Epidemiology & Health Science Team (Public Health)
Commentary regarding the adult health profiles 2012 (new Highland HSCP areas and Argyll & Bute CHP) December 2012
For the South & Mid Unit
This is an accompaniment to the actual measures which should be accessed at: http://intranet.nhsh.scot.nhs.uk/Org/CorpServ/PublicHealth/Epidemiology- HealthSciences/Pages/PublicationsResources.aspx under the section on Health Profiles
It is important that the user of these profiles reads the notes and caveats found with the actual measures
Contents (Commentary) Page
Category 1: Wider Determinants ...... 1 1.1 Population ...... 1 1.2 Ten year population trends (2001 to 2010) ...... 1 1.3 Ten year trend in births from 2001 to 2010 ...... 1 1.4 Population by Urban/rural classification ...... 1 1.5 Population in the most deprived data zones nationally ...... 2 1.6 Population in the most deprived data zones within NHS Highland ...... 2 1.7 Population in the most access deprived data zones within NHS Highland ...... 3 1.8 Populations who are income and employment deprived within NHS Highland ...... 3 1.9 Claimants of incapacity or severe disablement allowance (IBSDA); Job seekers Allowance (JSA) and total Pension credit (PC) claimants ...... 3 1.10 Housing: Single Adult Households; Vacant Dwellings; Second Homes ...... 4 1.11 Housing: Average House sale prices ...... 5 Summary for the wider determinants in respect of the South & Mid Unit ...... 5
Category 2: Potential for Health Improvement ...... 7 2.1 Life-expectancy at birth ...... 7 2.2 Hospitalisations for avoidable conditions ...... 7 2.3 Early Deaths from Cancer ...... 8 2.4 Smoking prevalence and Smoking Cessation ...... 8 Summary for the potential for health Improvement in respect of the South & Mid Unit ... 9
Category 3: Health Protection ...... 11 3.1 Screening ...... 11 3.2 Uptake of Flu vaccination ...... 11 Summary for Health Protection in respect of the South & Mid Unit ...... 12
Category 4: Healthcare ...... 13 4.1 Primary Care disease registers ...... 13 4.2 Disease management ...... 13 4.3 Hospitalisations ...... 14 4.4 Relative Health Need ...... 16 4.5 Older People ...... 16 Summary for Health Care in respect of the South & Mid Unit ...... 17
Category 1: Wider Determinants
1.1 Population
South & Mid Operational Unit This has the highest population, 144,000 as per mid-year 2010, equivalent to 46.3% of the total Health Board population and roughly twice the population of each of North & West and Argyll & Bute. It is also the youngest population within the Health Board with the proportion of those aged under 16 years at 18.1%. This is higher than the national average (17.5%) and the Health Board average (17.2%). Amongst the districts, Badenoch & Strathspey and Nairn & Ardersier have the “oldest” population with 9.3% of the population aged 75 years and over.
Overall across the units The proportion of the total population of the Health Board residing in each of the units is 46.3% in South & Mid, 28.7% in Argyll & Bute and 25% in the North & West. On average, Argyll & Bute has the oldest population, with 21.7% aged 65 years & over and South & Mid unit the youngest, with 18% aged less than 16 years.
1.2 Ten year population trends (2001 to 2010)
South & Mid Operational Unit The total population increased by 8.6%, greater than the increase in the national population of 3.1% over the same ten year period. The population of Inverness East increased the most by 16.4%. The proportion aged less than 16 years changed very little, 0.2% decrease compared to the 6% and 8% decreases in the Scottish and overall Health Board populations respectively. The increase in the older age groups was also higher than the National and Health Board trends, with an increase of 20% in those aged 65 to 74 years and 24.3% for those aged 75 years and over.
Overall across the units Over the ten years, the total population in NHS Highland increased by 3.5%, higher than the increase of 3.1% in the Scottish population. The population of the South & Mid unit increased by 8.6%, that of North & West by 1.7%. The population of Argyll & Bute decreased by 2.3%.
1.3 Ten year trend in births from 2001 to 2010
South & Mid Operational Unit The annual number of births (n = 1,664 in 2010) and the birth rate per 1000 women aged 15 to 44 years have increased during the ten years by 18% and 18.5% respectively. The actual rates have tended to be higher than the national average during the same period. Amongst the districts, the rates in East Ross and Inverness East are the highest.
Overall across the units For the Health Board as a whole, the annual number of births and the birth rate per 1000 women aged 15 to 44 years have increased by 10.7% and 18.9% over the ten year period. These compare with the national increases of 11.9% and 15.8% respectively. The birth rate increased the most in the North & West unit, 25%. The increase in the rate in the South & Mid unit was 18% and in Argyll & Bute the birth rate had increased by 13%. In terms of the number of births, the largest increase occurred in the South & Mid unit of 25%, 10% in the North & West unit and a 2% decrease in Argyll & Bute.
1.4 Population by Urban/rural classification
Epidemiology & Health Science Team (Public Health) 1
South & Mid Operational Unit Around 40% of the population live in the other urban areas (class 2) which are settlements of between 10,000 and 25,000 people. The remainder of the population are almost equally divided between remote small towns (class 3), accessible rural areas (class 6) and remote, rural areas (class 7). Less than 5% live in either class 5 or class 8.
Overall across the units Almost one third (31%) of the population of the Health Board live in very remote and rural areas (settlements of less than 3,000 people and are in excess of a one hour drive time away from settlement of over 10,000) and nearly one quarter (24%) live in other urban areas (settlements of 10,000 to 125,000 people). The units have their own unique profile of urban and rural populations: that of the North & West unit is predominantly (70%) dwellers of very remote and rural areas; that of the South & Mid unit, 40% live in other urban areas (settlements of 10,000 to 125,000 people); that of Argyll & Bute CHP, 40% populate the very remote rural area with a further 20% populating the very remote small towns (settlements of between 3,000 and 10,000 people with a drive time of over one hour to a settlement of over 10,000).
1.5 Population in the most deprived data zones nationally
South & Mid Operational Unit There are twelve data zones within the unit which are amongst the 15% most deprived nationally with a total population of nearly 9,000 (representing 6.2% of the Units overall population in 2010). Seven of the data zones are in the South area (within the districts of Inverness East (n = 2) and Inverness West (n =5)) and five of them in the Mid Area (all five in East Ross district). The populations of these data zones (i.e. the 15% most deprived) represent 20% of the total district population of East Ross, 17% of the district of Inverness West and 4% of the district of Inverness East. The individual data zones are listed in the relevant table in the profiles.
Overall across the units In terms of the percentage of the population living in the 15% most deprived areas classed nationally, Argyll & Bute has the highest at 7.5%; South & Mid the next at 6.6% and North & West the lowest at 3.2%. In terms of numbers of people residing in the most deprived data zones, South & Mid has the greatest (n = 8,981); Argyll & Bute next (n = 6,244) and North & West the smallest (n = 2,374) in 2010.
1.6 Population in the most deprived data zones within NHS Highland
When the deprivation scores for data zones are distributed within NHS Highland only, as opposed to being part of the national distribution, the following profiles were obtained:
South & Mid Operational Unit Twenty nine data zones in this unit were within the most 15% deprived amongst all those in NHS Highland. This compares to only twelve data zones within the most 15% deprived amongst all those nationally. They are located in the districts of East Ross (n = 9); Mid Ross (n = 3); Badenoch & Strathspey (n = 2); Inverness East (n = 6) and Inverness West (n = 9). This compares with the national distribution where the districts of Badenoch & Strathspey and Mid Ross were without any data zones within the 15% most deprived. The total resident population within the twenty nine data zones (n = 22,058) represented 15.3% of the overall population of the unit. Out of the five districts, East Ross had the highest percentage of its population living in the most deprived data zones (33%, 6,931 people) followed by Inverness West with 28%, (7,213 people).
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Overall across the units In terms of the percentage of the population living in the 15% most deprived areas classed within NHS Highland, Argyll & Bute has the highest at 16.6%; South & Mid the next at 15.3% and North & West the lowest at 11.5%. In terms of numbers of people residing in the most deprived data zones, South & Mid has the greatest (n = 22,058); Argyll & Bute next (n = 14,828) and North & West the smallest (n = 8,934) in 2010.
1.7 Population in the most access deprived data zones within NHS Highland
When the access (to basic services- see notes & caveats page within the profiles) deprivation scores for data zones are distributed within NHS Highland only as opposed to being part of the national distribution, the following profiles were obtained:
South & Mid Operational Unit Eleven data zones in this unit were within the most 15% access deprived amongst all those in NHS Highland. They are located in the districts of East Ross (n = 3); Mid Ross (n = 2); Badenoch & Strathspey (n = 3); Inverness East (n = 2) and Inverness West (n = 1). The total resident population within the eleven data zones (n = 8,134) represented 5.6% of the overall population of the unit. Out of the five districts, East Ross had the highest percentage of its population living in the most access deprived data zones (8.9%, 1,885 people) followed by Badenoch & Strathspey with 6.9%, (1,912 people).
Overall across the units In terms of the percentage of the overall populations in the operational units that are accessed deprived, North & West operational unit was the highest at 28%; Argyll & Bute the next at 18.3% and South & Mid the lowest at 5.6%. In terms of numbers of people residing in the most access deprived data zones, North & West has the greatest (n = 21,712); Argyll & Bute next (n = 16,290) and South & Mid the smallest (n = 8,134) in 2010.
1.8 Populations who are income and employment deprived within NHS Highland
These are based on data zone populations and claimants for various allowances and benefits (see notes & caveats page within the profiles).
South & Mid Operational Unit Overall, 18,550 and 8,940 are income deprived and employment deprived respectively. These equate to 13% and 10.4% of the overall population of the unit respectively. The rates of both parameters were higher in the districts of East Ross and Inverness West, particularly East Ross with an income deprivation rate of 19.3%
Overall across the units The average rates of both income and employment deprivation were similar amongst the three operational units i.e. similar to the NHS Health Board averages of 13% and 10.4%. Both these rates are lower than the national averages of 16.1% and 13% respectively.
1.9 Claimants of incapacity or severe disablement allowance (IBSDA); Job seekers Allowance (JSA) and total Pension credit (PC) claimants
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These are based on a quarterly snap-shot in time with the most up to date at the time of compiling these profiles as at the third quarter (September of 2011).
South & Mid Operational Unit Overall, 4,645 claimants for IBSDA were recorded amongst the population of the S & W operational unit equivalent to a rate of 3.9% amongst the population aged 16 years and over. The highest rates were East Ross and Inverness West, each at 5.5% which is higher than the national average of 4.9%. The lowest rate was in Badenoch & Strathspey at 2.9%.
Overall, 2,230 claimants of JSA were recorded amongst the population of the South & Mid unit, equivalent to a rate of 2.4% amongst the population aged 16 to 64 years. The highest rates were recorded in the districts of East Ross (3.6%) and Inverness West (3.5%).
Overall, 6,420 claimants of PC were recorded amongst the population of the South & Mid unit, equivalent to a rate of 18% amongst the population aged 60 years and over. The highest rate was recorded in the East Ross district at 24.3% and lowest in Inverness East at 13.4%.
Overall across the units The average claimant rates for Incapacity or severe disability (IBSD) benefit were similar amongst the three operational units i.e. similar to the NHS Health Board average of 3.7%. These rates are lower than the national average of 4.9%.
The average claimant rates for Job Seekers Allowance (JSA) for each of the three operational units were lower than the national rate (4.1%) with an overall rate for NHS Highland of 2.7%. The rate for Argyll & Bute was the highest at 3.2% and this was due only to a higher than national rate within the district of Bute & Cowal, 5%.
With the exceptions of Inverness West and East Ross, the claimant rates for Pension Credit (PC) recorded for all districts and localities were lower than the national average of 22.1%. The rate in Inverness West was slightly higher than the national rate (22.7%) and that in East Ross, higher (24.3%).
1.10 Housing: Single Adult Households; Vacant Dwellings; Second Homes
South & Mid Operational Unit Overall, the percentage of all dwellings which are single adult households was 33.4%, lower than the national average rate of 38%. With the exception of Inverness West (rate of 38.6%) the rates for all districts were lower than the national average.
Overall the rate of vacant dwellings for the Unit was lower than the national average (2.4% versus 3.0%). The rates for all of the districts were also lower than the national average. Across the districts, higher rates pertained to those within the Mid area (2.8%) and to Badenoch & Strathspey in the South (2.8%).
The percentage of second homes was in all districts higher than the national average, overall rate was 2.6% versus the national rate of 1.0%. The highest rate occurred in Badenoch & Strathspey (6.9%).
Overall across the units Overall, nearly one third (32.5%) of all dwellings are single adult households in NHS Highland but this rate is lower than the national average of 38%. The rates in all districts and
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localities are also lower than the national average with the one exception of Inverness West at 38.6%.
Nearly 5,000 dwellings in NHS Highland are vacant (1,500 in Argyll and Bute and 3,500 in Highland HSCP). The overall rate was however similar to the national average (3.1% versus 3%). The highest rate of vacant dwellings was found in Caithness (5.3%) and Bute & Cowal (4.3%).
There were over 8,500 second homes recorded across NHS Highland, nearly 4,000 of them in Argyll & Bute. The overall rate of 5.4% is 5 times higher than the national average of 1.0%. Argyll & Bute has the highest rate (8.4%). Amongst the sub-areas, Skye, Lochalsh & Wester Ross and Bute & Cowal record the highest rates, both at 11.4%.
1.11 Housing: Average House sale prices
South & Mid Operational Unit Out of the 34 sub areas (intermediate geographies) of the South & Mid unit, 20 of them (59%) recorded higher median house prices in 2010 than the national median (£135,000).The highest prices were in Black Isle North and South, and in Nairn Rural with the median prices in excess of £200,000. The lowest prices were recorded in Inverness Merkinch, (£77,500) and in Invergordon (£92,000).
Overall across the units There is a great deal of variation across all of the units with the biggest range from the lowest median price to the highest found in Argyll & Bute (the highest being 3.1 times the lowest). For NHS Highland as a whole, the median price was higher than the national average (£142,500 versus £135,500).
Summary for the wider determinants in respect of the South & Mid Unit
It has the highest population of all the units/CHP, and represents 46% of the total health Boards population. Also the “youngest population with the proportion aged under 16 years (18.1%) which is higher than the national and Health Board averages Population increased by 8.6% over ten years (2001 to 2010), more than the national and Health Board averages. Compared to the National and Health Board overall trends, the younger age group (less than 16 years) decreased the least and the older age groups (65-74y and 75 years & over), increased the most. The highest increase in total population was in Inverness East (16.4%). The number of births and birth rates increased by 18% and 18.5% respectively over the ten year period 2001 to 2011. The increase in the number of births was the largest across the units/CHP. Birth rates are the highest in East Ross and Inverness East. Around 40% of the population live in settlements of between 10,000 and 25,000, and most of the remainder, across three other area types and only 5% in remote towns or very remote rural areas. This profile contrasts with North & west unit and Argyll & Bute CHP in which 40% and 70% reside in very remote rural areas respectively. It has the largest number (9,000) of people living in the 15% nationally most deprived areas (twelve data zones) amongst the units/CHP. It represents 6.2% of the Units population compared to 7.5% in Argyll & Bute and 3.2% in the North & West unit. The data zones are in the districts of Inverness East (4% of population), Inverness West (17% of population) and in East Ross (20% of population). Using the NHS Highland- based distribution, increased the number of data zones to 29, and included additional
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data zones within Badenoch & Strathspey and Mid Ross. This re-scaling did not affect its relative position amongst the units/CHP. Consistent with the pattern of the urban/rural distribution of its population, the Unit has the lowest percentage living in the 15% most Access deprived areas a (5.6%). The East Ross district has the highest percentage (9%) followed by Badenoch & Strathspey (7%). The percentages of the population considered to be income or employment deprived were 13% and 10.4% respectively, the same as the health Board averages and lower than the national averages. The rate of income deprivation was highest in East Ross (19.3%). The units overall benefit claimant rates for IBSDA, JSA and Pension Credits were lower than the national average rates, the rates in East Ross were the highest within the unit for all three of these types of benefits. The percentages of single adult dwellings (33.4%) and vacant dwellings (2.4%) were both lower than the national averages and the vacant dwelling rate was also lower than the Health Board average (3.1%). The percentage of second homes 2.6%, although higher than the national average was the lowest across all of the units/CHP. Relative to the national median house price in 2010 (£135,000), nearly sixty percent of intermediate geographies were higher than this, particularly for Black Isle South & North and for Nairn Rural (median of £200,000). Lowest prices were in Merkinch (£77,500) and Invergordon (£92,000).
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Category 2: Potential for Health Improvement
2.1 Life-expectancy at birth
South & Mid Operational Unit Within the Unit, the range in life expectancy amongst the intermediate geographies, was 66.0 to 83.2 years for males and 75.1 to 87.0 for females. Lowest estimates applied to Inverness Merkinch for males (66.0 years) and for females (75.1 years). In contrast, highest estimates were in Nairn Rural for males (83.2 years) and for females (87.0 years). These can be compared to the average for the Health Board of 75.7 years for males and 80.5 years for females. On that basis, the life expectancies in Alness, Inverness Ballifeary & Dalneigh, Inverness Hilton, Inverness Muirtown, Nairn East and Inverness Merkinch were significantly lower and Black Isle North, Ross & Cromarty Central, Inverness Culloden & Balloch, Inverness East Rural, Inverness Westhill and Nairn Rural, significantly higher for male expectancy. For female expectancy, estimates for Inverness Ballifeary & Dalneigh, Inverness East Rural, Inverness Hilton and Inverness Merkinch were significantly lower and Inverness Culloden & Balloch, Black Isle South, Conon & Muir of Ord, Inverness Drummmond, Inverness Lochardil & Holm Mains, Loch Ness and Nairn Rural significantly higher.
Overall across the units Relative to the average life expectancy of Scotland (males, 74.5 years; females, 79.5 years), those for the Health Board, Highland HSCP and Argyll and Bute are significantly higher, (NHS Highland males, 75.7 years; females, 80.5 years). There was a wide range in estimates for smaller areas with Inverness Merkinch being lower overall for both males (66.0 years) and females (75.1 years). In contrast, Nairn Rural had the greatest life expectancy for both males (83.2 years) and females (87.0 years).
2.2 Hospitalisations for avoidable conditions
South & Mid Operational Unit Within the Unit, the range in the rates of hospitalisation associated with alcohol conditions amongst the intermediate geographies, was 767 to 3394 per 100,000 population relative to an overall Health Board rate of 1291 per 100,000. Significantly higher rates were in nine intermediate geographies of Alness, Dinwall, Inverness Ballifeary & Dalneigh, Inverness Central Raigmore & Longman, Inverness Drummond, Inverness Hilton, Inverness Kinmylies & South West, Inverness Muirtown and Inverness Merkinch, the latter the highest at 3394 per 100,000. Significantly lower rates applied to thirteen intermediate geographies of Black Isle North, Black Isle South, Conon & Muir of Ord, Ross & Cromarty Central, Ross & Cromarty East, Badenoch & Strathspey North, Badenoch & Strathspey South, Inverness East Rural, Inverness Inshes & Slackbuie, Inverness Lochardil & Holm Mains, Inverness Scorguie, Loch Ness and Nairn Rural, the latter being the lowest at 767per 100,000.
Within the Unit, the range in the rates of hospitalisation of patients aged 65 years & over due to a fall in the home amongst the intermediate geographies, was 478 to 1593 per 100,000 population relative to an overall Health Board rate of 892 per 100,000. A significantly higher rate applied to Inverness Muirtown at 1593 per 100,000. A significantly low rate applied to Ross & Cromarty East at 478 per 100,000.
The overall rate of hospitalisation due to drug misuse for the Unit was 27 per 100,000 population significantly lower to the national rate (128 per 100,000). The highest rate applied to Inverness West (59 per 100,000) but this was not significantly different to the Health Board average of 44 per 100,000. Significantly lower rates applied to Badenoch &
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Strathspey, Nairn & Ardersier Inverness, East Ross and Mid Ross, the latter being the lowest at 9 per 100,000).
Overall across the units For admissions due to alcohol, the rates for the Health Board and Highland HSCP were both significantly higher than the national average, 1291, 1289 versus 1088 per 100,000 population respectively. The rate in Argyll & Bute at 1117 per 100,000 was not significantly higher. The highest rates amongst the intermediate geographies in each of the operational units were in Wick South, Inverness Merkinch and Oban South and the lowest rates were found in Ross & Cromarty South West, Nairn Rural and Helensburgh North.
For patients aged 65 years & over hospitalised due to a fall in the home, the rates were significantly higher than the Scottish average of 710 per 100,000 population for the health Board (892 per 1000,0000), Highland HSCP (943 per 100,000) and Argyll & Bute (782 per 100,000). The highest rates amongst the intermediate geographies in each of the operational units were in Fort William North, Inverness Muirtown and Dunoon. The lowest rates were found in Ross & Cromarty South West, Ross & Cromarty East and Helensburgh North.
For patients hospitalised due to drug misuse, the rates were significantly lower than the Scottish average of 128 per 100,000 population for the health Board (44 per 100,000), Highland HSCP (41 per 100,000), North & West Unit (66 per 100,000), South & Mid Unit (27 per 100,000 and Argyll & Bute (50 per 100,000). The highest rates amongst the districts in each of the operational units were in Caithness, Inverness West (not significantly higher) and Bute & Cowal. The lowest rates were found in Sutherland, Mid Ross and Mid Argyll, Kintyre & Islay (not significantly).
2.3 Early Deaths from Cancer
South & Mid Operational Unit Within the Unit, the range in the mortality rates of those aged under 75 years from cancer amongst the intermediate geographies, was 46 to 217 per 100,000 population relative to an overall Health Board rate of 122 per 100,000. Higher rates applied to three of the intermediate geographies: Alness, Inverness Ballifeary & Dalneigh and Inverness Scorguie, the latter being the highest at 217 per 100,000. A significantly lower rate applied to Badenoch Strathspey North at 46 per 100,000.
Overall across the units For patients aged under 75 years, the death rates due to cancer, were significantly lower than the Scottish average of 135 per 100,000 population for the Health Board (122 per 100,000), Highland HSCP (121 per 100,000). The rate for Argyll & Bute was lower but not significantly (126 per 100,000). The highest rates amongst the intermediate geographies in each of the operational units were in Wick North (not significantly), Inverness Scorguie and Helensburgh East (not significantly). The lowest rates were found in Skye North West, Badenoch & Strathspey North and Lomond Shore (not significantly).
2.4 Smoking prevalence and Smoking Cessation
Please refer to the notes & caveats on this section, particularly the fact that the prevalence rates are based on a period prior to the legislation on smoking in public places.
South & Mid Operational Unit The overall prevalence of smoking in the 16 years and over population of the Unit was 25.4% (26.3% males and 24.6% females). These were similar to the overall Health Boards
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averages of 25.4%, 26.3% and 24.5% respectively. Within the Unit, there were twelve intermediate geographies with significantly higher rates than the average for the Health Board. These were Alness, Dingwall, Invergordon, Ross & Cromarty East, Seaboard, Badenoch & Strathspey Central, Inverness Ballifeary & Dalneigh, Inverness Kinmylies & Soth West, Inverness Smithton, Inverness Scorguie, Inverness Muirtown, and Inverness Merkinch the latter being the highest at 34.5%. The rate for males was also the highest in Inverness Merkinch. The highest rate for females was in Alness (34%). The rates for Black Isle South were the lowest for persons (18.7%), males (19%) and females (18.3%).
The overall uptake rate of the smoking Cessation services for the South & Mid Unit was the highest (9.8%) amongst the Units and higher than the Health Board average of 8.8%. The proportion of quitters at one month of all attempted quits was slightly higher (50.7%) than the Health Board average of 48.1%. Amongst the Districts, the highest uptake was in East Ross (15.4%) and lowest in Mid Ross (5.8%). The highest proportion of quitters of the total attempts was in Badenoch & Strathspey, Nairn & Ardersier (56.5%).
Overall across the units The smoking prevalence rates in persons aged 16 years & over for the Health Board, Highland HSCP and all Operational units including Argyll & Bute were significantly lower than the national average of 27.2%. This also applied to the rates for males (28.1%) and females (26.5%).
Relative to the national average uptake of smoking cessation services of 10.4%, the overall average for the Health Board (8.8%) and for the individual Units, were all lower. The highest uptake rate applied to South & Mid Operational Unit (9.8%) and the lowest in the North & West Operational Unit (5.2%).
In contrast, the proportion of successful quits at one month of those who had made quit attempts was higher for the Health Board (48.1%) and for each of the individual Units than the national average (37.7%). Highest rate amongst the units applied to the North & West where it was 54.3% of those who had attempted a quit. The proportion quit at one month of the estimated total number of smokers was 3.9% for Scotland and for the Health Board, 4.3%. The latter rates are dependent on both the uptake rate of the service and on the effectiveness of the service. The highest applied to the South & Mid Operational Unit (5%) and the lowest to the North & West Operational Unit (2.8%).
Summary for the potential for health Improvement in respect of the South & Mid Unit
Life expectancy at birth was lowest in Inverness Merkinch for both males (66 years) and females (75.1 years). On average, males in Merkinch can expect to live 9.6 years less and females, 5.4 years less than the overall average life-expectancies for NHS Highland. Other areas in which the life-expectancy was significantly lower for both males and females were: Inverness Ballifeary & Dalneigh and Inverness Hilton. For Inverness East Rural, the relative life-expectancy was the inverse for males and females: that for males higher and females lower. The life expectancy for Nairn Rural was the highest across the Health Board area, 83.2 years for males and 87 years for females. Hospitalisation associated with alcohol conditions was highest in Inverness Merkinch with a rate nearly three times the Health Boards average, lowest was in Nairn Rural. Hospitalisation of older people due to a fall in the home was highest in Inverness Muirtown and lowest in Ross & Cromarty East. Consistent with the overall Health Board average, the rates of hospitalisation due to drug misuse were lower than the
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national average and for most districts, significantly lower than the Health Boards average except for Inverness West which was similar to it. Across the Health Board, the rate of early deaths (under 75 years) was the highest in Inverness Scorguie and lowest in Badenoch & Strathspey. Both these rates were significantly different to the Health Boards average, nearly twice as high and less than one half of it respectively. The prevalence of smoking in adults was estimated to be the highest across the Health Board in Inverness Merkinch. Although the rate suggested that over one third are smokers compared to a Health Board average of one quarter, these rates precede the introduction of the restriction of smoking in enclosed public places and therefore are expected to have decreased since then. The uptake of smoking cessation services was at just under 10%, the highest and the efficiency, as measured by the proportion who have quitted at one month, the highest within the Health Board. The uptake of services in East Ross was the highest (>15%) across the Health Board.
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Category 3: Health Protection
Please refer to the notes & caveats on this section, particularly the fact that the overall rates do not necessarily reflect any inequalities of screening uptake or immunisation uptake amongst the population.
3.1 Screening
South & Mid Operational Unit The cervical screening uptake was 80.7% overall. Significantly higher uptake rates than the average for the Health Board (80.4%), were recorded in Inverness East (81.9%) and in Badenoch & Strathspey, Nairn & Ardersier (82%). The rates in Inverness West (79.1%) and in East Ross (77%) were significantly lower.
The Breast Screening uptake rate was 80.9% and this was significantly higher than the Scottish (74.9%) and the Health Boards (79.6%) averages. Amongst the districts, significantly higher rates than the Health Board average were in Badenoch & Strathspey, Nairn & Ardersier, Inverness East and Mid Ross, the latter being the highest at 83.8%. In contrast, the rate for East Ross (76.5%) was the significantly lower.
The Bowel Screening uptake rate was 59.5% and this was significantly higher than the Scottish average (54.5%) and similar to that of the Health Board (59.1%). Similar differences applied to males and females. Amongst the districts, the rates in Mid Ross (61.9%) and in Badenoch & Strathspey, Nairn & Ardersier (62.1%) were significantly higher than the average for the Health Board. In contrast, the rate in Inverness West (56.5%) was significantly lower than the Health Board average. These differences also applied to both females and males.
Overall across the units The average uptake of the cervical screening programme in NHS Highland was 80.4% and this is higher than the national average of 78.7% for 2011/12. A rate of 79.6% applied to Argyll & Bute, which is not significantly different to the national average but lower than the average for the Health Board. The rates for the units in North NHS Highland were just under 81%.
The average uptake rate of the breast screening programme in NHS Highland was 79.6% and this is significantly higher than the national average of 74.9% for 2010/11. The average rates pertaining to each of the Units and Argyll & Bute were significantly higher than the average national rate. Relative to the Health Board, the average for Argyll & Bute (76.1%) was significantly lower whilst the rates for the other units were significantly higher than the Health Boards average.
The average uptake rate of the bowel screening programme in NHS Highland was 59.1% and this is significantly higher than the national average of 54.5% for 2010/11. This was also the case for the rates for males, 55% versus 51% and for females, 63.1% versus 57.9%. Amongst the units, the rates in South & Mid were the highest although the differences were small.
3.2 Uptake of Flu vaccination
South & Mid Operational Unit The Flu vaccination uptake rate in those aged 65 years & over was 74.2% overall for the Unit, compared to an overall rate of 74.1% for the Health Board. The highest rate was
Epidemiology & Health Science Team (Public Health) 11 recorded for the GP Practices in Mid Ross (77.2%) and this was significantly higher than the Health Board average.
The flu vaccination rate in those aged under 65 years at risk was 59.4% overall for the Unit, compared to an overall rate of 60.6% for the Health Board. The rates in Mid Ross (72.6% and in Inverness West (65.8%) were significantly higher than the Health Board average. In contrast, the rates in East Ross (49.8%), Badenoch & Strathspey, Nairn & Ardersier (54.5%) and Inverness East (56.1%) were significantly lower than the Health Board average.
Overall across the units The average uptake rate of the flu vaccine in those aged 65 years & over in NHS Highland was 74.1% 2011/12 and this is significantly lower than the national average of 76.6% for the same period. Amongst the units, the rate in Argyll & Bute was the highest (74.6%) although the differences were small.
The average uptake rate of the flu vaccine in those aged under 65 years at risk in NHS Highland was 60.6% in 2011/12 and this is significantly higher than the national average of 59.7% for the same period. Amongst the units, the rates in North & West Operational unit and in Highland HSCP were also significantly higher than the national average. The rate in the North & West Operational Unit (64.2%) was also significantly higher than the average for the Health Board.
Summary for Health Protection in respect of the South & Mid Unit
The overall cervical screening uptake for the unit was 80.7%, similar to the average for the Health Board, higher rates in Inverness East and Badenoch & Strathspey, Nairn & Ardersier but lower rates in East Ross and Inverness West. The overall breast screening uptake for the unit was 80.9%, higher than both the Health Board and the National averages. The rate in Mid Ross (83.8%) was the highest across all of the districts in NHS Highland. The lowest rate was in East Ross (76.5%) which was significantly lower than the Health Boards average. The overall bowel screening uptake for the unit was 59.5%, similar to the Health Boards average rates. Significantly higher uptake applied to two of the districts, Mid Ross and Badenoch & Strathspey, Nairn & Ardersier whilst the uptake was significantly lower for Inverness West. The overall flu vaccination uptake rate in those aged 65 years & over for the unit was 74.2%, similar to the Health Board average. The rate for Mid Ross was significantly higher (77.2%). The overall flu vaccination uptake in those under 65 years at risk for the unit was 59.4%, a little lower than the Health Board average. The rates in Mid Ross (72.6%) and Inverness West (65.8%) were significantly higher whilst the rates in three of the districts, East Ross, Badenoch & Strathspey, Nairn & Ardersier and Inverness East, were significantly lower than the Health Board average.
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Category 4: Healthcare
4.1 Primary Care disease registers
The notes and caveats particularly apply when interpreting the prevalence of various conditions derived from these registers
South & Mid Operational Unit The average rate for the Unit was lower than the Health Board average for Hypertension (13.9%), Diabetes (4.0%) and CHD (4.3%).
The rate for the Mid area was notably higher than the average for the unit in relation to Asthma (7.1%), Hypertension (15.3%), Diabetes (4.5%), Obesity (10.1%), COPD (1.9%); and chronic kidney disease (5.1%). Between the two districts of the Mid area, specifically higher rates were noted for East Ross in relation to COPD (2.4%), Diabetes (4.8%), Obesity (12%), Learning Disabilities (0.9%) and CHD (4.7%). The rate of hypertension was the highest in the Mid Ross district (16.1%). Relative to the other two districts in the South area, rates for Inverness West were higher for Diabetes (4.2%), Obesity (9.9%) and Mental Health (1.3%). The prevalence rate of Mental Health was the highest in Inverness West (1.3%) across all three Operational Units.
Overall across the units Across the Operational units, highest rates were recorded in the North & West for Asthma, Hypertension, Obesity, CHD and Chronic Kidney Disease and this was due in every case, to higher rates recorded in the North area rather than the West area. The highest rate for Diabetes was recorded in Argyll & Bute which was due to the high rate recorded in the Bute & Cowal locality. The prevalence of Learning Disabilities was highest in the South & Mid unit due to higher rates recorded in both Inverness West and East Ross.
In contrast, across the Operational units, lower rates were recorded in the South & Mid Unit for Hypertension, Diabetes, and CHD and in every case this was due to the lower rates recorded in Inverness East. The lowest prevalence of Obesity was recorded for Argyll & Bute and this was due to the low rate recorded for Bute & Cowal.
4.2 Disease management
South & Mid Operational Unit The average rate for the Unit was similar to the Health Board average for the uptake of Flu immunisation for patients at high risk due to being on one or more of the registers for CHD or COPD or Diabetes or Stroke (includes TIA). Within the Unit, consistently higher rates of immunisation were recorded in Badenoch & Strathspey. Relatively lower rates pertaining to the conditions other than Diabetes were recorded in Inverness East.
The average percentage of patients with Dementia who have had a review within the last 15 months was 81.2% for the unit which was the same as the average for the Health Board. The rates for East Ross (72.4%) and for Inverness West (78.9%) were lower and for Badenoch & Strathspey (88.7%) higher than the Units average.
The average percentage of patients with long-term severe Mental Illness who had a review within the last 15 months was 94.9%, similar to that of the Health Board average (94.5%). Within the unit, the rate for Mid Ross was relatively lower (87%) and the rates for districts within the South area (average 97%) higher than the average for the unit.
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The average percentage of patients with Diabetes and/or CHD who had been screened for depression in the last 15 months was 90.4%, similar to the Health Boards average (89.6%). The rate pertaining to Mid Ross (87%) was lower than the Units average (91.6%).
The average percentage of patients with a new diagnosis of depression who had an assessment of its severity at the outset of treatment was 94.3%, similar to the Health Boards average of 94.4%. The rate for Badenoch & Strathspey was lower (90.3%).
The average percentage of the population estimated to be prescribed drugs for anxiety, depression or psychosis was a little lower for the Unit (8%) than the Health Board average of 8.5% and was the lowest rate amongst all of the Units. Higher percentages (10.3% ± 1.1%) were noted for the intermediate geography of Inverness Kinmylies & South West amongst those of four other areas and a lower percentage for Black Isle North (5.5% ± 0.7%), again amongst those of other areas (n = 8).
Overall across the units Across the Operational units, highest rates were recorded in the North & West for the proportion with dementia receiving a review and in the Argyll & Bute for screening in those with CHD or Diabetes. There were no very extreme rates and with the exception of Sutherland, no patterns were apparent in respect of persistently low or high rates for any of the sub-areas. The rates recorded in Sutherland were the highest in the North & West unit for all aspects of disease management other than for flu vaccination. In comparison with Scotland, the overall Health Board averages were similar to national values with two exceptions where it was lower: (1) the severity assessment of newly diagnosed patients with depression (94.4% versus 95.3%) and (2) for the percentage of the population prescribed drugs for anxiety, depression or psychosis (8.5% versus 9.7%).
4.3 Hospitalisations
Note that when a significant difference is noted, this is statistically significant based on the range as defined by the value ± 95% confidence intervals not overlapping with the overall Health Board range defined by its value ± 95% confidence intervals. See caveats for specifications of the data.
South & Mid Operational Unit Within the Unit, the hospitalisation rate for COPD was significantly higher than the overall NHS Highland rate (116 per 100,000 population) in eight of the intermediate geographies; Alness, Dingwall, Badenoch & Strathspey South, Badenoch & Strathspey South, Inverness Hilton, Inverness Ballifeary & Dalneigh, Inverness Muirtown and Inverness Merkinch, the latter being the highest at 322 per 100,000. In contrast, the rates for four other areas were significantly lower: Nairn West, Loch Ness, Inverness Lochardil & Holm Mains, and Inverness Inshes & Slackbuie, the latter with the lowest rate of 14.8 per 100,000.
Within the Unit, the hospitalisation rate for CHD (Coronary Heart Disease) was significantly higher than the overall NHS Highland rate (363 per 100,000 population) in nine of the intermediate geographies; Alness, Invergordon, Inverness Drummond, Inverness Hilton, Inverness Kinmylies & South West, Inverness Ballifeary & Dalneigh, Inverness Muirtown, Inverness Smithton, and Inverness Merkinch, the latter being the highest at 666 per 100,000. In contrast, the rate in Black Isle North (232 per 100,000), was the only rate that was significantly lower than the Health Board average. there were no areas with significantly lower rates than that of overall NHS Highland.
Within the Unit, the hospitalisation rate for CVD (Cerebrovasular Disease) was significantly higher than the overall NHS Highland rate (160 per 100,000 population) in one of the
Epidemiology & Health Science Team (Public Health) 14 intermediate geographies, Inverness Merkinch at 314 per 100,000. In contrast, there were three areas with significantly lower rates than that of overall NHS Highland, Nairn Rural, Loch Ness and Black Isle North, the latter with the lowest rate of 70 per 100,000).
Within the Unit, the hospitalisation rate for Asthma was significantly higher than the overall NHS Highland rate (713 per 100,000 population) in eleven of the intermediate geographies, Alness, Invergordon, Seaboard, Tain, Inverness Hilton, Inverness Ballifeary & Dalneigh, Inverness Central Raigmore & Longman, Inverness Smithton, Inverness Kinmylies & South West and Inverness Drakies, and Inverness Merkinch, the latter being the highest at 1488 per 100,000. In contrast, there was one area with a significantly lower rate than that of overall NHS Highland, Nairn Rural at 534 per 100,000.
Within the Unit, the emergency hospitalisation rate was significantly higher than the overall NHS Highland rate (6165 per 100,000) in nine of the intermediate geographies, Alness, Invergordon, Dingwall, Inverness Hilton, Inverness Ballifeary & Dalneigh, Inverness Central Raigmore & Longman, Inverness Muirtown, Inverness Kinmylies & South West and Inverness Merkinch, the latter being the highest at 10625 per 100,000. In contrast, of the remaining twenty five areas, fifteen had rates significantly lower than the NHS Highlands average, the lowest of which was Black Isle South at 4384 per 100,000.
Within the Unit, the Psychiatric hospitalisation rate was significantly higher than the overall NHS Highland rate (311 per 100,000) in seven of the intermediate geographies, Alness, Dingwall, Inverness Ballifeary & Dalneigh, Inverness Central Raigmore & Longman, Nairn East, Inverness Muirtown and Inverness Merkinch, the latter being the highest at 1158 per 100,000. In contrast, there were seven areas with significantly lower rates than the NHS Highlands average: Black Isle North, Badenoch & Strathspey North, Loch Ness, Inverness Lochardil & Holm Mains, Inverness Inshes & Slackbuie, Inverness Culloden & Balloch and Inverness Drakies, the latter being the lowest at 147 per 100,000.
Overall across the units Compared to the national average, the hospitalisation rates for COPD were significantly lower in NHS Highland and the only area for which the rate was significantly higher was Inverness Merkinch.
Compared to the national average, the overall hospitalisation rates for Coronary Heart Disease were significantly higher in NHS Highland and Highland HSCP. In contrast the average rate in Argyll & Bute was significantly lower. Significantly higher rates applied particularly to Inverness Merkinch (nearly twice the Health Board rate), Wick North and Oban South.
Compared to the national average, the overall hospitalisation rates for Cerebrovascular Disease were lower in NHS Highland, Highland HSCP and Argyll & Bute, differences being statistically significant except for the latter. Higher rates which were approximately twice the Health Boards average applied to Inverness Merkinch, Thurso East and Rothesay Town. Amongst the areas, significantly low rates in the order of one half the rate for the Health Board overall applied to Black Isle North, Helensburgh North, and Ross and Cromarty North West.
Compared to the national average, the overall hospitalisation rates for Asthma was significantly higher for the Health Board and the Highland HSCP. In contrast the overall rate for Argyll & Bute was significantly lower. Particularly high rates, more than twice the Health Board average, applied to Fort William North, and Inverness Merkinch. The lowest rate applied to Whiskey Isles, one fifth of the Health Boards average.
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Compared to the national average, Emergency hospitalisation rates were significantly lower for the Health Board, Highland HSCP and Argyll & Bute. Particularly high rates, which were 1.3-1.7 times the Health Board average, applied to Inverness Merkinch, Wick South and Dunoon. The lowest rates applied to Mull, Iona, Coll & Tiree and Black Isle South, approximately 30% lower than the Health Boards average.
Compared to the national average, the Psychiatric hospitalisation rates were significantly higher for the Highland HSCP and significantly lower for Argyll & Bute. Particularly high rates, which were 1.3-3.7 times the Health Board average, applied to Inverness Merkinch, Wick South and Greater Lochgilphead. The lowest rates applied to Caithness South, Inverness Drakies and Loch Awe.
4.4 Relative Health Need
Read notes & caveats which highlight the various confounders to the interpretation of any differences in the measures of disease rates.
South & Mid Operational Unit Within the Unit, the rate of patients newly diagnosed with cancer was significantly higher than the overall NHS Highland rate (398 per 100,000), in the intermediate geographies of Inverness Muirtown and Inverness Merkinch, the latter being the highest at 538 per 100,000. In contrast, the rate of one area was significantly lower, Conon & Muir of Ord at 319 per 100,000.
Within the Unit, the prevalence rate of diabetes was significantly higher than the overall NHS Highland rate (3.1%), in the intermediate geographies of Alness, Tain, Inverness Muirtown, Inverness Ballifeary & Dalneigh and Inverness Merkinch, the latter being the highest at 5%. In contrast, the rates were significantly lower for Black Isle North, Black Isle South, Badenoch & Strathspey South and Nairn Rural, the latter being the lowest at 2.1%.
Overall across the units Compared to the national average (413 per 100,000), the rate of newly diagnosed cancer was significantly lower for the Health Board overall (398 per 100,000) and for Argyll & Bute (381 per 100,000). Significantly higher rates were associated with Wick South, Inverness Muirtown and Inverness Merkinch.
Compared to the national average (3.5%), the prevalence rate of diabetes was significantly lower for the Health Board overall (3.1%), Highland HSCP (3.1%) and for Argyll & Bute (3.0%). Significantly higher rates were associated with Wick South (4.3%) and Inverness Merkinch (5%).
4.5 Older People
South & Mid Operational Unit Within the Unit, the rate of those aged 65 years & over who have had multiple admissions to hospital was significantly higher than the overall NHS Highland rate (4210 per 100,000), in four intermediate geographies of Inverness Ballifeary & Dalneigh, Inverness Hilton, Inverness Muirtown and Inverness Merkinch, the latter being the highest at 7382 per 100,000. In contrast there are eight areas with significantly lower rates, Black Isle North, Black Isle South, Ross & Cromarty Central, Ross & Cromarty East, Seaboard, Inverness West Rural, Loch Ness and Nairn East, the latter being the lowest at 2179 per 100,000.
Within the Unit, the rate of those aged 65 years & over with emergency hospitalisation was significantly lower than the overall NHS Highland rate (24142 per 100,000), in all of the
Epidemiology & Health Science Team (Public Health) 16 districts except for Inverness West. The overall rates for the South and the Mid areas were each significantly lower, 22072 per 100,000 and 20138 per 100,000 respectively than the Health Board average.
Within the Unit, the profile of patients aged 65 years & over at risk of hospitalisation (SPARRA), had the least at risk profile in Badenoch & Strathspey, Nairn and Ardersier and the Mid Ross districts of 5.1% and 5.2% in the 40% & over at risk category and 0.8% and 0.8% in the 60% & over at risk category respectively.
Overall across the units Compared to the national average (4608 per 100,000), the rate of those aged 65 years & over who have had multiple admissions to hospital was significantly lower for the Health Board overall (4210 per 100,000), Highland HSCP (4190 per 100,000) and for Argyll & Bute (4252 per 100,000). Significantly higher rates were associated with Caithness South (6514 per 100,000), Inverness Merkinch (7382 per 100,000), Campbeltown (6427 per 100,000) and Oban South (6450 per 100,000).
Compared to the national average (25320 per 100,000), the rate of those aged 65 years & over with emergency hospitalisation was significantly lower for the South & Mid operational unit (21420 per 100,000) and for Argyll & Bute CHP (24578 per 100,000, but significantly higher for the North & West operational unit (27908 per 100,000). Significantly higher rates were associated with Caithness (28872 per 100,000) Lochaber (32105 per 100,000) and Mid Argyll Kintyre & Islay (26604 per 100,000).
The proportion of patients categorised as 40% or over at risk of hospitalisation according to SPARRA, was 8% for Scotland as a whole. The equivalent profile for the operational units and for Argyll & Bute CHP, and the HSCP were all lower, the overall profile for the Health Board was 6.5% for this risk category. This also applied for the higher risk category of 60% and over, where the national proportion of 1.8% was higher than the relevant proportions pertaining to each of the units and the CHP, and against the Health Board proportion of 1.2%. Within NHS Highland, the profile with the highest risk of hospitalisation was the North & West Operational Unit with 7.6% being categorised with a 40% and above risk and 1.5% with a 60% and over risk.
Summary for Health Care in respect of the South & Mid Unit
The crude prevalence rates of Hypertension, Diabetes and CHD (three out of the ten conditions for which there is a primary care disease register) were lower for the unit than the overall rates for the Health Board. Comparisons are confounded by any differences in the population structure. With the exception of Learning Disabilities and Mental Health, rates of conditions were higher in the Mid area compared to the South area. The district of Inverness West recorded the highest rates for Mental Health conditions. For all of the measures reflecting disease management, the overall rates for the unit were similar to the Health Boards average rates with the exception for the drug prescribing rate for patients with depression, anxiety or psychosis, where it was relatively lower. Within the unit, higher rates of three disease management measures applied to the Badenoch & Strathspey district for (1) flu immunisation of those at high risk due to being on one or more of the disease registers (2) reviews of those with dementia (3) reviews of those with severe mental illness. The hospitalisation rates for COPD, CHD, CVD, Asthma, Emergency admission and Psychiatric admission were consistently higher in Inverness Merkinch by a factor of two to three times the Health Board average and with only one exception (Asthma),
Epidemiology & Health Science Team (Public Health) 17
they were the highest of all rates pertaining to intermediate geographies across the Health Board. The rates of newly diagnosed cancers were significantly higher in the Inverness Merkinch and Muirtown areas and significantly the lowest in Conon & Muir of Ord. The prevalence rate of Diabetes was significantly higher than the Health Board average in several intermediate geographies particularly in Inverness Merkinch and Muirtown and in Alness. A significantly lower rate applied to Nairn Rural. The rates of older people with multiple hospital admissions were significantly higher in four intermediate geographies. The rate in Inverness Merkinch was the highest in the Health Board with over a 3-fold difference between it and the lowest rate in Nairn Rural. The rates of emergency hospitalisations of older people were lower in all of the districts than the Health Board average, and all were significantly lower except for the rate in Inverness West. The profile of older patients at risk of hospitalisation, according to the SPARRA score, had the least risk profile as per over 40% and over 60% risk categories in the two districts of Badenoch & Strathspey, Nairn & Ardersier and Mid Ross.
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