Causes of Early Death in Table of Contents

S.No Title Page No. 2 Causes of Early death 1 2.1 Infant Mortality 5 2.2 Mortality in persons under 75 from all causes 12 2.3 Mortality in persons under 75 from cancer 15 2.4 Mortality in persons under 75 from cardiovascular diseases 21 2.5 Mortality in persons under 75 from liver diseases 30 2.6 Mortality in persons under 75 from respiratory diseases 35 2.7 Mortality rate from communicable diseases 39 2.8 Mortality rate from causes considered preventable 42 2.9 Excess mortality rate in adults with serious mental illness 46 2.10 Suicide (and injury of undetermined intent) 49 2.11 Deaths attributable to smoking 53 2.12 Excess winter deaths 56 Version Control

Description of Date Date of Version Status version Completed Distributed to distribution Health and Wellbeing 1.1 Draft Chapter 1 and 2 25/04/2016 Board 27/04/2016

1.2 Draft Chapter 1 and 2 03/08/2016 JSNA Steering Group 04/08/2016 Summary of outcomes Latest data Last data Better or worse refresh refresh Wolverhampton figure compared to last data Better or worse compared to Section Outcome year year latest data refresh England (latest data) 6.4 (per 1000 live 6.8 (per 1000 live Causes of early death Infant Mortality 2012/14 2011/13 births1) births) 4.0 (per 1000 live births) 412.4 (DSR2 per 408.5 (DSR per Causes of early death Mortality in persons under 75 from all causes 2012/14 2011/13 100,000) 100,000) 339.5 (DSR per 100,000) 158.8 (DSR per 152.4 (DSR per Causes of early death Mortality in persons under 75 from cancer 2012/14 2011/13 100,000) 100,000) 141.5 (DSR per 100,000) 35.5 (DSR per Causes of early death Mortality in persons under 75 from lung cancer 2012/14 2011/13 37.2 (DSR per 100,000) 100,000) 33.8 (DSR per 100,000) Mortality in persons under 75 from 97.9 (DSR per Causes of early death cardiovascular diseases 2012/14 2011/13 97.4 (DSR per 100,000) 100,000) 75.7 (DSR per 100,000 Mortality in persons under 75 from Coronary 55.7 (DSR per Causes of early death Heart Disease 2012/14 2011/13 52.7 (DSR per 100,000) 100,000) 41.9 (DSR per 100,000) 15.1 (DSR per Causes of early death Mortality in persons under 75 from Stroke 2012/14 2011/13 16.6 (DSR per 100,000) 100,000) 13.9 (DSR per 100,000) Mortality in persons under 75 from liver 28.9 (DSR per Causes of early death diseases 2012/14 2011/13 28 (DSR per 100,000) 100,000) 17.8 (DSR per 100,000) 18 (DSR per Causes of early death Alcohol related mortality rate 2012/14 2011/13 17.4 (DSR per 100,000) 100,000) 11.6 (DSR per 100,000) Mortality in persons under 75 from respiratory 47.1 (DSR per Causes of early death diseases 2012/14 2011/13 45.3 (DSR per 100,000) 100,000) 32.6 (DSR per 100,000) 31.9 (DSR per Causes of early death Mortality rate from communicable diseases 2012/14 2011/13 28 (DSR per 100,000) 100,000) 17.8 (DSR per 100,000) Mortality rate from causes considered 213.3 (DSR per 209.2 (DSR per Causes of early death preventable 2012/14 2011/13 100,000) 100,000) 182.7 (DSR per 100,000) Excess mortality rate in adults with serious Causes of early death mental illness 2012/14 2011/13 378.2 (ISR3) 329.7 (ISR) 351.8 (ISR) 8.5 (DSR per Causes of early death Suicide (and injury of undetermined intent) 2012/14 2011/13 8.8 (DSR per 100,000) 100,000) 8.9 (DSR per 100,000) 307.3 (DSR per 306.7 (DSR per Causes of early death Deaths attributable to smoking 2012/14 2011/13 100,000) 100,000) 274.8 (DSR per 100,000)

Causes of early death Excess winter deaths (all ages) 2011/14 2010/13 16.2 (Ratio) 20.8 (Ratio) 15.6 (Ratio)

Causes of early death Excess Winter deaths (aged 85+) 2011/14 2010/13 19.5 (Ratio) 25.2 (Ratio) 22.3 (Ratio) 1 Live Births implies birth following pregnancy where the fetus shows evidence of life such as breathing 2 DSR: Directly Standardised Rate is a method of standardisation used to account for the differences in populations for example, age and sex and to allow for comparisons between different areas. 3 ISR: Indirectly standardised Ratio is a method of standardisation used to account for differences in populations Infant Mortality in Wolverhampton Infant Mortality Infant Mortality rate (IMR) is defined as number of deaths under the age of one year, per 1000 live births. It consists of 2 components: • Neonatal mortality rate: rate of neonatal deaths (those occurring during the first 28 days of life) per 1000 live births • Post-neonatal mortality rate: rate of infants death occurring between 28 days and less than one year per 1000 live births Neonatal mortality is considered to reflect the health and care needs of both mother and new-born. Infant Mortality in Wolverhampton is reducing England Wolverhampton 1.5 2012/14 (per 1000 live births) 2012/14 (per 1000 live births) (per 1000 live births) 6.4 4.0 2001/03 2012/14

Neonatal Deaths Number of neonatal deaths in Wolverhampton 12 2004 2014 Infant Mortality in Wolverhampton compared to other local authorities

Infant Mortality in Wolverhampton 2012-14: Compared to other local authorities in England 8 th 7 Infant mortality in Wolverhampton is 7 worst 6 compared to other local authorities and is significantly lower compared to England. 5 4 3

2 Rateper 1000 live births 1 0

Infant Mortality in Wolverhampton 2012-14: Compared to CIPFA nearest neighbours 10 9 8 7 6 Infant Mortality in Wolverhampton is worse 5 4 compared to 12 of the 15 CIPFA nearest 3 2 neighbours. 1

Rateper 1000 live births 0 Infant Mortality

• In 2005-14, infant mortality is worse in 3 wards of Wolverhampton: , St Peters and

• In 2005-14, Infant mortality is lowest in followed by Tettenhall Wightwick and East Park.

• In 2005-14, rate of still births is worse in 3 wards of Wolverhampton: , Graiseley and

• In 2005-14, rate of still births is lowest in 4 wards of Wolverhampton: Bushbury North, , Penn and Blakenhall Risks factors for Infant Mortality in Wolverhampton 2004-2014

7 out of 10 infant deaths in Wolverhampton are in the most deprived areas

63% of infant deaths are 10% of infant deaths 57% of infant in babies born are in babies with deaths are in low prematurely at 34 congenital birth weight babies weeks abnormalities

14% mothers are 1 in 3 mothers smoke 22% mothers 6% mothers booked late for at time of delivery are obese are under 18 antenatal care What does this information tell me?

• Infant mortality in Wolverhampton has remained fairly static, despite a recent downward trend, and is worse than most local authorities in England. • Infant Mortality is influenced by a range of risk factors including smoking during pregnancy and early access to healthcare

Indicative Commissioning Needs

• Improving the risk factors through various commissioned services including – promoting early booking and attendance for antenatal care – preventing poor lifestyle choices including smoking during pregnancy, obesity and teenage conceptions – improving outcomes for premature births, low birth weight babies and babies from deprived areas of the City Mortality in persons aged under 75 from All causes Mortality rates in Under 75s from all causes

Premature mortality i.e. deaths occurring before a person reaches the age of 75 is a major public health concern. Premature mortality from all causes in Wolverhampton is improving All cause age standardised mortality rate for persons aged under 75 England 800 Wolverhampton 2012/14 (DSR 2012/14 (DSR 600 per 100,000) per 100,000) 400

200

rate perrate 100,000 412.4 339.5 0 1995- 1996- 1997- 1998- 1999- 2000- 2001- 2002- 2003- 2004- 2005- 2006- 2007- 2008- 2009- 2010- 2011- 2012- 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 Year Wolverhampton Comparator group England & Wales

Wolverhampton (DSR per 100,000) Wolverhampton (DSR per 100,000) 204 3.9 1995/97 2012/14 2011/13 2012/14 Mortality rates in Under 75s from all causes

All cause age standardised mortality rate for persons aged under 75 Premature mortality rate from all causes (2010-2014) in Wolverhampton 600 in 2010-14 is worst in most deprived 500 areas of Wolverhampton 400 DSR per 100,000 DSR per 100,000 300 200

rate perrate 100,000 528.1 117.7 100 0 2010-2014 0-19.9 20.0-39.9 40.0-59.9 60.0-79.9 80.0-100 Most Least Deprivation quintile (0-19.9 = most deprived to 80.0-100 = least deprived) Deprived Deprived Quintile Wolverhampton Comparator group England & Wales

• In 2010-2014, premature mortality due to all causes is worse in 3 wards of Wolverhampton: Bushbury South and Low Hill, St Peters and Ettingshall.

• In 2010-14, premature mortality due to CHD is lowest in 3 wards: , Tettenhall Wightwick and Wednesfield South. Mortality in persons aged under 75 from Cancer Mortality rates in Under 75s from Cancer

Premature mortality i.e. deaths occurring before a person reaches the age of 75 is a major public health concern. Cancer is one of the leading causes of premature mortality. Premature mortality from Cancer in Wolverhampton is improving

Wolverhampton England (DSR per 2012/14 (DSR per 100,000) 2012/14 100,000) 158.8 141.5

Wolverhampton (DSR per 100,000) Wolverhampton (DSR per 100,000) 44.6 6.4 1995/97 2012/14 2011/13 2012/14 Mortality rates in Under 75s from Cancer

Under 75 mortality rate for All Cancers (Persons) in Premature mortality rate due to all Wolverhampton 2012-2014: Compared to CIPFA nearest cancers in Wolverhampton in 2012-14 is neighbours 250 significantly worse compared to England 200 and West Midlands. 150 100 50 Premature mortality rate due to all DSR DSR per100,000 0 cancers in Wolverhampton is better

compared to 12 of 15 CIPFA nearest

Derby

Bolton

Salford

Walsall

Oldham

England

Sandwell

Coventry

Rochdale Knowsley

Gateshead neighbours.

Rotherham

Nottingham

Kingstonupon…

West Midlands

Stoke-on-Trent

Middlesbrough Wolverhampton

Under 75 Mortality rate from all cancers in Premature mortality rate from all cancers Wolverhampton 2001-03 to 2012-14 by gender in Wolverhampton has been consistently 250 higher in males compared to females. 200

However the gap between males and 150 females has reduced from 56.1 per 100

100,000 to 26.6 per 100,000. DSR per100,000 50

0 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 - 03 - 04 - 05 - 06 - 07 - 08 - 09 - 10 - 11 - 12 - 13 - 14

Male Female Mortality rates in Under 75s from Cancer

Cancers age standardised mortality rate for persons aged under Premature mortality rate for all cancers 75 (2010-2014) in Wolverhampton 200 in 2010-14 is worst in most deprived areas of Wolverhampton 150 DSR per 100,000 DSR per 100,000 100 186 57.1

rate perrate 100,000 50 2010-2014 0 Most Least 0-19.9 20.0-39.9 40.0-59.9 60.0-79.9 80.0-100 Deprived Deprived Deprivation quintile (0-19.9 = most deprived to 80.0-100 = least deprived)

Quintile Wolverhampton Comparator group England & Wales

• In 2010-2014, Premature mortality due to all cancers is worse in 4 wards of Wolverhampton: Bushbury South and Low Hill, St Peters, Ettingshall and . • In 2010-14, premature mortality due to all cancers is lowest in Penn followed by Tettenhall Wightwick and Park Mortality rates in Under 75s from Lung Cancer Premature mortality from lung cancer is an important public health concern in Wolverhampton

Lung Cancer age standardised mortality rate for persons aged under 75 Premature mortality from Lung Cancer in 70 Wolverhampton is improving 60 50 40 Wolverhampton England 30 2012/14 (DSR 2012/14 (DSR 20 per 100,000) per 100,000) rate perrate 100,000 10 0 1995- 1996- 1997- 1998- 1999- 2000- 2001- 2002- 2003- 2004- 2005- 2006- 2007- 2008- 2009- 2010- 2011- 2012- 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 37.2 33.8 Year Wolverhampton Comparator group West Midlands England & Wales

Wolverhampton (DSR per 100,000) Wolverhampton (DSR per 100,000) 13.7 1.7 1995/97 2012/14 2011/13 2012/14 Mortality rates in Under 75s from Lung Cancer

Lung Cancer age standardised mortality rate for persons aged under 75 (2010-14) in Wolverhampton Premature mortality rate for lung cancer 60 in 2010-14 is worst in most deprived 50 areas of Wolverhampton 40 30 DSR per 100,000 DSR per 100,000 20

rate perrate 100,000 10 49.3 16.9 0 0-19.9 20.0-39.9 40.0-59.9 60.0-79.9 80.0-100 2010-2014 Most Least Deprivation quintile (0-19.9 = most deprived to 80.0-100 = least deprived) Deprived Deprived Quintile Wolverhampton Comparator group England & Wales

• In 2010-2014, premature mortality due to lung cancer is worse in 4 wards of Wolverhampton: Bushbury South and Low Hill, St Peters, Ettingshall and Graiseley. • In 2010-14, premature mortality due to lung cancer is lowest in wards of south west: Tettenhall Regis, Park, Tettenhall Wightwick and Merry Hill. Mortality in persons aged under 75 from Cardiovascular diseases Mortality rates in Under 75s from Cardiovascular Diseases

Premature mortality i.e. deaths occurring before a person reaches the age of 75 is a major public health concern. Cardiovascular diseases is one of the leading causes of premature mortality.

Under 75 mortality rate from cardiovascular diseases (Persons) in Wolverhampton from 2001-2003 to 2012- Premature mortality from 2014 200 Cardiovascular diseases in 150 Wolverhampton is improving 100

50 Wolverhampton DSR per100,000 England 0 2012/14 2012/14 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 (DSR per 100,000) (DSR per 100,000) - 03 - 04 - 05 - 06 - 07 - 08 - 09 - 10 - 11 - 12 - 13 - 14 97.4 75.7 Wolverhampton West Midlands England

Wolverhampton (DSR per 100,000) Wolverhampton (DSR per 100,000) 0.5 68.3 2011/13 2012/14 2001/03 2012/14 Mortality rates in Under 75s from Cardiovascular Diseases

Under 75 Mortality rate from all Cardiovascular diseases Premature mortality rate due to all (Persons) in Wolverhampton 2012-14: Compared to cardiovascular diseases in CIPFA nearest neighbours 140 Wolverhampton in 2012-14 is significantly 120 worse compared to England and West 100 80 Midlands. 60 40 20 DSR DSR per100,000 0 Premature mortality rate due to all

cardiovascular diseases in

Derby

Bolton

Salford

Walsall

Oldham

England

Sandwell

Coventry

Rochdale Knowsley

Gateshead Wolverhampton is better compared to 9

Rotherham

Nottingham

Kingstonupon…

West Midlands Stoke-on-Trent

Middlesbrough of 15 CIPFA nearest neighbours. Wolverhampton

Under 75 mortality rate from cardiovascular diseases in Premature mortality rate from Wolverhampton 2001-03 to 2012-14 by gender cardiovascular diseases in Wolverhampton 250 has been consistently higher in males 200 compared to females. 150

100

However the gap between males and DSR per100,000 50 females has reduced dramatically from 0 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 130.8 per 100,000 to 76.2 per 100,000. - 03 - 04 - 05 - 06 - 07 - 08 - 09 - 10 - 11 - 12 - 13 - 14

This has been primarily due to reduction of Male Female mortality rate in males. Mortality rates in Under 75s from Coronary Heart Disease (CHD)

CHD age standardised mortality rate for persons aged under 75 Premature mortality from CHD in

180 Wolverhampton is improving 160 140 120 Wolverhampton England 100 2012/14 (DSR 2012/14 (DSR 80 per 100,000) per 100,000) 60

rate perrate 100,000 40 20 0 1995- 1996- 1997- 1998- 1999- 2000- 2001- 2002- 2003- 2004- 2005- 2006- 2007- 2008- 2009- 2010- 2011- 2012- 52.7 41.9 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 Year

Wolverhampton Comparator group West Midlands England & Wales

Wolverhampton (DSR per 100,000) Wolverhampton (DSR per 100,000) 104.8 3 1995/97 2012/14 2011/13 2012/14 Mortality rates in Under 75s from Coronary Heart Disease (CHD)

CHD age standardised mortality rate for persons aged under 75 Premature mortality rate for CHD in (2010-14) in Wolverhampton 80 2010-14 is worst in most deprived areas of Wolverhampton 60

40 DSR per 100,000 DSR per 100,000

20 rate perrate 100,000 72.5 26.9 0 0-19.9 20.0-39.9 40.0-59.9 60.0-79.9 80.0-100 2010-2014 Deprivation quintile (0-19.9 = most deprived to 80.0-100 = least deprived) Most Least Deprived Deprived Quintile Wolverhampton Comparator group England & Wales

• In 2010-2014, premature mortality due to CHD is worse in 3 wards of Wolverhampton: St Peters, Heath Town and East Park.

• In 2010-14, premature mortality due to CHD is lowest in wards of south west: Tettenhall Regis, Tettenhall Wightwick and Penn. Mortality rates in Under 75s from Stroke

Stroke age standardised mortality rate for persons aged under 75 Premature mortality from Stroke in 50 Wolverhampton is improving 40

30 Wolverhampton England 2012/14 2012/14 20 (DSR per 100,000) (DSR per 100,000)

rate perrate 100,000 10

0 1995- 1996- 1997- 1998- 1999- 2000- 2001- 2002- 2003- 2004- 2005- 2006- 2007- 2008- 2009- 2010- 2011- 2012- 16.6 13.9 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 Year Wolverhampton Comparator group West Midlands England & Wales

Wolverhampton (DSR per 100,000) Wolverhampton (DSR per 100,000) 31.2 1.5 1995/97 2012/14 2011/13 2012/14 Mortality rates in Under 75s from Stroke

Stroke age standardised mortality rate for persons aged under 75 (2010-14) in Wolverhampton Premature mortality rate for Stroke in 25 2010-14 is worst in most deprived areas 20 of Wolverhampton

15 DSR per 100,000 DSR per 100,000 10

rate perrate 100,000 5 22.2 5.5

0 2010-2014 0-19.9 20.0-39.9 40.0-59.9 60.0-79.9 80.0-100 Most Least Deprivation quintile (0-19.9 = most deprived to 80.0-100 = least deprived) Deprived Deprived

Quintile Wolverhampton Comparator group England & Wales

• In 2010-2014, premature mortality due to Stroke is worse in 3 wards of Wolverhampton: Bushbury South and Low Hill, Ettingshall and .

• In 2010-14, premature mortality due to Stroke is lowest in 2 wards: Tettenhall Wightwick and Wednesfield South. Mortality rates in Under 75s from Circulatory Diseases

Circulatory disease age standardised mortality rate for Premature mortality from circulatory persons aged under 75 diseases in Wolverhampton is 300 250 improving 200 Wolverhampton England 150 2012/14 (DSR per 100 2012/14 (DSR

50 per 100,000) 100,000) rate perrate 100,000 0 1995- 1996- 1997- 1998- 1999- 2000- 2001- 2002- 2003- 2004- 2005- 2006- 2007- 2008- 2009- 2010- 2011- 2012- 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 Year 97.7 76.4 Wolverhampton Comparator group West Midlands England & Wales

Wolverhampton (DSR per 100,000) Wolverhampton (DSR per 100,000) 151.1 0.3 1995/97 2012/14 2011/13 2012/14 Mortality rates in Under 75s from Circulatory Diseases

Circulatory disease age standardised mortality rate for persons Premature mortality rate for Circulatory aged under 75 (2010-14) in Wolverhampton diseases in 2010-14 is worst in most 150 deprived areas of Wolverhampton 100 DSR per 100,000 DSR per 100,000

50 rate perrate 100,000 0 133 39.1 0-19.9 20.0-39.9 40.0-59.9 60.0-79.9 80.0-100 Deprivation quintile (0-19.9 = most deprived to 80.0-100 = least deprived) 2010-2014 Most Least Quintile Wolverhampton Comparator group England & Wales Deprived Deprived

• In 2010-2014, premature mortality due to Circulatory diseases is worse in 4 wards of Wolverhampton: Bushbury South and Low Hill, Heath Town, Ettingshall and Bilston East. • In 2010-14, premature mortality due to Circulatory diseaaes is lowest in 3 wards: Tettenhall Regis, Tettenhall Wightwick and Penn Mortality in persons aged under 75 from Liver diseases Mortality rates in Under 75s from Liver diseases Premature mortality i.e. deaths occurring before a person reaches the age of 75 is a major public health concern. Liver diseases is one of the leading causes of premature mortality.

Under 75 mortality rate from liver diseases (Persons) in Premature mortality from Liver Wolverhampton from 2001-2003 to 2012-2014 40 diseases in Wolverhampton is 35 30 getting slightly worse compared to 25 2001/03 20 15

10 DSR DSR per100,000 Wolverhampton England 5 2012/14 (DSR per 2012/14 (DSR 0 100,000) per 100,000) 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 - 03 - 04 - 05 - 06 - 07 - 08 - 09 - 10 - 11 - 12 - 13 - 14 28 17.8 Wolverhampton West Midlands England

(DSR per 100,000) Wolverhampton Wolverhampton (DSR per 100,000) 0.7 0.9 2001/03 2012/14 2011/13 2012/14 Mortality rates in Under 75s from Liver diseases

Premature mortality rate due Toliver disease mortality in Wolverhampton in 2012-14 is significantly worse compared to the England and West Midlands average.

Premature mortality rate due to all liver diseases in Wolverhampton is worse compared to 10 of 15 CIPFA nearest neighbours.

Under 75 mortality rate from liver disease in Premature mortality rate from liver Wolverhampton 2001-03 to 2012-14 by gender 50 diseases in Wolverhampton has been 45 consistently higher in males compared to 40 35 females. However the gap between males 30 25 and females has reduced from 21.6 per 20 15 100,000 to 16.3 per 100,000 DSR per100,000 10 5 0 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 - 03 - 04 - 05 - 06 - 07 - 08 - 09 - 10 - 11 - 12 - 13 - 14

Male Female Alcohol related Mortality rates

Alcohol related age standardised mortality rate for persons all ages 30 Alcohol related mortality in 25 Wolverhampton is getting worse 20 15 Wolverhampton England 10 2012/14 (DSR 2012/14 (DSR

rate perrate 100,000 5 per 100,000) per 100,000) 0 1995- 1996- 1997- 1998- 1999- 2000- 2001- 2002- 2003- 2004- 2005- 2006- 2007- 2008- 2009- 2010- 2011- 2012- 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 Year 17.4 11.6

Wolverhampton Comparator group West Midlands England & Wales

Wolverhampton (DSR per 100,000) Wolverhampton (DSR per 100,000) 3.4 0.6 1995/97 2012/14 2011/13 2012/14 Alcohol related Mortality rates

Alcohol related age standardised mortality rate for persons all ages Alcohol related mortality rate in 2010-14 (2010-2014) in Wolverhampton is worst in most deprived areas of 30 25 Wolverhampton 20 DSR per 100,000 DSR per 100,000 15 10

rate perrate 100,000 5 24.9 4.5 0 0-19.9 20.0-39.9 40.0-59.9 60.0-79.9 80.0-100 2010-2014 Most Least Deprivation quintile (0-19.9 = most deprived to 80.0-100 = least deprived) Deprived Deprived Quintile Wolverhampton Comparator group England & Wales

• In 2010-2014, alcohol related mortality is worse in 3 wards of Wolverhampton: St Peters, Blackenhall and East Park. • In 2010-14, alcohol related mortality is lowest in 4 wards: Tettenhall Wightwick, Oxley, Bushbury North and Mortality in persons aged under 75 from Respiratory Diseases Mortality rates in Under 75s from Respiratory Diseases Respiratory disease is one of the top causes of death in England in under 75s and smoking is the major cause of chronic obstructive pulmonary disease (COPD), one of the major respiratory diseases

Under 75 Mortality rate from respiratory diseases in Premature mortality from Wolverhampton 2001-03 to 2012-14 respiratory disease in 50

Wolverhampton has worsened since 40 2001-03 with peaks and troughs 30 throughout 20 10

Wolverhampton England 0 2012/14 (DSR per 2012/14 (DSR 2001 - 2002 - 2003 - 2004 - 2005 - 2006 - 2007 - 2008 - 2009 - 2010 - 2011 - 2012 - 100,000) per 100,000) 03 04 05 06 07 08 09 10 11 12 13 14 Wolverhampton West Midlands England 45.3 32.6

Wolverhampton (DSR per 100,000) Wolverhampton (DSR per 100,000) 1.2 1.8 2001/03 2012/14 2011/13 2012/14 Mortality rates in Under 75s from Respiratory Diseases

Premature mortality rate from respiratory diseases in Wolverhampton in 2012-14 is significantly worse compared to the England and West Midlands average.

Premature mortality rate from respiratory diseases in Wolverhampton is better compared to 10 of 15 CIPFA nearest neighbours.

Mortality rate in persons aged under 75 from respiratory diseases in Wolverhampton 2001-03 to 2012-14 by Premature mortality rate from respiratory gender 70 diseases in Wolverhampton has been 60 50 consistently higher in males compared to 40 females. However the gap between males 30 20 and females has reduced from 29 per DSR per100,000 10 0 100,000 to 19 per 100,000. 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 - 03 - 04 - 05 - 06 - 07 - 08 - 09 - 10 - 11 - 12 - 13 - 14

Male Female Mortality rates in Under 75s from Respiratory Diseases

Premature mortality from respiratory diseases is worse in North East, South East and Inner City areas of Wolverhampton

•In 2010-2014, premature mortality from respiratory diseases is worse in 3 wards of Wolverhampton: St Peters, Blackbury South and Low Hill and Ettingshall.

•In 2010-14, premature mortality from respiratory diseases is lowest in 5 wards: Tettenhall Wightwick, Tettenhall Regis, Merry Hill, Penn and Wednesfield South. Mortality rate from communicable diseases Mortality rate from Communicable diseases

Prevention of the spread of communicable diseases is an important issue for Public Health. There is evidence that rapid identification, treatment and prevention of spread can reduce mortality.

Communicable diseases are infectious Mortality rate from communicable diseases in diseases transmissible (as from person to Wolverhampton 2001/03 - 2012/14 person) by direct contact with an affected 140 120 individual or individual's discharges or by 100 indirect means (as from a vector). 80 60 These include deaths recorded as following 40

ICD 10 codes DSR per100,000 20 0 • infectious and parasitic diseases A00-B99 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 • Influenza J09-J11 - 03 - 04 - 05 - 06 - 07 - 08 - 09 - 10 - 11 - 12 - 13 - 14 • Pneumonia J12-J18 Wolverhampton West Midlands England

Mortality rate from Communicable diseases in Wolverhampton is improving

Wolverhampton (DSR per 100,000) Wolverhampton England 2012/14 (DSR per 2012/14 (DSR 38.4 100,000) per 100,000) 2001/03 2012/14

28 17.8 3.9 2011/13 2012/14 Mortality rate from Communicable diseases

Mortality rate from communicable diseases (persons) in Wolverhampton 2012-14: Compared to CIPFA nearest Mortality rate from Communicable neighbours diseases in Wolverhampton in 2012-14 is 120 100 better compared to England, West 80 Midlands as well as most of the CIPFA 60 40 nearest neighbours except Walsall. 20

DSR DSR 100,000 per 0

Derby

Bolton

Salford

Walsall

Oldham

England

Sandwell

Coventry

Rochdale

Knowsley

Gateshead

Rotherham

Nottingham

Kingstonupon…

West Midlands

Stoke-on-Trent

Middlesbrough Wolverhampton

Mortality rate from communicable diseases in Wolverhampton has been consistently higher in males compared to females. However the gap between males and females has reduced from 26.6 per 100,000 to 19.1 per 100,000 Mortality rate from causes considered preventable Mortality rate from causes considered preventable The basic concept of preventable mortality is that deaths are considered preventable if, in the light of the understanding of the determinants of health at the time of death, all or most deaths from the underlying cause (subject to age limits if appropriate) could potentially be avoided by public health interventions in the broadest sense.

Mortality rate from causes considered preventable in Wolverhampton 2001-03 to 2012-14

300

250

200

150

100 DSR DSR per100,000 50

0 2001 - 03 2002 - 04 2003 - 05 2004 - 06 2005 - 07 2006 - 08 2007 - 09 2008 - 10 2009 - 11 2010 - 12 2011 - 13 2012 - 14

Wolverhampton West Midlands England

Mortality rate from causes considered preventable in Wolverhampton is improving

Wolverhampton (DSR per 100,000) Wolverhampton England 2012/14 (DSR per 2012/14 (DSR 70.7 100,000) per 100,000) 2001/03 2012/14

213.3 182.7 4.1 2011/13 2012/14 Mortality rate from causes considered preventable

Mortality from causes considered preventable (persons) Mortality rate from all causes considered in Wolverhampton 2012-14: Compared to CIPFA nearest neighbours preventable in Wolverhampton in 2012- 350 14 is significantly worse compared to the 300 250 England and West Midlands average. 200 150 100

50 Mortality rate from all causes considered DSR DSR per100,000

0 preventable in Wolverhampton is better

Derby

Bolton Salford

Walsall compared to 13 of 15 CIPFA nearest

Oldham

England

Sandwell

Coventry

Rochdale

Knowsley

Gateshead Rotherham

Nottingham neighbours.

Kingstonupon…

West Midlands

Stoke-on-Trent

Middlesbrough Wolverhampton

Mortality rate from causes considered preventable in Wolverhampton has been consistently higher in males compared to females. However the gap between males and females has reduced from 189.8 per 100,000 to 128.4 per 100,000 Mortality rate from causes considered preventable

Mortality rates from causes considered preventable in Mortality rate from cardiovascular Wolverhampton 2001-03 to 2012-14 by specific preventable disease considered preventable causes 140 Wolverhampton (DSR per 100,000) 120 53.2 100

80 2001/03 2012/14

60

DSR DSR 100,000 per 40 Mortality rate from cancer 20 considered preventable 0 2001 - 2002 - 2003 - 2004 - 2005 - 2006 - 2007 - 2008 - 2009 - 2010 - 2011 - 2012 - 03 04 05 06 07 08 09 10 11 12 13 14 Wolverhampton (DSR per 100,000) cardiovascular cancer liver disease respiratory disease 23.4 2001/03 2012/14

Mortality rate from liver disease Mortality rate from respiratory considered preventable disease considered preventable

Wolverhampton (DSR per 100,000) Wolverhampton (DSR per 100,000) 2.3 0.1 2001/03 2012/14 2001/03 2012/14 Excess Mortality rate in adults with serious mental illness Excess mortality rate in adults with serious mental illness The Disability Rights Commission has reported on serious inequalities experienced, in terms of reduced life expectancy, by those with severe mental illness. There is extensive published evidence that people with severe mental illness, such as schizophrenia, die between 15 and 25 years earlier than the average for the general population.

The ratio is expressed as a percentage of the observed number of deaths in adults in contact with secondary mental health services to the expected number of deaths in that population based on age- specific mortality rates in the general population of England.

Excess mortality rate in adults with serious mental illness in Wolverhampton is worsening Wolverhampton (ISR) Wolverhampton England 2013/14 (ISR) 2013/14 (ISR) 58.7 2009/10 378.2 351.8 2013/14 48.5 2011/13 2012/14 Excess mortality rate in adults with serious mental illness

Excess mortality rate in adults with serious mental illness in Wolverhampton in 2013-14 is worse compared to England and West Midlands.

Excess mortality rate in adults with serious mental illness in Wolverhampton is worse compared to 8 of 15 CIPFA nearest neighbours. Suicides (and injury of undetermined intent) Suicides (and injury of undetermined intent) Suicide is a significant cause of death in young adults, and is seen as an indicator of underlying rates of mental ill-health.

Suicide age standardised rate in Wolverhampton 2001-03 to 2012-14 16 14 12 10 8 6

4 DSR DSR per100,000 2 0 2001 - 03 2002 - 04 2003 - 05 2004 - 06 2005 - 07 2006 - 08 2007 - 09 2008 - 10 2009 - 11 2010 - 12 2011 - 13 2012 - 14

Wolverhampton West Midlands England

Suicide age standardised mortality rate in Wolverhampton is improving

Wolverhampton (DSR per 100,000) Wolverhampton England 2012/14 (DSR per 2012/14 (DSR 2.5 100,000) per 100,000) 2001/03 2012/14

8.8 8.9 0.3 2011/13 2012/14 Suicides (and injury of undetermined intent)

Suicide rate in Wolverhampton in 2012-14 is better compared to the England and West Midlands average.

Suicide rate in Wolverhampton is better compared to 12 of 15 CIPFA nearest neighbours.

Age standardised rate of suicides in Suicide age standardised rate in Wolverhampton 1995- Wolverhampton has been consistently 97 to 2012-14 by gender higher in males compared to females. 20 15 Gap between rate of suicides in males and 10

females has increased from 3.3 in 1995/97 5 rate perrate 100,000 to 13.7 in 2004/06 and started reducing 0

thereafter to 6.0 in 2009/10. However it

2004-2006 1996-1998 1997-1999 1998-2000 1999-2001 2000-2002 2001-2003 2002-2004 2003-2005 2005-2007 2006-2008 2007-2009 2008-2010 2009-2011 2010-2012 2011-2013 2012-2014 has started increasing again and has 1995-1997 reached 12.7 in 2012/14. Female Male Suicides (and injury of undetermined intent)

Suicide age standardised mortality rate for persons aged 15+ (2010- Suicide age standardised rate in 2010-14 2014) in Wolverhampton 14 is worst in most deprived areas of 12 Wolverhampton 10 8 DSR per 100,000 DSR per 100,000 6 4

rate perrate 100,000 2 11.7 8.3 0 0-19.9 20.0-39.9 40.0-59.9 60.0-79.9 80.0-100 2010-2014 Most Least Deprivation quintile (0-19.9 = most deprived to 80.0-100 = least deprived) Deprived Deprived Quintile Wolverhampton Comparator group England & Wales

• In 2010-2014, suicide age standardised mortality rate is worse in 4 wards of Wolverhampton: Bushbury South and Low Hill, Park, Graiseley and Ettingshall

• In 2010-14, suicide age standardised mortality rate is lowest in 3 wards: Tettenhall Wightwick, Oxley and Bushbury North Deaths attributable to smoking Deaths attributable to Smoking Smoking remains the biggest single cause of preventable mortality and morbidity in the world. It still accounts for 1 in 6 of all deaths in England, and there exist huge inequalities in smoking related deaths: areas with the highest death rates from smoking are about three times as high than areas with the lowest death rates attributable to smoking.

Smoking attributable mortality rate in Wolverhampton is improving

Wolverhampton England 2012/14 (DSR per 2012/14 (DSR 100,000) per 100,000) 307.3 274.8

Wolverhampton (DSR per 100,000) Wolverhampton (DSR per 100,000) 20.7 0.6 2007/09 2012/14 2011/13 2012/14 Deaths attributable to Smoking

Smoking attributable mortality rate from heart disease has reduced from 41.5 per 100,000 in 2007/09 to 37.2 per 100,000 in 2012/14.

Similar pattern has been observed for smoking attributable mortality rate from stroke which has reduced from 14.7 per 100,000 in 2007/09 to 11.8 in 2012/14

Smoking Attributable mortality rate (DSR) in Smoking Attributable mortality rate in Wolverhampton 2012-14: compared to CIPFA nearest Wolverhampton in 2012-14 is significantly neighbours 500 worse compared to the England and West 400 Midlands average. 300 200 100 Smoking attributable mortality rate in DSR per100,000 0

Wolverhampton is better compared to 13

Derby

Bolton

Salford

Walsall

Oldham

England

Sandwell

Coventry Rochdale

of 15 CIPFA nearest neighbours. Knowsley

Gateshead

Rotherham

Nottingham

Kingstonupon…

West Midlands

Stoke-on-Trent

Middlesbrough Wolverhampton Excess Winter Deaths Excess Winter Deaths Excess Winter Deaths Index (EWD Index) is the excess winter deaths measured as the ratio of extra deaths from all causes that occur in the winter months compared with the expected number of deaths, based on the average of the number of non-winter deaths.

Excess winter deaths (all ages) in Wolverhampton 2001/04 to 2011/14 Excess Winter deaths index (all 30 25 ages) in Wolverhampton is 20 15 improving Ratio 10 5 0 Aug Aug Aug Aug Aug Aug Aug Aug Aug Aug Aug Wolverhampton England 2001 - 2002 - 2003 - 2004 - 2005 - 2006 - 2007 - 2008 - 2009 - 2010 - 2011 - Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul 2011/14 (Ratio) 2011/14 (Ratio) 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 16.2 15.6 Wolverhampton West Midlands England

Wolverhampton (Ratio) Wolverhampton (Ratio) 0 4.6 2001/04 2011/14 2010/13 2011/14 Excess Winter Deaths

Excess Winter deaths index (all ages) in Wolverhampton in 2012-14 is better compared to the England and West Midlands average.

Excess winter deaths index in Wolverhampton is better compared to 12 of 15 CIPFA nearest neighbours.

Excess Winter Deaths Index (all ages) in Wolverhampton Excess winter deaths index in 2001/04 to 2011/14 by gender Wolverhampton has been consistently 30 25 higher in females compared to males. 20

However the gap between males and 15 Ratio females has reduced from 5.6 in 2001/04 10 to 2.1 in 2011/14. 5 0 Aug Aug Aug Aug Aug Aug Aug Aug Aug Aug Aug 2001 - 2002 - 2003 - 2004 - 2005 - 2006 - 2007 - 2008 - 2009 - 2010 - 2011 - Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

Male Female Excess Winter Deaths in persons aged 85+

Excess winter deaths index in persons aged 85+ in Wolverhampton 2001/04 to 2011/14 40 35 Excess Winter deaths index in 30 25 20

persons aged 85+ in Ratio 15 10 Wolverhampton is fluctuating 5 0 Aug Aug Aug Aug Aug Aug Aug Aug Aug Aug Aug 2001 - 2002 - 2003 - 2004 - 2005 - 2006 - 2007 - 2008 - 2009 - 2010 - 2011 - Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Wolverhampton England 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2011/14 (Ratio) 2011/14 (Ratio) Wolverhampton West Midlands England 19.5 22.3

Wolverhampton (Ratio) Wolverhampton (Ratio) 2.1 5.7 2001/04 2011/14 2010/13 2011/14 Excess Winter Deaths in persons aged 85+

Excess Winter deaths index (all ages) in Wolverhampton in 2012-14 is better compared to the England and West Midlands average.

Excess winter deaths index in Wolverhampton is better compared to 12 of 15 CIPFA nearest neighbours.

Excess winter deaths index in Wolverhampton has been consistently higher in females compared to males till 2009/12 and since then the trend has reversed. What does this information tell us? • Premature mortality from cancer, cardiovascular diseases, communicable diseases, causes considered preventable, suicide and smoking attributable mortality in Wolverhampton is improving. • Premature mortality from liver diseases has worsened from 2001/03 to 2005/07; however the trend has reversed and is now improving. • Premature mortality from respiratory diseases has worsened since 2001/03; however it has seen a slight drop in the last year. • Excess mortality rate in adults with serious mental illness is worsening. • Excess winter deaths index in persons aged 85+ is worsening. • Premature mortality is consistently higher in males compared to females with an exception of suicides and excess winter deaths. • The gap between males and females for all causes of premature mortality is reducing, with the exception of suicides. • Premature mortality from causes considered preventable is improving; however premature mortality from liver and respiratory diseases considered preventable is increasing. Indicative Commissioning needs

• Overall, premature mortality rates for the majority of conditions in Wolverhampton is worse than the England average. Lifestyle risk factors such as smoking, obesity and alcohol misuse are major contributors to the rate of premature mortality. Commissioned services need to focus on promoting healthier lifestyles and preventing the development of long term conditions that lead to premature mortality. • This can be achieved through training service providers to Make Every Contact Count5 across health, social care and the voluntary sector

5Making Every Contact Count is using daya to day interactions to support people in making positive lifestyle changes. See - https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/515949/Making_Every_Contact_Count_Consensus_Statement.pdf Important terms

1. Directly standardised rate (DSR): The DSR for an area is the number of deaths, usually expressed per 100,000, that would occur in that area if it had the same age structure as the standard population and the local age-specific rates of the area applied. Directly standardised mortality rate is calculated by dividing the number of deaths by the actual local population in a particular age group multiplied by the standard population for that particular age group and summing across the relevant age groups. The rate is usually expressed per 100,000.

2. Indirectly Standardised rate (ISR) or (Standardised Mortality Ratio (SMR) An SMR is essentially a comparison of the number of the observed deaths in a population with the number of expected deaths if the age-specific death rates were the same as a standard population. It is expressed as a ratio of observed to expected deaths, multiplied by 100. SMRs equal to 100 imply that the mortality rate is the same as the standard mortality rate. A number higher than 100 implies an excess mortality rate whereas a number below 100 implies below average mortality.

A SMR is calculated as the number of deaths observed within an area divided by the expected number of deaths within that area. This ratio is then multiplied by 100. To arrive at the expected number of deaths, for each age group, the standard age-specific death rate is multiplied by the local population in that age group. The number of expected deaths in each age group are then summed across all ages to arrive at the expected number of deaths for the local population. References

1. Public Health Outcomes Framework Accessed at http://www.phoutcomes.info/ 2. Public Health Mortality Database 3. Office of National Statistics (ONS) Accessed at https://www.ons.gov.uk/

Picture Credits a. Baby created by Saeed Farrahi, IR from The Noun Project b. Scales created by Aldric Rodriguez Iborra, ES from The Noun Project c. Fetus created by Anbileru Adaleru from The Noun Project d. No Smoking created by AIGA Collection from The Noun Project e. Obesity created by Piger, GB from The Noun Project f. Pregnant created by Gerardo Martin Martinez from The Noun Project g. DNA created by Isabel Foo, CA from The Noun Project h. Nurse created by Bridget Gahagan from the Noun Project i. Front cover picture from www.rediff.com References (cont)

Picture Credits j. Death Benefit created by Timothy Miller, US from the Noun Project k. Cancer created by Martha Ormiston, US from the Noun Project l. Heart created by PJ Witsakorn from the Noun Project m. Liver created by Icon 54 from the Noun Project n. No drink created by Nikita Kozin, RU from the Noun Project o. Lungs created by Healthcare Symbols collection from the Noun Project p. Infectious disease by Health care Symbols Collection from the Noun Project q. Public Health clinic created by Iconathon US from the Noun Project References (Contd.) r. Liver created by Icon 54 from the Noun Project s. Heart created by PJ Witsakorn from the Noun Project t. Cancer created by Martha Ormiston, US from the Noun Project u. Lungs created by Healthcare Symbols collection from the Noun Project v. Mental Health created by Healthcare Symbols collection from the Noun Project w. No Smoking created by AIGA Collection from the Noun Project