Health Inequalities
Mortality
All Age All Cause Mortality
The directly standardised all-age all-cause mortality rate for Lewisham was 604 persons per 100,000 population in 2009, or 648 per 100,000 population for the 3-year average 2007-91. For females the rates were 481 in 2009 and 524 for the three year average 2007-9. For males the rates were 759 in 2009, and 804 for the three-year average 2007-9. These are all significantly higher than the rates for London and England.
The following chart shows all age all cause mortality Standardised Mortality Ratios (SMRs) compared with England, with 95% confidence intervals, for all persons, for the 5-year average 2004-8, by ward2.
Mortality from all causes at Ward level Standardised mortality ratio with 95% confidence intervals Persons of all ages at Ward level. 5 year average, 2004-08
160
150
140
130
120
110
SMR (100 = England) 100
90
80
70
Crofton Park ward had significantly lower mortality than England. Mortality in Blackheath, Evelyn, Grove Park, Lee Green, and Whitefoot wards was not
1 NCHOD Compendium of Public Health 2 Note that SMRs depend on the difference in population structure between the two areas used, in this case, each ward and England. They should only be used for this comparison. It is not valid two compare two individual wards’ SMRS as no account is taken of the differences in population structure between the two wards. significantly different from England. All other wards in Lewisham had significantly higher mortality than England.
The following chart shows all age all cause SMRs compared with England, with 95% confidence intervals, for all males, for the 5-year average 2004-8, by ward
Mortality from all causes at Ward level Standardised mortality ratio with 95% confidence intervals Males of all ages at Ward level. 5 year average, 2004-08
170
160
150
140
130
120
110 SMR (100 = England) 100
90
80
70
No ward had significantly lower mortality among males than England. Mortality among males in Bellingham, Blackheath, Crofton Park, Grove Park, Lee Green, Telegraph Hill, and Whitefoot wards was not significantly different from England. Mortality in all other wards was significantly higher than England.
The following chart shows all age all cause mortality SMRs compared with England, with 95% confidence intervals, for all females, for the 5-year average 2004-8, by ward. Mortality from all causes at Ward level Standardised mortality ratio with 95% confidence intervals Females of all ages at Ward level. 5 year average, 2004-08
160
150
140
130
120
110
SMR (100 = England)100
90
80
70
60
Crofton Park ward had significantly lower mortality than England among females. Mortality in Blackheath, Brockley, Downham, Evelyn, Grove Park, Lee Green, Perry Vale, and Whitefoot wards was not significantly different from England. All other wards in Lewisham had significantly higher mortality than England.
All Cause Premature Mortality
Premature mortality is defined as mortality under the age of 75 years of age.
The directly standardised all-cause premature mortality rate for Lewisham was 317 persons per 100,000 population in 2009, or 343 per 100,000 population for the 3-year average 2007-93. For females the rates were 228 in 2009 and 253 for the three year average 2007-9. For Males the rates were 417 in 2009, and 446 for the three-year average 2007-9. These are all significantly higher than the rates for London and England.
The following chart shows premature all cause SMRs compared with England, with 95% confidence intervals at Local Authority Ward level for all persons, for the 5-year average 2004-84.
3 www. Nchod.nhs.uk NCHOD Compendium of Public Health 4 LHO Health Needs Analysis Toolkit http://hna.londonhp.nhs.uk/ Mortality from all causes at Ward level Standardised mortality ratio with 95% confidence intervals Persons under 75 years at Ward level. 5 year average, 2004-08
190
180
170
160
150
140
130
120
110 SMR (100 = England)100
90
80
70
No ward had significantly lower mortality than England. Premature mortality in Blackheath, Catford South, Crofton Park, Forest Hill, Grove Park, Ladywell, Lee green, Sydenham, and Telegraph Hill wards was not significantly different from England. All other wards had significantly higher premature morality than England.
The following chart shows premature all cause SMRs compared with England, with 95% confidence intervals, for all males, for the 5-year average 2004-8. Mortality from all causes at Ward level Standardised mortality ratio with 95% confidence intervals Males of under 75 years at Ward level. 5 year average, 2004-08
200
190
180
170
160
150
140
130
120
110 SMR (100 = England)100
90
80
70
No ward had significantly lower mortality for males than England. Premature mortality in Blackheath, Catford South, Crofton Park, Forest Hill, Grove Park, Ladywell, Lee green, and Telegraph Hill wards was not significantly different from England. All other wards had significantly higher premature morality than England.
The following chart shows premature all cause mortality SMRs compared with England, with 95% confidence intervals, for all females, for the 5-year average 2004-8. Mortality from all causes Standardised Mortality Ratios with 95% confidence intervals Females under 75 years by Ward, 5 year average, 2004-08
200
190
180
170
160
150
140
130
120
110 SMR 100 (100 = England) 90
80
70
60
Premature mortality among females in Bellingham, Evelyn, Lewisham Central and New Cross was higher than England. Premature mortality in all other wards was not significantly different from England.
Causes Amenable to Healthcare This indicator can give an indication as to the effectiveness of local healthcare interventions.
These are the causes of death for which there is evidence that they are amenable to healthcare interventions. Given timely, appropriate, and high quality care, death rates should be low among the age groups specified. Healthcare intervention includes preventing disease onset as well as treating disease. Lewisham’s premature mortality rate from causes amenable to healthcare is significantly higher than the rate for London.
The following charts and tables show the Directly Age Standardised premature mortality rates from cause amenable to health care, for persons, males, and females for the three year period 2007-9. Persons
DSR, 95%CI 95%CI PCT Persons Lower Upper England 96.37 95.89 96.85 London 98.55 97.14 99.96 Lewisham 121.14 112.15 130.13 Southwark 111.60 102.87 120.33 Lambeth 121.07 111.80 130.35 Bexley 83.41 76.60 90.23 Bromley 78.04 72.39 83.69 Greenwich 123.39 114.02 132.76
Mortality from causes considered amenable to health care Persons under 75 years, 3 year average 2007-09 Directly Age-Standardised Rates (DSR) per 100,000 population (with 95% confidence intervals)
140
130
120
110
DSR
100
90
80
70
60 England London Lewisham Southwark Lambeth Bexley Bromley Greenwich
Lewisham’s premature mortality in persons from causes amenable to health care was significantly higher than London and England. It was not significantly different from the other inner South East London boroughs. Males
DSR, 95%CI 95%CI PCT Males Lower Upper England 115.38 114.63 116.13 London 120.96 118.69 123.23 Lewisham 155.80 140.79 170.80 Southwark 135.13 121.14 149.12 Lambeth 153.18 137.81 168.56 Bexley 98.71 87.97 109.45 Bromley 92.17 83.27 101.06 Greenwich 164.10 148.41 179.80
Mortality from causes considered amenable to health care Males under 75 years, 3 year average 2007-09 Directly age Standardised Rates (DSR) per 100,000 population (with 95% confidence intervals)
180
170
160
150
140
DSR 130
120
110
100
90
80 England London Lewisham Southwark Lambeth Bexley Bromley Greenwich
Lewisham’s premature mortality in males from causes amenable to health care was significantly higher than London and England. It was not significantly different from the other inner South East London boroughs. Females
DSR, 95%CI 95%CI PCT Females Lower Upper England 78.59 77.98 79.20 London 78.56 76.82 80.29 Lewisham 91.29 80.68 101.90 Southwark 90.49 79.68 101.30 Lambeth 93.61 82.50 104.71 Bexley 70.13 61.46 78.79 Bromley 66.04 58.82 73.26 Greenwich 86.20 75.41 97.00
Mortality from causes considered amenable to health care Females under 75 years, 3 year average 2007-9 Directly age Standardised Rates (DSR) per 100,000 population (with 95% confidence intervals)
110
100
90
80
DSR
70
60
50
40 England London Lewisham Southwark Lambeth Bexley Bromley Greenwich
Lewisham’s premature mortality in females from causes amenable to health care was significantly higher than London and England. It was not significantly different from the other inner South East London boroughs. Premature Mortality from Circulatory Diseases
During the period 2007-9, premature mortality rates from circulatory diseases in Lewisham were significantly higher than in England as a whole5, as the following table and chart show.
Lewisham England Males 126.0 99.4 Females 59.6 43.2 Persons 90.7 70.5
Mortality from Circulatory Disease age <75 2007-9 DASR/100,000 Lewisham and England
140 130 120 110 100 DASR 90 80 70 60 50 40 Lewisham England Lewisham England Lewisham England
MALE Females Persons
Premature mortality from circulatory diseases has steadily decreased, in Lewisham and in England, as the following table and charts show.
Mortality age <75, 2000-2009, Lewisham and England, DASR/100,000 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 Males Lewisham 215.9 177.1 165.9 142.0 171.0 154.2 151.6 140.3 131.7 106.1 England 159.7 150.8 143.7 136.7 126.5 118.0 110.8 104.7 99.8 93.8 Persons Lewisham 136.9 129.0 124.7 114.7 115.0 109.6 103.1 95.1 101.9 75.3 England 114.1 107.9 102.8 97.8 89.7 84.0 79.0 74.4 71.0 66.1 Females Lewisham 67.9 88.4 88.8 89.6 67.0 70.1 60.7 55.4 75.2 48.2 England 72.0 68.1 64.8 61.6 55.4 52.2 49.1 45.8 43.8 40.0
5 www.nchod.nhs.uk NCHOD Compendium of Public Health Mortality from Circulatory Diseases 2000-2009 Age <75, DASR/100,000 Males, Persons, Females, Lewisham and England 250
200
150
DASR
100 Males Lewisham Males England Persons Lewisham Persons England 50 Females Lewisham Females England
0 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Because of year-to-year fluctuation, and in particular what appears to have been a statistical outlier in the female mortality in 2008, there is insufficient data available to conclude for certain that Lewisham’s rates of premature mortality from circulatory diseases have been falling more quickly than England’s. However, this is a reasonable hypothesis.
There is substantial inequality across Lewisham in premature mortality from circulatory diseases. The following charts show mortality aged <75 by Electoral Ward in Lewisham, as SMRs, for males, females, and persons for the 5-year period 2004-8. Mortality from all circulatory diseases at Ward level , 2004-08 Standardised Mortality Ratio with 95% confidence intervals Males aged < 75 years, 5 year average
250
200
150
SMR (100 = England) 100
50
Premature mortality among males from circulatory diseases was significantly higher than in England in Brockley, Downham, Evelyn, Lewisham Central, New Cross, Sydenham, and Whitefoot wards. The other wards were not significantly different from England.
Mortality from all circulatory diseases at Ward level, 2004-08 Standardised Mortality Ratio with 95% confidence intervals Females aged<75. 5 year average
300
250
200
150
SMR (100 = England) 100
50 Premature mortality among females from circulatory diseases was significantly higher than in England in Downham, Evelyn, Lewisham Central, and Perry Vale wards. In Bellingham, Grove Park, Sydenham, and Whitefoot it was not significantly different from England. In the other wards the total number of deaths aged <75 from circulatory diseases was too small to enable SMRs to be validly calculated.
Mortality from all circulatory diseases at Ward level, 2004-08 Standardised mortality ratio with 95% confidence intervals Persons aged< 75 years at Ward level, 5 year average
250
200
150
SMR (100 = England)100
50
Premature mortality among all persons from circulatory diseases was significantly higher than in England in Bellingham, Downham, Evelyn, Lewisham Central, New Cross, Perry Vale, Rushey Green, Sydenham, and Whitefoot wards. The other wards were not significantly different from England.
Because the number of premature deaths from circulatory diseases is quite small when broken down to this level, the corresponding uncertainty, as expressed by the 95% confidence intervals, is greater. However, Downham, Evelyn and Lewisham Central wards are high in all population groups. Premature Mortality from Cancer
During the period 2007-9, premature mortality rates from cancer in Lewisham were significantly higher than in England as a whole6 for males and all persons, as the following table and chart show. For females, though higher than England, the difference was not statistically significant at the usual 5% level.
Lewisham England Males 153.5 124.0 Females 108.5 101.2 Persons 128.9 112.1
Mortality from Cancer age <75 2007-9 DASR/100,000 Lewisham and England
170 160 150 140 130 DASR 120 110 100 90 80 Lewisham England Lewisham England Lewisham England
MALE Females Persons
Premature mortality from cancer has steadily decreased in England, but the position in Lewisham is equivocal, as the following table and charts show.
Mortality age <75, 2000-2009, Lewisham and England, DASR/100,000 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 Males Lewisham 182.7 159.8 145.6 167.7 168.2 170.7 146.6 153.8 152.7 154.1 England 144.5 141.3 140.6 136.5 132.5 129.8 128.8 126.1 123.9 122.0 Persons Lewisham 156.5 147.4 135.7 140.6 132.6 144.4 124.4 127.3 131.0 128.5 England 128.7 126.1 124.8 121.4 118.8 116.8 115.5 114.0 112.2 110.0 Females Lewisham 138.2 137.8 126.5 120.7 105.7 121.5 106.0 105.3 113.9 110.1 England 115.3 113.4 111.3 108.5 107.3 106.0 104.3 104.0 102.6 100.0
6 www.nchod.nhs.uk NCHOD Compendium of Public Health Mortality from Cancer 2000-2009 Age < 75, DASR/100,000 Males, Persons, Females, Lewisham and England 250
200
Males Lewisham 150 Males England DASR Persons Lewisham Persons England 100 Females Lewisham Females England
50
0 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
There is some indication of a reduction in premature mortality from cancer in females, but none of any such reduction among males.
There is some inequality across Lewisham in premature mortality from cancer, but this is not great. The following charts show mortality aged <75 by Electoral Ward in Lewisham, as SMRs, for males, females, and persons for the 5-year period 2004-8.
Mortality from all cancers at Ward level 2004-08 Standardised mortality ratio with 95% confidence intervals Males aged < 75years at Ward level. 5 year average
250
200
150
SMR (100 = England) 100
50 Premature mortality from cancer in males was significantly higher than England in Bellingham, New Cross, Perry Vale, and Whitefoot wards. No ward was significantly different from any other at the usual level of significance.
Mortality from all cancers at Ward level 2004-08 Standardised mortality ratio with 95% confidence intervals Females aged < 75 at Ward level, 5 year average
250
200
150
SMR (100 = England) 100
50
0
Premature mortality from cancer in females was significantly higher than England in Lewisham Central ward. No ward was significantly different from any other at the usual level of significance. Numbers of deaths in Brockley ward were too small to allow and SMR to be calculated validly. Mortality from all cancers at Ward level 2004-08 Standardised mortality ratio with 95% confidence intervals Persons aged < 75 years at Ward level, 5 year average
200
150
SMR (100 = England) 100
50
Premature mortality from cancer in all persons was significantly higher than England in Bellingham, Lewisham Central New Cross, and Perry Vale wards. No ward was significantly different from any other at the usual level of significance.