi Marchog Glyder Pentir* Hendre
Gwynedd 003 Arllechwedd Ogwen Gerlan Tregarth & Mynydd Llandygai
Gwynedd 004 Bethel Y Felinheli Llanrug
Gwynedd 005 Deiniolen Penisarwaun Llanberis Pentir*
Gwynedd 006 Cadnant Peblig (Caernarfon) Menai (Caernarfon) Seiont
Gwynedd 007 Bontnewydd Seiont Llanwnda Waunfawr Gwynedd 008 Groeslon Penygroes Llanllyfni Talysarn
Gwynedd 009 Bowydd & Rhiw Teigl Difflwys & Maenofferen Trawsfynydd
Gwynedd 010 Dolbenmaen Porthmadog West Penrhyndeudraeth* Porthmadog Tremadog Porthmadog East
Gwynedd 011 Abererch Llanaelhaearn Criccieth Llanystumdwy
Gwynedd 012 Efail newydd/Buan Pwllheli North Morfa Nefyn Pwllheli South Nefyn
Gwynedd 013 Dyffryn Ardudwy Llanbedr Harlech Penrhyndeudraeth*
Gwynedd 014 Aberdaron Llanbedrog Botwnnog Llanengan
Gwynedd 015 Bala Llandderfel C orris/Mawddwy
Gwynedd 016 Abermaw Dolgellau North Brithdir & Dolgellau South Llanfachreth/Ganllwyd/ Llanelltyd
Gwynedd 017 Aberdovey Llangelynin Bryn crug/Llanfihangel Tywyn *split between more than one MSOA
Date: 13.02.12 Version: 1 Page 217 of 318 Public Health Wales North Wales Profile 2011 Conwy MSOA Electoral Division Conwy 001 Craig y Don* Mostyn* Gogarth Tudno*
Conwy 002 Craig y Don* Tudno* Mostyn*
Conwy 003 Llandrillo yn Rhos* Penrhyn
Conwy 004 Llandrillo yn Rhos*
Conwy 005 Kinmel Bay Towyn
Conwy 006 Deganwy Marl
Conwy 007 Eirias* Rhiw* Glyn*
Conwy 008 Eirias* Rhiw* Glyn*
Conwy 009 Colwyn Llysfaen Llanddulas
Conwy 010 Abergele Pensarn Pentre Mawr Gele
Conwy 011 Llansanffraid Pensarn Mochdre
Conwy 012 Caerhun Conwy
Conwy 013 Bryn Pandy Capelulo Pant yr afon/Penmaenan
Conwy 014 Betws yn Rhos Llansannan Llangernyw Uwchled
Conwy 015 Betws y Coed Gower Crwst Trefriw Eglwysbach Uwch Conwy
*split between more than one MSOA
Date: 13.02.12 Version: 1 Page 218 of 318 Public Health Wales North Wales Profile 2011 Denbighshire MSOA Electoral Division
Denbighshire 001 Prestatyn North
Denbighshire 002 Prestatyn Central* Prestatyn East
Denbighshire 003 Prestatyn Central* Prestatyn South West
Denbighshire 004 Rhyl East Rhyl West
Denbighshire 005 Rhyl South East*
Denbighshire 006 Rhyl South West
Denbighshire 007 Rhyl South Rhyl South East*
Denbighshire 008 Dyserth Tremeirchion Prestatyn Meliden
Denbighshire 009 Bodelwyddan Rhuddlan
Denbighshire 010 St Asaph East Trefnant St Asaph West
Denbighshire 011 Denbigh Central Denbigh Upper/Henllan
Denbighshire 012 Denbigh Lower Llanrhaeadr yng Nghinmeirch
Denbighshire 013 Llanarmon yn Ial/Llandegla Llandyrnog Llanbedr Dyffryn Clwyd/Llangynhafal Denbighshire 014 Ruthin Corwen Llanfair Dyffryn Denbighshire 015 C lwyd/Gwyddelwern Efenechtyd
Denbighshire 016 Corwen Llangollen Llandrillo *split between more than one MSOA
Date: 13.02.12 Version: 1 Page 219 of 318 Public Health Wales North Wales Profile 2011 Flintshire MSOA Electoral Division Flintshire 001 Ffynnongroyw Trelawnyd & Gwaenysgor Gronant Flintshire 002 Holywell West Whitford Mostyn Flintshire 003 Bagillt East Holywell Central Bagillt West Holywell East Greenfield Flintshire 004 Flint Castle Flint Oakenholt Flint Coleshill* Flintshire 005 Flint Coleshill* Flint Trelawny Flintshire 006 Brynford Cilcain Caerwys Halkyn Flintshire 007 Connah's Quay Central Connah's Quay Golftyn* Flintshire 008 Connah's Quay Golftyn* Connah's Quay Wepre Connah's Quay South Flintshire 009 Sealand Shotton Higher Shotton East Shotton West Flintshire 010 Aston Northop Hall Connah's Quay South Flintshire 011 Mancot Queensferry Flintshire 012 Buckley Mountain Northop Flintshire 013 Aston Ewloe Buckley Pentrobin* Hawarden Flintshire 014 Argoed New Brighton Buckley Bistre West* Flintshire 015 Broughton North East Saltney Mold Junction Broughton South Saltney Stonebridge
Flintshire 016 Mold Broncoed Mold South Mold East Mold West Flintshire 017 Buckley Bistre East Buckley Pentrobin* Buckley Bistre West* Flintshire 018 Higher Kinnerton Penyffordd Flintshire 019 Gwernaffield Leeswood Gwernymynydd Treuddyn Flintshire 020 Caergwrle Llanfynydd Hope *split between more than one MSOA
Date: 13.02.12 Version: 1 Page 220 of 318 Public Health Wales North Wales Profile 2011 Wrexham MSOA Electoral Division Wrexham 001 Holt Rossett Llay*
Wrexham 002 Gresford East & West Marford & Hoseley
Wrexham 003 Gwersyllt East & South Llay*
Wrexham 004 Gwersyllt North Gwersyllt West
Wrexham 005 Bryn Cefn New Broughton Gwenfro
Wrexham 006 Brymbo Coedpoeth
Wrexham 007 Borras Park Rhosnesni
Wrexham 008 Garden Village Little Acton Grosvenor Stansty
Wrexham 009 Acton Maesydre
Wrexham 010 Cartrefle Wynnstay Queensway
Wrexham 011 Brynyffynnon Offa Erddig
Wrexham 012 Hermitage Whitegate Smithfield
Wrexham 013 Minera Penycae & Ruabon South* Penycae
Wrexham 014 Esclusham Ponciau* Johnstown*
Wrexham 015 Johnstown* Ponciau* Pant
Wrexham 016 Marchwiel Ruabon Penycae & Ruabon South*
Wrexham 017 Cefn Plas Madoc Llangollen Rural
Wrexham 018 Bronington Overton
Wrexham 019 Dyffryn Ceiriog/Ceiriog Valley Chirk South Chirk North *split between more than one MSOA
Date: 13.02.12 Version: 1 Page 221 of 318 Adroddiad Blynyddol Cyfarwyddwr Iechyd y Cyhoedd: Llyfr Siartiau
Appendix Two: Adroddiad Blynyddol Cyfarwyddwr Iechyd y Cyhoedd: Llyfr Siartiau Bwrdd Iechyd Prifysgol Betsi Cadwaladr
Cyhoeddwyd Gorffennaf 2011
Adroddiad Blynyddol Cyfarwyddwr Iechyd y Cyhoedd: Llyfr Siartiau
Cynnwys
1 CYFLWYNIAD ...... 2
2 DEMOGRAFFEG...... 2 2.1 Demograffeg: pwyntiau allweddol...... 2 2.2 Poblogaeth ...... 2 2.2.1 Poblogaeth yn ôl oed a rhyw ...... 2 2.2.2 Poblogaeth o dan 18 oed ...... 2 2.2.3 Y boblogaeth sydd yn 75 oed ac yn hŷn...... 2 2.2.4 Y boblogaeth sydd yn 85 oed ac yn hŷn...... 2 2.3 Amcanestyniadau poblogaeth...... 2 2.3.1 Amcanestyniadau poblogaeth fesul grŵp oedran...... 2 2.3.2 Amcanestyniadau poblogaeth, pobl sydd yn 75 oed ac yn hŷn...... 2 2.3.3 Amcanestyniadau poblogaeth, pobl sydd yn 85 oed ac yn hŷn...... 2 2.4 Genedigaethau...... 2 2.4.1 Cyfradd ffrwythlondeb gyffredinol ...... 2 2.5 Marwolaethau ...... 2 2.5.1 Marwolaethau pob achos ...... 2 2.5.2 Marwolaethau pob achos, o dan 75 oed...... 2
3 PENDERFYNYDDION IECHYD...... 2 3.1 Penderfynyddion iechyd: pwyntiau allweddol...... 2 3.2 Penderfynyddion ehangach iechyd ...... 2 3.2.1 Amddifadedd mewn perthynas â Chymru...... 2 3.2.2 Amddifadedd yn y bwrdd iechyd ...... 2 3.2.3 Anghydraddoldeb mewn marwolaethau pob achos ...... 2 3.3 Ffactorau ffordd o fyw ...... 2 3.3.1 Smygu fel y cofnodwyd gan oedolion ...... 2 3.3.2 Goryfed mewn pyliau fel y cofnodwyd gan oedolion ...... 2 3.3.3 Pum darn neu fwy o ffrwythau a llysiau'r dydd fel y cofnodwyd gan oedolion...... 2 3.3.4 Gweithgaredd corfforol fel y cofnodwyd gan oedolion ...... 2 3.3.5 Bod dros bwysau a gordewdra, oedolion yn seiliedig ar ddata hunan gofnodedig ...... 2
4 DEFNYDD O WASANAETHAU...... 2 4.1 Defnydd o wasanaethau: pwyntiau allweddol ...... 2 4.2 Gwasanaethau ataliaeth: brechu ...... 2 4.2.1 Imiwneiddio plant...... 2 4.2.2 Brechu rhag ffliw tymhorol...... 2 4.3 Rhaglenni Sgrinio Cenedlaethol yn Seiliedig ar Boblogaeth yng Nghymru. 2 4.3.1 Ymgymeriad rhaglenni sgrinio cenedlaethol yng Nghymru ...... 2 4.4 Gwasanaethau gofal sylfaenol ...... 2 4.4.1 Defnydd o ofal sylfaenol fel y nodir gan oedolion ...... 2 4.5 Defnydd o ofal eilaidd a thrydyddol ...... 2 4.5.1 Derbyniadau i’r ysbyty: unigolion o dan 75 oed ...... 2 4.5.2 Derbyniadau brys i’r ysbyty: unigolion o dan 75 oed ...... 2 4.5.3 Derbyniadau dewisol i’r ysbyty: unigolion o dan 75 oed...... 2
Adroddiad Blynyddol Cyfarwyddwr Iechyd y Cyhoedd: Llyfr Siartiau
5 STATWS IECHYD ...... 2 5.1 Statws iechyd: pwyntiau allweddol ...... 2 5.2 Iechyd corfforol ac iechyd meddwl ...... 2 5.2.1 Pwysau geni isel ...... 2 5.2.2 Iechyd corfforol fel y nodir gan oedolion* ...... 2 5.2.3 Iechyd meddwl fel y nodir gan oedolion* ...... 2 5.2.4 Salwch hirdymor sy’n cyfyngu fel y nodir gan oedolion ...... 2 5.2.5 Salwch meddwl fel y nodir gan oedolyn ...... 2 5.3 Marwolaeth yn sgil cyflyrau penodol...... 2 5.3.1 Marwolaeth yn sgil clefyd cylchrediad y gwaed, pob oed...... 2 5.3.2 Marwolaeth yn sgil clefyd cylchrediad y gwaed, o dan 75 oed...... 2 5.3.3 Marwolaeth yn sgil clefyd coronaidd y galon...... 2 5.3.4 Marwolaeth yn sgil canser...... 2 5.3.5 Marwolaeth yn sgil clefyd anadlol ...... 2 5.3.6 Goroesi canser ...... 2
ATODIAD A: ADRODDIADAU GWREIDDIOL A MWY O WYBODAETH ...... 2
ATODIAD B: GEIRFA ...... 2
ATODIAD C: MAPIAU YN DANGOS ARDALOEDD CYNNYRCH EHANGACH HAEN GANOL YN ARDAL BWRDD IECHYD PRIFYSGOL BETSI CADWALADR...... 2 © Ymddiriedolaeth GIG Iechyd Cyhoeddus Cymru 2011. Gellir atgynhyrchu rhannau o’r ddogfen hon heb ganiatâd ymlaen llaw, ar yr amod y caiff hynny ei wneud yn gywir ac na chaiff ei ddefnyddio mewn cyd destun camarweiniol. Dylid rhoi cydnabyddiaeth i Ymddiriedolaeth GIG Iechyd Cyhoeddus Cymru. Mae hawlfraint y trefniant teipograffyddol, y dyluniad a’r cynllun hwn yn eiddo i Ymddiriedolaeth GIG Iechyd Cyhoeddus Cymru.
Adroddiad Blynyddol Cyfarwyddwr Iechyd y Cyhoedd: Llyfr Siartiau
1 Cyflwyniad Mae llyfr siartiau Bwrdd Iechyd Prifysgol Betsi Cadwaladr wedi cael ei greu gan Arsyllfa Iechyd Cyhoeddus Cymru fel atodiad i Adroddiad Blynyddol Cyfarwyddwr Iechyd y Cyhoedd. Mae’n diweddaru ac yn ychwanegu at y llyfr siartiau a gynhyrchwyd gan Gyfarwyddwr Iechyd y Cyhoedd Bwrdd Iechyd Prifysgol Abertawe Bro Morgannwg ar gyfer ei Adroddiad Blynyddol Interim ef. Gwnaed penderfyniad gan Gyfarwyddwyr Iechyd y Cyhoedd Cymru i ddefnyddio’r dangosyddion hyn i lywio eu hadroddiadau blynyddol. Roedd dangosyddion llyfr siartiau Bwrdd Iechyd Prifysgol Abertawe Bro Morgannwg yn deillio o nifer o ffynonellau: • Arsyllfa Iechyd Cyhoeddus Cymru • Rhaglen Clefydau y Gellir eu Hatal gan Frechlyn (Iechyd Cyhoeddus Cymru) • Gwasanaethau Sgrinio Iechyd Cyhoeddus Cymru • Uned Gwybodaeth ac Arolygiaeth Canser Cymru (Iechyd Cyhoeddus Cymru) Mae’r llyfr siartiau hwn wedi ei ddiweddaru yn cyfuno gwybodaeth o’r adnoddau uchod ac yn ychwanegu gwybodaeth newydd o’r ffynonellau canlynol: O Arsyllfa Iechyd Cyhoeddus Cymru: • Adroddiad Blynyddol Cyfarwyddwr Iechyd y Cyhoedd: dangosyddion cynorthwyol, 2011 • Proffil Demograffeg, 2009 • Proffil Ffordd o Fyw, 2010 • Anghydraddoldeb mewn marwolaethau ym Mwrdd Iechyd Prifysgol Betsi Cadwaladr: datganiad interim i gefnogi adroddiadau blynyddol Cyfarwyddwyr Iechyd y Cyhoedd O ffynonellau eraill: • Arolwg Iechyd Cymru, Llywodraeth Cynulliad Cymru (wedi ei ailgyflwyno gan Arsyllfa Iechyd Cyhoeddus Cymru) • Iechyd Cyhoeddus Cymru, Rhaglen Clefydau y Gellir eu Hatal gan Frechlyn • Is adran Sgrinio (Iechyd Cyhoeddus Cymru) • Uned Gwybodaeth ac Arolygiaeth Canser Cymru (Iechyd Cyhoeddus Cymru) Mae’r dangosyddion wedi cael eu cyflwyno o dan y penawdau canlynol: demograffeg; penderfynyddion iechyd; defnyddio gwasanaethau a statws iechyd. Mae crynodeb o’r pwyntiau allweddol wedi ei gynnwys ar ddechrau pob pennod. Mae’r mapiau sydd wedi eu cynnwys yn y ddogfen hon yn dangos data yn ôl pumedau o ystod gyfartal yn ardal y bwrdd iechyd.
Adroddiad Blynyddol Cyfarwyddwr Iechyd y Cyhoedd: Llyfr Siartiau
Mae dolenni gwe wedi eu cynnwys yn Atodiad A ar gyfer yr adroddiadau gwreiddiol a cheir mwy o wybodaeth i gefnogi’r dangosyddion a ddefnyddir yn y llyfr siartiau hwn. Ceir rhestr o rai o’r termau a ddefnyddir yn y llyfr siartiau hwn yn Atodiad B. Mae Atodiad C yn cynnwys cyfres o fapiau ardaloedd awdurdod lleol yn dangos ffiniau’r Ardal Gynnyrch Ehangach Haen Ganol (MSOA) ar gyfer ardal y bwrdd iechyd.
2 Demograffeg
2.1 Demograffeg: pwyntiau allweddol Strwythur y boblogaeth Mae Bwrdd Iechyd Prifysgol Betsi Cadwaladr yn cynnwys chwe ardal awdurdod lleol: Ynys Môn; Gwynedd; Conwy; Sir Ddinbych; Sir y Fflint a Wrecsam. Amcangyfrifwyd mai poblogaeth y bwrdd iechyd oedd 679 o filoedd yn 2009. Mae strwythur oed y boblogaeth yn wahanol i Gymru gyda chyfran uwch o bobl yn 55 oed ac yn hŷn a chyfran lai rhwng 15 a 34 oed. Ar lefel awdurdod lleol, mae Conwy, Ynys Môn, Gwynedd a Sir Ddinbych yn dangos bod cyfran is o’r boblogaeth o dan 18 oed na gweddill Cymru. Ar lefel yr ardal gynnyrch ehangach haen ganol (MSOA), ceir cyfran uwch o bobl 18 oed ac yn hŷn yn rhannau o’r Rhyl ac yn ardaloedd Wynnstay, Queensway a Chartrefle o Wrecsam. Mae’r ardaloedd â’r cyfrannau isaf yn ardaloedd Abergele, Llandudno a Llandrillo yn Rhos o Gonwy; rhannau dwyreiniol Ynys Môn; rhannau o Fangor, ardaloedd Harlech a Thywyn o Wynedd ac o amgylch Llangollen yn Sir Ddinbych. Ar gyfer pobl 75 oed ac yn hŷn, mae gan Ynys Môn, Gwynedd, Sir Ddinbych a Chonwy gyfran uwch na’r cyfartaledd yn y grŵp oedran hwn gyda Sir y Fflint a Wrecsam â chyfran is na’r cyfartaledd. Yng Nghonwy, mae’r gyfran sydd yn 75 oed ac yn hŷn yn arbennig o uchel ar ychydig yn llai na deuddeg y cant. Ar lefel MSOA, mae’r gyfran uchaf yn ardaloedd Llandudno, Abergele, Llandrillo yn Rhos, Penrhyn, Deganwy a Marl o Gonwy a hefyd ardal Tywyn o Wynedd. Mae’r patrwm yn debyg iawn ymysg y rheiny sydd yn 85 oed ac yn hŷn. Amcanestyniadau poblogaeth Mae’r amcanestyniadau diweddaraf yn dangos, os yw’r tueddiadau presennol yn parhau, bydd nifer y bobl sydd yn 65 oed ac yn hŷn sy’n preswylio ym Mwrdd Iechyd Prifysgol Betsi Cadwaladr yn cynyddu 60 y cant rhwng 2008 a 2033. Yr amcanestyniad yw y bydd cyfran y bobl sydd yn 75 ac yn hŷn yn cynyddu o ryw saith ac wyth y cant yn Sir y Fflint a Wrecsam yn y drefn honno i ryw 15 a 14 y cant yn y drefn honno yn ystod y cyfnod hwn. Yng Nghonwy, yr amcanestyniad yw y bydd y gyfran yn codi o ryw 12 y cant i 18 y cant. Yr amcanestyniad yw y bydd canran y bobl sydd yn 85 oed ac yn hŷn yn dyblu o ryw 2 i 3.5 y cant i ryw 5.5 i 7 y cant erbyn 2033.
Adroddiad Blynyddol Cyfarwyddwr Iechyd y Cyhoedd: Llyfr Siartiau
Mae’r cynnydd yn nifer y bobl hŷn yn debygol o fod yn gysylltiedig â chynnydd mewn cyflyrau cronig fel clefydau cylchrediad y gwaed ac anadlol a chanserau. Bydd bodloni anghenion yr unigolion yn her allweddol i’r bwrdd iechyd. Yn yr hinsawdd economaidd sydd ohoni, bydd y cynnydd cymharol (ac absoliwt) yn y boblogaeth sy’n ddibynnol yn economaidd ac, mewn rhai achosion, o ran gofal, yn her fawr i gymunedau. Cyfradd genedigaethau Mae’r Gyfradd Ffrwythlondeb Gyffredinol (GFR) ar gyfer Bwrdd Iechyd Prifysgol Betsi Cadwaladr yn debyg iawn i’r gyfradd ar gyfer Cymru. Ar lefel awdurdod lleol, mae’r gyfradd ar ei huchaf yn Wrecsam ac ar ei hisaf yng Ngwynedd yn y bwrdd iechyd. Ar lefel yr MSOA, mae amrywiad sylweddol. Mae’r cyfraddau’n arbennig o isel yn rhannau o Fangor yng Ngwynedd lle mae cyfran uchel o’r boblogaeth yn fyfyrwyr. Yr ardaloedd â’r cyfraddau uchaf yw ardaloedd Queensway, Wynnstay a Chartrefle o Wrecsam; a rhannau o’r Rhyl a Bae Colwyn. Marwolaethau pob achos Mae cyfraddau marwolaethau pob achos yn ôl oed safonedig Ewrop yn ystyried strwythur oedran y boblogaeth, gan alluogi i gymariaethau dilys gael eu gwneud rhwng ardaloedd. Mae’r gyfradd ar gyfer Bwrdd Iechyd Prifysgol Betsi Cadwaladr yn is nag yng Nghymru. Yn y bwrdd iechyd, mae’r gyfradd ar ei hisaf ar Ynys Môn (597 fesul 100,000) ac ar ei huchaf yn Wrecsam (645 fesul 100,000). Ar lefel yr MSOA, mae’r amrywiad yn sylweddol gyda’r cyfraddau’n amrywio o 427 i 1016 fesul 100,000 o’r boblogaeth. Mae’r cyfraddau isaf ar y cyfan yn ardaloedd mwy gwledig dwyrain Ynys Môn; rhannau de ddwyreiniol ardal awdurdod lleol Wrecsam a Sir y Fflint. Ceir cyfraddau arbennig o uchel yn ardal Gorllewin Gwersyllt o Wrecsam a llain arfordirol y Rhyl. Mae’r patrwm yn debyg ymysg pobl o dan 75 oed. Mae’r bwrdd iechyd yn dangos tuedd sy’n gostwng mewn marwolaethau ymysg pobl o dan 75 oed rhwng 2000 a 2009 sydd ar y cyfan yn unol â phatrwm Cymru gyfan.
Adroddiad Blynyddol Cyfarwyddwr Iechyd y Cyhoedd: Llyfr Siartiau
2.2 Poblogaeth
2.2.1 Poblogaeth yn ôl oed a rhyw Bwrdd Iechyd Prifysgol Betsi Cadwaladr a Chymru
Adroddiad Blynyddol Cyfarwyddwr Iechyd y Cyhoedd: Llyfr Siartiau
2.2.2 Poblogaeth o dan 18 oed Ardaloedd cynnyrch ehangach haen ganol
Adroddiad Blynyddol Cyfarwyddwr Iechyd y Cyhoedd: Llyfr Siartiau
Adroddiad Blynyddol Cyfarwyddwr Iechyd y Cyhoedd: Llyfr Siartiau
Awdurdodau lleol
Adroddiad Blynyddol Cyfarwyddwr Iechyd y Cyhoedd: Llyfr Siartiau
2.2.3 Y boblogaeth sydd yn 75 oed ac yn hŷn Ardaloedd cynnyrch ehangach haen ganol
Adroddiad Blynyddol Cyfarwyddwr Iechyd y Cyhoedd: Llyfr Siartiau
Adroddiad Blynyddol Cyfarwyddwr Iechyd y Cyhoedd: Llyfr Siartiau
Awdurdodau lleol
Adroddiad Blynyddol Cyfarwyddwr Iechyd y Cyhoedd: Llyfr Siartiau
2.2.4 Y boblogaeth sydd yn 85 oed ac yn hŷn Ardaloedd cynnyrch ehangach haen ganol
Adroddiad Blynyddol Cyfarwyddwr Iechyd y Cyhoedd: Llyfr Siartiau
Adroddiad Blynyddol Cyfarwyddwr Iechyd y Cyhoedd: Llyfr Siartiau
2.3 Amcanestyniadau poblogaeth
2.3.1 Amcanestyniadau poblogaeth fesul grŵp oedran Bwrdd Iechyd Prifysgol Betsi Cadwaladr
Adroddiad Blynyddol Cyfarwyddwr Iechyd y Cyhoedd: Llyfr Siartiau
2.3.2 Amcanestyniadau poblogaeth, pobl sydd yn 75 oed ac yn hŷn Awdurdodau lleol ym Mwrdd Iechyd Prifysgol Betsi Cadwaladr*
Adroddiad Blynyddol Cyfarwyddwr Iechyd y Cyhoedd: Llyfr Siartiau
2.3.3 Amcanestyniadau poblogaeth, pobl sydd yn 85 oed ac yn hŷn Awdurdodau lleol ym Mwrdd Iechyd Prifysgol Betsi Cadwaladr*
Adroddiad Blynyddol Cyfarwyddwr Iechyd y Cyhoedd: Llyfr Siartiau
2.4 Genedigaethau
2.4.1 Cyfradd ffrwythlondeb gyffredinol Ardaloedd cynnyrch ehangach haen ganol
Mae’r niferoedd ar y map yn dangos MSOA gyda chyfradd sydd yn sylweddol uwch yn ystadegol na chyfradd Cymru gyfan.
Adroddiad Blynyddol Cyfarwyddwr Iechyd y Cyhoedd: Llyfr Siartiau
Adroddiad Blynyddol Cyfarwyddwr Iechyd y Cyhoedd: Llyfr Siartiau
Awdurdodau lleol
Adroddiad Blynyddol Cyfarwyddwr Iechyd y Cyhoedd: Llyfr Siartiau
2.5 Marwolaethau
2.5.1 Marwolaethau pob achos Ardaloedd cynnyrch ehangach haen ganol
Mae’r niferoedd ar y map yn dangos MSOA gyda chyfradd sydd yn sylweddol uwch yn ystadegol na chyfradd Cymru gyfan.
Adroddiad Blynyddol Cyfarwyddwr Iechyd y Cyhoedd: Llyfr Siartiau
Adroddiad Blynyddol Cyfarwyddwr Iechyd y Cyhoedd: Llyfr Siartiau
Awdurdodau lleol
Adroddiad Blynyddol Cyfarwyddwr Iechyd y Cyhoedd: Llyfr Siartiau
2.5.2 Marwolaethau pob achos, o dan 75 oed Ardaloedd cynnyrch ehangach haen ganol
Adroddiad Blynyddol Cyfarwyddwr Iechyd y Cyhoedd: Llyfr Siartiau
Adroddiad Blynyddol Cyfarwyddwr Iechyd y Cyhoedd: Llyfr Siartiau
Awdurdodau lleol
Adroddiad Blynyddol Cyfarwyddwr Iechyd y Cyhoedd: Llyfr Siartiau
Tueddiadau Bwrdd Iechyd Prifysgol Betsi Cadwaladr a Chymru
Adroddiad Blynyddol Cyfarwyddwr Iechyd y Cyhoedd: Llyfr Siartiau
3 Penderfynyddion iechyd
3.1 Penderfynyddion iechyd: pwyntiau allweddol Patrwm amddifadedd Mae patrwm yr amddifadedd fel y disgrifir gan Fynegai Amddifadedd Lluosog Cymru yn dangos bod yr ardaloedd mwyaf difreintiedig mewn ardaloedd arfordirol yn bennaf fel o amgylch y Rhyl a Bae Colwyn yn Sir Ddinbych; Caernarfon yng Ngwynedd a hefyd yn Wrecsam. Mae pedwar deg naw o’r 425 o ardaloedd cynnyrch ehangach haen is Bwrdd Iechyd y Brifysgol (12 y cant) ymysg y pumed mwyaf difreintiedig yng Nghymru gydag 80 (19 y cant) yn y pumed lleiaf difreintiedig. Fodd bynnag, mewn ardaloedd llai difreintiedig ceir clytiau o amddifadedd cudd yn aml. Dadansoddiad o’r cysylltiad rhwng amddifadedd ac iechyd gwael Mae’r cysylltiad rhwng amddifadedd economaidd gymdeithasol a chanlyniadau iechyd gwael wedi ei sefydlu ers amser. Bydd Arsyllfa Iechyd Cyhoeddus Cymru yn cyhoeddi proffil yn archwilio’r berthynas dros amser rhwng amddifadedd a marwolaethau yn ddiweddarach eleni. Mae’r llyfr siartiau hwn yn cynnwys rhywfaint o ddadansoddi rhagarweiniol a gyhoeddwyd ar gyfer ei gynnwys yn Adroddiadau Blynyddol Cyfarwyddwr Iechyd y Cyhoedd. Mae’r dadansoddiad yn dangos bod cyfradd marwolaethau pob achos yn ôl oed safonedig Ewrop yn y pumed ardal fwyaf ddifreintiedig ym Mwrdd Iechyd Prifysgol Betsi Cadwaladr ddwywaith y gyfradd yn y pumed ardal leiaf ddifreintiedig. Mae’r bwlch yn debyg iawn mewn dynion a menywod, ond ar draws y cyfnod a nodir, mae’r bwlch wedi lleihau ychydig ymysg dynion, ond wedi cynyddu ychydig ymysg menywod. Data ffordd o fyw Mae Arolwg Iechyd Cymru yn ffynhonnell gyfoethog o wybodaeth am ffordd o fyw. Arolwg hunan gofnodedig ydyw gyda sampl ar hap o ryw 15 mil o oedolion (16+ oed) y flwyddyn yng Nghymru. Mae’r sampl yn cael ei llunio er mwyn adrodd ar lefel awdurdod lleol. Mae dangosyddion ffordd o fyw yn ardal Bwrdd Iechyd Prifysgol Betsi Cadwaladr ar y cyfan yn well, neu’n debyg i, gyfartaledd Cymru. Mae bron un ym mhob pedwar person yn smygu, sy’n arwain at dros 1,300 o farwolaethau yn ardal y bwrdd iechyd. Mae cyfraddau hunan gofnodedig ychydig yn is na chyfartaledd Cymru ar Ynys Môn, Conwy a Sir y Fflint, ond ychydig yn uwch yng Ngwynedd, Sir Ddinbych a Wrecsam. Mae dros 40 y cant o’r boblogaeth yn ardal y bwrdd iechyd yn yfed mwy o alcohol na’r terfynau a argymhellir ac mae dros chwarter yn goryfed mewn pyliau o leiaf un diwrnod yr wythnos. Mae derbyniadau i’r ysbyty oherwydd alcohol yn is ymysg dynion na chyfartaledd Cymru ac yn debyg i Gymru ymysg menywod. Ar gyfer derbyniadau’n ymwneud â chyffuriau, mae’r gwrthwyneb yn wir. Mae dros 12 mil o dderbyniadau i’r ysbyty a 260 o farwolaethau yn cael eu hachosi gan alcohol bob blwyddyn yn ardal Bwrdd Iechyd Prifysgol Betsi Cadwaladr.
Adroddiad Blynyddol Cyfarwyddwr Iechyd y Cyhoedd: Llyfr Siartiau
Ar y cyfan, mae ychydig dros draean y bobl yn bwyta’r maint a argymhellir o ffrwythau a llysiau, a Gwynedd sydd â’r ganran uchaf. Mae’r darlun yn debyg ar gyfer gweithgaredd corfforol. Mae gwella deiet a gweithgaredd corfforol yn hanfodol er mwyn lleihau’r gyfran uchel o bobl sydd dros bwysau neu yn ordew. Mae rhwng 50 a 60 y cant o oedolion yn ardal y bwrdd iechyd naill ai dros bwysau neu yn ordew.
Adroddiad Blynyddol Cyfarwyddwr Iechyd y Cyhoedd: Llyfr Siartiau
3.2 Penderfynyddion ehangach iechyd
3.2.1 Amddifadedd mewn perthynas â Chymru Mae Mynegai Amddifadedd Lluosog Cymru (2008) yn cael ei greu ar lefel ardal fach o’r enw’r ardal cynnyrch ehangach haen is, ac mae’n deillio o ystod eang o ffactorau yn cynnwys incwm, cyflogaeth, iechyd, addysg, sgiliau a hyfforddiant, diogelwch cymunedol, tai, yr amgylchedd ffisegol a mynediad i wasanaethau. Mae’n fesuriad amddifadedd daearyddol y gellir ei ddefnyddio i ddangos anghydraddoldebau mewn iechyd ac awgrymu’r ardaloedd sydd fwyaf tebygol o fod angen mesurau i wella iechyd a rheoli afiechyd. Mae’r map hwn yn dangos lefel yr amddifadedd yn y bwrdd iechyd o’i gymharu â gweddill Cymru.
Adroddiad Blynyddol Cyfarwyddwr Iechyd y Cyhoedd: Llyfr Siartiau
Adroddiad Blynyddol Cyfarwyddwr Iechyd y Cyhoedd: Llyfr Siartiau
3.2.2 Amddifadedd yn y bwrdd iechyd Mae’r map hwn yn dangos y pumedau mwyaf a lleiaf difreintiedig yn y bwrdd iechyd. Y grwpiau hyn a ddefnyddir i ddangos anghydraddoldebau mewn marwolaethau yn yr adran nesaf.
Adroddiad Blynyddol Cyfarwyddwr Iechyd y Cyhoedd: Llyfr Siartiau
3.2.3 Anghydraddoldeb mewn marwolaethau pob achos Mae’r graffiau hyn yn cymharu marwolaethau yn y pumed ran fwyaf ddifreintiedig o boblogaeth y bwrdd iechyd â’r pumed ran leiaf ddifreintiedig o boblogaeth y bwrdd iechyd.
Adroddiad Blynyddol Cyfarwyddwr Iechyd y Cyhoedd: Llyfr Siartiau
3.3 Ffactorau ffordd o fyw
3.3.1 Smygu fel y cofnodwyd gan oedolion
Adroddiad Blynyddol Cyfarwyddwr Iechyd y Cyhoedd: Llyfr Siartiau
3.3.2 Goryfed mewn pyliau fel y cofnodwyd gan oedolion
Adroddiad Blynyddol Cyfarwyddwr Iechyd y Cyhoedd: Llyfr Siartiau
3.3.3 Pum darn neu fwy o ffrwythau a llysiau'r dydd fel y cofnodwyd gan oedolion
Adroddiad Blynyddol Cyfarwyddwr Iechyd y Cyhoedd: Llyfr Siartiau
3.3.4 Gweithgaredd corfforol fel y cofnodwyd gan oedolion
Adroddiad Blynyddol Cyfarwyddwr Iechyd y Cyhoedd: Llyfr Siartiau
3.3.5 Bod dros bwysau a gordewdra, oedolion yn seiliedig ar ddata hunan gofnodedig
Adroddiad Blynyddol Cyfarwyddwr Iechyd y Cyhoedd: Llyfr Siartiau
4 Defnydd o wasanaethau
4.1 Defnydd o wasanaethau: pwyntiau allweddol Imiwneiddio plant Mae cyfraddau imiwneiddio plant yn dangos tueddiadau hirdymor cadarnhaol, er eu bod yn dal islaw’r cyfraddau targed mewn nifer o ardaloedd allweddol. Mae imiwneiddio plant o dan flwydd oed yn cyrraedd y targed o 95%. Nid yw’r holl imiwneiddio sydd wedi ei drefnu ar gyfer plant yn ystod ail flwyddyn eu bywyd yn cyrraedd y targed o 95%, ac mae imiwneiddio plant pum mlwydd oed ac un ar bymtheg oed hefyd islaw’r targed ac eithrio’r targed o un dos o MMR erbyn 16 oed. Mae cyfraddau cael y brechlyn MMR yn peri pryder penodol oherwydd achosion eang o’r frech goch yng Nghymru yn 2009, ac achosion parhaus yn Ewrop yn 2011. Mae cyfraddau cael un dos o MMR ymysg plant dwy flwydd oed a dau ddos ymysg plant pum mlwydd oed wedi gwella ar y cyfan er 2004, ond mae angen i 95% gael dau ddos er mwyn dileu’r frech goch yn unol â nodau Sefydliad Iechyd y Byd. Bydd gwella cyfraddau’r plant cyn ysgol a phobl ifanc yn eu harddegau sy’n cael eu himiwneiddio yn lleihau’r peryg o achosion o glefydau y gellir eu hatal gan frechlyn yn y dyfodol. Brechu rhag ffliw tymhorol Yng Nghymru, mae imiwneiddio am ddim rhag ffliw tymhorol yn cael ei gynnig i bawb sydd yn 65 oed ac yn hŷn, a phobl rhwng 6 mis a 65 oed mewn grwpiau sydd mewn perygl clinigol (ar hyn o bryd clefyd anadlol cronig, clefyd y galon cronig, clefyd arennol cronig, clefyd yr iau cronig, cyflyrau niwrolegol cronig, diabetes mellitus, a gwrthimiwnedd), trigolion cartrefi gofal arhosiad hir a phrif ofalwyr person oedrannus neu anabl y gallai eu lles fod mewn perygl pe byddai’r gofalwr yn mynd yn sâl. Ar gyfer 2009/10, gosododd LlCC darged o gyfradd imiwneiddio o 70% ar gyfer pobl 65 oed ac yn hŷn. Ar gyfer ymgyrch imiwneiddio rhag ffliw tymhorol 2010/11, cafodd y targed cenedlaethol ei godi i darged Sefydliad Iechyd y Byd, sef 75% mewn grwpiau a argymhellir. Cafodd y targed hwn ei osod hefyd ar gyfer y rheiny sydd yn iau na 65 oed mewn grwpiau ‘mewn perygl’. Yn ystod ymgyrch 2010/11, cafodd imiwneiddio rhag y ffliw ei gynnig hefyd i fenywod beichiog nad oeddent yn grŵp mewn perygl clinigol yn flaenorol. Yn ystod 2010/11, roedd cyfraddau imiwneiddio rhag ffliw tymhorol ar gyfer Bwrdd Iechyd Prifysgol Betsi Cadwaladr ymysg pobl 65 oed ac yn hŷn 7% o dan y lefel darged. Yn ystod 2010/11, roedd cyfraddau imiwneiddio ymysg pobl o dan 65 oed yn y grwpiau risg 23% islaw'r lefel darged. Rhaglenni Sgrinio Cenedlaethol yn Seiliedig ar Boblogaeth yng Nghymru Mae cyfraddau ymgymeriad/cwmpas ym Mwrdd Iechyd Prifysgol Betsi Cadwaladr ar gyfer rhaglenni sgrinio cenedlaethol ar gyfer canser y coluddyn, y fron a cheg y groth a sgrinio clyw babanod ar y cyfan ar gyfartaledd â Chymru yn gyffredinol. Fodd bynnag, dim ond cyfraddau ar gyfer sgrinio clyw babanod sy’n cyrraedd cyfraddau targed y DU. Mae
Adroddiad Blynyddol Cyfarwyddwr Iechyd y Cyhoedd: Llyfr Siartiau
cyfraddau sgrinio serfigol yng ngrŵp oedran 25 64 ychydig islaw’r targed. Mae’r cyfraddau ar gyfer sgrinio canser y fron yng Nghonwy a sgrinio canser y coluddyn yn Wrecsam yn llawer is na’r awdurdodau lleol eraill. Gwasanaethau gofal sylfaenol Mae data diweddaraf Arolwg Iechyd Cymru yn dangos bod canrannau yn ôl oed safonedig y defnydd o wasanaethau gofal sylfaenol gan oedolion ym Mwrdd Iechyd Prifysgol Betsi Cadwaladr ar y cyfan ychydig yn is na’r rheiny ar gyfer Cymru yn gyffredinol, gydag ymweliadau â’r deintydd dros y 12 mis diwethaf yn eithriad. Gall hyn ymwneud â materion yn ymwneud â mynediad sy’n gysylltiedig ag ardaloedd gwledig y bwrdd iechyd. Defnydd o ofal eilaidd a thrydyddol Mae cyfraddau cyffredinol derbyn i’r ysbyty yn ôl oed safonedig ymysg personau o dan 75 oed ar gyfer 2009 ym Mwrdd Iechyd Prifysgol Betsi Cadwaladr yn dangos bod y cyfraddau cyffredinol ychydig yn is na chyfartaledd Cymru. Mae’r gyfradd yn amrywio o 128 fesul 1,000 yn Wrecsam i 157 ar Ynys Môn. Ar lefel yr Ardal Gynnyrch Ehangach Haen Ganol (MSOA) mae llawer mwy o amrywiad. Mae’r cyfraddau ar eu huchaf yn y Rhyl; ardaloedd Wynnstay, Queensway, Cartrefle o Wrecsam; Caernarfon yng Ngwynedd a Chaergybi ar Ynys Môn. Mae’r cyfraddau yn is ar y cyfan yn ardaloedd gwledig y bwrdd iechyd. Wrth edrych ar dderbyniadau brys yn y grŵp oedran hwn, mae cyfradd y bwrdd iechyd yn is nag ydyw ar gyfer Cymru. Ar lefel awdurdod lleol, unwaith eto mae’r gyfradd ar ei hisaf yn Wrecsam ac ar ei huchaf ar Ynys Môn. Ar lefel yr MSOA, mae’r gyfradd yn amrywio’n fawr (yn fwy nag ar gyfer yr holl dderbyniadau). Mae’r cyfraddau ar eu huchaf yn y Rhyl, ac yn ardaloedd Wynnstay; Queensway a Chartrefle o Wrecsam. Gall cyfraddau uchel o dderbyniadau brys i’r ysbyty fod yn arwydd o wasanaethau hunanofal a gofal sylfaenol annigonol. Fel yr holl dderbyniadau, ceir cyfraddau is yn ardaloedd mwy gwledig y bwrdd iechyd fel ardal Rossett a Gresffordd i’r gogledd o Wrecsam; ardaloedd canolog Sir Ddinbych; ardaloedd Caergwrle, Yr Hob a Llanfynydd yn Sir y Fflint ac ardaloedd deheuol Gwynedd. Mae cyfraddau derbyn dewisol y bwrdd iechyd ychydig islaw’r cyfraddau ar gyfer Cymru. Ar lefel awdurdod lleol, unwaith eto mae’r gyfradd ar ei hisaf yn Wrecsam ac ar ei huchaf ar Ynys Môn. Ar lefel yr MSOA, mae llai o amrywiad yn y gyfradd nag ar gyfer derbyniadau brys. Mae’r patrwm hefyd yn wahanol i dderbyniadau brys. Mae’r cyfraddau uchaf ar gael tua’r gorllewin i ardal y bwrdd iechyd mewn lleoedd fel Caergybi a Bodffordd ar Ynys Môn; ac yn ardaloedd Caernarfon, Deiniolen a Llanberis o Wynedd. Mae’r cyfraddau ar eu hisaf yn rhannau dwyreiniol awdurdod lleol Wrecsam fel Overton, Bronington, Holt a Gresffordd.
Adroddiad Blynyddol Cyfarwyddwr Iechyd y Cyhoedd: Llyfr Siartiau
4.2 Gwasanaethau ataliaeth: brechu Noder: Mae echelin Y yn y graffau yn yr adran hon wedi ei gwtogi
4.2.1 Imiwneiddio plant
Adroddiad Blynyddol Cyfarwyddwr Iechyd y Cyhoedd: Llyfr Siartiau
Adroddiad Blynyddol Cyfarwyddwr Iechyd y Cyhoedd: Llyfr Siartiau
Adroddiad Blynyddol Cyfarwyddwr Iechyd y Cyhoedd: Llyfr Siartiau
Adroddiad Blynyddol Cyfarwyddwr Iechyd y Cyhoedd: Llyfr Siartiau
Adroddiad Blynyddol Cyfarwyddwr Iechyd y Cyhoedd: Llyfr Siartiau
Adroddiad Blynyddol Cyfarwyddwr Iechyd y Cyhoedd: Llyfr Siartiau
Adroddiad Blynyddol Cyfarwyddwr Iechyd y Cyhoedd: Llyfr Siartiau
4.2.2 Brechu rhag ffliw tymhorol
Adroddiad Blynyddol Cyfarwyddwr Iechyd y Cyhoedd: Llyfr Siartiau
Mae’r llinell y tu mewn i’r blwch lliw yn cynrychioli cyfradd ganolrifol ymgymeriad practisau (mae gan hanner practisau’r awdurdod lleol gyfradd ymgymeriad uwch na’r gwerth canolrifol ac mae gan hanner gyfradd ymgymeriad is na’r gwerth canolrifol). Mae’r blwch lliw yn cynrychioli’r gwasgariad o ran cyfraddau ymgymeriad 50% canolog y practisau, gelwir hyn yn ystod ryngchwartel. Mae’r cudynnau sy’n ymestyn uwchlaw ac islaw’r blwch lliw yn cynrychioli lledaeniad cyfraddau ymgymeriad practisau ar gyfer y rhan fwyaf o’r practisau yn yr awdurdod lleol. Caiff unrhyw bractisau â chyfraddau ymgymeriad sy’n wahanol iawn i’r rhan fwyaf o’r practisau yn yr awdurdod lleol eu galw’n ‘allanolion’ ac maent yn ymddangos fel dotiau y tu allan i’r cudynnau.
Adroddiad Blynyddol Cyfarwyddwr Iechyd y Cyhoedd: Llyfr Siartiau
4.3 Rhaglenni Sgrinio Cenedlaethol yn Seiliedig ar Boblogaeth yng Nghymru Mae sgrinio’n broses o adnabod pobl sy’n ymddangos yn iach a allai fod mewn perygl uwch o gael clefyd neu gyflwr. Gallant gael cynnig gwybodaeth, mwy o brofion a thriniaeth briodol i leihau’r perygl a/neu unrhyw gymhlethdodau sy’n deillio o’r clefyd neu’r cyflwr. Yng nghyd destun rhaglenni sgrinio: Ymgymeriad yw cyfran y bobl sy’n cael eu gwahodd yn rheolaidd i gael eu sgrinio ac mae canlyniad eu prawf sgrinio’n cael ei gofnodi yn yr un cyfnod. Mae ymgymeriad yn fesuriad pwysig o dderbynioldeb rhaglen sgrinio. Mae safonau ymgymeriad gofynnol a gosodir targedau ar gyfer bob un o’r rhaglenni. Cwmpas yw cyfran y bobl sy’n preswylio ac yn gymwys ar adeg arbennig sydd wedi cael eu sgrinio o leiaf unwaith mewn cyfnod penodol o amser (yn dibynnu ar gyfnod sgrinio rhaglenni gwahanol).
4.3.1 Ymgymeriad rhaglenni sgrinio cenedlaethol yng Nghymru
Adroddiad Blynyddol Cyfarwyddwr Iechyd y Cyhoedd: Llyfr Siartiau
4.4 Gwasanaethau gofal sylfaenol
4.4.1 Defnydd o ofal sylfaenol fel y nodir gan oedolion
Adroddiad Blynyddol Cyfarwyddwr Iechyd y Cyhoedd: Llyfr Siartiau
4.5 Defnydd o ofal eilaidd a thrydyddol
4.5.1 Derbyniadau i’r ysbyty: unigolion o dan 75 oed Ardaloedd cynnyrch ehangach haen ganol
Adroddiad Blynyddol Cyfarwyddwr Iechyd y Cyhoedd: Llyfr Siartiau
Adroddiad Blynyddol Cyfarwyddwr Iechyd y Cyhoedd: Llyfr Siartiau
Awdurdodau lleol
Adroddiad Blynyddol Cyfarwyddwr Iechyd y Cyhoedd: Llyfr Siartiau
4.5.2 Derbyniadau brys i’r ysbyty: unigolion o dan 75 oed Ardaloedd cynnyrch ehangach haen ganol
Adroddiad Blynyddol Cyfarwyddwr Iechyd y Cyhoedd: Llyfr Siartiau
Adroddiad Blynyddol Cyfarwyddwr Iechyd y Cyhoedd: Llyfr Siartiau
Awdurdodau lleol
Adroddiad Blynyddol Cyfarwyddwr Iechyd y Cyhoedd: Llyfr Siartiau
4.5.3 Derbyniadau dewisol i’r ysbyty: unigolion o dan 75 oed Ardaloedd cynnyrch ehangach haen ganol
Adroddiad Blynyddol Cyfarwyddwr Iechyd y Cyhoedd: Llyfr Siartiau
Adroddiad Blynyddol Cyfarwyddwr Iechyd y Cyhoedd: Llyfr Siartiau
Awdurdodau lleol
Adroddiad Blynyddol Cyfarwyddwr Iechyd y Cyhoedd: Llyfr Siartiau
5 Statws iechyd
5.1 Statws iechyd: pwyntiau allweddol Gwelir patrymau cyffredinol parhaus ar draws mynegeion amrywiol statws iechyd. Mae gan Fwrdd Iechyd Prifysgol Betsi Cadwaladr ar y cyfan lefelau iechyd gwell na Chymru’n gyffredinol. Ar lefel yr awdurdod lleol, nid yw’r patrymau’n gwbl gyson ond i nifer mae lefelau dangosyddion marwolaeth yn is tuag at orllewin Gwynedd ac Ynys Môn ac yn uwch tuag at y dwyrain yn Sir y Fflint a Wrecsam. Pwysau geni isel Mae pwysau geni isel yn gysylltiedig ag iechyd a ffordd o fyw gwael ymysg mamau a cheir tystiolaeth gynyddol sy’n dangos cysylltiad ag effeithiau niweidiol yn nes ymlaen mewn bywyd. Mae canran y babanod unigol sy’n cael eu geni’n fyw sy’n pwyso o dan 2500g ym Mwrdd Iechyd Prifysgol Betsi Cadwaladr ychydig yn is na chyfartaledd Cymru. Ar lefel awdurdod lleol, mae’r gyfradd yn amrywio rhwng pump y cant yng Ngwynedd i chwech y cant yng Nghonwy a Sir Ddinbych. Ar lefel yr MSOA, mae’r ardaloedd â’r canrannau uchaf i’w cael yn ardal Cei Conna o Sir y Fflint; ardaloedd de orllewin y Rhyl yn Sir Ddinbych ac yn ardaloedd Wynnstay, Queensway, Cartrefle o Wrecsam. Mae’r cyfraddau isaf i’w cael yn ardaloedd deheuol Gwynedd; ardal Overton a Bronington o Wrecsam ac ardal Penhryn o Gonwy. Statws iechyd hunan gofnodedig Mae Arolwg Iechyd Cymru yn cynnwys nifer o gwestiynau am statws iechyd, yn cynnwys holiadur SF36 y gellir ei grynhoi yn sgorau iechyd corfforol ac iechyd meddwl cyffredinol. Mae’r canlyniadau diweddaraf yn dangos bod y sgorau iechyd corfforol ac iechyd meddwl hunan gofnodedig yn well ym Mwrdd Iechyd Prifysgol Betsi Cadwaladr nag yng Nghymru yn gyffredinol. Ar lefel yr awdurdod lleol, ar draws pob ardal, mae statws iechyd hunan gofnodedig naill ai’n well neu’n debyg i gyfartaledd Cymru. Marwolaeth yn sgil cyflyrau penodol Mae clefyd cylchrediad y gwaed yn cynnwys clefyd y galon a strôc a dyma’r achos sylfaenol mwyaf cyffredin o farwolaeth yng Nghymru. Mae ffactorau’n ymwneud â ffordd o fyw fel deiet, ymarfer corff, alcohol ac yn arbennig smygu yn adnabyddus fel rhai sy’n arwain at glefyd cylchrediad y gwaed. Mae cyfradd marwolaethau yn ôl oed safonedig Ewrop ar gyfer Bwrdd Iechyd Prifysgol Betsi Cadwaladr yn debyg i Gymru. Ar lefel yr awdurdod lleol, mae’r gyfradd ar ei hisaf ar Ynys Môn ac uchaf yn Wrecsam. Ar lefel yr MSOA, ceir amrywiad sylweddol. Mae’r cyfraddau’n arbennig o uchel yn ardal Gorllewin Gwersyllt o Wrecsam a llain arfordirol y Rhyl. Mae’r cyfraddau isaf yn bennaf yn ardaloedd gwledig y bwrdd iechyd mewn mannau fel Porthaethwy, Llaneilian, Llanddyfnan a Moelfre ar Ynys Môn; ardaloedd Bwcle, Llaneurgain, Soughton, Higher Kinnerton a Phenyffordd yn Sir y Fflint, ac ardaloedd Penycae, Riwabon a Marchwiail o awdurdod lleol Wrecsam. Gan ganolbwyntio ar farwolaethau yn sgil clefydau cylchrediad y gwaed ymysg pobl o dan 75 oed, mae’r patrwm yn
Adroddiad Blynyddol Cyfarwyddwr Iechyd y Cyhoedd: Llyfr Siartiau
debyg i ardal Gorllewin Gwersyllt yn Wrecsam a llain arfordirol y Rhyl unwaith eto’n dangos cyfraddau arbennig o uchel. Mae clefyd coronaidd y galon yn is gategori o fewn clefydau cylchrediad y gwaed ac mae’n cynnwys trawiadau ar y galon. Mae smygu yn un o brif achosion clefyd coronaidd y galon. Mae cyfraddau marwolaeth yn ôl oed safonedig Ewrop ar gyfer Bwrdd Iechyd Prifysgol Betsi Cadwaladr yn debyg i gyfradd Cymru ac ar lefel awdurdod lleol mae’r gyfradd ar ei hisaf ar Ynys Môn ac uchaf yn Wrecsam. Ar lefel yr MSOA, unwaith eto, mae llawer o amrywiad. Mae gan ardal Gorllewin Gwersyllt o Wrecsam gyfradd arbennig o uchel (dros ddwywaith cyfartaledd Cymru). Mae’r ardaloedd eraill â chyfraddau uchel yng Nghefn Mawr a Froncysyllte yn ardal awdurdod lleol Wrecsam; llain arfordirol y Rhyl a thref y Fflint. Canser yw ail achos mwyaf cyffredin marwolaeth yng Nghymru. Mae achosion o ganser yn amlffactoraidd, yn amrywio yn dibynnu ar y safle, ond mae smygu a ffactorau eraill yn ymwneud â ffordd o fyw yn ffactorau risg pwysig. Mae cyfradd marwolaethau yn ôl oed safonedig Ewrop ar gyfer Bwrdd Iechyd Prifysgol Betsi Cadwaladr yn debyg i Gymru ac nid oes llawer o amrywiad ar draws awdurdodau lleol yn ardal y bwrdd iechyd. Ar lefel yr MSOA mae amrywiad sylweddol. Mae’r cyfraddau uchaf i’w gweld yn rhannau o Gei Conna, ac ardaloedd Treffynnon, Bagillt a Greenfield o Sir y Fflint; ardaloedd Wynnstay, Queensway, Cartrefle, Hermitage, Smithfield a Whitegate o Wrecsam ac ardal de ddwyrain y Rhyl yn Sir Ddinbych. Mae’r ardaloedd â’r cyfraddau isaf tuag at ddwyrain ardal y bwrdd iechyd mewn mannau fel Northrop, Ewlo, Penyffordd a’r ardal i’r de o’r Wyddgrug yn Sir y Fflint; Dyserth, Meliden a Thremeirchion yn Sir Ddinbych; a Gresffordd, Bronington ac Overton yn Wrecsam. Mae clefyd anadlol yn achos cyffredin iawn o farwolaeth. Unwaith eto, mae smygu yn cyfrannu’n helaeth at farwolaeth yn sgil clefyd anadlol. Mae cyfradd marwolaethau yn ôl oed safonedig Ewrop ar gyfer Bwrdd Iechyd Prifysgol Betsi Cadwaladr yn debyg i Gymru. Ceir rhywfaint o amrywiad ar lefel awdurdod lleol gyda’r cyfraddau’n amrywio o 63 fesul 100,000 yng Nghonwy i 93 yn Wrecsam. Ar lefel yr MSOA mae amrywiad sylweddol gyda’r gyfradd yn fwy na threblu rhwng yr isaf a’r uchaf. Mae’r cyfyngau hyder ehangach ar y siartiau ‘caterpillar’ yn dangos bod llai o farwolaethau yn sgil clefyd anadlol na chanser neu glefyd cylchrediad y gwaed. Mae’r cyfraddau uchaf i’w canfod yn ardaloedd Gorllewin Gwersyllt, Wynnstay, Queensway a Chartrefle o Wrecsam. Mae’r cyfraddau hefyd yn uchel yn ardaloedd Hermitage, Smithfield a Whitegate o Wrecsam a’r llain arfordirol yn y Rhyl. Goroesi canser Goroesi cymharol yw’r dull mwyaf cyffredin a ddefnyddir mewn astudiaethau poblogaeth. Dyma gymhareb y goroesi a welir ymysg y grŵp o gleifion canser â’r goroesi a ddisgwylir pe byddent yn destun yr un cyfraddau marwolaeth cyffredinol yn ôl oed, rhyw a chyfnod calendr â’r boblogaeth gyffredinol. Daw’r tebygolrwydd disgwyliedig o dablau bywyd ar gyfer Cymru sy’n rhoi disgwyliad oes pobl ar gyfer blwyddyn benodol yn ôl oed a rhyw. Mae’r problemau sy’n deillio o oroesi crai felly’n cael eu goresgyn. Mae’n galluogi mesur amrywiadau yng nghyfraddau goroesi canser (neu i’r gwrthwyneb, marwolaethau) yn annibynnol ar amrywiadau mewn marwolaethau disgwyliedig (cefndir) sy’n gysylltiedig â ffactorau
Adroddiad Blynyddol Cyfarwyddwr Iechyd y Cyhoedd: Llyfr Siartiau
amrywiol (oed a rhyw yn y dadansoddiadau hyn). Mae’r data rhanbarthol ar gyfer Cymru yn dangos gwelliant graddol o ran goroesi cymharol un flwyddyn ar gyfer dynion a menywod. Mae ffigurau goroesi cymharol blwyddyn a phum mlynedd sy’n benodol i safle yn dangos nad oes unrhyw wahaniaethau arwyddocaol yn ystadegol rhwng Bwrdd Iechyd Prifysgol Betsi Cadwaladr a Chymru yn gyffredinol.
5.2 Iechyd corfforol ac iechyd meddwl
5.2.1 Pwysau geni isel Ardaloedd cynnyrch ehangach haen ganol
Mae’r rhifau ar y map yn dangos MSOA â chyfradd sylweddol uwch yn ystadegol na chyfradd Cymru gyfan.
Adroddiad Blynyddol Cyfarwyddwr Iechyd y Cyhoedd: Llyfr Siartiau
Adroddiad Blynyddol Cyfarwyddwr Iechyd y Cyhoedd: Llyfr Siartiau
Awdurdodau lleol
Adroddiad Blynyddol Cyfarwyddwr Iechyd y Cyhoedd: Llyfr Siartiau
5.2.2 Iechyd corfforol fel y nodir gan oedolion*
Adroddiad Blynyddol Cyfarwyddwr Iechyd y Cyhoedd: Llyfr Siartiau
5.2.3 Iechyd meddwl fel y nodir gan oedolion*
Adroddiad Blynyddol Cyfarwyddwr Iechyd y Cyhoedd: Llyfr Siartiau
5.2.4 Salwch hirdymor sy’n cyfyngu fel y nodir gan oedolion
Adroddiad Blynyddol Cyfarwyddwr Iechyd y Cyhoedd: Llyfr Siartiau
5.2.5 Salwch meddwl fel y nodir gan oedolyn
Adroddiad Blynyddol Cyfarwyddwr Iechyd y Cyhoedd: Llyfr Siartiau
5.3 Marwolaeth yn sgil cyflyrau penodol
5.3.1 Marwolaeth yn sgil clefyd cylchrediad y gwaed, pob oed Ardaloedd cynnyrch ehangach haen ganol
Mae’r rhifau ar y map yn dangos MSOA â chyfradd sylweddol uwch yn ystadegol na chyfradd Cymru gyfan.
Adroddiad Blynyddol Cyfarwyddwr Iechyd y Cyhoedd: Llyfr Siartiau
Adroddiad Blynyddol Cyfarwyddwr Iechyd y Cyhoedd: Llyfr Siartiau
Awdurdodau lleol
Adroddiad Blynyddol Cyfarwyddwr Iechyd y Cyhoedd: Llyfr Siartiau
5.3.2 Marwolaeth yn sgil clefyd cylchrediad y gwaed, o dan 75 oed Ardal cynnyrch ehangach haen ganol
Mae’r rhifau ar y map yn dangos MSOA â chyfradd sylweddol uwch yn ystadegol na chyfradd Cymru gyfan.
Adroddiad Blynyddol Cyfarwyddwr Iechyd y Cyhoedd: Llyfr Siartiau
Adroddiad Blynyddol Cyfarwyddwr Iechyd y Cyhoedd: Llyfr Siartiau
Awdurdodau lleol
Adroddiad Blynyddol Cyfarwyddwr Iechyd y Cyhoedd: Llyfr Siartiau
5.3.3 Marwolaeth yn sgil clefyd coronaidd y galon Ardaloedd cynnyrch ehangach haen ganol
Mae’r rhifau ar y map yn dangos MSOA â chyfradd sylweddol uwch yn ystadegol na chyfradd Cymru gyfan.
Adroddiad Blynyddol Cyfarwyddwr Iechyd y Cyhoedd: Llyfr Siartiau
Adroddiad Blynyddol Cyfarwyddwr Iechyd y Cyhoedd: Llyfr Siartiau
Awdurdodau lleol
Adroddiad Blynyddol Cyfarwyddwr Iechyd y Cyhoedd: Llyfr Siartiau
5.3.4 Marwolaeth yn sgil canser Ardaloedd cynnyrch ehangach haen ganol
Mae’r rhifau ar y map yn dangos MSOA â chyfradd sylweddol uwch yn ystadegol na chyfradd Cymru gyfan.
Adroddiad Blynyddol Cyfarwyddwr Iechyd y Cyhoedd: Llyfr Siartiau
Adroddiad Blynyddol Cyfarwyddwr Iechyd y Cyhoedd: Llyfr Siartiau
Awdurdodau lleol
Adroddiad Blynyddol Cyfarwyddwr Iechyd y Cyhoedd: Llyfr Siartiau
5.3.5 Marwolaeth yn sgil clefyd anadlol Ardaloedd cynnyrch ehangach haen ganol
Mae’r rhifau ar y map yn dangos MSOA â chyfradd sylweddol uwch yn ystadegol na chyfradd Cymru gyfan.
Adroddiad Blynyddol Cyfarwyddwr Iechyd y Cyhoedd: Llyfr Siartiau
Adroddiad Blynyddol Cyfarwyddwr Iechyd y Cyhoedd: Llyfr Siartiau
Awdurdodau lleol
Adroddiad Blynyddol Cyfarwyddwr Iechyd y Cyhoedd: Llyfr Siartiau
5.3.6 Goroesi canser
Adroddiad Blynyddol Cyfarwyddwr Iechyd y Cyhoedd: Llyfr Siartiau
Adroddiad Blynyddol Cyfarwyddwr Iechyd y Cyhoedd: Llyfr Siartiau
Goroesiad cymharol blwyddyn a phum mlynedd, yn ôl safle’r canser ardal Bwrdd Iechyd Prifysgol Betsi Cadwaladr, dynion a menywod, 2000 2004 (cyfyngau hyder o 95%) Cynhyrchwyd gan Uned Gwybodaeth ac Arolygiaeth Canser Cymru Gwrywaidd Goroesiad cymharol blwyddyn Safle’r Canser Betsi Cadwaladr Cymru Gyfan 88.80 (87.95, Y Prostad 89.37 (87.66, 90.85) 89.59) 22.84 (21.71, Yr Ysgyfaint 24.02 (21.75, 26.35) 24.00) 71.51 (70.12, Y Colon a’r Rhefr 73.70 (70.89, 76.28) 72.85) 86.10 (84.51, Y Bledren 88.17 (84.93, 90.75) 87.53) Pob malaenedd (ac eithrio 62.11 (61.57, NMSC) 63.14 (62.08, 64.19) 62.63) Goroesiad cymharol 5 mlynedd Safle’r Canser Betsi Cadwaladr Cymru Gyfan 77.17 (75.83, Y Prostad 77.81 (75.10, 80.27) 78.45) Yr Ysgyfaint 6.14 (4.87, 7.60) 5.36 (4.73, 6.04) 48.59 (46.91, Y Colon a’r Rhefr 52.99 (49.52, 56.33) 50.24) 72.34 (70.04, Y Bledren 73.96 (69.14, 78.14) 74.50) Pob malaenedd (ac eithrio 45.39 (44.79, NMSC) 46.39 (45.17, 47.60) 45.99) Benywaidd Goroesiad cymharol blwyddyn Safle’r Canser Betsi Cadwaladr Cymru Gyfan 93.41 (92.83, Y Fron 93.08 (91.84, 94.14) 93.94) 25.53 (24.09, Yr Ysgyfaint 25.46 (22.63, 28.38) 26.99) 68.80 (67.19, Y Colon a’r Rhefr 67.11 (63.82, 70.17) 70.36) 63.92 (61.50, Yr Ofari 60.38 (55.00, 65.32) 66.24) 89.83 (87.90, Corpus Uteri 90.11 (85.89, 93.12) 91.46) Pob malaenedd (ac eithrio 67.24 (66.71, NMSC) 66.40 (65.32, 67.45) 67.76) Goroesiad cymharol 5 mlynedd Safle’r Canser Betsi Cadwaladr Cymru Gyfan 82.06 (81.14, Y Fron 82.54 (80.66, 84.25) 82.94) Yr Ysgyfaint 9.56 (7.64, 11.72) 6.85 (6.00, 7.76) 49.18 (47.31, Y Colon a’r Rhefr 48.10 (44.41, 51.68) 51.01) 39.29 (36.78, Yr Ofari 35.97 (30.73, 41.22) 41.80) 77.77 (75.02, Corpus Uteri 79.39 (73.65, 84.02) 80.25) Pob malaenedd (ac eithrio 52.95 (51.74, 54.14) 52.76 (52.17,
Adroddiad Blynyddol Cyfarwyddwr Iechyd y Cyhoedd: Llyfr Siartiau
NMSC) 53.36) Yn sylweddol uwch na Chymru Yn sylweddol is na Chymru Ac eithrio NMSC: Ac eithrio canser y croen nad yw’n felanoma
Adroddiad Blynyddol Cyfarwyddwr Iechyd y Cyhoedd: Llyfr Siartiau
Atodiad A: Adroddiadau gwreiddiol a mwy o wybodaeth
Mae’r adroddiadau gwreiddiol ar gyfer y data sydd wedi ei gynnwys yn y llyfr siartiau hwn, ynghyd â mwy o wybodaeth ac, mewn rhai achosion, gwybodaeth fethodolegol a chanllawiau dehongli eraill ar gael gan gynhyrchwyr y siartiau, y tablau neu’r data sydd wedi ei gynnwys: Demograffeg Arsyllfa Iechyd www.publichealthwalesobservatory.wale Cyhoeddus Cymru s.nhs.uk Penderfynyddio Arsyllfa Iechyd www.publichealthwalesobservatory.wale n iechyd Cyhoeddus Cymru s.nhs.uk Defnydd o Rhaglen Clefydau y http://www.wales.nhs.uk/sitesplus/888/ wasanaethau Gellir eu Hatal gan page/43510 ataliaeth: Frechlyn brechu Defnydd o Gwasanaethau Sgrinio http://www.screeningservices.org.uk/ wasanaethau Iechyd Cyhoeddus ataliaeth: Cymru sgrinio Defnydd Arolwg Iechyd Cymru, http://new.wales.gov.uk/ oedolion o ofal Llywodraeth Cynulliad sylfaenol Cymru Defnydd o ofal Arsyllfa Iechyd www.publichealthwalesobservatory.wale eilaidd a Cyhoeddus Cymru s.nhs.uk thrydyddol Statws iechyd Arsyllfa Iechyd www.publichealthwalesobservatory.wale Cyhoeddus Cymru s.nhs.uk Goroesi canser Uned Gwybodaeth ac http://www.wales.nhs.uk/sites3/home.cf Arolygiaeth Canser m?OrgID=242 Cymru
Adroddiad Blynyddol Cyfarwyddwr Iechyd y Cyhoedd: Llyfr Siartiau
Atodiad B: Geirfa
Ardaloedd Cafodd ardaloedd cynnyrch ehangach haen ganol (MSOA) eu Cynnyrch rhyddhau gan y Swyddfa Ystadegau Gwladol (ONS) yn 2004. Mewn Ehangach cyferbyniad â ffiniau gweinyddol fel adrannau etholiadol (wardiau), Haen Ganol cafodd ardaloedd cynnyrch ehangach eu creu er mwyn dangos data ystadegol. Mae gan MSOA boblogaeth gymedrig o 7,500 ac isafswm o 5,000. Mae 413 MSOA yng Nghymru a 96 yn ardal Bwrdd Iechyd Prifysgol Betsi Cadwaladr. Mae’r rhain wedi eu nodi ar y mapiau yn Atodiad 2. Mae’r ONS wedi datgan y bydd daearyddiaeth ardaloedd cynnyrch ehangach yn sefydlog am 10 mlynedd o leiaf. Mantais defnyddio’r ddaearyddiaeth ystadegol yma yw sefydlogrwydd ac unffurfedd. Fodd bynnag, y brif anfantais yw nad ydynt yn cydymffurfio â ffiniau gweinyddol hysbys fel adrannau etholiadol (wardiau); mae hyn yn eu gwneud yn llai hwylus i’r cyhoedd a llywodraeth leol.
Cyfradd yn Mae safoni oedran yn galluogi cyfraddau i gael eu cymharu ar draws ôl oed poblogaethau gwahanol tra’n ystyried strwythurau oed gwahanol y safonedig poblogaethau hynny. Mae’r llyfr siartiau hwn yn defnyddio’r dull safoni uniongyrchol, sy’n creu’r gyfradd y byddech yn ei chael pe byddai gan y boblogaeth yr un strwythur oedran â phoblogaeth ‘safonol’. Mae poblogaeth safonol Cymru wedi cael ei defnyddio ar gyfer dangosyddion Arolwg Iechyd Cymru ac mae poblogaeth safonol ddamcaniaethol Ewrop (ESP) wedi cael ei defnyddio ar gyfer pob dangosydd safoni oedran arall sydd wedi ei gynnwys yn y llyfr siartiau hwn. Mae cyfradd safoni oedran yn galluogi cymharu rhwng y cyfraddau sydd wedi cael eu safoni i’r un boblogaeth safonol.
Cyfyngau Mae cyfyngau hyder yn ddangosyddion o’r amrywiad ar hap a hyder ddisgwylir gyda chyfradd. Mae’n rhaid ystyried cyfyngau hyder wrth asesu neu ddehongli cyfradd. Mae’r cyfwng hyder o 95% yn cynrychioli ystod â thebygolrwydd o 95% o gynnwys cyfradd sylfaenol y boblogaeth. Mae ystod y cyfwng hyder yn dibynnu ar faint y boblogaeth lle digwyddodd y digwyddiadau. Mae cyfraddau’n seiliedig ar boblogaethau bach yn debygol o fod â chyfyngau hyder ehangach ac mae poblogaethau mawr yn debygol o fod â chyfyngau hyder llai.
Arwyddocâd Gellir ystyried canlyniad yn arwyddocaol yn ystadegol os ystyrir ei ystadegol fod yn annhebygol o fod wedi digwydd trwy siawns yn unig. Mae’r sail ar gyfer barn o’r fath yn derfyn wedi ei osod ymlaen llaw yn ôl mympwy, 5% neu 0.05 fel arfer. Gall canlyniad fod yn arwyddocaol yn glinigol ond heb fod yn arwyddocaol yn ystadegol ac i’r gwrthwyneb.
Adroddiad Blynyddol Cyfarwyddwr Iechyd y Cyhoedd: Llyfr Siartiau
Atodiad C: Mapiau yn dangos Ardaloedd Cynnyrch Ehangach Haen Ganol yn ardal Bwrdd Iechyd Prifysgol Betsi Cadwaladr
Mae Arsyllfa Iechyd Cyhoeddus Cymru hefyd wedi creu map rhyngweithiol ar y we yn dangos ffiniau MSOA, gyda’r cyfleuster ychwanegol o gefndir mapio Arolwg Ordnans. Dilynwch y ddolen hon: http://www.wales.nhs.uk/sitesplus/922/page/49851
Adroddiad Blynyddol Cyfarwyddwr Iechyd y Cyhoedd: Llyfr Siartiau
Adroddiad Blynyddol Cyfarwyddwr Iechyd y Cyhoedd: Llyfr Siartiau
Adroddiad Blynyddol Cyfarwyddwr Iechyd y Cyhoedd: Llyfr Siartiau
Adroddiad Blynyddol Cyfarwyddwr Iechyd y Cyhoedd: Llyfr Siartiau
Adroddiad Blynyddol Cyfarwyddwr Iechyd y Cyhoedd: Llyfr Siartiau