Summary Background the Level of Population

Summary Hypertension is a major risk factor for ischaemic and haemorrhagic stroke, myocardial infarction,  The Isle of Wight has a statistically higher heart failure and premature death. Hypertension (worse) rate (4.1%) of Chronic Heart Disease is one of the most important preventable causes (CHD) than the England average of 3.4%. of premature morbidity and mortality in the UK.

 For hypertension (high blood pressure) the Isle Factors that can raise the risk of developing of Wight has a statistically significantly higher hypertension include obesity, smoking, excessive (worse) rate 16.7% than the England average alcohol consumption; high salt intake and a lack (13.6%). of exercise (NICE, 2010).

 For Stroke the Isle of Wight has a statistically NHS Health Check significantly higher (worse) rate 3.1% than the England average 2.54%. The NHS Health Check programme aims to help prevent heart disease, stroke, diabetes, kidney  The crude prevalence of CHD for the Isle of disease and certain types of dementia. Everyone Wight has seen a downward (better) trend with between the ages of 40 and 74, who has not a rate of 3.9% in 2012/13 statistically already been diagnosed with one of these significantly lower (better) than for the period conditions or have certain risk factors, will be 2005/6 to 2008/9 (4.5% to 4.3%). invited (once every five years) to have a check to assess their risk of heart disease, stroke, kidney  On the Isle of Wight for the period 2010-12 the disease and diabetes over the next 10 years and number of deaths from CHD for females (12 will be given support and advice to help them deaths per 100,000) was statistically reduce or manage that risk. significantly lower (better) than for males (42 deaths per 100,000). The significant difference between female and male mortality rates is The level of population need

also reflected in the England average females This factsheet examines the prevalence and 15 deaths per 100,000 and 51 for males. mortality rates of CHD, stroke and hypertension

on the Isle of Wight and its ONS comparator Background areas.

Cardiovascular disease (CVD) is a term that CVD – all circulatory disease describes a disease of the heart and circulation, generally due to reduced blood flow to the heart, Figure 1 shows the directly age standardised rate brain or body caused by plaques or blood clots. (DSR) of mortality from CVD for those aged less CVD is increasingly common after the age of 60, than 75 years per 100,000 population. DSR is a but rare below the age of 30; plaques (plates) of technique used to better allow populations to be fatty atheroma build up in the arteries during adult compared when the age profiles of the life. These can eventually cause narrowing of the populations are different; as in the case of the Isle arteries, or trigger a local thrombosis (blood clot) of Wight having a higher than average older population. which completely blocks the blood flow (NICE, 2010). The Isle of Wight rate is not statistically

The main types of CVD are: coronary heart significantly different from the England average or disease (CHD), stroke and peripheral arterial the majority of its Office of National Statistics disease (PAD). Globally CVD is the leading cause (ONS) comparator areas, but it has a statistically of death and is associated with the burden of significantly better rate of 57 deaths per 100,000 preventable illnesses (NICE, 2010). than Blackpool which has a rate of 100 per 100,000.

1 Produced by Isle of Wight Council Public Health Information Team

Figure 3: Figure 1: Chronic Heart Disease Crude Prevalence % - Isle of Wight and ONS Comparators: 2011/12 Mortality from All Circulatory Diseases (Under 75's): 2010-12 (pooled) Isle of Wight & ONS Comparator Local Authorities: PERSONS Cumbria

Blackpool UA Blackpool

Thanet Great Yarmouth and Waveney Portsmouth Torbay Scarborough

Southampton Isle Of Wight

Allerdale Cornwall Great Yarmouth ENGLAND Shepway

Carlisle Hampshire

Cumbria Portsmouth Torbay Southampton England 0.0 1.0 2.0 3.0 4.0 5.0 6.0 Isle of Wight Crude prevalence rate (%) Waveney Sources:Quality and Outcomes Framework accessed via NHS Information Centre Copyright © 2012, Weymouth & Portland Notes: These are crude rates and therefore do not take any account of the underlying age/sex distribution of the population

Hampshire

0 20 40 60 80 100 120 140

Directly Age Standardised Rate per 100,000 Population Using modelled estimates produced by the Sources: ONS Annual Death Extract & ONS Mid Year Population Estimates Eastern Region Public Health Observatory (ERPHO) for 2011/12, it is estimated that 8222

Figure 2 shows the DSR of mortality from CVD in people on the Isle of Wight have CHD with 2499 males and females aged under 75 per 100,000 (nearly 2%) of the population undiagnosed.

population from 2006 to 2012. The Isle of Wight Figure 4 shows the crude CHD prevalence for the has a general downward trend (better) in line with Isle of Wight and England trend from 2005/6 to the England average, but the Isle of Wight trend is 2012/13. The trend for England has remained not statistically significantly different from 2006 fairly constant with no statistically significant (121 deaths per 100,000) to 2012 (107 deaths per difference over the period. 100,000). The crude prevalence of CHD for the Isle of Wight Figure 2: has seen a downward (better) trend with a rate of Mortality from All Circulatory Diseases (Under 75's): 3.9% in 2012/13 statistically significantly lower 120 2006-2012 Time Trend: BY GENDER (better) than for the period 2005/6 to 2008/9 100 (4.5% - 4.3%).

80 Figure 4: 60 Crude CHD prevalence - Isle of Wight and England trend: 2005/6 - 2012/13 5.0

40 4.5

4.0 20 Isle of Wight Males England Males 3.5 Isle of Wight Females England Females 3.0 0

2006 2007 2008 2009 2010 2011 2012 2.5 Directly Age Standardised Rate per 100,000 Population100,000perRate Standardised AgeDirectly Sources: ONS Annual Death Extract & ONS Mid Year Population Estimates 2.0 (%) Rate PrevalenceCrude 1.5 1.0 Isle of Wight England Chronic Heart Disease (CHD) 0.5 0.0 2005-06 2006-07 2007-08 2008-09 2009-10 2010-11 2011-12 2012-13 Figure 3 shows the crude prevalence of the

Sources: Quality and Outcomes Framework percentage of people on the CHD register in Notes: These are crude rates and therefore do not take any account of the underlying age/sex distribution of the population. Localities are defined 2011/12, the Isle of Wight has a statistically according to GP practices. higher (worse) rate (4.1%) of CHD than the England average of 3.4% but lower (better) than Figure 5 shows mortality from CHD for the Isle of two of its ONS comparator areas. Wight and its ONS comparator area for the period 2010-2012 (pooled). The Isle of Wight is not NB This is a crude rate and does not take into statistically significantly different (61 deaths per account the higher than England average older 100,000) compared to the England average (69 population of the Isle of Wight. per 100,000) but has statistically significantly lower (better) mortality from CHD than four of its ONS comparator area for males and three for females.

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Figure 5: lower (better) rates than four of its ONS Mortality from Coronary Heart Disease (All Ages): 2010-12 (pooled) Isle of Wight & ONS Comparator Local Authorities: BY GENDER comparator areas.

Hampshire CC Females Males Dorset CC Figure 7: SOUTH EAST Isle of Wight UA Modelled estimates of Stroke prevalence - Isle of Wight and ONS Comparators: November 2009 Weymouth and Portland CD

Cornwall UA Blackpool Torbay UA Waveney CD Torbay Shepway CD ENGLAND GT Yarmouth & Waveney Portsmouth UA Cornwall & Isle of Southampton UA Scilly Great Yarmouth CD Cumbria CC Isle of Wight Allerdale CD Thanet CD Cumbria Blackpool UA Hampshire 0 20 40 60 80 100 120 140 160 180 Directly Standardised Rate per 100,000 England Source: HSCIC indicator portal & ONS population estimates Portsmouth

Figure 6 shows mortality rates from CHD from Southampton 2008-10 to 2010-12 for all ages, males and 0.0 0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0 4.5 5.0 Estimated Crude prevalence rate (%) females. In general the number of deaths from Sources: Eastern Region Public Health Observatory

CHD for females is statistically significantly lower (better) than for males. Notes: The Eastern Region Public Health

On the Isle of Wight for the period 2010-12 the Observatory (ERPHO) has produced practice number of deaths from CHD for females (12 level prevalence estimates through modelling. deaths per 100,000) was statistically significantly The models require practice level inputs of lower (better) than for males (42 deaths per population, ethnicity, smoking and deprivation. 100,000). The significant difference between For practices with populations that significantly female and male mortality rates is also reflected differ from a ‘typical’ population (e.g. large BME in the England average of 15 deaths per 100,000 population that has very different smoking pattern for females and 51 for males. to England average) the assumptions of the model may not apply and discrepancies may The trend in mortality rates for CHD from 2008-10 occur. to 2010-12, deaths for males on the Isle of Wight reflects the England average trend with a gradual Figure 8 shows the mortality rate from stroke per decline in the number of deaths from CHD. This 100,000 this rate has been age standardised, trend is statistically significant for the England from 2008-10 to 2010-12. There has been no average but is not statistically significant for the statistically significant change in the mortality rate Isle of Wight. from stroke on the Isle of Wight. The England average over the same time period has shown a Figure 6: statistically significant improvement in mortality Mortality from Coronary Heart Disease (<75): rates for both males and females. 2008-10 to 2010-12 Time Trend: BY GENDER Isle of Wight Males Isle of Wight Females Figure 8: 70 England Males England Females Mortality from Stroke (all ages) - Isle of Wight and England time trend: 2008-10 to 2010-12 60

50 Isle of wight Males Isle of Wight Females 40 50 ENGLAND Males ENGLAND Females

30 45

20 40 35 10

Directly standardised rate per 100,000perrate standardisedDirectly 30 0

2008-10 2009-11 2010-12 100,000perrate standardised - 25 Sources: HSCIC & ONS Revised Mid Year Population Estimates 20

15 Stroke/Cerebrovascular Accident (CVA) ageDirectly 10

Figure 7 shows modelled estimates of crude 5 0 stroke prevalence rates. The Isle of Wight has a 2008-10 2009-11 2010-12 statistically significantly higher (worse) rate 3.1% Sources: HSCIC & ONS Mid Year Population Estimates than the England average of 2.54% and one of its ONS comparator areas, Cumbria which has a rate of 2.8%. However it has statistically significantly

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Hypertension

Figure 9 shows the crude hypertension prevalence for the Isle of Wight and its ONS comparator areas. The Isle of Wight has a statistically significantly higher (worse) rate 16.7% than the England average (13.6%) and three of its ONS comparator areas.

Notes: These are crude rates and therefore do not take any account of the underlying age/sex distribution of the population.

Figure 9: Crude Hypertension prevalence - Isle of Wight and ONS Comparators: 2011/12

Dorset PCT

Isle Of Wight NHS PCT Great Yarmouth and Waveney PCT

Torbay Care Trust

Blackpool PCT

Cumbria Teaching PCT Cornwall and Isles Of Scilly PCT

Hampshire PCT

England

Portsmouth

Southampton

0.0 2.0 4.0 6.0 8.0 10.0 12.0 14.0 16.0 18.0 Crude prevalence rate (%)

Sources:Quality and Outcomes Framework accessed via NHS Information Centre

Modelled estimates created in 2009 by ERPHO for the Isle of Wight show that 43043 people are living with hypertension against the recorded numbers of 23520; this means that 19523 people 13.8% of the total population of the Isle of Wight, potentially are living with undiagnosed hypertension. For England the estimated percentage of undiagnosed hypertension is 9.6%.

References

NICE. (2010, June). Prevention of Cardiovascular Disease. Accessed May 9, 2014, from nice.org.uk: http://www.nice.org.uk/nicemedia/live/13024/4927 3/49273.pdf

Useful websites

CVD prevention http://www.patient.co.uk/health/preventing- cardiovascular-diseases#nav-4

Health Checks www.nhs.uk/Conditions/nhs-health- check/Pages/NHS-Health-Check.aspx

4 Produced by Isle of Wight Council Public Health Information Team