East Midlands Profile A summary of public health in the region 2018
East Midlands Profile: A summary of public health in the region 2018
About Public Health England
Public Health England exists to protect and improve the nation’s health and wellbeing, and reduce health inequalities. We do this through world-leading science, knowledge and intelligence, advocacy, partnerships and the delivery of specialist public health services. We are an executive agency of the Department of Health and Social Care, and a distinct delivery organisation with operational autonomy to advise and support government, local authorities and the NHS in a professionally independent manner.
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Prepared by: James Hollinshead, Principal Public Health Intelligence Analyst and Robyn Bates, Public Health Analyst. For queries relating to this document, please contact: [email protected]
© Crown copyright 2018 You may re-use this information (excluding logos) free of charge in any format or medium, under the terms of the Open Government Licence v3.0. To view this licence, visit OGL or email [email protected]. Where we have identified any third party copyright information you will need to obtain permission from the copyright holders concerned.
Published: December 2018 PHE publications PHE supports the UN Gateway number: 2018676 Sustainable Development Goals
2 East Midlands Profile: A summary of public health in the region 2018
Contents
About Public Health England 2 Executive summary 4 The East Midlands 5
Child and maternal health 9 Adult health 15 Older people 20
Mortality 23 Health inequalities 25 Appendix 26
3 East Midlands Profile: A summary of public health in the region 2018
Executive summary
Indicators where the East Midlands is significantly better than England: Children in low income families (under 16s) Statutory homelessness Obese children (year 6) Incidence of TB New sexually transmitted infections (STI) Diabetes diagnoses Alcohol specific hospital stays (under 18s)
Indicators where the East Midlands is similar to England: Under 18 conceptions Smoking prevalence in adults Hip fractures in people aged 65 and over Dementia diagnosis rate Suicide rate Under 75 mortality rate: all causes Under 75 mortality rate: cancer Excess winter deaths Employment rate
Indicators where the East Midlands is significantly worse than England: GCSEs achieved Smoking status at time of delivery Breastfeeding initiation Excess weight in adults Hospital stays for self-harm Hospital stays for alcohol related harm Life expectancy at birth (Males) Life expectancy at birth (Females) Infant mortality Killed and seriously injured on roads Under 75 mortality rate: Cardiovascular disease Percentage of physically active adults
4 East Midlands Profile: A summary of public health in the region 2018
Introduction
This report summarises a selection of the public health indicators from the PHE Local Authority Health Profiles and the Public Health Outcomes Framework, providing a high level overview of public health outcomes at regional level. For some indicators we have produced figures showing the East Midlands as 100 people; if the East Midlands were made up of 100 people, how many of them would be affected by a certain health issue?
The appendix provides a summary of the 2018 health profile data. Including a graphic to illustrate which East Midlands local authorities are ranked in the best and worst 10 performing local authorities in the country and an overview of all the East Midlands health profile indicators.
The PHE Fingertips platform contains further profiling information for a wide range of health issues and risk factors and can be accessed via fingertips.phe.org.uk
The East Midlands
Public Health England East Midlands includes the local authority areas of Derby City, Derbyshire County, Nottingham City, Nottinghamshire County, Leicester City, Leicestershire County, Rutland County, Lincolnshire County and Northamptonshire County.
The East Midlands has borders with 5 other regions; Yorkshire and The Humber, the North West, the West Midlands, the South East and East of England, and is bordered by the North Sea coastline to the east.
In area, it is 15,600 square km making it the fourth largest English region, smaller than the South West, East of England and the South East.
The region covers 12% of the total area of England.
There are 36 districts contained within the counties in the region (figure 1).
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Figure 1. East Midlands region including local district, county, unitary authorities and CCG boundaries
The population in 2017 The population of the East Midlands was estimated to be 4.8 million people in mid- 2017, one of the smallest English regions in terms of population.
It estimated that the population will increase to 5.3 million in the next 20 years (between 2018 and 2038), an increase of 10%.
The East Midlands population is ageing. It was estimated that there were around 911,000 people in the East Midlands aged 65 or over in 2017. By 2038 this is projected to have increased to over 1.3 million, resulting in over a quarter of the population being 65 years or over (figure 2).
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Figure 2. East Midlands population pyramid, 2017 and 2038
Source: ONS subnational population estimates and projections.
Deprivation (2015) In relation to other regions of England, the East Midlands has lower levels of deprivation. However, in 2016 it was estimated that 18.5% or approximately 875,000 of the population still lived in areas classified as being in the most deprived quintile in England (Figure 3).
The relative position of the region, in terms of percentage of persons living in the most deprived areas, masks the inequalities occurring within the region and within different groups, with many health challenges linked to socio-economic factors.
The poorest performing areas for health outcomes tend to be areas with high levels of deprivation: in large cities (Nottingham, Leicester, and Derby); on the coastal strip of Lincolnshire; and in areas of industrial decline, eg Nottinghamshire and Derbyshire, (figures 4 and 5).
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Figure 3: The East Midlands as 100 people – The percentage of people living in each national deprivation quintile
Source: Index of Multiple Deprivation 2015
Figure 4. Deprivation in the East Midlands by MSOA
Contains Ordnance Survey data © Crown copyright and database right 2017. Contains National Statistics data © Crown copyright and database right 2017. Source: Index of Multiple Deprivation 2015
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Figure 5. Percentage of people living in the 20% most deprived areas in England, 2016
Source: PHE Local Authority Health Profiles.
Child and maternal health
Maternal health There were 53,299 babies born in the East Midlands in 2016. The General Fertility Rate was 60.9 per 100,000, compared to 62.5 per 100,000 in England.
Rates of stillbirth in 2014 to 2016 in the East Midlands were similar to the national average (4.5 per 1,000 compared to 4.5 per 1,000 nationally).
Teenage conception was similar to England in 2016 (19.4 in the East Midlands compared to 18.8 nationally) as shown in figure 6.
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Figure 6. East Midlands and England rate of teenage conceptions, 1998-2016
Source: Public Health Outcomes Framework.
However, smoking at time of delivery (SATOD) was significantly higher in the East Midlands compared to England, with 13.3% of pregnant women continuing to smoke during pregnancy compared to 10.7% in England in 2016/2017 (figures 7 and 8). The SATOD figure has however fallen since 2010/2011 (from 15.8%), although this is at a slower rate than England.
Figure 7: The East Midlands as 100 people – Smoking at time of delivery
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Figure 8. Percentage of women smoking during pregnancy in the East Midlands, 2016/17. Value for Rutland has been suppressed due to small counts
Significantly worse than England Similar to England Significantly better than England England
Source: Public Health Outcomes Framework.
Breastfeeding initiation rates in the East Midlands in 2016/2017 were significantly worse than England, with 69.7% of women initiating breastfeeding, compared to 74.5% nationally.
Poverty 16.1% of children under the age of 16 lived in low income families in the East Midlands in 2015 (Figure 9), significantly better than the England value of 16.8%. However, this still means that approximately one in six children under the age of 16 live in low income families in the East Midlands, equating to 135,945 children.
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Figure 9: The East Midlands as 100 people – Children in low income families
Education Child development and attainment was poor in 2016/17, with only 68.9% of 5 year olds reaching a good level of development at the end of their first year at school. In 2015/2016, GCSE attainment was also poor, with 55.1% of pupils in the East Midlands achieving 5 grades A*-C (including English and Maths). This was the second lowest in the country (figure 10).
Figure 10. Percentage of children reaching expected levels of development at age 5 (2016/17) and achieving 5 GCSEs (A*-C) 2015/16
Source: PHE Fingertips.
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Obesity 22.7% of reception children were overweight (including obese) in the East Midlands in 2016/17, increasing to 33.5% at age 10/11 years. Although these figures are similar to or better than England, this still means that one in five children in reception class and one in three 10/11 year olds are overweight.
One in five children in reception is overweight or obese (2016/17)
One in three children in year 6 (10/11 yrs) is overweight or obese (2016/17)
Image taken from PHE Obesity slide set https://www.noo.org.uk/slide_sets
General health and wellbeing According to the 2014/15 What About Youth Survey, the health of 15 year olds in the region is generally good, with 29.8% reporting their own health as excellent and 52.0% eating the recommended 5 or more portions of fruit and vegetables each day. 7.6% were current smokers, significantly lower than England (8.2%) but 20.1% had tried an electronic cigarette, significantly higher than England (18.4%) (figure 11).
Figure 11. General health of 15 year olds, 2014/15
Source: PHE Health Behaviours In Young People Profile.
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Vaccinations and Immunisations Generally, the East Midlands is achieving the ambition of over 90% of the target population receiving their appropriate vaccinations, with trends increasing across the indicators. However, in 2016/17 the East Midlands regional uptake of the MMR vaccination for two doses decreased to 88.8% (Figure 12), lower than ambition but similar to the England average (87.6%).
The East Midlands has among the highest Dtap/IPV/Hib vaccination rates in the country (95.4% and 96.7% of children were immunised at one and two years respectively in 2016/17), although the recent trend shows that these are decreasing.
Figure 12. Vaccination coverage in the East Midlands, 2016/17 – ambition: 90%
Source: PHE Health Protection Profile.
Screening In the East Midlands in 2016/17:
99.0% of newborn babies completed hearing screening within 4 weeks, significantly higher than the England average of 98.4% newborn blood spot screening coverage was 96.1%, significantly lower than the England average of 96.5% antenatal sickle cell and thalassaemia screening coverage was 99.3%, similar to the England average of 99.3% 99.3% of eligible women received antenatal screening for HIV antenatal screening rates for Hepatitis B (95.4%) and syphilis (97.3%) were both lower than England averages (2015)
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Adult health
Life expectancy In 2014 to 2016, life expectancy at birth for males and females in the East Midlands was significantly lower than England (79.3 for males and 82.9 for females). Healthy life expectancy at birth was also significantly lower than England, at 62.7 for both males and females.
There is a difference of 8.9 years in life expectancy at birth (2014 to 2016) for males between the most deprived areas of the East Midlands and the most affluent. For females this difference was 7.2 years. The difference in life expectancy between the most deprived areas and the most affluent areas also varied between local authorities, as shown in figure 13.
Figure 13. Slope index of inequality in life expectancy at birth within East Midlands local authorities, 2014-2016
Source: Public Health Outcomes Framework.
Lifestyle risk factors As shown in figure 14, nearly two thirds of adults in the East Midlands in 2016/17 were overweight or obese (63.3%), significantly higher than England (61.3%), and over a quarter of a million adults were recorded as having diabetes in 2016/17 (282,454). In 2016/17, 65.0% of adults in the region were physically active, significantly lower than England. In 2015/16, only 18.5% of the population utilised outdoor space for exercise/health reasons.
In 2017 15.7% of the adult population in the East Midlands smoked, similar to England (14.9%). However, there is variation in the rates between men and women (figures 16 and 17). Adult smoking prevalence in the East Midlands fell from 20.2% in 2011. Smoking prevalence in the routine and manual category has also fallen and in 2017 was 24.8%, again similar to England (25.7%).
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Figure 14: The East Midlands as 100 people – Lifestyle risk factors
16 East Midlands Profile: A summary of public health in the region 2018
Figures 15, 16 and 17 - Smoking prevalence in adults – current smokers, 2017
Proportion of adults smoking by district in the East Midlands
5% - 9%
10% - 14% 15% - 19% 20% - 24% 25% - 29%
Smoking prevalence in males - Smoking prevalence in females - current smokers, 2017 current smokers, 2017
Contains Ordnance Survey data © Crown copyright and database right 2017. Contains National Statistics data © Crown copyright and database right 2017.
Source: Public Health Outcomes Framework.
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There were 31,280 alcohol related admissions to hospital in the East Midlands in 2015/16, a rate of 686 per 100,000, which is significantly higher than England. Rates for both males and females were also significantly higher than England. More recent data is not currently available due to the data quality issue affecting data for admissions to Nottingham University Hospitals.
Killed or seriously injured on the roads Around 6,000 people were killed or seriously injured on the roads in the East Midlands in 2014-16 (42.1 per 100,000, significantly higher than the national rate of 39.7 per 100,000). The rate has fallen since 2009/10 in the East Midlands. This reduction has been at a faster rate than England.
Screening In 2017 in the East Midlands screening rates for breast cancer (79.1%), cervical cancer (75.4%) and bowel cancer (60.4%) were all significantly higher than the England average (figure 18).
Figure 18. Screening rates for breast, cervical and bowel cancer, 2017.
Source: Public Health Outcomes Framework.
49.1% of cancer patients in 2016 were diagnosed at an early stage in the East Midlands, compared to the England value of 52.6%.
In 2013/14 – 2017/18, 46.8% of the eligible East Midlands population aged 40-74 years received a Health Check, significantly higher than the England average of 44.3%. The County and UA level variation is shown in figure 19.
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Figure 19. Cumulative percentage of eligible population receiving NHS Health check (2013/2014 to 2017/2018)
Source: Public Health Outcomes Framework
Immunisation In 2017/18, 73.6% of eligible East Midlands adults aged 65+ years received the flu vaccine (figure 20), compared with an England value of 72.6%. The proportion of at risk individuals receiving the flu vaccine in the East Midlands was 49.7%, compared to the England average of 48.9%. For both groups, coverage was below the national ambition.
Figure 20. Vaccination coverage in the East Midlands
Ambition: 75% 55%
Source: PHE Health Protection Profile.
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Other health outcomes The East Midlands 2016/17 rate of preventable sight loss from diabetic eye disease was 2.8 per 100,000 population, equating to 114 people. The rate is similar to England (3.1 per 100,000). Rates in the East Midlands have decreased from 4.1 per 100,000 in 2010/11.
In 2017, there were 18,013 cases of new STI diagnoses among people aged 15-64 years in the East Midlands (excluding Chlamydia in those aged under 25 years). The diagnosis rate was 599 per 100,000 population, compared to the England rate of 794 per 100,000. In addition, in the East Midlands in 2017, there were 295 diagnosed cases of syphilis. The syphilis diagnosis rate (6.2 per 100,000 population) was significantly lower than the England rate of 12.5 per 100,000, but has been increasing since 2012.
PHE recommends that local authorities should be working towards achieving a chlamydia detection rate of at least 2,300 per 100,000 population. In 2017, 30 out of the 40 district and unitary authorities in the East Midlands were significantly below this target.
The prevalence of opiate and/or crack use (2014/2015) in the East Midlands was similar to England at 8.4 and 8.6 per 1,000 populations respectively. East Midlands drug treatment completion rates in 2016 for both opiate and non-opiate users were significantly lower than the England average.
Older people
In 2014-16, life expectancy at age 65 for males (18.6 years) and females (20.9 years) in the East Midlands was significantly lower than England (18.8 yrs for males and 21.1 yrs for females). Since 2001/03 there has been an increasing trend for both male and female life expectancy at 65 in the East Midlands. However, there is large variation in years lived in poor health across the region (figure 21).
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Figure 21. Years lived in poor health for males and females in the East Midlands by MSOA, 2009-2013
21 East Midlands Profile: A summary of public health in the region 2018
The East Midlands had significantly lower emergency hospital admission rates for injuries due to falls in older people compared to England in 2015/16 (2,104 in the East Midlands compared to 2,169 nationally), however 18,053 older people were admitted to hospital due to a fall. More recent data is not available due to a data quality issue affecting admissions data for Nottingham University Hospitals.
In 2017, the East Midlands had a higher recorded prevalence of dementia in people aged 65 years and over compared to England (4.5% and 4.3% respectively). A total of 40,919 people aged 65 years and over were included on GP prevalence registers in the region.
During 2015/16, there were 31,565 emergency hospital admissions of East Midlands residents where mention of dementia was recorded as either a primary or a secondary diagnosis. More recent data is not available due to a data quality issue affecting admissions data for Nottingham University Hospitals.
In 2016/17, 83.2% of men aged 65 years eligible for abdominal aortic aneurysm screening were offered the service, significantly higher than the England average of 80.9%.
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Mortality
25,189 people died in the East Midlands between 2014-16 due to causes considered preventable, a rate of 184.8 per 100,000, which is not significantly different to England (182.8 per 100,000). In line with the trend across England, the East Midlands rate has fallen from 257.2 per 100,000 population in 2001/03 (figure 22).
Figure 22. Mortality rates from preventable causes, 2001-3 to 2014-16
Source: Public Health Outcomes Framework.
The East Midlands had a similar all-age excess winter deaths rate to England in August 2013 to July 2016, with 18.6% more deaths from all causes in winter than would be expected based on the average number of non-winter deaths.
The premature mortality rate from cardiovascular disease (CVD) in 2014-2016 in the East Midlands (75.3 per 100,000) was significantly higher than England (73.5 per 100,000). The rate of premature deaths from CVD considered preventable halved between 2001-2003 and 2014-2016 from 102.4 to 49.1 per 100,000.
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In the East Midlands in 2014-16, almost 10,000 people aged under 75 died from cancer considered preventable. The rate (79.8 per 100,000) was similar to England (79.4 per 100,000). In 2014-16, the under 75 mortality rates for liver disease (17.8 per 100,000) and respiratory disease (33.7 per 100,000) were similar in the East Midlands compared to England (18.3 and 33.8 per 100,000 respectively).
The East Midlands suicide rate for the years 2014-16 (9.5 per 100,000) was similar to that for England (9.9 per 100,000). During this period, 1,177 East Midlands residents died from suicide.
Suicide in the East Midlands is over 3 times as common among males as females. Between 2001/2003 to 2008/2010 in the East Midlands there was a decrease in the suicide rate from 10.2 to 8.7 per 100,000 population. Since then however, in common with England, the rate has increased to 9.5 per 100,000 in 2014-2016 (figure 23).
Figure 23. Suicide rate in East Midlands and England, 2001-2003 to 2014-2016
Source: Public Health Outcomes Framework
In 2014-2016, 1,401 East Midlands residents died from a range of specified communicable disease including influenza and the rate of 10.6 per 100,000 population is similar to the England rate of 10.7 per 100,000 population.
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Health inequalities
There is a gap in life expectancy between the East Midlands and England as a whole. In 2012-14, this gap was -0.2 years for both males and females, meaning that those born in the East Midlands can expect to live 0.2 years less than the average for England.
Excess deaths are the number of 'extra' deaths that occur in the East Midlands because it has a higher mortality rate for that cause of death than England. If these deaths were prevented, then the contribution of that cause of death to the overall life expectancy gap would be eliminated (figure 24). There is also a large gap in the number of excess deaths between those in the least deprived areas of the East Midlands and the most deprived areas (Figure 25).
Figure 24. Number of excess deaths, East Midlands compared to England, 2012- 2014
Circulatory 267 66 Cancer 28 174 Respiratory 251 Digestive 184 214 External causes 100 10 Mental & behavioural 180 259 Other 286 Deaths under 28 days 28 15
Figure 25. Number of excess deaths in the East Midlands in the most deprived compared with the least deprived quintile, by broad cause of death, 2012-2014
Circulatory 1680 1100 Cancer 1069 831 Respiratory 1083 890 Digestive 480 339
External causes 361 151
Mental & behavioural 284 499
Other 420 465
Deaths under 28 days 28 33
Source: PHE Segment Tool.
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Appendix
Local Authorities in the East Midlands that appear in the best 10 nationally
26 East Midlands Profile: A summary of public health in the region 2018
Local Authorities in the East Midlands that appear in the worst 10 nationally
27 East Midlands Profile: A summary of public health in the region 2018
Health profile indicators: overview of the East Midlands
Source: Local authority health profiles.
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