Health and Wellbeing in Ayrshire and Arran Volume 2: Longitudinal Trends

Local population health trends across time based on ScotPHO profile data, September 2019

AUTHOR: September Alister Hooke 2019

Public Health Department NHS Ayrshire & Arran

Version no: FINAL REPORT

Prepared by: Dr. Alister Hooke, Senior Public Health Research Officer

Effective from: September 2019

Lead reviewers: Dr. Lynne Hamilton, Consultant in Public Health Medicine

Marlene McMillan, Public Health Programme Lead

CONTENTS

SECTION HEADING PAGE

Introduction to second volume 1

A Life expectancy and mortality 2

B Ill health and injury 4

C Mental health 6

D Behaviours which impact on health 8

E Women’s and children’s health 11

F Immunisations and screenings 14

G Social care 16

H Education 18

I Crime 20

J Economy 23

K Environment 25

L Overview of trends 27

Health and wellbeing: DATA TABLES 28

Health and wellbeing in Ayrshire and Arran

Introduction to second volume

In the first volume1 of this series, data drawn from online ScotPHO area profiles were used to build a cross-sectional picture of the current health status of Ayrshire and Arran. A wide- ranging depiction of population health was compiled using the most up-to-date data available across a selection of key indicators. Comparisons were made with other HSCP areas in Scotland and also with Scotland as a whole. This second volume examines the historic health trends of the local population. The aim is to broaden understanding of the health and wellbeing status of the local population, to determine what if any critical changes have occurred over time, and to ascertain where trends may be heading in future. This in turn will inform where local health improvement efforts or service responses may need to be directed or strengthened in future. More broadly, this report is intended to support all partner organisations involved in improving population health.

The term EASR appearing in this report denotes, for any measure of population health, the European age-sex standardised rate per 100,000 population (using ESP2013). This takes the relevant measure, e.g., number of patients hospitalised with asthma, and transforms the measure into a rate allowing comparison of data across time (as well as across geographical areas). This is because the volume of any local population is in constant flux over time as a result of year-on-year variations in rates of birth, death, and population flow in and out of an area. To allow proper comparison over time, progressive changes in population size need to be accommodated so that we can be confident that observed changes in data (up or down) are not stemming from changes in population size but from changes in the pattern of population health itself, e.g., real increase in prevalence of asthma leading to corresponding increase in rate of patients hospitalised with that condition.

To maintain consistency in reporting, the structure of the present volume follows that of the previous one, with data organised under the same headings. This will allow cross-referencing of reports for those who wish to focus on a particular topic (or set of topics), or more broadly draw a more complete picture, both cross-sectional and longitudinal, of local population health.

1 Available on request via e-mail correspondence to: [email protected]

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A. Life expectancy and mortality

SEE DATA TABLES A1 AND A2 FOR MORE DETAILS (page 28 of report)

LIFE EXPECTANCY: 3-year rolling interval data (calendar years)

Analysis of 3-year rolling interval data showed that, from 2001 to 2016, male and female life expectancy (LE) increased substantially overall in Ayrshire and Arran and Scotland (Figure 1). Within this general trend, a number of specific details were found:  Female LE: In 2001-03 [2002 midpoint], female LE ranged from 78-79 years. Figures rose after that, peaking in 2010-12 [2011] at 80-81 years and levelling off after that in all three local areas, with the Scottish figure also flattening after 2012-14 [2013].  Male LE: In 2001-03 [2002], male LE ranged from 73-74 years. Local and national figures rose quite steeply after that, peaking in 2012-14 [2013] at 76-78 years and levelling off since then in all areas.  Gender comparison: From 2001 to 2016, male LE rose faster than female LE, with an overall increase of 3-4 years for males compared to only 2 years for females. As such, the LE gap has narrowed between males and females, from a 5-6 year gap in the baseline period 2001-03 to a 3-4 year gap in the most recent period 2014-16.  Area comparison: Among women, South maintained highest female LE over the relevant period, with East lowest and North in between. South males also ranked highest among local men, while men in North and East generated similar and comparatively lower LE figures which were consistently under the Scottish average.

FIGURE 1: Life expectancy in years, 2001 to 2016: by gender and geographical area

84 83 82 81 Females: Scotland 80 Females: South Ayrshire 79 78 Females: North Ayrshire 77 Females: East Ayrshire 76 Males: Scotland 75 Males: South Ayrshire 74 Males: North Ayrshire 73 Males: East Ayrshire 72 71 70 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Midpoint year (3-year rolling interval)

Source: https://www.scotpho.org.uk

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MORTALITY: 3-year rolling interval data (calendar years)

From 2002 to 2017, rates of death from all causes (all ages) reduced locally and nationally (Figure 2). Within this overarching trend, steady and somewhat parallel declines in area mortality rates were observed from 2002-04 [2003 midpoint] to 2010-12 [2011], before levelling off after that. In 2002-04 [2003], local and national data ranged from around 1,400- 1,600 per 100,000 population, falling to around 1,100-1,300 per 100,000 over the period from 2010-12 [2011] to 2015-17 [2016], demonstrating a substantial drop over time of around 300 deaths per 100,000 in all areas.

Within this shared pattern of decline in rates, differences between areas were evident. In particular, East rates consistently ranked highest over the relevant period, with South lowest and North in between. At all time points, rates in South were lower than Scottish rates, and rates in East and North were conversely above the national average.

It is also worth noting that death rates and life expectancy figures levelled off around the same time, with the former reaching a floor and the latter a ceiling at or shortly after 2011. This may indicate a potentially close and inverse relationship between the two sets of data, with improvements in respective figures concurrently plateauing. The levelling of data after 2011 may signify some adverse and slightly time-lagged impact on population health arising from economic recession which began in 2008.

FIGURE 2: Deaths all causes (all ages), 2002 to 2017: EASR per 100,000 population, 3-year rolling average by geographical area

1800 1700 1600 1500 1400 1300 1200 Scotland 1100 1000 East Ayrshire 900 800 North Ayrshire 700 South Ayrshire 600 500 400 300 200 100 0 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Midpoint year (3-year rolling interval)

Source: https://www.scotpho.org.uk

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B. Ill health and injury

SEE DATA TABLES B1 AND B2 FOR MORE DETAILS (page 29 of report)

RESPIRATORY PROBLEMS: 3-year rolling interval data (financial years)

From 2002/03 to 2017/18, patient hospitalisation trends for COPD and asthma were strikingly different, with the former highly variable compared to the latter (Figure 3). Detailed analysis revealed that:  COPD: Hospitalisation rates for COPD grew from 2002/03-04/05 [2003/04 midpoint] to 2010/11-12/13 [2011/12], with steeper increases occurring in North and East than in South or Scotland. And while rates have flattened since 2010/11-12/13 [2011/12] in East and North (and Scotland), rates have continued to rise in South. Local rates increased by 90-100 hospitalisations per 100,000 over the whole period, while the Scottish rate only rose by around 20 per 100,000. All local rates are now significantly above the national average and the gap between areas has widened, with East rates elevated above the rest, historically and currently.  Asthma: Compared to COPD, asthma figures were fairly level across time. East and South hospitalisation rates fluctuated around 100 per 100,000 for most of the period, though lately the East figure has risen to just over 125 per 100,000. Rates in North have been consistently higher than in East, South and Scotland. The North rate peaked in 2012/13-14/15 [2013/14] to over 130 per 100,000 where the figure has remained much on a level since then. Scottish figures fell slightly over the whole period.

FIGURE 3: Patients hospitalised with respiratory problems, 2002/03 to 2017/18: EASR per 100,000 population, 3-year rolling average by condition and area

400 375 350 325 COPD: Scotland 300 COPD: East Ayrshire 275 250 COPD: North Ayrshire 225 COPD: South Ayrshire 200 175 Asthma: Scotland 150 125 Asthma: East Ayrshire 100 Asthma: North Ayrshire 75 50 Asthma: South Ayrshire 25 0

Midpoint year (3-year rolling interval) Source: https://www.scotpho.org.uk

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EMERGENCY HOSPITALISATION: 3-year rolling interval data (calendar years)

From 2011 to 2017, the rate of patients with emergency hospitalisations in Ayrshire and Arran far exceeded equivalent national figures. Detailed analysis revealed the following:  Patients (all ages) with emergency hospitalisations: While emergency hospitalisation rates in Scotland were flat from 2011 to 2017 at around 7,500 per 100,000 population, local rates were not only in excess of the national average, they also increased over this short space of time (Figure 4a). Rates in South increased faster over this period than elsewhere. Local increases show no sign of slowing down in future and this will impact on services. Due to the steeper incline in South, the gap between the three local areas closed, with local rates now ranging between 9,500 and 10,000 per 100,000. Rates in North remained highest over time.  Patients aged 65+ with multiple emergency hospitalisations: Similarities were found in trends for multiple emergency hospitalisations among patients aged 65+, including: (1) flat national trend; (2) relatively elevated and increasing rates in all local areas; (3) faster increase in South; and (4) closing of gap between local areas (Figure 4b). The national rate has been relatively stable around 5,500 per 100,000. In the most recent period 2015-17 [2016 midpoint], local rates ranged between 6,000 and 6,500 per 100,000. Rates in East remained highest over the relevant period.

FIGURE 4a: Patients with emergency hospitalisations: FIGURE 4b: Patients aged 65+ with multiple EASR per 100,000, 3-year rolling average emergency hospitalisations: EASR per 100,000, 3-year rolling average

11000 11000 10500 10500 10000 10000 9500 9500 9000 9000 8500 8500 8000 8000 7500 7500 7000 7000 6500 6500 6000 6000 5500 5500 5000 5000 4500 4500 4000 4000 3500 3500 3000 3000 2500 2500 2000 2000 1500 1500 1000 1000 500 500 0 0 2012 2013 2014 2015 2016 2012 2013 2014 2015 2016 Midpoint year (3-year rolling interval) Midpoint year (3-year rolling interval)

Scotland East Ayrshire North Ayrshire South Ayrshire

Source: https://www.scotpho.org.uk

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C. Mental health

SEE DATA TABLES C1 AND C2 FOR MORE DETAILS (page 30 of report)

PRESCRIBING FOR MENTAL HEALTH: Single year data (financial years)

From 2010/11 to 2017/18, the percentage of people in Ayrshire and Arran and Scotland prescribed drugs for mental health problems (anxiety/depression/psychosis) increased substantially, with increases over this 7-year period being fairly linear both locally and nationally (Figure 5). In 2010/11, area percentages ranged from 15-17%, shifting upward to 19-21% in 2017/18. Increases over time were around 4% in East, South and Scotland. North figures rose a little more steeply, however, increasing by around 5%. Over the whole period, national figures were lowest and South Ayrshire figures highest. East and North figures were in between, though North figures have now caught up with the high levels reported in South. Looking ahead, the elevating trends show no sign of slowing down locally or nationally.

FIGURE 5: Population prescribed drugs for anxiety/depression/psychosis, 2010/11 to 2017/18: percentage by geographical area

25 24 23 22 21 20 19 18 17 16 15 Scotland 14 East Ayrshire 13 12 North Ayrshire 11 South Ayrshire 10 9 8 7 6 5 4 3 2 1 0 2010/11 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18

Source: https://www.scotpho.org.uk

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PSYCHIATRIC HOSPITALISATION: 3-year rolling interval data (financial years)

Analysis of 3-year rolling interval data revealed that, from 2002/03 to 2017/18, local and national rates of patients recorded with a psychiatric hospitalisation dropped markedly (Figure 6). In 2002/03-04/05 [2003/04 midpoint], South and East rates were higher than elsewhere, but differential declines in rates after that time resulted in convergence of area data in 2008/09-10/11 [2009/10]; in particular, area rates ranged quite broadly from about 350 to 425 per 100,000 in 2002/03-04/05 [2003/04] but ranged narrowly from about 300 to 325 per 100,000 in 2008/09-10/11 [2009/10]. After converging in 2008/09-10/11 [2009/10], rates continued to fall steadily and commensurately in Scotland, North and South Ayrshire, with rates in these areas ranging narrowly from about 250 to 275 per 100,000 in the recent period 2015/16-17/18 [2016/17]. In contrast, the pattern in East broke away from the rest, with rates dropping sharply from 2008/09-10/11 [2009/10] to 2012/13-14/15 [2013/14], before abruptly levelling off around 200 per 100,000 where the rate has remained since, well below the reports of other areas.

These trends are unlikely to reflect prevalence of mental health problems in the respective populations, and indeed contradict the findings reported for prescribing (see Figure 5 above). They are likely influenced by enduring change in delivery of psychiatric healthcare in Scotland, with the balance of care continuing to shift from hospital to community.

FIGURE 6: Patients with a psychiatric hospitalisation, 2002/03 to 2017/18: EASR per 100,000 population, 3-year rolling average by geographical area 500 475 450 425 400 375 350 325 Scotland 300 275 East Ayrshire 250 North Ayrshire 225 200 South Ayrshire 175 150 125 100 75 50 25 0

Midpoint year (3-year rolling interval)

Source: https://www.scotpho.org.uk

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D. Behaviours which impact on health

SEE DATA TABLES D1, D2 AND D3 FOR MORE DETAILS (page 31 of report)

SMOKING PREVALENCE (ADULTS 16+): Single year data (calendar years)

From 2012 to 2017, smoking prevalence mostly declined locally and nationally (Figure 7). The rate of decline in Scotland was steady and linear, dropping by 6% from 24% in 2012 to 18% in 2017. A larger drop of 9% was observed in East Ayrshire where prevalence decreased from 28% in 2012 to 19% in 2017, with East reports remaining above the Scottish average. In North, rates fell overall by 6% from 28% in 2012 to 22% in 2017, despite the pattern of decline being interrupted by an upward spike in 2016. The South trend was exceptional, showing no overall change in adult smoking prevalence due to an unusually low baseline report of 15% in 2012, which rose sharply to 22% in 2013 before returning to the baseline figure of 15% in 2017, with South reports consistently under the Scottish average over the relevant period.

Overall, these figures reflect a continuing trend of decline in rates of tobacco smoking among Scottish adults which was precipitated in large part and reinforced by the national ban on smoking in public places, plain retail packaging, increased taxation on tobacco products, etc. Moreover, trends look set to continue declining for the foreseeable future, with the steady decline in national figures, in particular, showing no sign at present of slowing down.

FIGURE 7: Smoking prevalence among adults (aged 16+), 2012 to 2017: percentage of adult population who are smokers by geographical area 30 28 26 24 22 20 Scotland 18 East Ayrshire 16 North Ayrshire 14 South Ayrshire 12 10 8 6 4 2 0 2012 2013 2014 2015 2016 2017

Source: https://www.scotpho.org.uk

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ALCOHOL-RELATED HOSPITAL STAYS: Single year data (financial years)

From 2002/03 to 2017/18, rates of alcohol-related hospital stays fell substantially in all areas, with marked declines evident during an 8-year period from 2007/08 to 2015/16 (Figure 8). During the earlier period from 2002/03 to 2007/08, local and national rates mostly increased, South Ayrshire excepted. In 2007/08, the rate peaked in Scotland before falling by 200 per 100,000 to the lowest report in 2015/16. North and East rates also peaked in 2007/08 and then fell even more sharply to their lowest points in 2015/16 – the observed declines were twice the national equivalent, amounting to decreases of 360 and 420 per 100,000 in North and East respectively. South rates peaked earlier in 2003/04, then fell by around 300 per 100,000 to a low point in 2015/16, again well exceeding the national decrease. Since 2015/16, rates have pretty much stabilised, though small inclines occurred recently in North and South. As a consequence of steeper decreases over time in local figures, area reports have essentially narrowed. Indeed, East and South Ayrshire figures have recently converged with national figures despite starting at much higher baseline levels in 2002/03, though North figures remain notably elevated above those of all other areas.

FIGURE 8: Alcohol-related hospital stays, 2002/03 to 2017/18: EASR per 100,000 population by geographical area 1350 1300 1250 1200 1150 1100 1050 1000 950 900 850 Scotland 800 750 East Ayrshire 700 650 North Ayrshire 600 550 South Ayrshire 500 450 400 350 300 250 200 150 100 50 0

Source: https://www.scotpho.org.uk

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DRUG-RELATED HOSPITAL STAYS: 3-year rolling interval data (financial years)

From 2002/03 to 2017/18, rates of drug-related hospital stays increased notably in all areas, with more marked increases seen in North and East than in South and Scotland (Figure 9). From 2002/03-04/05 [2003/04 midpoint] to 2012/13-14/15 [2013/14], rates in Scotland, East and North Ayrshire increased while rates in South fluctuated fairly steadily around 160 per 100,000. However, a turning point in the trends was apparent in 2012/13-14/15 [2013/14], after which local and national rates began to climb sharply, including in South Ayrshire where the trend had previously been quite flat. As a result of this recent sharp climb in the data, overall 15-year changes in rates amounted to an increase of 190 per 100,000 in North, 140 per 100,000 in East, 90 per 100,000 in South and 80 per 100,000 in Scotland as a whole. Local increases were therefore, in relation to the national comparator, more than double in North, over one and a half times in East, and marginally greater in South. The recent increases in all areas merit further investigation. Moreover, the disparity between local and national rates appears set to widen in future, also warranting attention.

FIGURE 9: Drug-related hospital stays, 2002/03 to 2017/18: EASR per 100,000 population, 3-year rolling average by geographical area 400 380 360 340 320 300 280 260 Scotland 240 East Ayrshire 220 200 North Ayrshire 180 South Ayrshire 160 140 120 100 80 60 40 20 0

Midpoint year (3-year rolling interval)

Source: https://www.scotpho.org.uk

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E. Women’s and children’s health

SEE DATA TABLES E1, E2 AND E3 FOR MORE DETAILS (page 32 of report)

WOMEN SMOKING DURING PREGNANCY: 3-year rolling interval data (financial years)

From 2003/04 to 2017/18, trends for women smoking during pregnancy showed marked declines in all areas (Figure 10). The national decline has been fairly persistent, year on year, falling by around 9% over 14 years. Local rates also dropped by 8-10% over the same period, showing commensurate decreases in line with the national decrease. However, local rates have been consistently above the national rate at every time point, with North rates highest, South rates lowest and East rates in between. East and North rates have been significantly in excess of the national average throughout the relevant period.

These trends are clearly reflective of wider trends relating to adult smoking, where declines in local and national figures were also evident (see Figure 7 above). A noteworthy difference between trends for adult smoking and women smoking during pregnancy relates to the fact that reports of pregnant women in South routinely exceeded the national average, while reports of adult smoking in South routinely fell short of the national average. Closer examination showed that, in the current period 2015/16-17/18 [2016/17 midpoint], pregnant women in South Ayrshire reported rates of smoking no different from the South general population (17%). This contrasts with all other areas (East, North and Scotland) where pregnant women’s reports of smoking fell below that of the general population by 3-5%.

FIGURE 10: Women smoking during pregnancy, 2003/04 to 2017/18: percentage, 3-year rolling average by geographical area 40 38 36 34 32 30 28 26 Scotland 24 22 East Ayrshire 20 18 16 North Ayrshire 14 12 South Ayrshire 10 8 6 4 2 0

Midpoint year (3-year rolling interval)

Source: https://www.scotpho.org.uk

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BREASTFEEDING AT 6-8 WEEK REVIEW: 3-year rolling interval data (financial years)

From 2002/03 to 2017/18, the percentage of babies exclusively breastfed, as recorded at the 6-8 week postnatal review, increased nationally while decreased locally in all HSCP areas (Figure 11). In Scotland, there was a modest 3% increase over time due to an incline in the national figures which began in 2011/12-13/14 [2012/13 midpoint] and has picked up pace recently during the current period 2015/16-17/18 [2016/17]. In contrast, local figures fell by 4-8% over the 15-year period, with the greatest decline observed in East; the percentage decreases were 8% in East, 5% in South and 4% in North. Thus while gains appear to have happened nationally, they have not happened locally. Local declines look set to continue in the near future, and if Scottish figures should continue to rise then the gap between local and national rates will continue to widen.

FIGURE 11: Babies exclusively breastfed at 6-8 week review, 2002/03 to 2017/18: percentage, 3-year rolling average by geographical area

35 34 33 32 31 30 29 28 27 26 25 24 23 22 21 20 19 Scotland 18 17 East Ayrshire 16 15 North Ayrshire 14 13 South Ayrshire 12 11 10 9 8 7 6 5 4 3 2 1 0

Midpoint year (3-year rolling interval)

Source: https://www.scotpho.org.uk

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CHILD DENTAL HEALTH IN P7: Single year data (financial years)

From 2012/13 to 2017/18, dental health reports relating to children in primary 7 (age 10-11) showed marked increase in percentage of children reported with no obvious decay in Scotland and Ayrshire and Arran (Figure 12). The main bulk of improvement occurred in all geographical areas between 2014/15 and 2015/16, with a substantial hike of 16% in the national report and even greater hikes of 20-28% in local reports. This pattern of increase has been sudden, raising questions concerning potential factors underlying such sizeable and abrupt changes in local and national trends. Meanwhile, trends look to have stabilised in the last three years, though reports in East Ayrshire appear to have dropped away somewhat and may continue to do so in future.

FIGURE 12: Child dental health checks in P7, 2012/13 to 2017/18: percentage of children with no obvious decay by geographical area

90 87 84 81 78 75 72 69 66 63 60 57 54 Scotland 51 East Ayrshire 48 45 North Ayrshire 42 39 South Ayrshire 36 33 30 27 24 21 18 15 12 9 6 3 0 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18

Source: https://www.scotpho.org.uk

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F. Immunisations and screenings

SEE DATA TABLES F1 AND F2 FOR MORE DETAILS (page 33 of report)

UPTAKE OF MMR AT 24 MONTHS: 3-year rolling interval data (calendar years)

From 2004 to 2018, the rate of uptake of immunisation for MMR (measles, mumps and rubella) at 24 months increased substantially in Scotland and Ayrshire and Arran (Figure 13). There was a strong systematic rise in rates over eight years from 2004-06 [2005 midpoint] to 2012-14 [2013], after which immunisation rates largely flattened in all areas. In 2004-06 [2005], area rates ranged between 90-92%, elevating to between 95-98% in 2012-14 [2013] where rates have generally remained since then. The overall 14-year increase in area rates ranged from 4 to 7%, with the greatest increase (improvement) being seen in East Ayrshire, which currently reports the highest rate followed closely by South Ayrshire. Scotland and North Ayrshire reports were relatively commensurate and notably lower (by about 2%) than the reports of the other two areas during the recent period.

FIGURE 13: Immunisation uptake of MMR at 24 months, 2004 to 2018: percentage of children this age, 3-year rolling average by geographical area

100

95 Scotland

94 East Ayrshire 93 North Ayrshire 92 South Ayrshire 91

85 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Midpoint year (3-year rolling interval)

Source: https://www.scotpho.org.uk

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BOWEL SCREENING UPTAKE: 3-year rolling interval data (calendar years)

From 2008 to 2017, the rate of bowel screening uptake among adults aged 50-74 years old increased overall in Scotland and Ayrshire and Arran, though rates have been falling in the recent period (Figure 14). There were strong increases in area rates initially from the period extending from 2008-10 [2009 midpoint] to 2013-15 [2014], at which time rates peaked in all areas; specifically, rates ranged from 51-56% in 2008-10 [2009] and rose steadily to 56-60% in 2013-15 [2014]. However, rates began dropping after that so that area rates ranged between 54-59% in the most recent period 2015-17 [2016], still above the baseline reports in 2008-10 [2009]. The rankings of area reports have been perfectly consistent at all time points, with South rates well above the national average, and rates in North and East fairly commensurate and below the national average. Projecting forward, it looks as though rates may be set to continue falling for the foreseeable future, locally and nationally.

FIGURE 14: Bowel screening uptake, 2008 to 2017: percentage of all eligible men and women invited (aged 50-74), 3-year rolling average by geographical area

65 64 63 62 61 60 59 58 57 56 Scotland 55 East Ayrshire 54 53 North Ayrshire 52 South Ayrshire 51 50 49 48 47 46 45 2009 2010 2011 2012 2013 2014 2015 2016

Midpoint year (3-year rolling interval)

Source: https://www.scotpho.org.uk

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G. Social care

SEE DATA TABLES G1 AND G2 FOR MORE DETAILS (page 34 of report)

CHILDREN LOOKED AFTER: Single year data (calendar years)

From 2011 to 2017, the rate of children looked after by local authority, among children aged 0-18 years old, decreased in Scotland and East Ayrshire, while increased in North and South Ayrshire (Figure 15). The decrease in Scotland as a whole was fairly steady and gradual, dropping from around 16 to 14 per 1,000 over 7 years. The decrease in East Ayrshire began in 2013, dropping more steeply than the national rate from around 22 to 16 per 1,000 since that time. The increase in South was modest, from around 16 to 18 per 1,000, and even more modest in North, from around 21 to 22 per 1,000. However, it is noted that the North rate has been progressively falling since peaking in 2015 (at 24 per 1,000), and the South rate also fell slightly from 2016 to 2017. In terms of ranking, North rates have remained well above Scottish rates throughout the relevant period, with East and South rates in between. Looking ahead, the national rate appears likely to continue falling at the gradual pace observed over the last 7 years. And recent declines in rates in all three local areas suggest that local rates may also end up declining in line with the national trend.

FIGURE 15: Children looked after by local authority, 2011 to 2017: crude rate per 1,000 children aged 0 to 18 years old by geographical area

30 29 28 27 26 25 24 23 22 21 Scotland 20 19 18 East Ayrshire 17 16 North Ayrshire 15 14 South Ayrshire 13 12 11 10 9 8 7 6 5 4 3 2 1 0 2011 2012 2013 2014 2015 2016 2017

Source: https://www.scotpho.org.uk

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PEOPLE 65+ WITH CARE NEEDS: Single year data (calendar years)

From 2006 to 2017, the percentage of people aged 65 or more with high levels of care needs who are cared for at home2 steadily increased in Scotland, marginally increased overall in North Ayrshire, and decreased overall in East and South Ayrshire (Figure 16). The national increase was consistent and rather linear, increasing by 6% over 11 years from 29% to 35%. On the other hand, local data showed no clear trend, likely due to small number variation. While the rate in North increased overall by 6% in 11 years (from 25% in 2006 to 31% in 2017), the trend was predominantly upward from 2006 to 2015 (peaking at 40% in 2015) but has fallen sharply since then to the current period. An overall decline of 4% was observed in South (from 40% in 2006 to 36% in 2017), mainly accounted for by a sizeable dip in the figures from 2011 to 2012 with the trend somewhat on a level since then. In East, the decrease was more pronounced, falling 12% over 11 years (from 42% in 2006 to 30% in 2017), mainly accounted for by a sharp decline in rates from 2009 to 2011 with the trend levelling off in the last 5 years.

FIGURE 16: People aged 65+ with high levels of care needs who are cared for at home, 2006 to 2017: percentage by geographical area 60 57 54 51 48 45 42 39 36 Scotland 33 East Ayrshire 30 North Ayrshire 27 24 South Ayrshire 21 18 15 12 9 6 3 0 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Source: https://www.scotpho.org.uk

2 People 65+ with high levels of care needs are defined as those who are: (1) receiving 10+ hours of home care purchased or provided by a local authority; (2) resident in a care home; or (3) resident long-term in NHS hospital.

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H. Education SEE DATA TABLES H1 AND H2 FOR MORE DETAILS (page 35 of report)

SCHOOL LEAVER QUALIFICATIONS (1): Single year data (financial years)

From 2009/10 to 2015/16, percentages of school leavers with one or more qualification at SCQF3 Level 6 increased in quite parallel fashion in all areas, locally and nationally (Figure 17). The 6-year increases ranged somewhat consistently and narrowly from 9% in East to 14% in North Ayrshire. In 2009/10 the range was from 45-55% across all areas, shifting up by around 10 percentage points to a range of 55-65% in the latest period. Thus, overall, there appears to have been marked improvement across the board in school leaver qualification at this level. In 2015/16, South gave the highest report and has remained in a relatively higher position over time compared to other areas. The recent report in East was lowest, with North’s report marginally exceeding that of East due to more rapid incline in the North data (especially since 2013/14). However, all areas have improved substantially.

FIGURE 17: School leavers with one or more qualification at SCQF Level 6, 2009/10 to 2015/16: percentage by geographical area 75 72 69 66 63 60 57 54 51 Scotland 48 45 East Ayrshire 42 39 North Ayrshire 36 33 South Ayrshire 30 27 24 21 18 15 12 9 6 3 0 2009/10 2010/11 2011/12 2012/13 2013/14 2014/15 2015/16

Source: https://www.scotpho.org.uk

3 Scottish Credit and Qualifications Framework

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SCHOOL LEAVER QUALIFICATIONS (2): Single year data (calendar years)

From 2009/10 to 2017/18, the percentage of school leavers living in the most deprived quintile with one or more qualification at SCQF Level 6 increased substantially and proportionately across all areas, locally and nationally (Figure 18). In 2009/10, area rates for this demographic ranged narrowly from 24-29%, increasing universally thereafter with reported rates markedly higher and more narrowly ranging from 43-46% in 2017/18. This is a substantial growth of around 20 percentage points in all areas.

Comparing increases among leavers living in the most deprived areas with those for all leavers – that is, comparing changes in rates over the 6-year interval from 2009/10 to 2015/16 (more recent data is not yet available on ScotPHO for all leavers) – the scale of increase was practically equivalent between the two groups in East and North Ayrshire. However, in South Ayrshire and Scotland as a whole, the increases were four percentage points higher in the deprived group compared to all leavers, signifying improvement (i.e., narrowing of the inequalities gap) in those two areas.

FIGURE 18: School leavers living in the most deprived quintile with one or more qualification at SCQF Level 6, 2009/10 to 2017/18: percentage by geographical area 75 72 69 66 63 60 57 54 51 48 45 Scotland 42 39 East Ayrshire 36 North Ayrshire 33 30 South Ayrshire 27 24 21 18 15 12 9 6 3 0

Source: https://www.scotpho.org.uk

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I. Crime SEE DATA TABLES I1, I2 AND I3 FOR MORE DETAILS (page 36 of report)

CRIME RATE: Single year data (calendar years)

From 2004 to 2017, reported rates of crime in Scotland and Ayrshire and Arran fell in a highly structured way (Figure 19). Patterns of decline in rates were concurrently stepwise across areas, though subtle variations in pace of decline have resulted in the gap between areas narrowing in the recent period, 2014-17. Abrupt drops in recorded crime rates occurred in 2007, 2010 and 2014, with the latter year generating the steepest observed drop in all areas. As a result, reported rates fell substantially over the 13-year period by 18 per 1,000 population in South and 25 per 1,000 in North Ayrshire, with decreases in Scotland and East Ayrshire somewhere in between. However, the highly systematic and somewhat angular nature of changes in the historic data raises a question as to whether or not these trends are reflecting artefacts of the crime data recording process rather than prevalence of crime itself. In absence of a definitive answer to this question, it cannot be asserted with confidence that crime itself is decreasing in Scotland.

FIGURE 19: Crime rates (based on violence, sexual offences, domestic housebreaking, vandalism, drug offences and common assault), 2004 to 2017: crude rate per 1,000 population by geographical area 75 72 69 66 63 60 57 54 51 48 45 Scotland 42 39 East Ayrshire 36 33 North Ayrshire 30 27 South Ayrshire 24 21 18 15 12 9 6 3 0 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Source: https://www.scotpho.org.uk

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DOMESTIC ABUSE: Single year data (financial years)

From 2003/04 to 2016/17, the rate of reported incidents of domestic abuse largely increased, locally and nationally, with area trends following broadly similar trajectories (Figure 20). In the main, area trends climbed fairly steeply from 2003/04 to 2011/12, then levelled off from 2011/12 to 2014/15 before falling away after that, particularly in the three local areas. Closer examination of the data, however, revealed distinctions between areas. First, rates in South Ayrshire actually decreased marginally over 13 years by 5 per 1,000 population, mainly due to a sharp drop during the recent period 2014/15-16/17. Moreover, rates in all other areas increased quite divergently – by 27, 50 and 60 per 1,000 in Scotland, North and East Ayrshire respectively. While 13-year increases in North and East were essentially double that of Scotland, North and East figures sharply declined in the recent period 2014/15-16/17 in line with South, while Scottish figures barely changed during that time.

FIGURE 20: Domestic abuse incidents, 2003/04 to 2016/17: crude rate per 10,000 population by geographical area

150 145 140 135 130 125 120 115 110 105 100 95 90 85 Scotland 80 East Ayrshire 75 70 North Ayrshire 65 60 South Ayrshire 55 50 45 40 35 30 25 20 15 10 5 0

Source: https://www.scotpho.org.uk

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PRISON POPULATION: Single year data (calendar years)

From 2002 to 2014, increased rates in the adult prison population – that is, standardised rates of people aged 16+ in prison per 100,000 general population – increased substantially, both locally and nationally (Figure 21). The 12-year increases ranged from about 60 per 100,000 in Scotland to 100 per 100,000 in North Ayrshire, with East and South Ayrshire rates increasing by around 90 per 100,000. This means that increases in rates were more sizeable locally than nationally, thereby accounting for a widening of the gap between Scotland and local areas over time (compare data for 2002 and 2014 in Figure 21). While 12-year increases were quite substantial, local figures stopped rising after 2009, stabilising since then in the range 210 to 260 per 100,000; and national figures also stabilised during the same period well below the local data, fluctuating narrowly between 160 and 170 per 100,000.

FIGURE 21: Prisoner population (16+ year olds) based on prisoners home address, 2002 to 2014: directly age standardised rate per 100,000 population by geographical area

300 290 280 270 260 250 240 230 220 210 200 190 180 Scotland 170 160 East Ayrshire 150 140 North Ayrshire 130 120 South Ayrshire 110 100 90 80 70 60 50 40 30 20 10 0 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

Source: https://www.scotpho.org.uk

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J. Economy SEE DATA TABLES J1 AND J2 FOR MORE DETAILS (page 37 of report)

INCOME DEPRIVED: Single year data (financial years)

From 2004 to 2017, the percentage of the total population classified as income deprived fell marginally in all areas with the exception of North Ayrshire where the figure in 2017 was much the same as that in 2004 (Figure 22). In general, area trends demonstrated concurrent and small stepwise changes, not entirely unexpected given the nature of this data; namely, that shifts in data would likely be modest, intermittent and reflect some kind of correspondence between local and national levels. (This is in contrast to reported crime rates where similar systematic patterns over time were unexpected – see Section I above.) Changes over 13 years in income deprived were decreases of 1.8% in Scotland, 1.1% in East, 0.4% in South, and effectively no change in North Ayrshire. Progress (i.e., reduction of income deprivation) therefore appears to have occurred faster at national than local level, with the situation in North fairly static unlike East and South which showed modest signs of progress.

FIGURE 22: Percentage of total population classified as income deprived within SIMD income domain, 2004 to 2017: calculated using 2011 base population estimates 24 23 22 21 20 19 18 17 Scotland 16 15 East Ayrshire 14 13 North Ayrshire 12 11 South Ayrshire 10 9 8 7 6 5 4 3 2 1 0 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Source: https://www.scotpho.org.uk

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EMPLOYMENT DEPRIVED: Single year data (financial years)

From 2004/05 to 2017/18, the percentage of working age population (age 16-64) classified as employment deprived fell marginally in all areas (Figure 23). Reductions over 13 years ranged from 0.5% in North Ayrshire to 2.3% in Scotland, with East and South Ayrshire in between. Thus Scottish progress (reduction in employment deprivation) exceeded local progress, as was the case with income deprivation. Further correspondence between employment and income deprivation (compare Figures 23 and 22) was evident as follows: small intermittent and stepwise changes over 13 years; three distinct and simultaneous shifts in both sets of data; and commensurate changes in a common direction over time. Two exceptions to this conformity were that North Ayrshire demonstrated no overall change in income deprivation despite a small reduction in employment deprivation, and coincident jumps in the data observed in 2007/08 in Figure 23 and in 2007 in Figure 22 were in opposite directions; upward for income deprivation and downward for employment deprivation.

FIGURE 23: Percentage of working age population (16-64) classified as employment deprived within SIMD income domain, 2004/05 to 2017/18: calculated using 2011 base population estimate 24 23 22 21 20 19 18 17 16 15 14 Scotland 13 East Ayrshire 12 11 North Ayrshire 10 9 South Ayrshire 8 7 6 5 4 3 2 1 0

Source: https://www.scotpho.org.uk

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K. Environment SEE DATA TABLES K1 AND K2 FOR MORE DETAILS (page 38 of report)

LIVING IN AN ‘ACCESS DEPRIVED’ AREA: Single year data (calendar years)

From 2002 to 2017, the percentage of population living in 15% most ‘access deprived’4 areas in Scotland fluctuated considerably in Ayrshire and Arran over time, with local area figures all crossing above and below the 15% Scottish average and yielding highest relative reports at certain intervals (Figure 24). As such, there was no discernible regularity to local area trends. In North Ayrshire, for example, the pattern was mainly below (better than) the national average for most of the 15-year interval, but there was an unusual blip from 2007-09 when ‘access deprivation’ figures significantly elevated in North, exceeding 20% and comprising the highest recorded for any area over the relevant period. In East Ayrshire, rates were also mostly below the national average, but in the recent period, 2014-17, rates rose above the 15% line, placing East above (worse than) Scotland and the other two local areas. In South Ayrshire, rates also fluctuated somewhat erratically over time around the 15% line, recently falling below (better than) the national average.

FIGURE 24: Percentage of population living in 15% most 'access deprived' areas (data zones) in Scotland, 2002 to 2017: calculated using 2011 base population estimates

25 24 23 22 21 20 19 18 Scotland 17 16 15 East Ayrshire 14 13 12 North Ayrshire 11 10 South Ayrshire 9 8 7 6 5 4 3 2 1 0

Source: https://www.scotpho.org.uk

4 The SIMD provides a relative measure of deprivation which means that the main output from SIMD - the SIMD ranks - can be used to compare data zones by providing a relative ranking from most deprived (rank 1) to least (rank 6,505). The SIMD can then be used to identify Scotland's most deprived small areas in relation to its composite domains, including geographical access to services, by applying a cut-off such as 15%.

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LIVING NEAR A DERELICT SITE: Single year data (calendar years)

From 2007 to 2017, the percentage of population living near (within 500 metres of) a derelict site increased locally and nationally to varying degrees (Figure 25). In Scotland, the 10-year increase was fairly marginal, rising by 3% from 27-30%, with most of that change occurring from 2007-09. The change in East Ayrshire was a 3% increase from 23-26%. However, North and South rates elevated more considerably than those in East and Scotland, increasing respectively by 8% from 32-40% and by 12% from 21-33%, so that these two areas currently yield rates above (worse than) the Scottish average. Only East currently yields rates below (better than) the national average. Since 2015 rates have been fairly stable in all areas.

FIGURE 25: Percentage of population living within 500 metres of a derelict site

60 58 56 54 52 50 48 46 44 42 40 38 36 Scotland 34 32 East Ayrshire 30 28 North Ayrshire 26 South Ayrshire 24 22 20 18 16 14 12 10 8 6 4 2 0 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Source: https://www.scotpho.org.uk

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L. Overview of trends

A number of improvements to population health and wellbeing were evident among the various data trends presented in this report. Of note, in this context, were reduced rates of smoking among the general population and an even stronger decline in rates among pregnant women. Another positive sign was a sizeable fall in alcohol-related hospital stays over the last 15 years, although national and local rates have levelled off in the last 5 years. Further positive indications include overall improvements in child dental health and uptake of immunisation of MMR and bowel screening, though these trends have recently stalled or slightly declined. One clear area of progress has been ongoing improvement in school leavers’ qualifications, including those living in the most deprived areas. Slight progress was also seen in gradually declining levels of income and employment deprivation locally, though progress has stalled or remained comparatively slow in North Ayrshire.

Despite the above gains, some deficits were also evident in the data trends. Of note, in this context, was a pronounced rise in drug-related hospitals stays, with marked increases locally and nationally over the last few years coinciding with sharp increases in drug-related deaths occurring within a similar time frame. Adverse impacts on population health and capacity of local services to cope cannot be exaggerated if these trends persist. Other trends raising ‘red flags’ for population health and services include sizeable local increases in emergency hospitalisations (all ages and older people), hospital admissions for COPD, prescribing for mental health problems, and social care provision for older people in their own homes. Some of these problems have likely been created by increased life expectancy, though life expectancy has levelled off in the last few years. Indicators of child health showed that breastfeeding rates at 6-8 week antenatal review had notably declined in local areas, potentially affecting the development and health of children at an early age. Moreover, rates of children looked after in Ayrshire and Arran have remained significantly elevated above national rates, currently and historically. And while crime rates appear to have fallen (though relevant data appears somewhat artefactual), local increases in domestic abuse and the adult prison population raise concern and potentially place further pressure on local services.

The various deficits highlighted here suggest that remedial action is required across a range of public health issues, locally and nationally, to counter potential problems for population health and attendant pressures on services in future.

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Health and wellbeing: DATA TABLES

A. Life expectancy and mortality

TABLE A1: Life expectancy in years by area and gender: 3-year rolling average

2001- 2002- 2003- 2004- 2005- 2006- 2007- 2008- 2009- 2010- 2011- 2012- 2013- 2014- 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Scotland 73.5 73.8 74.2 74.6 74.8 75.0 75.3 75.8 76.2 76.5 76.8 77.1 77.1 77.1 East Ayrshire 72.6 73.5 73.7 74.5 74.1 74.6 74.6 75.5 75.8 76.1 75.8 75.9 76.1 76.5 Females North Ayrshire 72.7 73.3 73.8 74.0 73.8 74.0 74.2 75.2 75.3 76.0 75.9 76.5 76.1 75.9 South Ayrshire 74.0 74.4 75.0 75.7 75.7 75.5 75.9 76.4 77.2 77.3 77.7 78.2 77.7 77.5 Scotland 78.8 79.0 79.2 79.5 79.7 79.8 80.0 80.3 80.6 80.7 80.9 81.1 81.1 81.1 East Ayrshire 77.9 78.4 77.9 78.2 77.9 78.4 78.7 79.5 79.9 80.2 79.7 79.7 79.4 79.8 Males North Ayrshire 78.5 79.1 78.9 79.0 79.1 79.1 79.3 79.6 80.3 80.7 81.0 81.0 80.8 80.5 South Ayrshire 79.2 79.6 80.0 80.5 80.6 80.9 80.9 81.1 81.0 81.2 80.9 81.0 81.0 80.8

TABLE A2: Deaths from all causes (all ages): EASR per 100,000 population, 3-year rolling average

2002- 2003- 2004- 2005- 2006- 2007- 2008- 2009- 2010- 2011- 2012- 2013- 2014- 2015- 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 Scotland 1464.0 1426.3 1372.0 1348.8 1328.2 1300.0 1260.6 1218.1 1198.7 1181.0 1163.1 1165.0 1159.2 1167.1 East Ayrshire 1555.8 1551.5 1459.6 1451.4 1419.1 1401.4 1334.8 1280.2 1234.9 1254.6 1248.0 1265.6 1261.4 1269.1 North Ayrshire 1507.4 1467.7 1423.6 1421.8 1408.4 1400.9 1309.1 1258.0 1202.4 1215.7 1199.2 1235.9 1219.2 1223.1 South Ayrshire 1404.8 1350.3 1295.9 1259.8 1237.2 1217.9 1217.9 1199.8 1178.2 1145.6 1117.5 1130.3 1120.3 1112.7

Source: https://www.scotpho.org.uk

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B. Ill health and injury

TABLE B1: Patients hospitalised with respiratory problems by condition and area: EASR per 100,000 population,

3-year rolling average

2002/03 2003/04 2004/05 2005/06 2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13 2013/14 2014/15 2015/16 to to to to to to to to to to to to to to 2004/05 2005/06 2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 Scotland 229.9 229.9 228.0 229.4 241.8 239.1 239.5 236.2 244.1 243.4 243.7 242.7 245.9 247.0 East Ayrshire 272.6 281.8 291.2 316.0 342.3 339.4 338.6 338.0 369.0 367.7 373.9 358.8 362.0 365.0 COPD North Ayrshire 220.4 239.9 234.9 247.7 275.8 290.4 311.4 309.3 319.0 307.0 311.3 316.0 323.3 320.2 South Ayrshire 201.7 218.7 226.7 235.5 244.1 240.5 232.7 234.0 254.0 263.1 266.3 267.2 279.9 289.0 Scotland 99.0 99.0 103.6 101.0 105.1 100.2 98.6 91.8 91.5 88.9 90.5 89.9 92.5 92.3 East Ayrshire 106.9 105.8 105.4 110.7 111.0 110.5 103.2 101.7 105.3 103.3 109.7 103.1 112.8 127.6 Asthma North Ayrshire 113.0 113.6 118.8 114.5 116.7 112.5 116.5 116.9 124.3 126.6 135.3 131.2 129.2 131.0 South Ayrshire 94.6 101.4 105.2 98.9 102.0 108.0 107.3 110.0 106.2 99.6 103.3 99.6 107.5 109.7

TABLE B2: Patient emergency hospitalisations: EASR per 100,000 population, 3-year rolling average

2011-2013 2012-2014 2013-2015 2014-2016 2015-2017 Scotland 7439.1 7506.8 7564.1 7615.6 7601.0 Patients (all ages) with East Ayrshire 9131.1 9234.8 9264.4 9452.9 9685.3 emergency hospitalisations North Ayrshire 9165.0 9313.1 9481.0 9680.2 9893.7 South Ayrshire 8424.4 8662.0 8874.6 9178.0 9451.2 Scotland 5309.9 5370.2 5390.2 5413.4 5422.3 Patients aged 65+ with multiple East Ayrshire 6311.9 6513.6 6405.9 6498.1 6578.5 emergency hospitalisations North Ayrshire 5801.1 5935.9 6166.1 6216.9 6277.3 South Ayrshire 5892.0 6005.2 6157.5 6242.2 6502.5

Source: https://www.scotpho.org.uk

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C. Mental health

TABLE C1: Percentage of population prescribed drugs for anxiety/depression/psychosis

2010/11 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18

Scotland 15.0 15.6 16.2 16.8 17.4 18.0 18.5 18.8 East Ayrshire 15.8 16.6 17.1 17.7 18.3 19.2 19.7 20.1 North Ayrshire 16.3 16.9 17.6 18.4 19.3 19.9 20.6 21.1 South Ayrshire 16.9 17.7 18.2 18.9 19.3 20.0 20.8 21.3

TABLE C2: Patients with a psychiatric hospitalisation: EASR per 100,000 population, 3-year rolling average

Source: https://www.scotpho.org.uk

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D. Behaviours which impact on health

TABLE D1: Estimated percentage of adult population (aged 16+) who smoke

2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 Scotland 23.8 22.3 21.2 20.7 19.6 18.0 East Ayrshire 28.1 23.7 24.5 21.0 22.1 19.2 North Ayrshire 27.9 26.6 22.8 23.3 27.0 21.8 South Ayrshire 15.5 21.6 19.1 18.8 16.9 15.2

TABLE D2: Alcohol-related hospital stays: EASR per 100,000 population

2002/ 2003/ 2004/ 2005/ 2006/ 2007/ 2008/ 2009/ 2010/ 2011/ 2012/ 2013/ 2014/ 2015/ 2016/ 2017/ 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 Scotland 743.1 740.8 795.4 779.4 809.3 855.5 828.1 771.4 759.8 749.6 699.1 706.4 676.5 674.1 685.4 676.3 East Ayrshire 984.4 880.4 959.2 1030.7 1070.6 1084.6 983.6 966.4 980.9 925.2 820.1 805.2 751.0 662.0 738.3 658.0 North Ayrshire 1095.7 1040.5 1037.1 1033.0 1043.4 1170.6 1111.4 1163.2 1119.8 1093.6 925.4 922.6 868.3 814.7 895.5 894.9 South Ayrshire 1035.9 1081.6 1049.2 1030.5 998.8 993.0 978.9 1044.9 914.3 875.6 795.0 772.8 717.2 697.0 705.4 758.1

TABLE D3: Drug-related hospital stays: EASR per 100,000 population, 3-year rolling average

Source: https://www.scotpho.org.uk

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E. Women’s and children’s health

TABLE E1: Percentage of women smoking during pregnancy: 3-year rolling average

2003/04 2004/05 2005/06 2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13 2013/14 2014/15 2015/16 to to to to to to to to to to to to to 2005/06 2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 Scotland 24.7 24.0 23.3 22.4 21.5 20.8 20.5 20.0 19.4 18.5 17.3 16.3 15.4 East Ayrshire 29.5 28.4 27.6 26.9 27.1 27.0 27.2 26.2 25.2 24.4 22.4 20.7 19.1 North Ayrshire 31.0 30.4 29.3 28.9 28.3 28.5 28.5 28.6 27.9 26.9 25.2 24.3 23.1 South Ayrshire 25.6 26.6 26.1 25.3 24.6 24.7 24.1 24.0 23.0 22.3 19.4 18.2 16.8

TABLE E2: Percentage of babies exclusively breastfed at 6-8 week postnatal review: 3-year rolling average

TABLE E3: Percentage of P7 children (aged 10-11) with no obvious tooth decay

2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 Scotland 45.0 47.7 51.6 67.9 69.4 71.2 East Ayrshire 40.7 43.1 47.3 75.3 70.5 63.0 North Ayrshire 42.2 45.1 50.8 71.2 73.4 72.5 South Ayrshire 43.3 43.8 54.7 77.7 72.2 78.4

Source: https://www.scotpho.org.uk

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F. Immunisations and screenings

TABLE F1: Immunisation uptake of MMR at 24 months: percentage of children this age, 3-year rolling average

2004 to 2005 to 2006 to 2007 to 2008 to 2009 to 2010 to 2011 to 2012 to 2013 to 2014 to 2015 to 2016 to 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

Scotland 90.1 91.4 92.1 92.6 93.0 93.6 94.1 94.8 95.3 95.5 95.3 95.0 94.6 East Ayrshire 90.0 91.6 93.1 93.8 94.5 95.4 96.1 96.9 97.6 97.7 97.7 97.4 97.2 North Ayrshire 89.7 91.3 92.0 92.2 92.6 93.4 94.3 95.5 96.2 95.9 95.6 95.3 94.7 South Ayrshire 91.8 93.1 94.1 93.6 93.5 93.8 94.8 95.8 96.3 96.2 96.7 96.7 96.8

TABLE F2: Bowel screening uptake: percentage of eligible adults aged 50-74 invited, 3-year rolling average

2008 to 2009 to 2010 to 2011 to 2012 to 2013 to 2014 to 2015 to 2010 2011 2012 2013 2014 2015 2016 2017

Scotland 54.1 54.5 55.1 56.0 57.3 57.6 57.2 56.4 East Ayrshire 51.4 53.0 54.1 54.8 56.2 56.4 55.7 54.7 North Ayrshire 51.4 52.7 53.5 54.0 55.5 55.9 55.1 54.1 South Ayrshire 56.0 57.1 58.2 58.9 60.1 60.2 59.6 58.8

Source: https://www.scotpho.org.uk

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G. Social care

TABLE G1: Children aged 0-18 years old looked after by local authority: crude rate per 1,000 children of this age

2011 2012 2013 2014 2015 2016 2017

Scotland 15.5 15.6 15.4 15.0 14.9 14.8 14.3 East Ayrshire 20.6 21.0 21.4 20.7 19.1 19.2 16.1 North Ayrshire 20.7 21.0 21.6 22.3 24.0 23.0 22.2 South Ayrshire 15.9 16.9 17.7 16.8 16.2 19.0 18.4

TABLE G2: Percentage of people aged 65+ with high levels of care needs*

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Scotland 29.3 30.4 31.5 31.2 32.1 32.2 33.0 34.1 34.3 35.4 34.8 35.2 East Ayrshire 42.0 40.8 43.5 41.1 30.9 27.8 35.8 31.5 30.3 30.3 31.5 29.9 North Ayrshire 24.6 27.1 32.8 35.8 31.5 30.8 36.2 38.0 40.3 41.6 34.3 31.3 South Ayrshire 40.4 41.6 43.3 43.1 42.3 41.1 34.1 36.9 34.6 31.7 37.1 35.8

* People 65+ with high levels of care needs are defined as those who are: (1) receiving 10+ hours of home care purchased or provided by a local authority; (2) resident in a care home; or (3) resident long-term in NHS hospital.

Source: https://www.scotpho.org.uk

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H. Education

TABLE H1: Percentage of all school leavers with one or more qualification at SCQF Level 6

2009/10 2010/11 2011/12 2012/13 2013/14 2014/15 2015/16

Scotland 50.3 52.3 55.7 55.7 58.0 60.2 61.6 East Ayrshire 47.4 49.6 54.7 53.5 57.1 57.8 56.8 North Ayrshire 45.4 47.3 48.9 54.7 51.9 55.9 59.3 South Ayrshire 53.3 54.8 59.1 54.4 57.0 61.0 65.0

TABLE H2: Percentage of school leavers in most deprived quintile with one or more qualification at SCQF Level 6

2009/10 2010/11 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18

Scotland 27.0 30.2 33.6 34.9 38.5 41.2 42.7 43.0 44.4 East Ayrshire 28.8 31.0 36.5 40.7 40.6 42.1 38.0 38.2 45.3 North Ayrshire 27.8 29.6 34.6 37.3 33.9 41.7 42.2 40.3 46.0 South Ayrshire 24.2 27.5 37.6 25.0 30.8 42.3 40.0 42.9 42.9

Source: https://www.scotpho.org.uk

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I. Crime

TABLE I1: Crime rates:* crude rate per 1,000 population

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 Scotland 53.4 53.2 52.9 49.2 48.9 48.7 41.0 40.7 40.6 40.5 30.9 30.8 30.6 30.5 East Ayrshire 52.2 52.2 52.1 50.2 49.9 49.7 42.7 42.6 42.6 42.7 32.9 32.9 32.9 32.9 North Ayrshire 58.6 58.5 58.5 52.6 52.5 52.5 48.4 48.3 48.5 48.7 32.9 33.0 33.1 33.1 South Ayrshire 45.7 45.7 45.6 45.0 44.9 45.0 38.5 38.4 38.4 38.4 27.5 27.5 27.5 27.4

* Based on recorded incidents of violence, sexual offences, domestic housebreaking, vandalism, drug offences and common assault.

TABLE I2: Domestic abuse incidents: crude rate per 10,000 population

2003/04 2004/05 2005/06 2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 Scotland 81.4 85.8 88.7 95.2 96.6 103.7 99.3 105.9 112.9 113.1 109.7 112.0 108.1 108.8 East Ayrshire 44.6 87.4 85.4 95.4 103.6 103.0 104.3 113.3 116.6 115.1 123.3 128.3 125.8 110.3 North Ayrshire 73.1 83.0 87.4 106.4 106.8 118.9 128.4 130.0 137.4 132.3 134.2 134.1 126.7 123.4 South Ayrshire 94.9 92.0 84.8 95.9 102.1 98.1 107.4 110.6 112.0 114.4 111.0 115.2 100.2 89.8

TABLE I3: Adult 16+ prison population: directly age standardised rate per 100,000 general population

2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 Scotland 102.7 113.2 116.8 119.1 123.0 131.6 146.0 163.2 163.3 167.1 173.6 163.0 161.9 East Ayrshire 127.5 141.0 134.3 140.1 161.1 188.2 180.5 210.5 237.2 226.3 231.1 227.6 216.3 North Ayrshire 160.9 167.3 180.9 139.6 171.4 196.6 213.8 251.2 257.7 216.5 238.2 251.9 261.5 South Ayrshire 115.3 106.8 125.4 123.4 129.7 164.7 154.7 208.5 216.6 221.1 220.3 207.1 207.7

Source: https://www.scotpho.org.uk

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J. Economy

TABLE J1: Percentage of total population classified as income deprived within SIMD income domain: calculated using 2011 base population estimates

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 Scotland 13.9 13.9 13.8 15.1 15.0 14.9 13.3 13.2 13.2 13.2 12.3 12.3 12.2 12.2 East Ayrshire 16.7 16.6 16.6 18.0 17.9 17.8 16.4 16.4 16.3 16.4 15.5 15.5 15.5 15.5 North Ayrshire 17.3 17.2 17.2 19.0 18.9 18.9 17.6 17.5 17.6 17.7 17.3 17.3 17.3 17.3 South Ayrshire 13.1 13.0 13.0 14.9 14.9 14.9 13.1 13.1 13.1 13.1 12.7 12.7 12.7 12.6

TABLE J2: Percentage of working age population (16-64) classified as employment deprived within SIMD income domain: calculated using 2011 base population estimate

2004/05 2005/06 2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18

Scotland 12.9 12.8 12.7 11.5 11.4 11.4 12.2 12.1 12.2 12.2 10.7 10.6 10.6 10.6 East Ayrshire 15.3 15.2 15.2 13.8 13.7 13.7 14.7 14.7 14.8 15.0 13.4 13.5 13.5 13.6 North Ayrshire 15.8 15.8 15.8 14.6 14.6 14.7 15.9 15.9 16.1 16.3 15.1 15.1 15.3 15.3 South Ayrshire 12.8 12.8 12.8 11.7 11.8 11.9 12.6 12.6 12.7 12.8 11.6 11.7 11.7 11.8

Source: https://www.scotpho.org.uk

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K. Environment

TABLE K1: Percentage of population living in 15% most 'access deprived' areas (data zones) in Scotland: calculated using 2011 base population estimates

2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Scotland 15.0 15.0 15.0 15.0 15.0 15.0 15.0 15.0 15.0 15.0 15.0 15.0 15.0 15.0 15.0 15.0 East Ayrshire 9.9 9.9 14.8 15.1 15.3 13.1 13.3 13.3 11.9 12.1 12.3 12.3 15.5 15.9 16.2 16.5 North Ayrshire 12.2 12.3 11.3 11.3 11.1 20.9 21.2 20.8 11.2 11.4 11.5 11.7 9.9 10.0 10.1 10.1 South Ayrshire 18.5 17.8 13.4 13.5 12.9 13.8 13.8 13.9 18.4 18.6 18.6 18.8 13.5 12.9 13.0 13.1

TABLE K2: Percentage of population living within 500 metres of a derelict site

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Scotland 27.3 29.4 30.8 29.8 30.1 30.9 29.7 29.2 29.7 30.3 29.8 East Ayrshire 23.0 23.0 25.5 25.1 28.1 28.9 28.1 28.1 28.0 28.2 26.2 North Ayrshire 32.0 40.1 41.1 39.9 45.2 43.3 39.3 39.9 39.5 39.3 39.7 South Ayrshire 21.1 22.3 23.7 20.9 20.4 22.5 24.8 25.0 30.9 33.0 32.5

Source: https://www.scotpho.org.uk

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