Director of Public Health Annual Report: Chart Book
Director of Public Health Annual Report: Chart Book
Published July 2011
Director of Public Health Annual Report: Chart Book
Contents
1 INTRODUCTION ...... 1
2 DEMOGRAPHY ...... 2 2.1 Demography: key points ...... 2 2.2 Population ...... 4 2.2.1 Population by age and sex ...... 4 2.2.2 Population aged under 18 ...... 5 2.2.3 Population aged 75 and over ...... 8 2.2.4 Population aged 85 and over ...... 11 2.3 Population projections ...... 13 2.3.1 Population projections by age group ...... 13 2.3.2 Population projections, persons aged 75 and over ...... 14 2.3.3 Population projections, persons aged 85 and over ...... 15 2.4 Births ...... 16 2.4.1 General fertility rate ...... 16 2.5 Deaths ...... 19 2.5.1 All-cause mortality ...... 19 2.5.2 All-cause mortality, aged under 75 ...... 22
3 DETERMINANTS OF HEALTH ...... 26 3.1 Determinants of health: key points ...... 26 3.2 Wider determinants of health ...... 27 3.2.1 Deprivation in relation to Wales ...... 27 3.2.2 Deprivation within the health board ...... 28 3.2.3 Inequality in all-cause mortality ...... 29 3.3 Lifestyle factors ...... 30 3.3.1 Smoking as reported by adults ...... 30 3.3.2 Binge drinking as reported by adults ...... 31 3.3.3 Five or more fruit or vegetables a day as reported by adults32 3.3.4 Physical activity as reported by adults ...... 33 3.3.5 Overweight and obesity, adults based on self reported data 34
4 USE OF SERVICES ...... 35 4.1 Use of services: key points ...... 35 4.2 Prevention services: vaccination uptake ...... 37 4.2.1 Childhood immunisations ...... 37 4.2.2 Seasonal influenza vaccination ...... 41 4.3 Population Based National Screening Programmes in Wales ... 43 4.3.1 Uptake of national screening programmes in Wales ...... 43 4.4 Primary care services ...... 44 4.4.1 Use of primary care as reported by adults ...... 44 4.5 Use of secondary and tertiary care ...... 45 4.5.1 Hospital admissions: individuals aged under 75 ...... 45 4.5.2 Emergency hospital admissions: individuals aged under 75 . 48 4.5.3 Elective hospital admissions: individuals aged under 75 ..... 51
Director of Public Health Annual Report: Chart Book
5 HEALTH STATUS ...... 54 5.1 Health status: key points ...... 54 5.2 Physical and mental health ...... 56 5.2.1 Low birth weight ...... 56 5.2.2 Physical health as reported by adults* ...... 59 5.2.3 Mental health as reported by adults* ...... 60 5.2.4 Limiting long term illness as reported by adults ...... 61 5.2.5 Mental illness as reported by adult ...... 62 5.3 Mortality from specific conditions ...... 63 5.3.1 Mortality from circulatory disease, all ages ...... 63 5.3.2 Mortality from circulatory disease, under 75s ...... 66 5.3.3 Mortality from coronary heart disease ...... 69 5.3.4 Mortality from cancer ...... 72 5.3.5 Mortality from respiratory disease ...... 75 5.3.6 Cancer survival ...... 78
APPENDIX A: ORIGINAL SOURCE REPORTS AND FURTHER INFORMATION ...... 81
APPENDIX B: GLOSSARY ...... 82
APPENDIX C: MAPS SHOWING MIDDLE SUPER OUTPUT AREAS IN THE HYWEL DDA HEALTH BOARD AREA ...... 83
© 2011 Public Health Wales NHS Trust. Material contained in this document may be reproduced without prior permission provided it is done so accurately and is not used in a misleading context. Acknowledgement to Public Health Wales NHS Trust to be stated. Copyright in the typographical arrangement, design and layout belongs to Public Health Wales NHS Trust.
Director of Public Health Annual Report: Chart Book
1 Introduction
This Hywel Dda Health Board chart book has been produced by the Public Health Wales Observatory as an appendix to the Director of Public Health Annual Report.
It updates and adds to the chart book produced by the Director of Public Health for Abertawe Bro Morgannwg University Health Board (UHB) for his Interim Annual Report. A decision was made by the Wales Directors of Public Health to use these indicators to inform their annual reports.
The Abertawe Bro Morgannwg UHB chart book indicators originated from a number of sources: Public Health Wales Observatory Vaccine Preventable Disease Programme (Public Health Wales) Screening Division (Public Health Wales) Welsh Cancer Intelligence and Surveillance Unit (Public Health Wales)
This updated chart book draws together information from the above resources and adds new information sourced from:
The Public Health Wales Observatory: Director of Public Health Annual Report: supporting indicators, 2011 Demography Profile, 2009 Lifestyle Profile, 2010 Inequalities in mortality in Hywel Dda Health Board: interim release to support Directors of Public Health annual reports
From other sources: Welsh Health Survey, Welsh Assembly Government (repackaged by the Public Health Wales Observatory) Public Health Wales, Vaccine Preventable Disease Programme Screening Division (Public Health Wales) Welsh Cancer Surveillance and Intelligence Unit (Public Health Wales)
The indicators have been presented under the following chapter headings: demography; determinants of health; use of services and health status. A summary of key points is included at the beginning of each chapter.
Maps included in this document show data by fifths of equal range within the health board area.
Included in Appendix A are web links for the original source reports and further information to support the used in this chart book.
A glossary of some of the terms used in this chart book is included in Appendix B.
Appendix C comprises of a series of local authority area maps showing the MSOA boundaries for the health board area.
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Director of Public Health Annual Report: Chart Book
2 Demography
2.1 Demography: key points
Population structure
Hywel Dda Health Board covers three local authority areas: Carmarthenshire; Ceredigion and Pembrokeshire. The population of Hywel Dda Health Board is estimated to have been 375 thousand in 2009. Close to 50 per cent of the Hywel Dda Health Board population live in the Carmarthenshire local authority area. The age structure of the population is different to Wales with lower proportions of persons aged 0-4 and 20-44, and higher proportions of persons aged 50 and over.
At local authority level, the proportion of persons aged under 18 in Carmarthenshire and Pembrokeshire is similar to Wales. There is a lower proportion of persons aged under 18 in Ceredigion. At middle super output area level (MSOA), higher proportions of persons aged under 18 are found in the Llwynhendy, Bynea and Pemberton areas of Llanelli, as well as parts of Haverfordwest, Pembroke and Pembroke Dock in Pembrokeshire. The areas with the lowest proportions are Aberystwyth and areas to the east of the town centre in Ceredigion.
Among the older age groups the proportion aged 75 and over is higher than Wales. Within the health board, all local authority areas have proportions higher than Wales, with the highest in Ceredigion. At the MSOA level, the highest proportions are found in the Tenby; Penally and Caldey Island area of Pembrokeshire, southern parts of the Carmarthen town and Llangunnor in Carmarthenshire, and Aberporth; Pen-parc and Cardigan in Ceredigion. The pattern is similar in those aged 85 and over.
Population projections
The latest projections indicate that if current trends continue, the number of persons aged 65 and over resident in Hywel Dda Health Board will increase by 67 per cent between 2008 and 2033. The proportion aged 75 and over is projected to increase from around 10 per cent at local authority level to around 16 to 18 per cent over this period, the sharpest increases being in Ceredigion and Pembrokeshire. The percentage aged 85 and over is projected to more than double from around three per cent to six to seven per cent by 2033.
The increase in the number of older people is likely to be associated with a rise in chronic conditions whose prevalence is strongly age-related such as circulatory and respiratory diseases and cancers. Meeting the needs of these individuals will be a key challenge for the health board. In the current economic climate, the relative (and absolute) increase in economically dependent and, in some cases, care-dependent populations will pose particular challenges to communities.
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Birth rate
The General Fertility Rate (GFR) for Hywel Dda Health Board is slightly lower than the rate for Wales. Within the health board, the rate is notably lower in Ceredigion which has the lowest local authority area rate in Wales. At the MSOA level, there is also considerable variation. Rates are particularly low in north Aberystwyth. Low rates are also found in Lampeter; both Aberystwyth and Lampeter having large student populations. The areas with the highest rates are in the Capel; Lleidi; Llwynhendy; Bynea; Pemberton; Seaside; Tyshia; Machynys; Felinfoel; Dafen and Morfa areas of Llanelli and the northern parts of Carmarthen town in Carmarthenshire, and Haverfordwest; Carew; Lamphey; Manorbier and Milton in Pembrokeshire.
All-cause mortality
The European age-standardised all-cause mortality rate takes into account the age structure of the population, allowing valid comparisons to be made between areas. The rate for Hywel Dda Health Board is lower than Wales. Within the health board, Ceredigion has the lowest local authority rate in Wales whereas the rate for Carmarthenshire is slightly above the rate for Wales. At the MSOA level, variation is considerable with rates ranging from 459 to 838 per 100,000 population. The lowest rates are found in the areas of Lampeter, Llanfihangel Ystrad, Llangybi, Llanwenog, Llanarth, Llandysiliogogo, Penybryn, New Quay, Bow St, Ceulanamaesmawr, Tirymynach, Trefeurig and Borth in Ceredigion. The highest rates are found in the Capel and Lliedi areas of Llanelli in Carmarthenshire. Among persons aged under 75 years the pattern is similar to the rate for all persons, with the exception of the Capel and Lliedi areas in Carmarthenshire where the rate is much closer to average and not amongst the highest for the health board. The health board exhibits a decreasing trend in mortality in persons under 75 years from 2000 to 2009 and with rates below the all Wales pattern.
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2.2 Population
2.2.1 Population by age and sex
Wales and Hywel Dda Health Board
Proportion of population by age and sex Hywel Dda Health Board: 2009 Produced by the Public Health Wales Observatory using data from 2009 mid year population estimates, Office for National Statistics
Hywel Dda females Hywel Dda 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
12 10 8 6 4 2 0 2 4 6 8 10 12 Proportion (%) of population
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2.2.2 Population aged under 18
Middle super output areas
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Percentage of population aged under 18 in Hywel Dda Health Board area, 2009 Produced by Public Health Wales Observatory, using data from ONS (MYE)
Ceredigion Carmarthenshire
001 21.2 025 25.0 004 19.6 020 23.8 006 19.3 007 22.6 009 18.9 026 22.5 010 18.8 013 22.3
005 18.5 024 21.9 MSOA 007 18.3 015 21.8 003 17.8 010 21.6 Ceredigion % 008 17.7 022 21.4 = 17.6 002 8.1 018 21.1 % under 18 009 21.1 017 20.9 Pembrokeshire 005 20.8 013 011 20.5 25.7 MSOA 005 25.1 016 20.4 015 25.0 021 20.1 012 23.0 019 20.1 010 22.9 006 20.1 009 22.3 023 20.0 004 21.8 003 19.9 001 006 21.5 19.8 004
007 20.6 18.9 MSOA 014 002 20.1 18.8 002 001 20.0 18.6 012 003 19.9 18.0 Carms 008 % = 20.7 014 19.8 15.6 % under 18 008 19.5 011 18.7 Pembs % = 21.5 016 17.8 % under 18
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Local authorities
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 Merthyr
Pembrokeshire
Blaenau Gwent Blaenau
Monmouthshire
Isle of Anglesey of Isle
Carmarthenshire Neath Port Talbot Port Neath
Areas ordered geographically from north west to south east RhonddaTaff Cynon
The Vale of Glamorgan of Vale The
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2.2.3 Population aged 75 and over
Middle super output areas
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Percentage of population aged 75 and over in Hywel Dda Health Board area, 2009 Produced by Public Health Wales Observatory, using data from ONS (MYE)
Ceredigion Carmarthenshire
009 13.0 008 13.2 010 11.8 022 11.3 005 11.2 023 11.1 004 10.7 011 11.0 007 9.9 021 10.9
006 9.7 004 10.9 MSOA 008 9.6 013 10.8 001 9.4 020 10.8 003 7.9 Ceredigion 002 10.6 % = 10 002 6.4 012 10.5 % 75 and over 014 10.0 024 9.7 Pembrokeshire 009 9.5 007 9.3 016 13.5 MSOA 010 011 12.2 9.1 001 002 11.8 9.0 016 007 10.7 9.0 005 008 10.4 9.0 003 014 10.3 8.9 019 003 10.0 8.9 018 006 10.0 8.8 015 004 9.5 8.3 MSOA 006 012 9.5 8.2 026 8.1 001 9.4 025 7.9 Carms 010 9.3 % = 9.7 017 7.7 015 8.7 % 75 and over 009 7.4 013 7.0 Pembs % = 9.8 005 6.8 % 75 and over
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Local authorities
Percentage of population aged 75 and over by local authority, 2009 Produced by Public Health Wales Observatory, using data from ONS ( MYE)
Wales = 8.6%
11.9%
10.6%
10.2%
9.8%
9.7% 9.7% 9.7%
9.6% 10.0%
8.9%
8.9% 8.8%
8.5%
8.2%
8.1%
7.9% 7.9% 7.9%
7.7%
7.5%
7.4%
6.7%
Powys Cardiff
Conwy
Torfaen
Newport
Bridgend
Flintshire
Swansea
Gwynedd
Wrexham
Caerphilly
Ceredigion
Denbighshire
Merthyr Tydfil Merthyr
Pembrokeshire
Blaenau Gwent Blaenau
Monmouthshire
Isle of Anglesey of Isle
Carmarthenshire Neath Port Talbot Port Neath
Areas ordered geographically from north west to south east RhonddaTaff Cynon
The Vale of Glamorgan of Vale The
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2.2.4 Population aged 85 and over
Middle super output areas
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Director of Public Health Annual Report: Chart Book
Percentage of population aged 85 and over in Hywel Dda Health Board area, 2009 Produced by Public Health Wales Observatory, using data from ONS (MYE) Isle of Anglesey
MSOA Health Board (2.8%) Wales (2.5%) Local Authority
0.0 Ceredigion 2.0 4.0 6.0 Carmarthenshire8.0 10.0 12.0
008 748009 4.0 020 4.2 005 3.5010 3.7 011 3.7 002 3.2004 3.6 008 3.6 004 2.7 005 3.3 023 3.5 007 2.5 001 2.9 022 3.3 006msoa 2.4 001 006 2.8 004 3.0 2.4MSOA 009 2.3008 2.8 001 3.0 003 1.8007 2.7 021 3.0 Ceredigion 0.0 003 2.02.6 4.0 6.0 013 8.0 2.9 10.0 12.0 % = 3.1 002 2.2 002 2.8 % 85 and over 007 2.5 018 2.5 Pembrokeshire 010 2.5 006 2.5 016 4.1 MSOA 024 007 3.7 2.5 012 002 3.7 2.5 009 011 3.3 2.5 016 008 3.2 2.4 025 006 3.0 2.3 026 003 2.7 2.3 005 001 2.7 2.2 015 015 2.5 2.1 MSOA 014 014 2.5 2.1 003 2.0 004 2.4 019 1.9 Carms 012 2.2 % = 2.7 017 1.8 010 2.2 % 85 and over 013 1.9 009 1.7 Pembs % = 2.7 005 1.6 % 85 and over
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2.3 Population projections
2.3.1 Population projections by age group
Hywel Dda Health Board
2008-based population projections for Hywel Dda 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+ 80
70
60
50
40
30
20
10
0 Percentage change from 2008from changePercentage -10
-20
2012 2013 2014 2015 2016 2017 2018 2025 2026 2027 2028 2029 2030 2031 2008 2009 2010 2011 2019 2020 2021 2022 2023 2024 2032 2033
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2.3.2 Population projections, persons aged 75 and over
Local authorities within Hywel Dda Health Board*
Projected population, 2008-2033, % aged 75 and over Produced by Public Health Wales Observatory, using data from the Welsh Assembly Government
Ceredigion Pembrokeshire Carmarthenshire Wales
20
18
16
14 %
12
10
8
6
2009 2010 2013 2014 2016 2017 2018 2020 2021 2024 2025 2027 2028 2031 2032 2008 2011 2012 2015 2019 2022 2023 2026 2029 2030 2033
* Y-axis is truncated
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2.3.3 Population projections, persons aged 85 and over
Local authorities within Hywel Dda Health Board*
Projected population, 2008-2033, % aged 85 and over Produced by Public Health Wales Observatory, using data from the Welsh Assembly Government
Ceredigion Pembrokeshire Carmarthenshire Wales 8
7
6
5 %
4
3
2
2008 2009 2012 2013 2015 2016 2017 2019 2020 2021 2023 2024 2025 2027 2028 2031 2032 2010 2011 2014 2018 2022 2026 2029 2030 2033
* Y-axis is truncated
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2.4 Births
2.4.1 General fertility rate
Middle super output areas
Numbers on map indicate MSOAs with a rate statistically significantly higher than the all Wales rate.
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General fertility rate per 1,000 in Hywel Dda Health Board area, females aged 15-44, 2006- 08 Produced by Public Health Wales Observatory, using data from ONS (ADBE, MYE)
Ceredigion Carmarthenshire
010 58 022 76 009 57 025 74 001 56 026 74 006 53 007 73 007 53 020 72
005 52 024 66 MSOA 004 49 015 63 008 39 010 62 003 32 Ceredigion 013 62 GFR = 41 002 14 017 61 GFR 021 60 006 60 Pembrokeshire 001 59 005 018 59 72 MSOA 014 71 011 58 012 70 016 56 010 70 012 56 004 013 68 55 008 006 68 55 019 015 67 54 003 002 63 53 009 008 61 53 MSOA 023 001 59 53 005 50 009 58 002 47 Carms 016 57 GFR = 60 014 45 003 56 GFR 011 53 004 50 Pembs GFR = 62 007 45 GFR
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Local authorities
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 Merthyr
Pembrokeshire
Blaenau GwentBlaenau
Monmouthshire
Isle of AngleseyofIsle
Carmarthenshire
Neath Port TalbotNeathPort RhonddaTaff Cynon
Areas ordered geographically from north west to south east The Vale ofGlamorgan Vale The
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2.5 Deaths
2.5.1 All-cause mortality
Middle super output areas
Numbers on map indicate MSOAs with a rate statistically significantly higher than the all Wales rate.
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All-cause mortality in Hywel Dda 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)
Ceredigion Carmarthenshire
010 591 022 838 009 585 026 786 002 578 024 766 005 535 023 754 003 526 011 735
004 507 013 730 MSOA 006 496 008 711 001 475 025 694 008 462 Ceredigion 010 682 EASR = 517 007 459 018 672 EASR per 100,000 020 651 002 650 Pembrokeshire 016 642 015 642 015 774 MSOA 005 725 001 624 012 012 695 621 009 013 682 606 003 008 659 606 007 006 658 599 021 003 647 590 019 002 642 582 004 574
010 610 MSOA 006 568 016 603 014 566 001 580 017 564 Carms EASR 011 576 = 652 005 505 007 566 EASR per 100,000 009 535 004 517 Pembs EASR = 619 014 494 EASR per 100,000
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Local authorities
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 Merthyr
Pembrokeshire
Blaenau GwentBlaenau
Monmouthshire
Isle of AngleseyofIsle
Carmarthenshire
Neath Port Talbot NeathPort RhonddaTaff Cynon Areas ordered geographically from north west to south east The Vale ofGlamorgan Vale The
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2.5.2 All-cause mortality, aged under 75
Middle super output areas
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All-cause mortality in Hywel Dda 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) Isle of Anglesey MSOA EASR with 95% confidence intervalMSOA Health Board (EASR = 310) Wales (EASR = 331) Local Authority
0 10 20 30 40 50 60 70 80 90 100 Ceredigion Carmarthenshire 003 748 002 342 026 488 007 367 006 009346 326 013 401 001 010329 299 024 393 009 003321 278 020 388 004msoa 303 005 260 010 382 002 240
005 004226 260 025 372 MSOA 008 007214 233 018 371
0010 232100 200 300 400 008 500 364 600 700 800 008 023 229 Ceredigion 362 006 213 EASR = 262 011 354 EASR per 100,000 022 340 016 324 Pembrokeshire 001 314 005 021 310 439 MSOA 015 438 007 309 012 410 014 307 013 353 006 293 003 351 012 287 002 002 348 286 019 006 339 283 004 010 331 282 015 011 317 279 MSOA 009 016 293 275 017 008 288 269 003 267 009 265 Carms EASR 005 240 = 327 014 260 EASR per 100,000 007 248 001 248 Pembs EASR = 317 004 233 EASR per 100,000
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Local authorities
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
MerthyrTydfil
Pembrokeshire
Blaenau GwentBlaenau
Monmouthshire
Isle of AngleseyIsleof
Carmarthenshire
Neath Port Talbot NeathPort RhonddaTaff Cynon
Areas ordered geographically from north west to south east The Vale ofGlamorgan Vale The
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Wales and Hywel Dda Health Board trend
All-cause mortality rate trend for Hywel Dda Health Board, persons aged under 75: 2000 to 2009 Produced by the Public Health Wales Observatory, using data from ONS (ADDE, MYE)
Hywel Dda Health Board Wales 500
400
300
200
100 EASR per 100,000 per EASR population
0 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
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3 Determinants of health
3.1 Determinants of health: key points
Pattern of deprivation
The pattern of deprivation as described by the Welsh Index of Multiple Deprivation shows that the most deprived areas are located in the areas of Pantyffynnon; Pembrey; Burry Port; Glanymor; Morfa; Pemberton and Cwmbach in Carmarthenshire; Cardigan town in Ceredigion, and Monkton and Gelliswick in Pembrokeshire. The least deprived areas are found to the west of Aberystwyth town in Ceredigion, Llanedi; Fforest; Hendy; Swiss Valley and Graig in Carmarthenshire, and Llandissillio and Clunderwen in Pembrokeshire.
Analysis of the association between deprivation and poor health
The association between socioeconomic deprivation and poor health outcomes is well- established. The Public Health Wales Observatory will be publishing a profile examining the relationship over time between deprivation and mortality later this year. This chart book contains some preliminary analysis released for inclusion in Director of Public Health Annual Reports. The analysis shows that the European age-standardised all-cause mortality rate in the most deprived fifth of areas within Hywel Dda Health Board is nearing twice that of the rate in the least deprived fifth for males and the gap is slightly lower for females. The charts also show the gap is narrowing marginally among females but may be widening among males.
Lifestyle data
The Welsh Health Survey is a rich source of information on lifestyle. It is a self-reported survey randomly sampling around 15 thousand adults (aged 16+) per year in Wales. The sample is constructed to allow reporting at local authority level.
Lifestyle indicators in the Hywel Dda Health Board area are generally better than, or similar to, the Wales average. However, almost one in four people smoke, leading to around 730 deaths per year within the health board area.
Two out of five people drink more alcohol than the recommended limits and nearly one quarter binge drink on at least one day a week. Hospital admissions due to alcohol and drugs are generally less common than in Wales as a whole, with particularly low levels found in Ceredigion. Nevertheless, nearly 6,500 hospital admissions and 140 deaths of Hywel Dda residents are caused by alcohol each year.
Overall, only around two in five people eat the recommended amount of fruit and vegetables. A third of the population meet physical activity guidelines. Improving diet and physical activity are essential to reducing the high proportions of people who are overweight or obese. Nearly 60 per cent of adults in the health board area are either overweight or obese.
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3.2 Wider determinants of health
3.2.1 Deprivation in relation to Wales
The Welsh Index of Multiple Deprivation (2008) is produced at a small area level called lower super output area, and is derived from a broad range of factors including income, employment, health, education, skills and training, community safety, housing, physical environment and access to services. It 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.
This map shows the level of deprivation in the health board in comparison to the rest of Wales.
Overall Welsh Index of Multiple Deprivation 2008 Fifths of deprivation, Low er Super Output Areas, Data source: WAG Most deprived (22) Next most deprived (41) Median (90) Next least deprived (66) Aberystwyth Least deprived (11)
Local authority boundary
A Roads
Motorway
Cardigan
Lam peter
Llandovery
St David's Fishguard
Llandeilo Carm arthen
Haverfordwest
Milford Haven Burry Port Llanelli Pem broke Dock 0 10 20 miles
This map is reproduced from Ordnance Survey material with the permission of Ordnance Survey on behalf of the Controller of Her Majesty's Stationery Office © Crown copyright. Unauthorised reproduction infringes Crown copyright and may lead to prosecution or civil proceedings. Wales Centre for Health. Licence Number: 100044810. 2009
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Director of Public Health Annual Report: Chart Book
3.2.2 Deprivation within the health board
This map shows the most and least deprived fifths within the health board. It is this grouping that is used to demonstrate inequalities in mortality in the next section.
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3.2.3 Inequality in all-cause mortality
These graphs compare mortality in the most deprived fifth of the health board population with the least deprived fifth of health board population.
All-cause mortality, under 75, males, European age-standardised rate (EASR) per 100,000, Hywel Dda HB and Wales, 2001-09 Produced by Public Health Wales Observatory, using ADDE/MYE (ONS), WIMD 2008 (WAG)
Most deprived within Hywel Dda (95% CI) Wales EASR Least deprived within Hywel Dda Hywel Dda overall 700
600
500
400
300
200
100 Rate Ratio - most deprived divided by least deprived 1.8 1.7 1.7 1.8 1.8 1.8 1.9 0 2001-03 2002-04 2003-05 2004-06 2005-07 2006-08 2007-09
All-cause mortality, under 75, females, European age-standardised rate (EASR) per 100,000, Hywel Dda HB and Wales, 2001-09 Produced by Public Health Wales Observatory, using ADDE/MYE (ONS), WIMD 2008 (WAG)
Most deprived within Hywel Dda (95% CI) Wales EASR Least deprived within Hywel Dda Hywel Dda overall 450 400 350 300 250 200 150 100 50 Rate Ratio - most deprived divided by least deprived 1.6 1.6 1.5 1.7 1.7 1.8 1.6 0 2001-03 2002-04 2003-05 2004-06 2005-07 2006-08 2007-09
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Director of Public Health Annual Report: Chart Book
3.3 Lifestyle factors
3.3.1 Smoking as reported by adults
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 Cwm
Swansea
Bridgend
Flintshire
Gwynedd
Wrexham
Caerphilly
Hywel Dda Hywel
Ceredigion
Denbighshire
Merthyr Tydfil Merthyr
AneurinBevan
Blaenau GwentBlaenau
Pembrokeshire
Monmouthshire
Isle of AngleseyIsleof
BetsiCadwaladr
Carmarthenshire
Neath Port Talbot NeathPort
RhonddaTaf Cynon
The Vale ofGlamorgan Vale The
Cardiff & Vale University&Vale Cardiff AbertaweMorgannwgBro
Areas ordered geographically from north west to south east
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Director of Public Health Annual Report: Chart Book
3.3.2 Binge drinking as reported by adults
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 Cwm
Swansea
Bridgend
Flintshire
Gwynedd
Wrexham
Caerphilly
Hywel Dda Hywel
Ceredigion
Denbighshire
Merthyr Tydfil Merthyr
AneurinBevan
Blaenau GwentBlaenau
Pembrokeshire
Monmouthshire
Isle of AngleseyIsleof
Betsi Cadwaladr Betsi
Carmarthenshire
Neath Port Talbot NeathPort
RhonddaTaf Cynon
The Vale ofGlamorgan Vale The
Cardiff & Vale University&Vale Cardiff AbertaweMorgannwgBro
Areas ordered geographically from north west to south east
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Director of Public Health Annual Report: Chart Book
3.3.3 Five or more fruit or vegetables a day as reported by adults
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 Cwm
Swansea
Bridgend
Flintshire
Gwynedd
Wrexham
Caerphilly
Hywel Dda Hywel
Ceredigion
Denbighshire
Merthyr Tydfil Merthyr
AneurinBevan
Pembrokeshire
Blaenau GwentBlaenau
Monmouthshire
Betsi Cadwaladr Betsi
Isle of AngleseyofIsle
Carmarthenshire
Neath Port Talbot NeathPort
RhonddaTaf Cynon
The Vale ofGlamorgan Vale The
Cardiff & Vale University&Vale Cardiff AbertaweMorgannwgBro
Areas ordered geographically from north west to south east
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Director of Public Health Annual Report: Chart Book
3.3.4 Physical activity as reported by adults
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 Cwm
Swansea
Bridgend
Flintshire
Gwynedd
Wrexham
Caerphilly
Hywel Dda Hywel
Ceredigion
Denbighshire
Merthyr Tydfil Merthyr
AneurinBevan
Blaenau GwentBlaenau
Pembrokeshire
Monmouthshire
Isle of AngleseyIsleof
Betsi Cadwaladr Betsi
Carmarthenshire
Neath Port Talbot NeathPort
RhonddaTaf Cynon
The Vale ofGlamorgan Vale The
Cardiff & Vale University&Vale Cardiff AbertaweMorgannwgBro
Areas ordered geographically from north west to south east
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Director of Public Health Annual Report: Chart Book
3.3.5 Overweight and obesity, adults based on self reported data
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 60 60 61 60 60 60 61 63 60 56 57 56 56 59 59 57 59 58
54 52 53 55 52 54 55 53 55 55
Powys Powys
Cardiff
Conwy
Torfaen
Newport
Cwm Taf Cwm
Swansea
Bridgend
Flintshire
Gwynedd
Wrexham
Caerphilly
Hywel Dda Hywel
Ceredigion
Denbighshire
Merthyr Tydfil Merthyr
AneurinBevan
Blaenau GwentBlaenau
Pembrokeshire
Monmouthshire
Isle of AngleseyIsleof
Betsi Cadwaladr Betsi
Carmarthenshire
Neath Port Talbot NeathPort
RhonddaTaf Cynon
The Vale ofGlamorgan Vale The
Cardiff & Vale University&Vale Cardiff AbertaweMorgannwgBro
Areas ordered geographically from north west to south east
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Director of Public Health Annual Report: Chart Book
4 Use of services
4.1 Use of services: key points
Childhood immunisations
Childhood immunisation uptake rates show positive long term trends, although remain below target rates in a number of key areas. Immunisations in children under one year of age reach the 95% target. All immunisations scheduled for children in their second year of life do not reach the 95% target, and coverage of immunisations in five year olds and sixteen year olds are also below target. MMR vaccine uptake is a particular concern given a large outbreak of measles in Wales in 2009, and ongoing outbreaks in Europe in 2011. Uptakes of one dose of MMR in two year olds and two doses in five year olds have improved since 2004, but a 95% uptake of two doses is needed to eliminate measles in line with WHO goals. Improving uptake of pre-school and teenage immunisation will reduce risk of outbreaks of vaccine preventable diseases in future.
Seasonal influenza vaccination
In Wales, free seasonal influenza immunisation is offered to all people aged 65 years and over, and people between 6 months and 65 years in clinical risk groups (currently chronic respiratory disease, chronic heart disease, chronic renal disease, chronic liver disease, chronic neurological conditions, diabetes mellitus, and immunosuppression), residents of long-stay care homes and those who were the main carer for an elderly or disabled person whose welfare may be at risk if the carer fell ill. For 2009/10 WAG set a target immunisation uptake rate of 70% for people aged 65 years and over. For the 2010/11 seasonal influenza immunisation campaign the national uptake target was raised to the WHO target of 75% uptake in recommended groups. This target was also put in place for those younger than 65 years in ‘at-risk’ groups. During the 2010/11 campaign influenza immunisation was also offered to pregnant women who were not an existing clinical risk group.
Uptake of seasonal influenza immunisation for Hywel Dda Health Board in persons aged 65 years and over during 2010/11 was 11% under the target level. In persons aged under 65 years in the at risk groups, uptake during 2010/11 was 29% below the target level.
Population Based National Screening Programmes in Wales
Uptake/coverage rates in Hywel Dda Health Board for the national screening programmes for bowel, breast and cervical cancer and newborn hearing screening are generally on a par with Wales overall. However, newborn hearing screening is the only programme achieving the UK target rate. Rates in Ceredigion for cervical screening for 20 to 64 yr olds are noticeably lower than for Wales and the other local authorities.
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Director of Public Health Annual Report: Chart Book
Primary care services
The latest Welsh Health Survey data show that age-standardised percentages of primary care service use by adults in Hywel Dda Health Board are broadly on a par with those for Wales as a whole.
Use of secondary and tertiary care
Age-standardised overall hospital admission rates in persons aged under 75 years for 2009 in Hywel Dda Health Board show that overall rates are slightly lower than Wales; the rate for Ceredigion being the lowest of the 22 local authorities. Drilling down to the MSOA level there is considerable variation. Rates are lowest in the Lampeter, Llanfihangel Ystrad, Llangybi and Llanwenog areas of Ceredigion; the highest rates are found in the areas of Kidwelly; Mynyddygarreg; Trimsaran; Pembrey; Achddu; Seaside; Morfa; Machynys and Tyisha in Carmarthenshire.
Looking at emergency admissions in this age group, the health board rate is below that of Wales; the lowest rate at local authority level across Wales being Ceredigion. At the MSOA level the rate varies with the lowest rates found in Tenby, Penally and Caldey Island in Pembrokeshire. The rate is notably higher in the Seaside, Morfa, Machynys and Tyisha areas of Carmarthenshire compared to other MSOAs in the health board. High rates of emergency hospital admission may be indicative of inadequate self-care and primary care services.
The health board elective admission rate is slightly above that for Wales. However, the rate in Ceredigion is lower than in Carmarthenshire, Pembrokeshire and Wales. At the MSOA level rates are highest in the Kidwelly, Mynyddygarreg and Trimsaran areas of Carmarthenshire; the lowest rate is found in the Lampeter, Llanfihangel Ystrad, Llangybi and Llanwenog areas of Ceredigion.
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Director of Public Health Annual Report: Chart Book
4.2 Prevention services: vaccination uptake
Note: Y-axes in the graphs of this section are truncated
4.2.1 Childhood immunisations
Routine childhood immunisation Hywel Dda 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 2005 1 2006 2 2006 3 2006 4 2006 1 2007 2 2007 3 2007 4 2008 1 2009 2 2009 3 2009 4 2009 1 2010 2 2010 3 2010 2004 4 2004 1 2005 2 2005 3 2005 4 2007 1 2008 2 2008 3 2008 4 2010 Cover quarter
Routine childhood immunisation Hywel Dda Health Board area, 2011 quarter 1 Produced by Public Health Wales Vaccine Preventable Disease Programme, from the Public Health Wales COVER reports
Hywel Dda HB Summary - COVER98 5 in 1 primary by age 1y (3 doses) 96.1% MenC primary by age 1y (2 doses) 95.9% PCV primary by age 1y (2 doses) 95.9% MMR by age 2y (1st dose) 89.2% PCV by age 2y (final (3rd) dose) 88.8% Hib/MenC booster by age 2y 92.9% MMR by age 5y (2nd dose) 86.9% 4 in 1 pre-school booster by age 5y 88.6% MMR coverage (1 dose) by age 16y 89.0% MMR coverage (2 doses) by age 16y 78.9% 3 in 1 Teenage booster by age 16y 44.5%
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Director of Public Health Annual Report: Chart Book
Routine childhood immunisation Carmarthenshire area, trends 2004-2011 Produced by Public Health Wales Vaccine Preventable Disease Programme, from the Public Health Wales COVER reports
100 Carmarthenshire
90
80 % uptake%
70 5 in 1 at 1yr Men C at 1 yr MMR 1 at 2yrs MMR2 at 5yrs 4 in 1 at 5 yrs 95% target
60
2004 1 2004 2 2004 3 2004 1 2005 2 2005 3 2005 4 2005 3 2006 4 2006 1 2007 2 2007 4 2007 1 2008 2 2008 3 2008 4 2008 2 2009 3 2009 4 2009 1 2010 2 2010 4 2010 1 2011 2006 1 2006 2 2006 3 2007 1 2009 3 2010 2004 4 2004
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Director of Public Health Annual Report: Chart Book
Routine childhood immunisation Ceredigion area, trends 2004-2011 Produced by Public Health Wales Vaccine Preventable Disease Programme, from the Public Health Wales COVER reports
100 Ceredigion
90
80 % uptake%
70 5 in 1 at 1yr Men C at 1 yr MMR 1 at 2yrs MMR2 at 5yrs 4 in 1 at 5 yrs 95% target
60
2004 2 2004 3 2004 4 2004 1 2005 2 2005 4 2005 1 2006 2 2006 3 2006 4 2006 3 2007 4 2007 1 2008 2 2008 1 2009 2 2009 3 2009 4 2009 1 2010 3 2010 4 2010 1 2011 2005 3 2005 1 2007 2 2007 3 2008 4 2008 2 2010 2004 1 2004
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Director of Public Health Annual Report: Chart Book
Routine childhood immunisation Pembrokeshire area, trends 2004-2011 Produced by Public Health Wales Vaccine Preventable Disease Programme, from the Public Health Wales COVER reports
100 Pembrokeshire
90
80 % uptake%
70 5 in 1 at 1yr Men C at 1 yr MMR 1 at 2yrs MMR2 at 5yrs 4 in 1 at 5 yrs 95% target
60
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 2 2008 3 2008 4 2008 1 2009 2 2009 3 2009 4 2009 1 2010 2 2010 3 2010 4 2010 1 2011 2007 3 2007 4 2007 1 2008
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Director of Public Health Annual Report: Chart Book
4.2.2 Seasonal influenza vaccination
Uptake of seasonal influenza immunisation in Hywel Dda Health Board area, 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 Carmarthenshire 36,001 23,324 64.8 18,397 8,676 47.2 Ceredigion 19,402 11,610 59.8 8,368 3,732 44.6 Pembrokeshire 25,903 17,226 66.5 12,841 5,689 44.3 Health Board total 81,306 52,160 64.2 39,606 18,097 45.7
Distribution of practice level seasonal influenza immunisation uptake rates (patients aged 65 years and over), Hywel Dda Health Board area, 2010/2011 Produced by Public Health Wales Vaccine Preventable Disease Programme, data source: Audit +
Carmarthenshire
Ceredigion
Pembrokeshire
20 30 40 50 60 70 80 90 100 Uptake% (65y and over) Produced by Public Health Wales Vaccine Preventable Disease Programme Data source: Audit Plus Data Quality System
Distribution of practice level seasonal influenza immunisation uptake rates (patients aged under 65 years at risk), Hywel Dda Health Board area, 2010/2011 Produced by Public Health Wales Vaccine Preventable Disease Programme, data source: Audit +
Carmarthenshire
Ceredigion
Pembrokeshire
20 30 40 50 60 70 80 90 100 Uptake% (under 65y at risk) Produced by Public Health Wales Vaccine Preventable Disease Programme Data source: Audit Plus Data Quality System
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Director of Public Health Annual Report: Chart Book
The line inside the shaded box represents the median practice uptake rate (half of the local authority practices have an uptake higher than the median value and half have an uptake lower than the median value). The shaded box represents the spread in uptake rates of the central 50% of practices, this is called the interquartile range. The whiskers extending above and below the shaded box represent the spread in practice uptake rates for the majority of practices within the local authority. Any practices with uptake rates that are very different from the majority of practices within the local authority are termed ‘outliers’ and appear as dots outside the whiskers.
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Director of Public Health Annual Report: Chart Book
4.3 Population Based National Screening Programmes in Wales
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).
4.3.1 Uptake of national screening programmes in Wales Uptake of breast, bowel, cervical and newborn hearing screening programme statistics for Hywel Dda Health Board area, period 1 April 2009-31 March 2010 compared to all Wales Produced by Screening Division, Public Health Wales
Screening Age range / Test Wales Carmarthe Pembroke UK target rate Hywel Dda Ceredigion programme frequency in Wales rate nshire shire Currently 60-69 years / Bowel Screening1 Uptake: 60% 55.3% 57.2% 57.6% 57.0% 56.6% every 2 years 50-70 years / every 3 Uptake: Minimum Breast Screening2 76.2% 79.5% 79.2% 78.7% 79.9% years 70%, Target 80% 3 20-64 years / every 3 Coverage: 80% at 5 Cervical Screening 76.2% 74.9% 76.3% 69.1% 76.7% (aged 20-64) years years (aged 25-64) 4 20-64 years / every 3 Coverage: 80% at 5 Cervical Screening 79.5% 78.9% 79.0% 77.9% 79.4% (aged 25-64) years years (aged 25-64) Newborn Hearing Newborn babies / within Uptake: 95% 99.7% 99.4% 99.7% 97.9% 99.8% Screening5 first month of birth
Notes 1 Bowel: Uptake of people invited April 2009 to end of March 2010 2 Breast: uptake stated (of those routinely invited, number screened) 3 Cervical (aged 20-64): coverage stated, tested within 5 years 4 Cervical (aged 25-64): coverage stated, tested within 5 years - the 25-64 age range allows direct comparison with England 5 Newborn: uptake stated (of babies born, number tested)
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4.4 Primary care services
4.4.1 Use of primary care as reported by adults
Hywel Dda 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 6 6 5 hospital treatment or a visit to casualty In the past twelve months: Pharmacist 69 68 70 Dentist 72 72 70 Optician 50 49 49 Unweighted base (i) All aged 16+ 3,803 3,803 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.
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Director of Public Health Annual Report: Chart Book
4.5 Use of secondary and tertiary care
4.5.1 Hospital admissions: individuals aged under 75
Middle super output areas
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Director of Public Health Annual Report: Chart Book
Hospital admissions in Hywel Dda 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) Isle of Anglesey
MSOA EASR with 95%MSOA Health Board (EASR = 141) Wales (EASR = 145) Local Authority confidence interval
Ceredigion003 748 Carmarthenshire 006 169 003 149 018 172 009 162 009 143 021 171 001 161 001 141 026 171 007 153
006msoa 136 025 163 005 153 004 132 020 158 004 147 010 128 024 157 MSOA 002 139 002 124 010 154 008 138 005 120 Axis019 Title 153 Ceredigion 007 115 EASR = 126 022 149 008 105 013 149 EASR per 1,000 007 148 011 144 Pembrokeshire 012 144
015 169 017 144 MSOA 013 162 023 144 012 161 015 142 010 159 008 141 005 158 006 139 009 150 009 137 001 149 016 134 014 002 148 132 003 006 148 129 MSOA 005 007 144 128 001 003 140 123 002 Carms EASR 011 137 121 004 = 145 014 135 118 EASR per 1,000 016 135 008 132 Pembs EASR = 148 004 131 EASR per 1,000
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Director of Public Health Annual Report: Chart Book
Local authorities
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 Merthyr
Pembrokeshire
Blaenau Gwent Blaenau
Monmouthshire
Isle of Anglesey of Isle
Carmarthenshire
Neath Port Talbot Port Neath RhonddaTaff Cynon Areas ordered geographically from north west to south east The Vale of Glamorgan of Vale The
47
Director of Public Health Annual Report: Chart Book
4.5.2 Emergency hospital admissions: individuals aged under 75
Middle super output areas
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Director of Public Health Annual Report: Chart Book
Emergency hospital admissions in Hywel Dda 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) Isle of Anglesey
MSOA EASR with 95%MSOA Health Board (EASR = 59) Wales (EASR = 68) Local Authority confidence interval
Ceredigion 006 748 Carmarthenshire 001 003 78 73 026 87 009002 77 66 021 78 003001 76 60 025 75
005004 71 58 010 71 msoa 007009 67 57 024 70 004006 56 020 70
MSOA 65 005 013 67 002 61 50 008010 46 019 67 60 Ceredigion Axis Title 008 45 EASR = 54 022 67 007 44 008 66 EASR per 1,000 018 65 023 65 Pembrokeshire 015 63 005 011 62 72 MSOA 015 72 017 60 013 70 012 58 012 70 007 57 010 67 002 55 006 009 63 55 009 007 60 53 014 002 59 53 016 006 56 52 MSOA 003 003 56 49 005 001 55 49 001 47 Carms EASR 008 55 = 62 004 46 004 51 EASR per 1,000 014 51 011 49 Pembs EASR = 60 016 43 EASR per 1,000
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Director of Public Health Annual Report: Chart Book
Local authorities
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
70.9 71.2
68.8
68.1
67.2
66.8
65.2
63.4 63.5
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 Merthyr
Pembrokeshire
Blaenau Gwent Blaenau
Monmouthshire
Isle of Anglesey of Isle
Carmarthenshire Neath Port Talbot Port Neath
Areas ordered geographically from north west to south east RhonddaTaff Cynon
The Vale of Glamorgan of Vale The
50
Director of Public Health Annual Report: Chart Book
4.5.3 Elective hospital admissions: individuals aged under 75
Middle super output areas
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Director of Public Health Annual Report: Chart Book
Elective hospital admissions in Hywel Dda 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) Isle of Anglesey MSOA EASR with 95% MSOA EASR with 95%MSOA Health Board (EASR = 80) Wales (EASR = 77) Local Authority confidenceconfidence interval interval
003Ceredigion748 Carmarthenshire 006 00989 82 018 111 00901087 78 021 98
00100385 78 025 92
00400685 72 007 89 msoa 001 024 007 84 71 89 005007 67 010 87 MSOA 84 004 66 012 85 008 79 005 65 026 85 002 78 Ceredigion 002 60 EASR = 69 Axis Title020 85 008 58 013 85 EASR per 1,000 017 85 022 84 Pembrokeshire 011 83 015 019 83 92 MSOA 013 90 016 82 012 90 009 80 016 89 015 80 011 88 006 79 023 002 84 78 014 006 84 77 008 005 84 77 003 003 84 77 MSOA 005 001 83 77 001 007 82 69 004 68 Carms EASR 009 82 = 83 002 64 010 81 EASR per 1,000 014 81 008 76 Pembs EASR = 84 004 72 EASR per 1,000
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Director of Public Health Annual Report: Chart Book
Local authorities
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 Merthyr
Pembrokeshire
Blaenau Gwent Blaenau
Monmouthshire
Isle of Anglesey of Isle
Carmarthenshire Neath Port Talbot Port Neath
Areas ordered geographically from north west to south east RhonddaTaff Cynon The Vale of Glamorgan of Vale The
53
Director of Public Health Annual Report: Chart Book
5 Health status
5.1 Health status: key points
There are consistent general patterns exhibited across the various indices of health status. Hywel Dda Health Board has generally better levels of health than Wales as a whole. Between the three local authority areas of the health board, Carmarthenshire shows the poorest levels of health and Ceredigion the best having taken account of age, however there is considerable variation within local authority areas.
Low birth weight
Low birth weight is associated with poor maternal health and lifestyle and there is increasing evidence to show an association with adverse effects later in life. The percentage of singleton live born babies weighing under 2500g in Hywel Dda Health Board is slightly lower than Wales, with Ceredigion having the lowest rate of the 22 local authority areas. At the MSOA level, the areas with the highest percentages are found in Hundleton; Monkton and Pembroke Dock areas in Pembrokeshire. Areas well below the Wales average are Newquay; Llangrannog; Penbryn and Llanarth in Ceredigion, and Llansteffan; Laugharne; Pendine; Llangynog; Llanllwch; Red Roses; Llandovery; Llansawel; Porthyrhyd and Pumsaint in Carmarthenshire.
Self-reported health status
The Welsh Health Survey contains a number of questions on health status, including the SF36 questionnaire which can be summarised into overall physical and mental health scores. The latest results show that self reported physical and mental health scores are better in Hywel Dda Health Board than in Wales as a whole. At the local authority level, self reported physical and mental health scores are generally worse in Carmarthenshire when compared with Ceredigion or Pembrokeshire. The data also show that a higher percentage of adults in Hywel Dda Health Board reported having a limiting long term illness in comparison to Wales (which includes problems related to old age). This is due to the particularly high rate in Carmarthenshire; almost three in ten adults resident in the area reporting a limiting long term illness. Looking at persons reporting current treatment for a mental health condition, the overall health board rate is slightly lower than Wales, but the rate in Carmarthenshire matches Wales.
Mortality from specific conditions
Circulatory disease includes heart disease and stroke and is the most common underlying cause of death in Wales. Lifestyle factors such as diet, exercise, alcohol consumption and especially smoking are known to be implicated in circulatory disease. The European age- standardised mortality rate in all persons for Hywel Dda Health Board is comparable to Wales but there is a substantial variation across local authorities in the health board area. Ceredigion exhibits the lowest local authority rate in Wales while the Carmarthenshire rate is much higher than Wales. At MSOA level the variation is even greater with the rate between the lowest and highest areas more than doubling. The lowest rates are found in the areas of
54
Director of Public Health Annual Report: Chart Book
New Quay; Llangrannog; Llanarth and Penbryn in Ceredigion. The highest rate by far is found in the Capel and Lliedi areas in Carmarthenshire. When looking at mortality rates from circulatory disease in persons under 75 years only, the pattern is broadly similar although notably the rate for the Capel and Lliedi areas of Carmarthenshire is marginally below the Wales average for the age group; the highest rate is found in parts of Haverfordwest in Pembrokeshire.
Coronary heart disease is a sub-category within circulatory disease and includes heart attacks. Smoking is a major cause of coronary heart disease. The European age-standardised mortality rate for Hywel Dda Health Board is slightly better than the Wales rate and there is some variation across local authorities; the Carmarthenshire rate is similar to Wales while the rates for Ceredigion and Pembrokeshire are below. At MSOA level, once again, variation is high. The pattern is similar to that for circulatory disease with the lowest rates in New Quay; Llangrannog; Penarth and Llanarth in Ceredigion, and the highest rates are found in Cross Hands; Penygroes; Llannon and Tumble in Carmarthenshire.
Cancer is the second most common cause of death in Wales. Causes of cancer are multifactorial, varying depending on the site but smoking and other lifestyle factors are important risk factors. The European age-standardised mortality rate for Hywel Dda Health Board is lower than Wales and at local authority level, Ceredigion has the lowest local rate in Wales. At MSOA level there is significant variation. The lowest rates are located in the Lampeter, Llanfihangel Ystrad, Llangybi and Llanwenog areas of Ceredigion. Pembroke Dock in Pembrokeshire is where the highest rates of cancer mortality are found.
Respiratory disease is a very common cause of death. Once again, smoking is a major risk factor for respiratory disease. The European age-standardised mortality rate for Hywel Dda Health Board is lower than Wales but there is substantial variation across the local authorities in the health board area; the rates for Ceredigion and Pembrokeshire are very similar and well below the Wales rate, whereas the rate for Carmarthenshire is on a par with Wales. At the MSOA level there is considerable variation with the rate almost quadrupling between lowest and highest. The wider confidence intervals on the caterpillar charts are indicative of the fact that there are fewer respiratory disease deaths than for cancer or circulatory disease. The lowest rates are found in Carew, Lamphey, Cosheston, Manorbier, and Milton in Pembrokeshire. The highest rates are again found in Lliedi, Capel, Seaside, Morfa, Machynys and Tyisha in Carmarthenshire.
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 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.
The site-specific one and five year relative survival figures indicate that there is little difference between Hywel Dda Health Board and Wales as a whole except for lung cancer in females where the five year survival was statistically significantly worse than Wales.
55
Director of Public Health Annual Report: Chart Book
5.2 Physical and mental health
5.2.1 Low birth weight
Middle super output areas
Numbers on map indicate MSOAs with a rate statistically significantly higher than the all Wales rate.
56
Director of Public Health Annual Report: Chart Book
Low birth weight in Hywel Dda Health Board area, percentage of singleton live births, 1998- 2007 Produced by Public Health Wales Observatory, using data from ONS (ADBE, MYE)
Ceredigion Carmarthenshire
009 6.5 023 7.0 002 6.3 025 6.8 003 5.0 026 6.8 010 4.2 007 6.6 001 4.2 021 6.4
006 4.1 024 6.4 MSOA 008 3.9 017 6.2 004 3.7 011 6.2 005 3.2 Ceredigion 015 6.1 %LBW = 4.4 007 2.7 010 6.1 % low birth weight 008 6.0 013 5.9 Pembrokeshire 009 5.8 018 5.8 015 7.5 MSOA 013 7.0 001 5.7 010 6.9 006 5.6 006 6.8 020 5.3 022 012 6.7 5.2 012 005 6.4 5.1 016 011 5.3 4.5 014 5.2 005 4.0
016 5.0 004 3.8 MSOA 008 5.0 003 3.8 009 4.6 019 3.8 002 2.8 004 4.1 Carms %LBW = 5.6 003 4.0 014 2.7 % low birth weight 007 3.9 001 3.8 Pembs %LBW = 5.5 002 3.5 % low birth weight
57
Director of Public Health Annual Report: Chart Book
Local authorities
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 Merthyr
Blaenau GwentBlaenau
Pembrokeshire
Monmouthshire
Isle of AngleseyIsleof
Carmarthenshire
Neath Port Talbot NeathPort RhonddaTaff Cynon
Areas ordered geographically from north west to south east ofGlamorgan Vale The
58
Director of Public Health Annual Report: Chart Book
5.2.2 Physical health as reported by adults*
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 Cwm
Swansea
Bridgend
Flintshire
Gwynedd
Wrexham
Caerphilly
Hywel Dda Hywel
Ceredigion
Denbighshire
Merthyr Tydfil Merthyr
AneurinBevan
Pembrokeshire
Blaenau GwentBlaenau
Monmouthshire
BetsiCadwaladr
Isle of AngleseyIsleof
Carmarthenshire
Neath Port Talbot NeathPort
RhonddaTaf Cynon
The Vale ofGlamorgan Vale The
Cardiff & Vale University&Vale Cardiff AbertaweMorgannwgBro
Areas ordered geographically from north west to south east
* Y-axis is truncated to 45
59
Director of Public Health Annual Report: Chart Book
5.2.3 Mental health as reported by adults*
Mean SF-36 Mental 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 = 49.9
51.6 51.6
51.3 51.3
51.2
51.0 51.0 51.0
50.7 50.7
50.3
50.2 50.2
50.1
49.8
49.7 49.7
49.6
49.5
49.4
49.3
49.2
49.1
48.9
48.7
48.6
48.5
48.0
47.7
Powys Powys
Cardiff
Conwy
Torfaen
Newport
Cwm Taf Cwm
Swansea
Bridgend
Flintshire
Gwynedd
Wrexham
Caerphilly
Hywel Dda Hywel
Ceredigion
Denbighshire
Merthyr Tydfil Merthyr
AneurinBevan
Blaenau GwentBlaenau
Pembrokeshire
Monmouthshire
Isle of AngleseyIsleof
BetsiCadwaladr
Carmarthenshire
Neath Port Talbot NeathPort
RhonddaTaf Cynon
The Vale ofGlamorgan Vale The
Cardiff & Vale University&Vale Cardiff AbertaweMorgannwgBro
Areas ordered geographically from north west to south east
* Y-axis is truncated to 45
60
Director of Public Health Annual Report: Chart Book
5.2.4 Limiting long term illness as reported by adults
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 Cwm
Swansea
Bridgend
Flintshire
Gwynedd
Wrexham
Caerphilly
Hywel Dda Hywel
Ceredigion
Denbighshire
Merthyr Tydfil Merthyr
AneurinBevan
Pembrokeshire
Blaenau GwentBlaenau
Monmouthshire
BetsiCadwaladr
Isle of AngleseyIsleof
Carmarthenshire
Neath Port Talbot NeathPort
RhonddaTaf Cynon
The Vale ofGlamorgan Vale The
Cardiff & Vale University&Vale Cardiff AbertaweMorgannwgBro
Areas ordered geographically from north west to south east
61
Director of Public Health Annual Report: Chart Book
5.2.5 Mental illness as reported by adult
Adults who reported currently being treated for a mental 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 = 10
15 14 13 13 13 12 11 11 11 10 10 10 10 10 10 10 9 9 9 8 8 8 8 8 8 7 7 7
6
Powys Powys
Cardiff
Conwy
Torfaen
Newport
Cwm Taf Cwm
Swansea
Bridgend
Flintshire
Gwynedd
Wrexham
Caerphilly
Hywel Dda Hywel
Ceredigion
Denbighshire
Merthyr Tydfil Merthyr
AneurinBevan
Blaenau GwentBlaenau
Pembrokeshire
Monmouthshire
Isle of AngleseyIsleof
BetsiCadwaladr
Carmarthenshire
Neath Port Talbot NeathPort
RhonddaTaf Cynon
The Vale ofGlamorgan Vale The
Cardiff & Vale University&Vale Cardiff Abertawe Bro MorgannwgAbertaweBro
Areas ordered geographically from north west to south east
62
Director of Public Health Annual Report: Chart Book
5.3 Mortality from specific conditions
5.3.1 Mortality from circulatory disease, all ages
Middle super output areas
Numbers on map indicate MSOAs with a rate statistically significantly higher than the all Wales rate.
63
Director of Public Health Annual Report: Chart Book
Mortality from circulatory disease in Hywel Dda 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)
Ceredigion Carmarthenshire
005 215 022 308 006 200 015 282 010 199 023 276 009 195 013 275 001 175 010 270
003 173 026 264 MSOA 004 167 011 259 008 155 018 258 002 143 Ceredigion 001 256 EASR = 176 007 138 016 250 EASR per 100,000 003 244 025 239 Pembrokeshire 017 236 024 233 005 272 MSOA 006 260 020 228 015 253 021 222 012 244 002 221 013 241 008 221 008 235 004 220 003 220 012 214 002 208 009 202
007 207 014 197 MSOA 019 011 205 194 006 001 198 185 005 Carms 016 198 174 007 EASR = 235 010 189 170 EASR per 100,000 004 189 009 182 Pembs EASR = 213 014 154 EASR per 100,000
64
Director of Public Health Annual Report: Chart Book
Local authorities
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 Merthyr
Pembrokeshire
Blaenau GwentBlaenau
Monmouthshire
Isle of AngleseyofIsle
Carmarthenshire
Neath Port Talbot NeathPort RhonddaTaff Cynon
Areas ordered geographically from north west to south east ofGlamorgan Vale The
65
Director of Public Health Annual Report: Chart Book
5.3.2 Mortality from circulatory disease, under 75s
Middle super output areas
Numbers on map indicate MSOAs with a rate statistically significantly higher than the all Wales rate.
66
Director of Public Health Annual Report: Chart Book
Mortality from circulatory disease in Hywel Dda 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)
Ceredigion Carmarthenshire
005 88 026 128 009 83 013 119 003 80 018 116 001 70 020 115 010 67 010 113
006 67 017 108 MSOA 004 67 025 105 002 55 011 102 008 51 Ceredigion 023 102 EASR = 67 007 39 015 100 EASR per 100,000 024 99 016 98 Pembrokeshire 021 93 001 93 005 148 MSOA 015 129 008 90 012 118 003 89 006 112 004 89 003 101 022 87 002 98 012 85 011 98 002 69 013 97 006 69
010 80 009 66 MSOA 007 008 75 65 014 007 72 63 005 Carms 009 68 63 019 EASR = 91 004 67 58 EASR per 100,000 001 66 016 63 Pembs EASR = 87 014 51 EASR per 100,000
67
Director of Public Health Annual Report: Chart Book
Local authorities
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
91.5
91.4
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 Merthyr
Blaenau GwentBlaenau
Pembrokeshire
Monmouthshire
Isle of AngleseyofIsle
Carmarthenshire
Neath Port Talbot PortNeath RhonddaTaff Cynon
Areas ordered geographically from north west to south east The Vale ofGlamorgan Vale The
68
Director of Public Health Annual Report: Chart Book
5.3.3 Mortality from coronary heart disease
Middle super output areas
Numbers on map indicate MSOAs with a rate statistically significantly higher than the all Wales rate.
69
Director of Public Health Annual Report: Chart Book
Mortality from coronary heart disease in Hywel Dda 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)
Ceredigion Carmarthenshire
006 122 015 146 005 103 018 142 010 99 026 138 003 97 022 136 001 83 020 134
009 81 016 127 MSOA 002 80 010 126 008 76 025 124 004 76 Ceredigion 001 124 EASR = 87 007 68 017 121 EASR per 100,000 013 118 003 116 Pembrokeshire 021 114 012 111 005 138 MSOA 013 136 023 111 011 012 130 110 014 006 125 104 019 015 109 103 008 003 104 102 004 016 97 100 002 011 93 90 006
010 93 88 MSOA 024 002 92 87 007 008 92 86 009 84 Carms 007 88 EASR = 112 005 78 009 83 EASR per 100,000 014 79 001 74 Pembs EASR = 98 004 73 EASR per 100,000
70
Director of Public Health Annual Report: Chart Book
Local authorities
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 Merthyr
Pembrokeshire
Blaenau GwentBlaenau
Monmouthshire
Isle of AngleseyofIsle
Carmarthenshire
Neath Port Talbot NeathPort RhonddaTaff Cynon Areas ordered geographically from north west to south east The Vale ofGlamorgan Vale The
71
Director of Public Health Annual Report: Chart Book
5.3.4 Mortality from cancer
Middle super output areas
Numbers on map indicate MSOAs with a rate statistically significantly higher than the all Wales rate.
72
Director of Public Health Annual Report: Chart Book
Mortality from all cancers in Hywel Dda 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)
Ceredigion Carmarthenshire
002 198 022 220 010 178 024 208 009 174 010 206 003 169 020 200 007 153 013 195
004 153 023 192 MSOA 005 144 007 190 006 139 009 189 001 131 Ceredigion 005 186 EASR = 154 008 120 018 185 EASR per 100,000 014 183 025 183 Pembrokeshire 016 179 019 179 013 243 MSOA 015 213 006 177 005 209 004 175 003 205 011 174 012 202 021 166 009 199 026 166 014 196 002 166 002 191 001 161
011 190 015 160 MSOA 008 016 182 157 012 006 182 155 017 Carms 008 173 142 003 EASR = 177 001 162 142 EASR per 100,000 004 147 010 143 Pembs EASR = 186 007 139 EASR per 100,000
73
Director of Public Health Annual Report: Chart Book
Local authorities
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
193.4
193.2
192.2
191.2
189.6
189.2
187.2
186.4
186.3
184.5
184.3
184.1
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 Merthyr
Blaenau GwentBlaenau
Pembrokeshire
Monmouthshire
Isle of AngleseyIsleof
Carmarthenshire
Neath Port Talbot NeathPort RhonddaTaff Cynon
Areas ordered geographically from north west to south east ofGlamorgan Vale The
74
Director of Public Health Annual Report: Chart Book
5.3.5 Mortality from respiratory disease
Middle super output areas
Numbers on map indicate MSOAs with a rate statistically significantly higher than the all Wales rate.
75
Director of Public Health Annual Report: Chart Book
Mortality from respiratory disease in Hywel Dda 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)
Ceredigion Carmarthenshire
010 67 022 122 009 64 026 120 004 64 011 108 005 62 023 99 008 57 016 98
002 52 007 98 MSOA 006 47 024 98 003 46 008 96 Ceredigion 007 45 018 93 EASR = 55 001 43 010 87 EASR per 100,000 025 87 002 84 Pembrokeshire 003 80 012 80 015 99 MSOA 012 88 001 80 010 71 013 75 004 64 015 71 003 63 009 69 008 63 017 65 002 62 020 64 005 61 019 64
007 60 006 63 MSOA 004 001 57 62 021 013 56 57 014 Carms 006 52 54 005 EASR = 82 016 51 39 EASR per 100,000 009 42 011 36 Pembs EASR = 59 014 33 EASR per 100,000
76
Director of Public Health Annual Report: Chart Book
Local authorities
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 Merthyr
Pembrokeshire
Blaenau GwentBlaenau
Monmouthshire
Isle of AngleseyofIsle
Carmarthenshire
Neath Port Talbot PortNeath RhonddaTaff Cynon Areas ordered geographically from north west to south east The Vale ofGlamorgan Vale The
77
Director of Public Health Annual Report: Chart Book
5.3.6 Cancer survival
One year relative survival, all cancer (excluding non melanoma skin cancer), males, Wales regions, all persons, 1994/6-2006/8 Produced by the Welsh Cancer Intelligence and Surveillance Unit
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 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
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Director of Public Health Annual Report: Chart Book
One year relative survival, all cancer (excluding non melanoma skin cancer), females, Wales regions, all persons, 1994/6-2006/8 Produced by the Welsh Cancer Intelligence and Surveillance Unit
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
79
Director of Public Health Annual Report: Chart Book
One year and five year relative survival, by cancer site Hywel Dda 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 Hywel Dda All Wales Prostate 88.54 (86.09, 90.58) 88.80 (87.95, 89.59) Lung 20.49 (17.47, 23.69) 22.84 (21.71, 24.00) Colorectal 69.87 (66.06, 73.34) 71.51 (70.12, 72.85) Bladder 83.55 (78.69, 87.39) 86.10 (84.51, 87.53) All malignancies (excl NMSC) 61.96 (60.49, 63.39) 62.11 (61.57, 62.63)
5 year relative survival Cancer Site Hywel Dda All Wales Prostate 75.11 (71.14, 78.62) 77.17 (75.83, 78.45) Lung 4.56 (3.04, 6.54) 5.36 (4.73, 6.04) Colorectal 46.14 (41.71, 50.44) 48.59 (46.91, 50.24) Bladder 68.15 (61.45, 73.95) 72.34 (70.04, 74.50) All malignancies (excl NMSC) 45.27 (43.59, 46.94) 45.39 (44.79, 45.99)
Female 1 year relative survival Cancer Site Hywel Dda All Wales Breast 93.40 (91.72, 94.76) 93.41 (92.83, 93.94) Lung 19.71 (15.93, 23.80) 25.53 (24.09, 26.99) Colorectal 67.58 (63.14, 71.61) 68.80 (67.19, 70.36) Ovary 62.52 (55.51, 68.74) 63.92 (61.50, 66.24) Corpus Uteri 90.16 (84.38, 93.87) 89.83 (87.90, 91.46) All malignancies (excl NMSC) 68.37 (66.91, 69.79) 67.24 (66.71, 67.76)
5 year relative survival Cancer Site Hywel Dda All Wales Breast 80.34 (77.71, 82.69) 82.06 (81.14, 82.94) Lung 4.27 (2.51, 6.73) 6.85 (6.00, 7.76) Colorectal 46.45 (41.50, 51.23) 49.18 (47.31, 51.01) Ovary 35.68 (28.95, 42.46) 39.29 (36.78, 41.80) Corpus Uteri 72.73 (64.36, 79.45) 77.77 (75.02, 80.25) All malignancies (excl NMSC) 52.55 (50.88, 54.19) 52.76 (52.17, 53.36)
Significantly higher than Wales Significantly lower than Wales
Excl NSCM: Excluding non melanoma skin cancer
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Appendix A: Original source reports and further information
The original reports for the data included in this chart book, together with further information and, in some cases, methodological information and other guides to interpretation can be found through the producers of the charts, tables or data included:
Demography Public Health Wales Observatory www.publichealthwalesobservatory. wales.nhs.uk
Determinants of Public Health Wales Observatory www.publichealthwalesobservatory. health wales.nhs.uk
Use of prevention Vaccine Preventable Disease http://www.wales.nhs.uk/sitesplus/ services: Programme 888/page/43510 vaccination uptake
Use of prevention Public Health Wales Screening http://www.screeningservices.org.u services: screening Services k/
Use of primary care Welsh Assembly Government, http://new.wales.gov.uk/ by adults Welsh Health Survey
Use of secondary Public Health Wales Observatory www.publichealthwalesobservatory. and tertiary care wales.nhs.uk
Health status Public Health Wales Observatory www.publichealthwalesobservatory. wales.nhs.uk
Cancer survival Welsh Cancer Surveillance and http://www.wales.nhs.uk/sites3/ho Intelligence Unit me.cfm?OrgID=242
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Appendix B: Glossary
Middle Super Middle super output areas (MSOAs) were released by the Office Output Areas for National Statistics (ONS) in 2004. In contrast with administrative boundaries such as electoral divisions (wards), super output areas were created for the purpose of showing statistical data. MSOAs have a mean population of 7,500 and a minimum of 5,000. There are 413 MSOAs in Wales and 52 MSOAs in the Hywel Dda Health Board area. These are shown on the maps in Appendix 2. The ONS have stated that super output area geographies will be fixed for at least 10 years. The advantage of using these statistical geographies is stability and homogeneity. However, the main drawback is that they do not conform to known administrative boundaries such as electoral divisions (wards); this makes them less amenable to the public and local government.
Age- Age-standardisation allows comparison of rates across different standardised populations while taking account of the different age structures of rate those populations. This chart book uses the direct standardisation method, which produces the rate you would get if the population had the same age-structure as a particular ‘standard’ population. The Wales standard population has been used for the Welsh Health Survey indicators and the theoretical European standard population (ESP) has been used for all other age-standardised indicators included in this chart book.
An age-standardised rate only allows for comparison between the rates which have been standardised to the same standard population. Confidence Confidence intervals are indications of the random variation that intervals 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 a 95% probability of including the underlying 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.
Statistical A result may be deemed statistically significant if it is considered significance unlikely to have occurred by chance alone. The basis for such judgements is a predetermined and arbitrary cut-off, usually taken as 5% or 0.05. A result may be clinically significant whilst not being statistically significant and vice versa.
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Appendix C: Maps showing Middle Super Output Areas in the Hywel Dda Health Board area
The Public Health Wales Observatory has also produced a web-based interactive map showing MSOA boundaries, with the added facility of background Ordnance Survey mapping. Follow this link: http://www2.nphs.wales.nhs.uk/InstantAtlas/GeographyTool/atlas.html
Ceredigion
A Ceredigion 001 B Ceredigion 002 C Ceredigion 003 D Ceredigion 004 E Ceredigion 005 F Ceredigion 006 G Ceredigion 007 H Ceredigion 008 I Ceredigion 009 J Ceredigion 010
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Pembrokeshire
A Pembrokeshire 001 B Pembrokeshire 002 C Pembrokeshire 003 D Pembrokeshire 004 E Pembrokeshire 005 F Pembrokeshire 006 G Pembrokeshire 007 H Pembrokeshire 008 I Pembrokeshire 009 J Pembrokeshire 010 K Pembrokeshire 011 L Pembrokeshire 012 M Pembrokeshire 013 N Pembrokeshire 014 O Pembrokeshire 015 P Pembrokeshire 016
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Carmarthenshire
A Carmarthenshire 001 N Carmarthenshire 014 B Carmarthenshire 002 O Carmarthenshire 015 C Carmarthenshire 003 P Carmarthenshire 016 D Carmarthenshire 004 Q Carmarthenshire 017 E Carmarthenshire 005 R Carmarthenshire 018 F Carmarthenshire 006 S Carmarthenshire 019 G Carmarthenshire 007 T Carmarthenshire 020 H Carmarthenshire 008 U Carmarthenshire 021 I Carmarthenshire 009 V Carmarthenshire 022 J Carmarthenshire 010 W Carmarthenshire 023 K Carmarthenshire 011 X Carmarthenshire 024 L Carmarthenshire 012 Y Carmarthenshire 025 M Carmarthenshire 013 Z Carmarthenshire 026
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