Director of Public Health Annual Report: Chart Book

Director of Public Health Annual Report: Chart Book

Published July 2011 Director of Public Health Annual Report: Chart Book Contents

1 INTRODUCTION ...... 1

2 DEMOGRAPHY ...... 2 2.1 Demography: key points ...... 2 2.2 Population ...... 4 2.2.1 Population by age and sex ...... 4 2.2.2 Population aged under 18 ...... 5 2.2.3 Population aged 75 and over ...... 8 2.2.4 Population aged 85 and over ...... 11 2.3 Population projections ...... 13 2.3.1 Population projections by age group ...... 13 2.3.2 Population projections, persons aged 75 and over ...... 14 2.3.3 Population projections, persons aged 85 and over ...... 15 2.4 Births ...... 16 2.4.1 General fertility rate ...... 16 2.5 Deaths ...... 19 2.5.1 All-cause mortality ...... 19 2.5.2 All-cause mortality, aged under 75 ...... 22

3 DETERMINANTS OF HEALTH ...... 26 3.1 Determinants of health: key points ...... 26 3.2 Wider determinants of health ...... 27 3.2.1 Deprivation in relation to Wales ...... 27 3.2.2 Deprivation within the health board ...... 28 3.2.3 Inequality in all-cause mortality ...... 29 3.3 Lifestyle factors ...... 30 3.3.1 Smoking as reported by adults ...... 30 3.3.2 Binge drinking as reported by adults ...... 31 3.3.3 Five or more fruit or vegetables a day as reported by adults32 3.3.4 Physical activity as reported by adults ...... 33 3.3.5 Overweight and obesity, adults based on self reported data 34

4 USE OF SERVICES ...... 35 4.1 Use of services: key points ...... 35 4.2 Prevention services: vaccination uptake ...... 37 4.2.1 Childhood immunisations ...... 37 4.2.2 Seasonal influenza vaccination ...... 41 4.3 Population Based National Screening Programmes in Wales ... 43 4.3.1 Uptake of national screening programmes in Wales ...... 43 4.4 Primary care services ...... 44 4.4.1 Use of primary care as reported by adults ...... 44 4.5 Use of secondary and tertiary care ...... 45 4.5.1 Hospital admissions: individuals aged under 75 ...... 45 4.5.2 Emergency hospital admissions: individuals aged under 75 . 48 4.5.3 Elective hospital admissions: individuals aged under 75 ..... 51 Director of Public Health Annual Report: Chart Book

5 HEALTH STATUS ...... 54 5.1 Health status: key points ...... 54 5.2 Physical and mental health ...... 57 5.2.1 Low birth weight ...... 57 5.2.2 Physical health as reported by adults* ...... 60 5.2.3 Mental health as reported by adults* ...... 61 5.2.4 Limiting long term illness as reported by adults ...... 62 5.2.5 Mental illness as reported by adult ...... 63 5.3 Mortality from specific conditions ...... 64 5.3.1 Mortality from circulatory disease, all ages ...... 64 5.3.2 Mortality from circulatory disease, under 75s ...... 67 5.3.3 Mortality from coronary heart disease ...... 70 5.3.4 Mortality from cancer ...... 73 5.3.5 Mortality from respiratory disease ...... 76 5.3.6 Cancer survival ...... 79

APPENDIX A: ORIGINAL SOURCE REPORTS AND FURTHER INFORMATION ...... 82

APPENDIX B: GLOSSARY ...... 83

APPENDIX C: MAPS SHOWING MIDDLE SUPER OUTPUT AREAS IN THE ABERTAWE BRO MORGANNWG UHB AREA ...... 84

© 2011 Public Health Wales NHS Trust. Material contained in this document may be reproduced without prior permission provided it is done so accurately and is not used in a misleading context. Acknowledgement to Public Health Wales NHS Trust to be stated. Copyright in the typographical arrangement, design and layout belongs to Public Health Wales NHS Trust. Director of Public Health Annual Report: Chart Book

1 Introduction

This chart book has been produced by the Public Health Wales Observatory as an appendix to the Director of Public Health Annual Report.

It updates and adds to the chart book produced by the Director of Public Health for Abertawe Bro Morgannwg University Health Board (UHB) for his Interim Annual Report. A decision was made by the Wales Directors of Public Health to use these indicators to inform their annual reports.

The Abertawe Bro Morgannwg UHB chart book indicators originated from a number of sources: Public Health Wales Observatory Vaccine Preventable Disease Programme (Public Health Wales) Screening Division (Public Health Wales) Welsh Cancer Intelligence and Surveillance Unit (Public Health Wales)

This updated chart book draws together information from the above resources and adds new information sourced from:

The Public Health Wales Observatory: Director of Public Health Annual Report: supporting indicators, 2011 Demography Profile, 2009 Lifestyle Profile, 2010 Inequalities in mortality in Abertawe Bro Morgannwg University Health Board: interim release to support Directors of Public Health annual reports

From other sources: Welsh Health Survey, Welsh Assembly Government (repackaged by the Public Health Wales Observatory) Public Health Wales, Vaccine Preventable Disease Programme Screening Division (Public Health Wales) Welsh Cancer Surveillance and Intelligence Unit (Public Health Wales)

The indicators have been presented under the following chapter headings: demography; determinants of health; use of services and health status. A summary of key points is included at the beginning of each chapter.

Maps included in this document show data by fifths of equal range within the health board area.

Included in Appendix A are web links for the original source reports and further information to support the used in this chart book.

A glossary of some of the terms used in this chart book is included in Appendix B.

Appendix C comprises of a series of local authority area maps showing the MSOA boundaries for the health board area.

1

Director of Public Health Annual Report: Chart Book 2 Demography

2.1 Demography: key points

Population structure

The population of Abertawe Bro Morgannwg UHB is estimated to have been 503 thousand in 2009. Close to 50 per cent of the Abertawe Bro Morgannwg UHB population live in the Swansea local authority area.

The age structure of the population is similar to Wales but with slightly lower proportions of persons aged under 18 years. At middle super output area level (MSOA), higher proportions of persons aged under 18 are found in Townhill; Penlan and Penderry in Swansea, as well as in parts of the south of Neath and the town of Bridgend. The areas with the lowest proportions are in the Brynmill and Sandfields areas in Swansea.

The large student population in Swansea contributes to a higher proportion aged 20 to 24 years than the Wales average.

Among the older age groups the proportion aged 75 and over is about the same as Wales. Within the health board, Bridgend has a lower proportion than Neath Port Talbot or Swansea. At the MSOA level, the highest proportions are found in the Gower, Mumbles, West Cross and Sketty areas of Swansea and in Porthcawl. The pattern is very similar in those aged 85 and over.

Population projections

The latest projections indicate that if current trends continue, the number of persons aged 65 and over resident in Abertawe Bro Morgannwg UHB will increase by 55 per cent between 2008 and 2033. The proportion aged 75 and over is projected to increase from around eight or nine per cent at local authority level to around 12 t 15 per cent over this period, the sharpest increases being in Bridgend and Neath Port Talbot. The percentage aged 85 and over is projected to double from around 2.5 percent to around five per cent by 2033.

The increase in the number of older people is likely to be associated with a rise in chronic conditions whose prevalence is strongly age-related such as circulatory and respiratory diseases and cancers. Meeting the needs of these individuals will be a key challenge for the health board. In the current economic climate, the relative (and absolute) increase in economically dependent and, in some cases, care-dependent populations will pose particular challenges to communities.

Birth rate

The General Fertility Rate (GFR) for Abertawe Bro Morgannwg UHB is almost identical to the rate for Wales and there is little variation across the local authorities within the health board although the rate for Swansea is slightly lower than Wales. At the MSOA level, there is

2

Director of Public Health Annual Report: Chart Book considerable variation. Rates are particularly low in areas of Swansea where there are high numbers of students (Brynmill, Uplands, Sketty and Killay). The areas with the highest rates are in the Townhill, Landore, Birchgrove, Mynydd Bach and Penderry areas of Swansea; and in Cornelly, Nantyffyllon and parts of the town of Bridgend.

All-cause mortality

The European age-standardised all-cause mortality rate takes into account the age structure of the population, allowing valid comparisons to be made between areas. The rate for Abertawe Bro Morgannwg UHB is higher than Wales. Within the health board, rates are higher in Neath Port Talbot and Bridgend. At the MSOA level, variation is considerable with rates ranging from 438 to 914 per 100,000 population. The lowest rates are found in the south-western suburbs of Swansea and the Gower; the highest rates are found in the Tondu and Nantyffyllon areas of Bridgend and the Landore and Townhill areas of Swansea. Among persons aged under 75 years the pattern is similar. The health board exhibits a decreasing trend in mortality in persons under 75 years from 2000 to 2009 which is generally in line with the all Wales pattern.

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Director of Public Health Annual Report: Chart Book

2.2 Population

2.2.1 Population by age and sex

Wales and Abertawe Bro Morgannwg University Health Board

Proportion of population by age and sex Abertawe Bro Morgannwg University Health Board: 2009 Produced by the Public Health Wales Observatory using data from 2009 mid year population estimates, Office for National Statistics

Abertawe Bro Morgannwg females Abertawe Bro Morgannwg males Wales females Wales males 85+ 80-84 75-79 70-74 65-69 60-64 55-59 50-54 45-49 40-44 35-39 30-34 25-29 20-24 15-19 10-14 05-09 00-04

12 10 8 6 4 2 0 2 4 6 8 10 12 Proportion (%) of population

4

Director of Public Health Annual Report: Chart Book

2.2.2 Population aged under 18

Middle super output areas

5

Director of Public Health Annual Report: Chart Book

Percentage of population aged under 18 in Abertawe Bro Morgannwg University Health Board area, 2009 Produced by Public Health Wales Observatory, using data from ONS (MYE)

Swansea Neath Port Talbot

011 29.1 012 25.1 019 27.5 011 22.8 006 23.7 019 22.2 013 23.6 016 21.7 010 23.3 005 21.3 001 22.5 001 21.1 004 22.1 014 21.1 015 22.1 007 21.0 014 21.8 017 20.9 005 21.1 004 20.9

008 21.0 MSOA 013 20.8 021 20.5 006 20.7 017 20.4 018 20.6 002 20.3 002 20.5 016 20.1 010 20.5 020 20.0 003 20.4

MSOA 012 19.8 009 18.7 003 19.8 015 18.0 Neath Port Talbot % = 20.8 018 19.6 008 16.8 007 19.4 % under 18 009 18.5 022 18.3 Bridgend 029 17.7 017 26.9 028 17.4 001 24.0 030 17.2 010 031 16.4 23.4 004 023 15.5 23.2 016 024 14.2 23.2 027 13.6 Swansea 015 22.6 % = 19.6 026 9.3 007 21.6 025 8.1 002 21.6 % under 18 003 21.6 005 21.4

MSOA 008 21.3 009 21.2 012 21.0 013 20.1 014 19.6 006 19.6 019 18.4 Bridgend % 011 17.8 = 21.4 018 16.8 % under 18

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Director of Public Health Annual Report: Chart Book

Local authorities

Percentage of population aged under 18 by local authority, 2009 Produced by Public Health Wales Observatory, using data from ONS (MYE)

Wales = 21.0%

23.2%

22.4%

22.3% 22.2%

21.8%

21.5% 21.5%

21.4% 21.4% 21.4%

21.2% 21.1%

20.8%

20.6% 20.7%

20.6%

20.3%

20.2% 20.2%

19.9%

19.6%

17.6%

Powys Cardiff

Conwy

Torfaen

Newport

Bridgend

Flintshire

Swansea

Gwynedd

Wrexham

Caerphilly

Ceredigion

Denbighshire

Merthyr Tydfil Merthyr

Pembrokeshire

Blaenau Gwent Blaenau

Monmouthshire

Isle of Anglesey of Isle

Carmarthenshire Neath Port Talbot Port Neath

Areas ordered geographically from north west to south east RhonddaTaff Cynon

The Vale of Glamorgan of Vale The

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Director of Public Health Annual Report: Chart Book

2.2.3 Population aged 75 and over

Middle super output areas

8

Director of Public Health Annual Report: Chart Book

Percentage of population aged 75 and over in Abertawe Bro Morgannwg University Health Board area, 2009 Produced by Public Health Wales Observatory, using data from ONS (MYE)

Swansea Neath Port Talbot

028 16.8 008 12.4 022 15.1 016 11.3 031 14.8 015 10.4 029 14.7 003 9.9 027 14.5 013 9.4 030 11.8 010 9.2 023 10.2 017 9.2 009 9.8 006 8.8 001 9.4 018 8.7 018 9.3 011 8.6

017 9.1 MSOA 005 8.6 025 8.8 007 8.4 005 8.6 001 8.3 012 8.5 004 8.2 014 8.5 014 7.9 015 8.3 009 7.8

MSOA 020 8.3 002 7.8 024 8.3 012 6.3 Neath Port Talbot % = 8.9 026 8.2 019 6.2 002 8.1 % 75 and over 007 8.0 008 7.5 Bridgend 021 7.5 018 16.1 003 7.3 019 11.4 013 6.9 013 9.7 016 6.7 011 9.4 019 6.1 012 010 5.8 Swansea 9.1 % = 9.0 006 004 5.6 8.9 014 011 5.5 8.6 006 4.9 002 8.1 010 7.8 % 75 and over 005 7.8

MSOA 008 7.6 003 7.5 009 7.2 017 6.2 001 6.0 004 5.9 007 5.8 Bridgend % 015 4.8 = 8.1 016 4.6 % 75 and over

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Director of Public Health Annual Report: Chart Book

Local authorities

Percentage of population aged 75 and over by local authority, 2009 Produced by Public Health Wales Observatory, using data from ONS ( MYE)

Wales = 8.6%

11.9%

10.6%

10.2%

9.8%

9.7% 9.7% 9.7%

9.6% 10.0%

8.9%

8.9% 8.8%

8.5%

8.2%

8.1%

7.9% 7.9% 7.9%

7.7%

7.5%

7.4%

6.7%

Powys Cardiff

Conwy

Torfaen

Newport

Bridgend

Flintshire

Swansea

Gwynedd

Wrexham

Caerphilly

Ceredigion

Denbighshire

Merthyr Tydfil Merthyr

Pembrokeshire

Blaenau Gwent Blaenau

Monmouthshire

Isle of Anglesey of Isle

Carmarthenshire Neath Port Talbot Port Neath

Areas ordered geographically from north west to south east RhonddaTaff Cynon

The Vale of Glamorgan of Vale The

10

Director of Public Health Annual Report: Chart Book

2.2.4 Population aged 85 and over

Middle super output areas

11

Director of Public Health Annual Report: Chart Book

Percentage of population aged 85 and over in Abertawe Bro Morgannwg University Health Board area, 2009 Produced by Public Health Wales Observatory, using data from ONS (MYE) Isle of Anglesey

MSOA Health Board (2.5%) Wales (2.5%) Local Authority

0.0 Swansea 2.0 4.0 6.0 Neath Port8.0 Talbot 10.0 12.0

028 008 008 748 5.1 3.7 005 3.5031 5.1 016 3.2 002 3.2022 4.8 010 2.9 004 2.7029 4.7 018 2.9 007 2.5027 4.2 003 2.8

006msoa 2.4030 3.4 013 2.8 001 2.4 005 3.1 004 2.7 009 2.3 001 2.9 015 2.7 003 1.8 026 2.9 017 2.7 0.0 009 2.02.7 4.0 6.0 005 8.0 2.5 10.0 12.0

023 2.6 MSOA 009 2.5 024 2.5 001 2.5 025 2.5 011 2.5 014 2.4 014 2.3 012 2.4 002 2.1 017 2.4 006 2.0

MSOA 002 2.3 007 2.0 018 2.3 019 1.8 Neath Port Talbot % = 2.6 015 2.3 012 1.5 007 2.0 % 85 and over 013 1.9 008 1.9 Bridgend 003 1.8 018 5.3 020 1.8 006 3.3 016 1.7 019 3.2 011 1.7 011 2.6 021 1.7 012 004 1.4 2.4 010 2.4 019 1.4 Swansea 014 006 1.4 % = 2.6 2.3 010 1.3 013 2.3 % 85 and over 003 2.2 008 2.2

MSOA 002 2.1 005 1.8 017 1.7 009 1.7 001 1.6 004 1.4 016 1.3 Bridgend % 015 1.1 = 2.2 007 0.9 % 85 and over

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Director of Public Health Annual Report: Chart Book

2.3 Population projections

2.3.1 Population projections by age group

Abertawe Bro Morgannwg University Health Board

2008-based population projections for Abertawe Bro Morgannwg University Health Board, persons: 2008 to 2033 Produced by the Public Health Wales Observatory, using data from the Welsh Assembly Government

0-15 16-24 25-44 45-64 65+ 60

50

40

30

20

10

0 Percentage change from 2008from changePercentage -10

-20

2012 2013 2014 2015 2016 2017 2018 2025 2026 2027 2028 2029 2030 2031 2008 2009 2010 2011 2019 2020 2021 2022 2023 2024 2032 2033

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Director of Public Health Annual Report: Chart Book

2.3.2 Population projections, persons aged 75 and over

Local authorities within Abertawe Bro Morgannwg University Health Board*

Projected population, 2008-2033, % aged 75 and over Produced by Public Health Wales Observatory, using data from the Welsh Assembly Government

Swansea Neath Port Talbot Bridgend Wales

15

14

13

12

11 % 10

9

8

7

6

2008 2010 2011 2014 2015 2017 2018 2021 2022 2025 2026 2028 2029 2032 2033 2009 2012 2013 2016 2019 2020 2023 2024 2027 2030 2031

* Y-axis is truncated

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Director of Public Health Annual Report: Chart Book

2.3.3 Population projections, persons aged 85 and over

Local authorities within Abertawe Bro Morgannwg University Health Board*

Projected population, 2008-2033, % aged 85 and over Produced by Public Health Wales Observatory, using data from the Welsh Assembly Government Swansea Neath Port Talbot Bridgend Wales

6.0

5.5

5.0

4.5

4.0 %

3.5

3.0

2.5

2.0

2008 2009 2012 2013 2015 2016 2017 2019 2020 2021 2023 2024 2025 2027 2028 2031 2032 2010 2011 2014 2018 2022 2026 2029 2030 2033

* Y-axis is truncated

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Director of Public Health Annual Report: Chart Book

2.4 Births

2.4.1 General fertility rate

Middle super output areas

Numbers on map indicate MSOAs with a rate statistically significantly higher than the all Wales rate.

16

Director of Public Health Annual Report: Chart Book

General fertility rate per 1,000 in Abertawe Bro Morgannwg University Health Board area, females aged 15-44, 2006-08 Produced by Public Health Wales Observatory, using data from ONS (ADBE, MYE)

Swansea Neath Port Talbot

019 81 018 70 011 80 017 69 013 77 013 67 016 74 011 64 006 73 012 64 010 72 008 63 014 66 002 62 008 66 019 60 021 65 010 60

015 64 001 59 MSOA 017 64 016 59 009 64 015 59 002 62 014 57 029 62 005 57 028 61 006 57 001 60 003 56

MSOA 004 58 004 53 Neath Port Talbot 031 58 007 49 GFR = 59 003 57 009 43 005 57 GFR 030 55 018 54 Bridgend 012 52 014 76 022 48 010 74 007 47 017 72 020 47 001 70 024 37 007 68 025 34 004 66 027 32 Swansea 006 65 023 28 GFR = 58 015 62 026 26 003 61 GFR 002 60

MSOA 009 59 016 59 008 57 012 56 005 56 011 55 019 51 Bridgend 013 45 GFR = 62 018 43 GFR

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Director of Public Health Annual Report: Chart Book

Local authorities

General fertility rate per 1,000, by local authority, 2006-08 95% confidence Produced by Public Health Wales Observatory, using data from ONS (ADBE, MYE) interval

Wales = 59.7

66.0

64.3

64.2

62.8 62.8

62.3

62.0

61.5

61.0

60.4

60.3

60.2

59.9

59.8

59.8

59.4

58.5

58.2

57.9

57.5

56.9

41.3

Powys

Cardiff

Conwy

Torfaen

Newport

Swansea

Bridgend

Flintshire

Gwynedd

Wrexham

Caerphilly

Ceredigion

Denbighshire

Merthyr Tydfil Merthyr

Pembrokeshire

Blaenau GwentBlaenau

Monmouthshire

Isle of AngleseyofIsle

Carmarthenshire

Neath Port TalbotNeathPort RhonddaTaff Cynon

Areas ordered geographically from north west to south east The Vale ofGlamorgan Vale The

18

Director of Public Health Annual Report: Chart Book 2.5 Deaths

2.5.1 All-cause mortality

Middle super output areas

Numbers on map indicate MSOAs with a rate statistically significantly higher than the all Wales rate.

19

Director of Public Health Annual Report: Chart Book

All-cause mortality in Abertawe Bro Morgannwg University Health Board area, all persons, 2004-08, European age-standardised rates per 100,000 Produced by Public Health Wales Observatory, using data from ONS (ADDE, MYE)

Swansea Neath Port Talbot

019 825 011 798 016 819 016 747 011 817 005 742 021 807 012 741 014 806 008 737 017 025 791 721 002 001 736 701 013 726 004 692 012 706 018 690

010 699 010 685 MSOA 026 692 014 677 006 689 013 675 018 674 019 663 008 671 001 641 009 024 660 637 003 005 654 595

MSOA 007 017 636 552 Neath Port Talbot 009 015 503 630 EASR = 667 006 022 612 480 029 610 EASR per 100,000 004 606 002 602 Bridgend 007 598 006 914 015 596 001 851 003 567 010 814 020 491 007 781 030 481 014 765 031 476 003 755 028 472 Swansea 004 711 027 469 EASR = 636 002 708 023 438 005 EASR per 100,000 702 019 692

MSOA 008 677 012 650 016 635 009 628 018 608 015 590 017 584 Bridgend 013 543 EASR = 684 011 508 EASR per 100,000

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Director of Public Health Annual Report: Chart Book

Local authorities

All cause mortality by local authority, all persons, 2004-08, European 95% confidence age-standardised rates per 100,000 interval Produced by Public Health Wales Observatory, using data from ONS (ADDE, MYE)

Wales = 635.1

751.9

741.7

708.5

697.9

684.2

666.7

651.7

644.7

636.6

636.2

636.1

635.3

620.0

619.7

618.5

611.8

611.3

597.0

595.6

550.3

533.2

516.6

Powys

Cardiff

Conwy

Torfaen

Newport

Swansea

Bridgend

Flintshire

Gwynedd

Wrexham

Caerphilly

Ceredigion

Denbighshire

Merthyr Tydfil Merthyr

Pembrokeshire

Blaenau GwentBlaenau

Monmouthshire

Isle of AngleseyofIsle

Carmarthenshire

Neath Port Talbot NeathPort RhonddaTaff Cynon Areas ordered geographically from north west to south east The Vale ofGlamorgan Vale The

21

Director of Public Health Annual Report: Chart Book

2.5.2 All-cause mortality, aged under 75

Middle super output areas

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Director of Public Health Annual Report: Chart Book

All-cause mortality in Abertawe Bro Morgannwg University Health Board area, persons aged under 75 years, 2004-08, European age-standardised rates per 100,000 Produced by Public Health Wales Observatory, using data from ONS (ADDE, MYE) Isle of Anglesey MSOA EASR with 95% confidence intervalMSOA Health Board (EASR = 342) Wales (EASR = 331) Local Authority

0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0 80.0 90.0 100.0 Swansea Neath Port Talbot 003 748 016 025007 366.5 525 458 019006 345.6 524 012 444 001 011 328.9 496 011 435 009 320.7 021 462 017 426 004msoa 303.5 016 457 008 407 002 240.5 013 389 026005 226.1 436 014008 213.6 417 005 380 001 002 369 0.0 404100.0 200.0 300.0 400.0 500.0 600.0 700.0 800.0 010 363 014 362 008 353 004 347

013 352 MSOA 010 344 017 347 018 337 005 347 019 323 012 341 003 311 002 324 001 305 024 322 007 268

MSOA 029 321 009 262 009 318 015 236 Neath Port Talbot EASR = 349 015 317 006 223 006 316 EASR per 100,000 004 314 022 304 Bridgend 007 296 001 499 018 287 006 483 003 259 014 465 023 217 012 394 028 211 010 392 027 210 003 389 020 208 007 378 031 203 Swansea EASR = 331 019 377 030 200 008 EASR per 100,000 370 004 370

MSOA 002 354 005 322 016 318 011 307 017 299 018 287 009 280 015 276 Bridgend EASR = 352 013 238 EASR per 100,000

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Director of Public Health Annual Report: Chart Book

Local authorities

All cause mortality by local authority, persons aged under 75 years, 95% confidence 2004-08, European age-standardised rates per 100,000 interval Produced by Public Health Wales Observatory, using data from ONS (ADDE, MYE)

Wales = 331

416

404

380

373

352

349

346

342

332

331

331

330

327

319

318

317

312

310

296

269

263

262

Powys

Cardiff

Conwy

Torfaen

Newport

Swansea

Bridgend

Flintshire

Gwynedd

Wrexham

Caerphilly

Ceredigion

Denbighshire

MerthyrTydfil

Pembrokeshire

Blaenau GwentBlaenau

Monmouthshire

Isle of AngleseyIsleof

Carmarthenshire

Neath Port Talbot NeathPort RhonddaTaff Cynon

Areas ordered geographically from north west to south east The Vale ofGlamorgan Vale The

24

Director of Public Health Annual Report: Chart Book

Wales and Abertawe Bro Morgannwg University Health Board trend

All-cause mortality rate trend for Abertawe Bro Morgannwg University Health Board, persons aged under 75: 2000 to 2009 Produced by the Public Health Wales Observatory, using data from ONS (ADDE, MYE)

Abertawe Bro Morgannwg University Health Board Wales 500

400

300

200

100 EASR per 100,000 per EASR population

0 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

25

Director of Public Health Annual Report: Chart Book 3 Determinants of health

3.1 Determinants of health: key points

Pattern of deprivation

The pattern of deprivation as described by Welsh Index of Multiple Deprivation shows that the most deprived areas are located in parts of Swansea, Neath, Port Talbot and in the northern areas of the Bridgend and Neath Port Talbot local authority areas in places like Blackmill; Nantyffyllon; Glyncorrwg and Glyn-neath. The least deprived areas are in places like the Gower and the southern part of the Bridgend local authority area.

Analysis of the association between deprivation and poor health

The association between socioeconomic deprivation and poor health outcomes is well- established. The Public Health Wales Observatory will be publishing a profile examining the relationship over time between deprivation and mortality later this year. This chart book contains some preliminary analysis released for inclusion in Director of Public Health Annual Reports. The analysis shows that the European age-standardised all-cause mortality rate in the most deprived fifth of areas within Abertawe Bro Morgannwg UHB is more than twice that of the rate in the least deprived fifth. This gap is slightly higher in males than females. The charts also show the gap is not narrowing and that it may even be widening among males.

Lifestyle data

The Welsh Health Survey is a rich source of information on lifestyle. It is a self-reported survey randomly sampling around 15 thousand adults (aged 16+) per year in Wales. The sample is constructed to allow reporting at local authority level.

Lifestyle indicators in the Abertawe Bro Morgannwg UHB area are generally worse than, or similar to, the Wales average. Almost one in four people smoke, leading to around 1,000 deaths per year within the health board area.

Nearly half the population of the health board area drinks more alcohol than the recommended limits and nearly one third binge drink on at least one day a week. Hospital admissions due to alcohol and drugs are more common than in Wales as a whole, with particularly high levels found in Swansea. In total, nearly 10,000 hospital admissions and 190 deaths are caused by alcohol each year.

Overall, only around a third of people eat the recommended amount of fruit and vegetables. The picture is similar for physical activity. Improving diet and physical activity are essential to reducing the high proportions of people who are overweight or obese. Nearly 60 per cent of adults in the health board area are either overweight or obese.

26

Director of Public Health Annual Report: Chart Book

3.2 Wider determinants of health

3.2.1 Deprivation in relation to Wales

The Welsh Index of Multiple Deprivation (2008) is produced at a small area level called lower super output area, and is derived from a broad range of factors including income, employment, health, education, skills and training, community safety, housing, physical environment and access to services. It is a geographically based deprivation measure which can be used to show inequalities in health and suggest areas likely to most need measures to improve health and manage ill-health.

This map shows the level of deprivation in the health board in comparison to the rest of Wales.

Overall Welsh Index of Multiple Deprivation 2008 Fifths of deprivation, Low er Super Output Areas, Data source: WAG Most deprived (86) Next most deprived (69) Median (48) Next least deprived (46) Least deprived (74)

Local authority boundary

A Roads

Motorway

Gorseinon

Sw ansea Neath

Port Talbot 0 5 10 miles

Porthcaw l Bridgend

This map is reproduced from Ordnance Survey material with the permission of Ordnance Survey on behalf of the Controller of Her Majesty's Stationery Office © Crown copyright. Unauthorised reproduction infringes Crown copyright and may lead to prosecution or civil proceedings. Wales Centre for Health. Licence Number: 100044810. 2009

27

Director of Public Health Annual Report: Chart Book

3.2.2 Deprivation within the health board

This map shows the most and least deprived fifths within the health board. It is this grouping that is used to demonstrate inequalities in mortality in the next section.

28

Director of Public Health Annual Report: Chart Book

3.2.3 Inequality in all-cause mortality

These graphs compare mortality in the most deprived fifth of the health board population with the least deprived fifth of health board population.

All-cause mortality, under 75, males, European age-standardised rate (EASR) per 100,000, ABM UHB and Wales, 2001-09 Produced by Public Health Wales Observatory, using ADDE/MYE (ONS), WIMD 2008 (WAG)

Most deprived within ABM (95% CI) Wales EASR Least deprived within ABM ABM overall 800 700 600 500 400 300 200 100 Rate Ratio - most deprived divided by least deprived 2.2 2.2 2.1 2.1 2.3 2.5 2.7 0 2001-03 2002-04 2003-05 2004-06 2005-07 2006-08 2007-09

All-cause mortality, under 75, females, European age-standardised rate (EASR) per 100,000, ABM UHB and Wales, 2001-09 Produced by Public Health Wales Observatory, using ADDE/MYE (ONS), WIMD 2008 (WAG)

Most deprived within ABM (95% CI) Wales EASR Least deprived within ABM ABM overall 500 450 400 350 300 250 200 150 100 Rate Ratio - most deprived divided by least deprived 50 2.0 2.3 2.4 2.2 2.0 2.0 2.2 0 2001-03 2002-04 2003-05 2004-06 2005-07 2006-08 2007-09

29

Director of Public Health Annual Report: Chart Book 3.3 Lifestyle factors

3.3.1 Smoking as reported by adults

Adults who reported being a current smoker by local authority and health board, age standardised percentage, 2008-2009 Produced by Public Health Wales Observatory using data from the Welsh Health Survey, 2008 and 2009

Wales = 24

30 26 27 26 26 24 25 25 24 24 25 24 25 24 24 24 22 22 22 22 22 23 22 22 23 23 23 23

20

Powys Powys

Cardiff

Conwy

Torfaen

Newport

Cwm Taf Cwm

Swansea

Bridgend

Flintshire

Gwynedd

Wrexham

Caerphilly

Hywel Dda Hywel

Ceredigion

Denbighshire

Merthyr Tydfil Merthyr

AneurinBevan

Blaenau GwentBlaenau

Pembrokeshire

Monmouthshire

Isle of AngleseyIsleof

BetsiCadwaladr

Carmarthenshire

Neath Port Talbot NeathPort

RhonddaTaf Cynon

The Vale ofGlamorgan Vale The

Cardiff & Vale University&Vale Cardiff AbertaweMorgannwgBro

Areas ordered geographically from north west to south east

30

Director of Public Health Annual Report: Chart Book

3.3.2 Binge drinking as reported by adults

Adults who reported binge drinking on at least one day in the past week by local authority and health board, age standardised percentage, 2008- 2009 Produced by Public Health Wales Observatory using data from the Welsh Health Survey, 2008 and 2009

Wales = 28

31 32 31 29 30 30 29 29 29 29 29 29 27 27 28 27 27 28 28 28 28 27 26 25 25

23 23 22 23

Powys Powys

Cardiff

Conwy

Torfaen

Newport

Cwm Taf Cwm

Swansea

Bridgend

Flintshire

Gwynedd

Wrexham

Caerphilly

Hywel Dda Hywel

Ceredigion

Denbighshire

Merthyr Tydfil Merthyr

AneurinBevan

Blaenau GwentBlaenau

Pembrokeshire

Monmouthshire

Isle of AngleseyIsleof

Betsi Cadwaladr Betsi

Carmarthenshire

Neath Port Talbot NeathPort

RhonddaTaf Cynon

The Vale ofGlamorgan Vale The

Cardiff & Vale University&Vale Cardiff AbertaweMorgannwgBro

Areas ordered geographically from north west to south east

31

Director of Public Health Annual Report: Chart Book

3.3.3 Five or more fruit or vegetables a day as reported by adults

Adults who reported eating five/more portions fruit/veg the previous day by local authority/health board, age standardised percentage, 2008-2009 Produced by Public Health Wales Observatory using data from the Welsh Health Survey, 2008 and 2009

Wales = 36

42 41 39 39 39 39 39 39 40 37 37 37 37 38 37 38 35 34 33 33 33 33 31 32 32

29 29 28 29

Powys Powys

Cardiff

Conwy

Torfaen

Newport

Cwm Taf Cwm

Swansea

Bridgend

Flintshire

Gwynedd

Wrexham

Caerphilly

Hywel Dda Hywel

Ceredigion

Denbighshire

Merthyr Tydfil Merthyr

AneurinBevan

Pembrokeshire

Blaenau GwentBlaenau

Monmouthshire

Betsi Cadwaladr Betsi

Isle of AngleseyofIsle

Carmarthenshire

Neath Port Talbot NeathPort

RhonddaTaf Cynon

The Vale ofGlamorgan Vale The

Cardiff & Vale University&Vale Cardiff AbertaweMorgannwgBro

Areas ordered geographically from north west to south east

32

Director of Public Health Annual Report: Chart Book

3.3.4 Physical activity as reported by adults

Adults who reported meeting physical activity guidelines in the past week by local authority/health board, age standardised percentage, 2008-2009 Produced by Public Health Wales Observatory using data from the Welsh Health Survey, 2008 and 2009

Wales = 29

39 39 36 34 33 33 33 34 31 31 30 30 30 30 30 29 28 28 27 28 27 27 28 28 28

26 25 26 26

Powys Powys

Cardiff

Conwy

Torfaen

Newport

Cwm Taf Cwm

Swansea

Bridgend

Flintshire

Gwynedd

Wrexham

Caerphilly

Hywel Dda Hywel

Ceredigion

Denbighshire

Merthyr Tydfil Merthyr

AneurinBevan

Blaenau GwentBlaenau

Pembrokeshire

Monmouthshire

Isle of AngleseyIsleof

Betsi Cadwaladr Betsi

Carmarthenshire

Neath Port Talbot NeathPort

RhonddaTaf Cynon

The Vale ofGlamorgan Vale The

Cardiff & Vale University&Vale Cardiff AbertaweMorgannwgBro

Areas ordered geographically from north west to south east

33

Director of Public Health Annual Report: Chart Book

3.3.5 Overweight and obesity, adults based on self reported data

Adults who were overweight or obese by local authority and health board, age standardised percentage, 2008-2009 Produced by Public Health Wales Observatory using data from the Welsh Health Survey, 2008 and 2009

Wales = 57

62 60 60 61 60 60 60 61 63 60 56 57 56 56 59 59 57 59 58

54 52 53 55 52 54 55 53 55 55

Powys Powys

Cardiff

Conwy

Torfaen

Newport

Cwm Taf Cwm

Swansea

Bridgend

Flintshire

Gwynedd

Wrexham

Caerphilly

Hywel Dda Hywel

Ceredigion

Denbighshire

Merthyr Tydfil Merthyr

AneurinBevan

Blaenau GwentBlaenau

Pembrokeshire

Monmouthshire

Isle of AngleseyIsleof

Betsi Cadwaladr Betsi

Carmarthenshire

Neath Port Talbot NeathPort

RhonddaTaf Cynon

The Vale ofGlamorgan Vale The

Cardiff & Vale University&Vale Cardiff AbertaweMorgannwgBro

Areas ordered geographically from north west to south east

34

Director of Public Health Annual Report: Chart Book

4 Use of services

4.1 Use of services: key points

Childhood immunisations

Childhood immunisation uptake rates show positive long term trends, although remain below target rates in a number of key areas. Immunisations in children under one year of age reach the 95% target. All immunisations scheduled for children in their second year of life do not reach the 95% target, and coverage of immunisations in five year olds and sixteen year olds are also below target. MMR vaccine uptake is a particular concern given a large outbreak of measles in Wales in 2009, and ongoing outbreaks in Europe in 2011. Uptakes of one dose of MMR in two year olds and two doses in five year olds have improved since 2005, but a 95% uptake of two doses is needed to eliminate measles in line with WHO goals. Improving uptake of pre-school and teenage immunisation will reduce risk of outbreaks of vaccine preventable diseases in future.

Seasonal influenza vaccination

In Wales, free seasonal influenza immunisation is offered to all people aged 65 years and over, and people between 6 months and 65 years in clinical risk groups (currently chronic respiratory disease, chronic heart disease, chronic renal disease, chronic liver disease, chronic neurological conditions, diabetes mellitus, and immunosuppression), residents of long-stay care homes and those who were the main carer for an elderly or disabled person whose welfare may be at risk if the carer fell ill. For 2009/10 WAG set a target immunisation uptake rate of 70% for people aged 65 years and over. For the 2010/11 seasonal influenza immunisation campaign the national uptake target was raised to the WHO target of 75% uptake in recommended groups. This target was also put in place for those younger than 65 years in ‘at-risk’ groups. During the 2010/11 campaign influenza immunisation was also offered to pregnant women who were not an existing clinical risk group.

Uptake of seasonal influenza immunisation for Abertawe Bro Morgannwg UHB in persons aged 65 years and over during 2010/11 was 10% under the target level. In persons aged under 65 years in the at risk groups, uptake during 2010/11 was 29% below the target level.

Population Based National Screening Programmes in Wales

Uptake/coverage rates in Abertawe Bro Morgannwg UHB for the national screening programmes for bowel, breast and cervical cancer and newborn hearing screening are generally on a par with or slightly higher than Wales overall. However only rates for cervical and newborn hearing screening achieve the UK target rates, the other programmes fall slightly short of the targets. Rates in Swansea for breast and cervical screening for 20 to 64 yr olds are noticeably lower than for Wales and the other local authorities.

35

Director of Public Health Annual Report: Chart Book

Primary care services

The latest Welsh Health Survey data show that age-standardised percentages of primary care service use by adults in Abertawe Bro Morgannwg UHB are broadly on a par with or very slightly higher than those for Wales as a whole.

Use of secondary and tertiary care

Age-standardised overall hospital admission rates in persons aged under 75 years for 2009 in Abertawe Bro Morgannwg UHB show that overall rates are similar to Wales. The rate is slightly higher rate in Neath Port Talbot compared to Swansea and Bridgend. Drilling down to the MSOA level there is considerable variation. Rates are lowest in the Gower, Mumbles, Mayals and Killay areas of Swansea.

Looking at emergency admissions in this age group, the health board rate is slightly above that of Wales and is higher in Swansea and lower in Bridgend. At the MSOA level the rate varies greatly (more than for all admissions) with the lowest rates again found in Gower and south western suburbs of Swansea and also in the southern part of Bridgend in areas such as Lalestone, St Brides and Coychurch. Conversely, the highest rates are found in Sandfields, Townhill, Landore, Cockett and Penderry areas of Swansea. High rates of emergency hospital admission may be indicative of inadequate self-care and primary care services.

The health board elective admission rate is slightly below that for Wales. The rate in Swansea is lower than in Bridgend or Neath Port Talbot. At the MSOA level rates are highest in the Briton Ferry, Neath, Port Talbot and Glyncorrwg areas of Neath Port Talbot; the Nantyffyllon, Maesteg, Pyle, Bryncethin, and Morfa areas of Bridgend; and St Thomas in Swansea.

36

Director of Public Health Annual Report: Chart Book 4.2 Prevention services: vaccination uptake

Note: Y-axes in the graphs of this section are truncated

4.2.1 Childhood immunisations

Routine childhood immunisation Abertawe Bro Morgannwg University Health Board area, trends 2004-2011 Produced by Public Health Wales Vaccine Preventable Disease Programme, from the Public Health Wales COVER reports

100

90

80 % uptake %

70 5 in 1 at 1yr MMR 1 at 2yrs MMR2 at 5yrs 4 in 1 at 5 yrs Men C at 1 yr 95% target

60

2011 1 2011

2004 1 2004 2 2004 3 2004 1 2005 2 2005 4 2005 1 2006 4 2006 1 2007 3 2007 4 2007 2 2008 3 2008 4 2008 2 2009 3 2009 1 2010 2 2010 3 2010 2004 4 2004 3 2005 2 2006 3 2006 2 2007 1 2008 1 2009 4 2009 4 2010 Cover quarter

37

Director of Public Health Annual Report: Chart Book

Routine childhood immunisation Abertawe Bro Morgannwg University Health Board area, 2011 quarter 1 Produced by Public Health Wales Vaccine Preventable Disease Programme, from the Public Health Wales COVER reports

Abertawe Bro Morgannwg UHB Summary - COVER98 5 in 1 primary by age 1y (3 doses) 97.3% MenC primary by age 1y (2 doses) 97.1% PCV primary by age 1y (2 doses) 97.1% MMR by age 2y (1st dose) 90.8% PCV by age 2y (final (3rd) dose) 90.8% Hib/MenC booster by age 2y 93.9% MMR by age 5y (2nd dose) 86.5% 4 in 1 pre-school booster by age 5y 89.3% MMR coverage (1 dose) by age 16y 92.0% MMR coverage (2 doses) by age 16y 82.5% 3 in 1 Teenage booster by age 16y 76.8%

Routine childhood immunisation Bridgend local authority area, trends 2004-2011 Produced by Public Health Wales Vaccine Preventable Disease Programme, from the Public Health Wales COVER reports

100 Bridgend LA

90

80 % uptake %

70 5 in 1 at 1yr Men C at 1 yr MMR 1 at 2yrs MMR2 at 5yrs 4 in 1 at 5 yrs 95% target

60

2004 2 2004 3 2004 4 2004 1 2005 3 2005 4 2005 1 2006 2 2006 4 2006 1 2007 2 2007 3 2007 1 2008 2 2008 3 2008 4 2008 2 2009 3 2009 4 2009 1 2010 3 2010 4 2010 1 2011 2005 2 2005 3 2006 4 2007 1 2009 2 2010 2004 1 2004

38

Director of Public Health Annual Report: Chart Book

Routine childhood immunisation Neath Port Talbot local authority area, trends 2004-2011 Produced by Public Health Wales Vaccine Preventable Disease Programme, from the Public Health Wales COVER reports

100 Neath Port Talbot LA

90

80 % uptake %

70 5 in 1 at 1yr Men C at 1 yr MMR 1 at 2yrs MMR2 at 5yrs 4 in 1 at 5 yrs 95% target

60

2004 1 2004 2 2004 3 2004 1 2005 2 2005 3 2005 4 2005 2 2006 3 2006 4 2006 1 2007 3 2007 4 2007 1 2008 2 2008 4 2008 1 2009 2 2009 3 2009 1 2010 2 2010 3 2010 4 2010 2006 1 2006 2 2007 3 2008 4 2009 1 2011 2004 4 2004

39

Director of Public Health Annual Report: Chart Book

Routine childhood immunisation Swansea local authority area, trends 2004-2011 Produced by Public Health Wales Vaccine Preventable Disease Programme, from the Public Health Wales COVER reports

100 Swansea LA

90

80 % uptake %

70 5 in 1 at 1yr Men C at 1 yr MMR 1 at 2yrs MMR2 at 5yrs 4 in 1 at 5 yrs 95% target

60

2004 1 2004 2 2004 3 2004 4 2004 2 2005 3 2005 4 2005 1 2006 3 2006 4 2006 1 2007 2 2007 4 2007 1 2008 2 2008 3 2008 1 2009 2 2009 3 2009 4 2009 2 2010 3 2010 4 2010 1 2011 2006 2 2006 3 2007 4 2008 1 2010 2005 1 2005

40

Director of Public Health Annual Report: Chart Book

4.2.2 Seasonal influenza vaccination

Uptake of seasonal influenza immunisation in Abertawe Bro Morgannwg University Health Board, 2010/2011 Produced by Public Health Wales Vaccine Preventable Disease Programme, data source: Audit +

Patients aged 65y and over Total Patients patients immunised Uptake (%) Bridgend 27,274 18,364 67.3 Neath Port Talbot 26,161 16,635 63.6 Swansea 43,064 27,570 64.0 Health Board total 96,499 62,569 64.8

Patients aged under 65y at risk Total Patients patients immunised Uptake (%) Bridgend 16,559 7,422 44.8 Neath Port Talbot 15,626 7,248 46.4 Swansea 24,398 11,160 45.7 Health Board total 56,583 25,830 45.6

Distribution of practice level seasonal influenza immunisation uptake rates (patients aged 65 years and over), Abertawe Bro Morgannwg University Health Board area, 2010/2011 Produced by Public Health Wales Vaccine Preventable Disease Programme, data source: Audit +

Bridgend

Neath Port Talbot

Swansea

30 40 50 60 70 80 90 100 Uptake% (65y and over) Produced by Public Health Wales Vaccine Preventable Disease Programme Data source: Audit Plus Data Quality System

41

Director of Public Health Annual Report: Chart Book

Distribution of practice level seasonal influenza immunisation uptake rates (patients aged under 65 years at risk), Abertawe Bro Morgannwg University Health Board area, 2010/2011 Produced by Public Health Wales Vaccine Preventable Disease Programme, data source: Audit +

Bridgend

Neath Port Talbot

Swansea

30 40 50 60 70 80 90 100 Uptake% (under 65y at risk) Produced by Public Health Wales Vaccine Preventable Disease Programme Data source: Audit Plus Data Quality System

The line inside the shaded box represents the median practice uptake rate (half of the local authority practices have an uptake higher than the median value and half have an uptake lower than the median value). The shaded box represents the spread in uptake rates of the central 50% of practices, this is called the interquartile range. The whiskers extending above and below the shaded box represent the spread in practice uptake rates for the majority of practices within the local authority. Any practices with uptake rates that are very different from the majority of practices within the local authority are termed ‘outliers’ and appear as dots outside the whiskers.

42

Director of Public Health Annual Report: Chart Book 4.3 Population Based National Screening Programmes in Wales

Screening is a process of identifying apparently healthy people who may be at increased risk of a disease or condition. They can then be offered information, further tests and appropriate treatment to reduce their risk and/or any complications arising from the disease or condition.

In the context of screening programmes:

Uptake is the proportion of people routinely invited for screening for who a screening test result is recorded within the same invitation episode. Uptake is an important measure of the acceptability of a screening programme. There are minimum uptake standards and targets set for each of the programmes.

Coverage is the proportion of people resident and eligible at a particular point in time who have been screened at least once in a defined time period (dependent on the screening interval of the different programmes).

4.3.1 Uptake of national screening programmes in Wales Uptake of breast, bowel, cervical and newborn screening programme statistics for Abertawe Bro Morgannwg UHB area, period 1 April 2009-31 March 2010 compared to all Wales Produced by Screening Division, Public Health Wales

Abertawe Bro Screening Age range / Test Wales Neath Port UK target rate Morgannwg Bridgend Swansea programme frequency in Wales rate Talbot University Currently 60-69 years / Bowel Screening1 Uptake: 60% 55.3% 57.4% 59.3% 57.8% 56.1% every 2 years 50-70 years / every 3 Uptake: Minimum Breast Screening2 76.2% 77.2% 77.7% 79.2% 73.9% years 70%, Target 80% 3 20-64 years / every 3 Coverage: 80% at 5 Cervical Screening 76.2% 76.2% 77.1% 77.9% 74.6% (aged 20-64) years years (aged 25-64) 4 20-64 years / every 3 Coverage: 80% at 5 Cervical Screening 79.5% 79.6% 79.6% 80.4% 79.2% (aged 25-64) years years (aged 25-64) Newborn Hearing Newborn babies / within Uptake: 95% 99.7% 99.8% 99.8% 99.9% 99.7% Screening5 first month of birth

Notes 1 Bowel: Uptake of people invited April 2009 to end of March 2010 2 Breast: uptake stated (of those routinely invited, number screened) 3 Cervical (aged 20-64): coverage stated, tested within 5 years 4 Cervical (aged 25-64): coverage stated, tested within 5 years - the 25-64 age range allows direct comparison with England 5 Newborn: uptake stated (of babies born, number tested)

43

Director of Public Health Annual Report: Chart Book

4.4 Primary care services

4.4.1 Use of primary care as reported by adults

Abertawe Bro Morgannwg UHB adults who reported particular service use, Welsh Health Survey 2008 & 2009.

Age- Observed standardised Wales per cent percent per cent

Health service use Family doctor (GP) in the past two weeks 19 19 18 In the past three months: Accident, injury or poisoning needing 5 5 5 hospital treatment or a visit to casualty In the past twelve months: Pharmacist 71 71 70 Dentist 72 72 70 Optician 50 50 49

Unweighted base (i) All aged 16+ 4,176 4,176 29,331

Source: Welsh Health Survey 2008 + 2009 (i) Bases vary: those shown are for the whole sample. Age-standardised rate is standardised to the Wales population.

44

Director of Public Health Annual Report: Chart Book

4.5 Use of secondary and tertiary care

4.5.1 Hospital admissions: individuals aged under 75

Middle super output areas

45

Director of Public Health Annual Report: Chart Book

Hospital admissions in Abertawe Bro Morgannwg UHB area, persons aged under 75, 2009, European age-standardised rates per 1,000 Produced by Public Health Wales Observatory, using data from NWIS (PEDW), ONS (MYE) Isle of Anglesey

MSOA EASR with 95%MSOA Health Board (EASR = 146) Wales (EASR = 145) Local Authority confidence interval

Swansea003 748 Neath Port Talbot

006 169 011 179 013 177 009 162 019 178 017 166 001 161 016 176 008 162 007 021 153 012 160 msoa 169 005 013 153 169 016 158 004 008 147 160 004 158 009002 139 160 001 156 008 011 014 138 158 Axis Title 151 002 157 002 147 001 157 007 147

025 155 MSOA 005 146 005 153 015 142 017 152 014 141 026 149 018 141 010 146 003 139 029 145 010 139

MSOA 009 015 143 137 Neath Port Talbot 022 143 019 136 EASR = 150 012 142 006 124 003 141 EASR per 1,000 006 138 004 134 Bridgend 007 134 001 164 018 133 014 164 020 128 007 160 027 123 010 157 024 122 002 155 030 118 016 154 028 115 Swansea 008 153 023 112 EASR = 145 005 149 031 107 EASR per 1,000 004 149 003 146

MSOA 012 144 011 143 009 138 006 136 019 136 018 136 013 134 Bridgend EASR = 146 017 133 015 128 EASR per 1,000

46

Director of Public Health Annual Report: Chart Book

Local authorities

Hospital admissions by local authority, persons aged under 75, 2009, 95% confidence European age-standardised rates per 1,000 interval Produced by Public Health Wales Observatory, using data from NWIS (PEDW), ONS (M YE)

Wales = 145.1

175.5

167.7

162.5

159.2

156.8

155.2

152.0

150.0

148.2

147.5

145.8 145.5

145.0 144.8

141.4 141.9

141.0

138.7

137.6

137.1

128.0

125.7

Powys Cardiff

Conwy

Torfaen

Newport

Bridgend

Flintshire

Swansea

Gwynedd

Wrexham

Caerphilly

Ceredigion

Denbighshire

Merthyr Tydfil Merthyr

Pembrokeshire

Blaenau Gwent Blaenau

Monmouthshire

Isle of Anglesey of Isle

Carmarthenshire

Neath Port Talbot Port Neath RhonddaTaff Cynon Areas ordered geographically from north west to south east The Vale of Glamorgan of Vale The

47

Director of Public Health Annual Report: Chart Book

4.5.2 Emergency hospital admissions: individuals aged under 75

Middle super output areas

48

Director of Public Health Annual Report: Chart Book

Emergency hospital admissions in Abertawe Bro Morgannwg UHB area, persons aged under 75, 2009, European age-standardised rates per 1,000 Produced by Public Health Wales Observatory, using data from NWIS (PEDW), ONS (MYE) Isle of Anglesey

MSOA EASR with 95%MSOA Health Board (EASR = 72) Wales (EASR = 68) Local Authority confidence interval

Swansea006 748 Neath Port Talbot 001 78 019 103 013 89 009 77 011 102 004 85 003 76 016 99 016 80 005 71 008 80 msoa 025 95 007 013 67 95 017 80 004 021 65 92 012 78 002026 61 90 001 74 008008 005 70 60 90 Axis Title 009 87 018 68 017 86 002 68

014 84 MSOA 010 67 005 79 014 66 002 78 003 64 015 77 015 62 001 76 019 60 012 75 011 60

MSOA 007 60 022 75 Neath Port Talbot 003 74 009 60 EASR = 71 010 69 006 57 029 69 EASR per 1,000 018 68 020 66 Bridgend 024 65 014 78 006 64 001 78 004 64 007 76 007 63 016 73 030 59 003 71 027 58 008 70 023 57 Swansea 004 70 028 49 EASR = 76 002 68 031 47 010 EASR per 1,000 66 005 64

MSOA 012 63 011 63 019 62 006 62 009 60 018 59 017 58 Bridgend EASR = 65 015 56 013 55 EASR per 1,000

49

Director of Public Health Annual Report: Chart Book

Local authorities

Emergency hospital admissions by local authority, persons aged under 95% confidence 75, 2009, European age-standardised rates per 1,000 interval Produced by Public Health Wales Observatory, using data from NWIS (PEDW), ONS (M YE)

Wales = 68.5

97.8

86.4

85.0

83.4

76.9

76.0

75.4

70.9 71.2

68.8

68.1

67.2

66.8

65.2

63.4 63.5

62.3

61.1

60.5

59.6

55.3

53.8

Powys Cardiff

Conwy

Torfaen

Newport

Bridgend

Flintshire

Swansea

Gwynedd

Wrexham

Caerphilly

Ceredigion

Denbighshire

Merthyr Tydfil Merthyr

Pembrokeshire

Blaenau Gwent Blaenau

Monmouthshire

Isle of Anglesey of Isle

Carmarthenshire Neath Port Talbot Port Neath

Areas ordered geographically from north west to south east RhonddaTaff Cynon

The Vale of Glamorgan of Vale The

50

Director of Public Health Annual Report: Chart Book

4.5.3 Elective hospital admissions: individuals aged under 75

Middle super output areas

51

Director of Public Health Annual Report: Chart Book

Elective hospital admissions in Abertawe Bro Morgannwg UHB area, persons aged under 75, 2009, European age-standardised rates per 1,000 Produced by Public Health Wales Observatory, using data from NWIS (PEDW), ONS (MYE) Isle of Anglesey MSOA EASR with 95% MSOA Health Board (EASR = 76) Wales (EASR = 77) Local Authority confidence interval

Swansea003 748 Neath Port Talbot 006 89 021 83 013 89 009 87 001 82 011 86 001 85 013 81 007 86 004

005 85 81 008 84 msoa 014007 84 81 001 84

009005 84 80 012 83 017 016008 79 80 83 002 80 016 82 78 Axis Title 010 78 002 82 019 77 005 79

011 77 MSOA 004 78 007 76 015 77 029 75 009 77 008 74 003 76 017 73 018 75 015 72 019 75

MSOA 010 73 006 72 Neath Port Talbot 022 72 014 71 EASR = 79 004 71 006 68 012 70 EASR per 1,000 025 68 003 67 Bridgend 020 67 010 88 027 66 002 87 026 65 008 86 018 65 014 84 023 62 001 84 028 58 007 83 024 57 Swansea 005 81 030 57 EASR = 72 011 81 031 54 016 EASR per 1,000 80 012 80

MSOA 004 79 013 78 009 78 017 75 006 75 019 74 003 74 Bridgend EASR = 79 018 74 015 69 EASR per 1,000

52

Director of Public Health Annual Report: Chart Book

Local authorities

Elective hospital admissions by local authority, persons aged under 75, 95% confidence 2009, European age-standardised rates per 1,000 interval Produced by Public Health Wales Observatory, using data from NWIS (PEDW), ONS (M YE)

Wales = 76.9

86.6

86.0

84.4

83.7

82.8

81.5 81.6

79.5 79.9

79.2

77.9 77.8 77.4 77.4

77.2 76.9

73.2

72.2

71.7 71.6

68.6

63.9

Powys Cardiff

Conwy

Torfaen

Newport

Bridgend

Flintshire

Swansea

Gwynedd

Wrexham

Caerphilly

Ceredigion

Denbighshire

Merthyr Tydfil Merthyr

Pembrokeshire

Blaenau Gwent Blaenau

Monmouthshire

Isle of Anglesey of Isle

Carmarthenshire Neath Port Talbot Port Neath

Areas ordered geographically from north west to south east RhonddaTaff Cynon The Vale of Glamorgan of Vale The

53

Director of Public Health Annual Report: Chart Book

5 Health status

5.1 Health status: key points

There are consistent general patterns exhibited across the various indices of health status. Abertawe Bro Morgannwg UHB has generally poorer levels of health than Wales as a whole, although not as bad as some areas of the south Wales valleys and parts of north Wales. Between the three local authority areas of the health board, Neath Port Talbot shows the poorest levels of health and Swansea the best, however there is considerable variation within local authority areas.

Low birth weight

Low birth weight is associated with poor maternal health and lifestyle and there is increasing evidence to show an association with adverse effects later in life. The percentage of singleton live born babies weighing under 2500g in Abertawe Bro Morgannwg UHB is similar to Wales. At the MSOA level, the areas with the highest percentages are found in Sandfields, Townhill, Penderry and Bonymaen areas of Swansea; the Briton Ferry and Neath areas of Neath Port Talbot; and the Nantyffyllon, Cornelly and Morfa areas of Bridgend.

Self-reported health status

The Welsh Health Survey contains a number of questions on health status, including the SF36 questionnaire which can be summarised into overall physical and mental health scores. The latest results show that self reported physical and mental health scores are worse in Abertawe Bro Morgannwg UHB than in Wales as a whole. At the local authority level, self reported physical and mental health scores are worse in Neath Port Talbot than in Swansea or Bridgend. The data also show that Abertawe Bro Morgannwg UHB has the highest age- standardised self-reported rate of limiting long term illness (which includes problems related to old age) in Wales. At the local authority level, Neath Port Talbot exhibits the highest self- reported rate of limiting long term illness in Wales. Looking at persons reporting current treatment for a mental health condition, the health board rate is similar to Wales, but the rate in Bridgend is higher.

Mortality from specific conditions

Circulatory disease includes heart disease and stroke and is the largest cause of death in Wales. Lifestyle factors such as diet, exercise, alcohol consumption and especially smoking are known to be implicated in circulatory disease. The European age-standardised mortality rate for Abertawe Bro Morgannwg UHB is similar to Wales and there is no substantial variation across local authorities in the health board area although the rate for Bridgend is slightly higher than Wales. However, at MSOA level there is a doubling of the rate between the lowest and highest areas. Areas with the lowest rates are found in the Gower, Mumbles, Sketty and Killay areas of Swansea; the Duffryn, Bryn Coch, Cadoxton and Baglan areas of

54

Director of Public Health Annual Report: Chart Book

Neath Port Talbot; and the Lalestone, Coity, Litchard and Pendre areas of Bridgend. Areas with the highest rates are in the Landore, Pontarddulais, Townhill, Penderry, St Thomas and Bonymaen areas of Swansea; and the Aberkenfig, Pontycymer and Cornelly areas of Bridgend. For persons aged under 75 years, the pattern is similar at the MSOA level.

Coronary heart disease is a sub-category within circulatory disease and includes heart attacks. Smoking is a major cause of coronary heart disease. The European age-standardised mortality rate for Abertawe Bro Morgannwg UHB is similar to the Wales rate and there is no substantial variation across local authorities in the health board area. At MSOA level, once again, variation is high. The pattern is very similar to that for circulatory disease with the lowest rates in the Gower and south-west Swansea; areas immediately to the north of the towns of Neath and Port Talbot and in the southern areas of Bridgend. Rates are highest in places like Landore, Pontarddulais, Townhill, Penderry, St Thomas and Bonymaen areas of Swansea; and in the Mount Pleasant area of Neath.

Cancer is the second most common cause of death in Wales. Causes of cancer are multifactorial, varying depending on the site but smoking and other lifestyle factors are important risk factors. The European age-standardised mortality rate for Abertawe Bro Morgannwg UHB is similar to Wales and there is no substantial variation across local authorities in the health board area. At MSOA level there is significant variation. The pattern is familiar with the lowest rates located in Gower and south west suburbs of Swansea; Bryn- coch to the north of Neath; and Lalestone, Oldcastle and Pen-y-fai to the south of Bridgend. Rates are highest in the Landore, Townhill, Penderry, and St Thomas areas of Swansea; the Mount Pleasant area of Neath; the Sandfields area of Port Talbot; the Cymmer and Glyncorrwg area to the north of the local authority area and the Nantyffyllon and Morfa areas of Bridgend local authority area.

Respiratory disease is a very common cause of death. Once again, smoking is a major risk factor for respiratory disease. The European age-standardised mortality rate for Abertawe Bro Morgannwg UHB is similar to Wales and there is no substantial variation across local authorities in the health board area although the rate for Neath Port Talbot and Bridgend are slightly higher than Wales. At the MSOA level there is considerable variation with the rate trebling between lowest and highest. The wider confidence intervals on the caterpillar charts are indicative of the fact that there are fewer respiratory disease deaths than for cancer or circulatory disease. The lowest rates are found in Killay, Sketty and the area close to Morrison hospital within Swansea; and Coychurch in Bridgend. The highest rates are in the northern areas of Bridgend such as Blackmill, Ogmore Vale, Nant-y-moel, Bryncethin, Llangynwyd and Aberkenfig; Aberavon and Glyncorrwg in Neath Port Talbot; and Landore in Swansea.

Cancer survival

Relative survival is the most widely used method in population studies. It is the ratio of the survival observed in the group of cancer patients to the survival that would be expected if they were subject to the same overall mortality rates by age, sex and calendar period as the general population. The expected probabilities are obtained from life tables for Wales that provide the life expectancy of persons for a given year by age and sex. The problems arising with crude survival are therefore overcome. It enables one to measure variations in cancer survival (or its complement, mortality) independently of variations in expected (background) mortality associated with various factors (age and sex in these analyses).The regional data

55

Director of Public Health Annual Report: Chart Book for Wales indicate a steady improvement in one year relative survival for both males and females.

The site-specific one and five year relative survival figures indicate that there is little difference between Abertawe Bro Morgannwg UHB and Wales as a whole except for ovarian cancer where the five year survival was statistically significantly better.

56

Director of Public Health Annual Report: Chart Book

5.2 Physical and mental health

5.2.1 Low birth weight

Middle super output areas

Numbers on map indicate MSOAs with a rate statistically significantly higher than the all Wales rate.

57

Director of Public Health Annual Report: Chart Book

Low birth weight in Abertawe Bro Morgannwg UHB area, percentage of singleton live births, 1998-2007 Produced by Public Health Wales Observatory, using data from ONS (ADBE, MYE)

Swansea Neath Port Talbot

019 8.7 013 7.3 014 8.1 012 6.9 011 7.8 003 6.9 025 7.6 017 6.7 026 7.3 008 6.5 016 6.8 016 6.4 021 6.8 002 6.4 013 6.3 001 6.3 018 5.9 011 6.2

027 5.8 007 6.1 MSOA 008 5.8 014 5.9 015 5.8 005 5.2 002 5.6 004 5.2 017 5.4 019 5.1 029 5.3 006 5.0 007 5.2 018 4.5

MSOA 005 4.7 015 4.3 010 4.6 010 3.9 Neath Port Talbot %LBW = 5.7 006 4.5 009 3.3 003 4.4 % low birth weight 009 4.3 012 4.2 Bridgend 020 4.1 014 8.6 022 4.1 001 7.7 024 4.0 010 7.5 023 3.9 003 7.1 001 3.6 009 6.1 031 3.3 007 030 3.2 5.9 008 004 2.8 Swansea 5.8 %LBW = 5.5 006 028 1.8 5.7 004 5.6 % low birth weight 011 5.5

MSOA 017 5.3 002 5.0 012 4.9 016 4.6 015 4.1 005 4.1 019 4.0 Bridgend 013 3.9 %LBW = 5.7 018 3.3 % low birth weight

58

Director of Public Health Annual Report: Chart Book

Local authorities

Low birth weight by local authority, percentatge of singleton live 95% confidence births, 1998-2007 interval Produced by Public Health Wales Observatory, using data from ONS (ADBE, MYE)

Wales = 5.8%

7.8%

7.6%

6.8%

6.5%

6.2%

6.1%

6.0%

6.0%

6.0%

5.7%

5.7%

5.6%

5.5%

5.5%

5.5%

5.4%

5.4%

5.3%

5.0%

5.0%

4.9%

4.4%

Powys

Cardiff

Conwy

Torfaen

Newport

Swansea

Bridgend

Flintshire

Gwynedd

Wrexham

Caerphilly

Ceredigion

Denbighshire

Merthyr Tydfil Merthyr

Blaenau GwentBlaenau

Pembrokeshire

Monmouthshire

Isle of AngleseyIsleof

Carmarthenshire

Neath Port Talbot NeathPort RhonddaTaff Cynon

Areas ordered geographically from north west to south east ofGlamorgan Vale The

59

Director of Public Health Annual Report: Chart Book

5.2.2 Physical health as reported by adults*

Mean SF-36 Physical component summary score by local authority and health board, age standardised rate, 2008-2009 Produced by Public Health Wales Observatory using data from the Welsh Health Survey, 2008 and 2009

Wales = 48.8

50.3

50.2

49.9

49.8

49.7 49.7 49.7 49.7

49.6

49.5

49.3 49.3

49.2

49.1

49.0 49.0

48.6

48.4

48.2 48.2

48.1 48.1 48.1

48.0

47.7 47.7

47.5

47.4

47.0

Powys Powys

Cardiff

Conwy

Torfaen

Newport

Cwm Taf Cwm

Swansea

Bridgend

Flintshire

Gwynedd

Wrexham

Caerphilly

Hywel Dda Hywel

Ceredigion

Denbighshire

Merthyr Tydfil Merthyr

AneurinBevan

Pembrokeshire

Blaenau GwentBlaenau

Monmouthshire

BetsiCadwaladr

Isle of AngleseyIsleof

Carmarthenshire

Neath Port Talbot NeathPort

RhonddaTaf Cynon

The Vale ofGlamorgan Vale The

Cardiff & Vale University&Vale Cardiff AbertaweMorgannwgBro

Areas ordered geographically from north west to south east

* Y-axis is truncated to 45

60

Director of Public Health Annual Report: Chart Book

5.2.3 Mental health as reported by adults*

Mean SF-36 Mental component summary score by local authority and health board, age standardised rate, 2008-2009 Produced by Public Health Wales Observatory using data from the Welsh Health Survey, 2008 and 2009

Wales = 49.9

51.6 51.6

51.3 51.3

51.2

51.0 51.0 51.0

50.7 50.7

50.3

50.2 50.2

50.1

49.8

49.7 49.7

49.6

49.5

49.4

49.3

49.2

49.1

48.9

48.7

48.6

48.5

48.0

47.7

Powys Powys

Cardiff

Conwy

Torfaen

Newport

Cwm Taf Cwm

Swansea

Bridgend

Flintshire

Gwynedd

Wrexham

Caerphilly

Hywel Dda Hywel

Ceredigion

Denbighshire

Merthyr Tydfil Merthyr

AneurinBevan

Blaenau GwentBlaenau

Pembrokeshire

Monmouthshire

Isle of AngleseyIsleof

BetsiCadwaladr

Carmarthenshire

Neath Port Talbot NeathPort

RhonddaTaf Cynon

The Vale ofGlamorgan Vale The

Cardiff & Vale University&Vale Cardiff AbertaweMorgannwgBro

Areas ordered geographically from north west to south east

* Y-axis is truncated to 45

61

Director of Public Health Annual Report: Chart Book

5.2.4 Limiting long term illness as reported by adults

Adults who reported having a limiting long-term illness by local authority and health board, age standardised percentage, 2008-2009 Produced by Public Health Wales Observatory using data from the Welsh Health Survey, 2008 and 2009

Wales = 27

33 31 31 32 31 30 30 30 29 29 29 29 27 28 28 25 25 26 26 26 26 26 26 25

24 23 24 24 24

Powys Powys

Cardiff

Conwy

Torfaen

Newport

Cwm Taf Cwm

Swansea

Bridgend

Flintshire

Gwynedd

Wrexham

Caerphilly

Hywel Dda Hywel

Ceredigion

Denbighshire

Merthyr Tydfil Merthyr

AneurinBevan

Pembrokeshire

Blaenau GwentBlaenau

Monmouthshire

BetsiCadwaladr

Isle of AngleseyIsleof

Carmarthenshire

Neath Port Talbot NeathPort

RhonddaTaf Cynon

The Vale ofGlamorgan Vale The

Cardiff & Vale University&Vale Cardiff AbertaweMorgannwgBro

Areas ordered geographically from north west to south east

62

Director of Public Health Annual Report: Chart Book

5.2.5 Mental illness as reported by adult

Adults who reported currently being treated for a mental illness by local authority and health board, age standardised percentage, 2008-2009 Produced by Public Health Wales Observatory using data from the Welsh Health Survey, 2008 and 2009

Wales = 10

15 14 13 13 13 12 11 11 11 10 10 10 10 10 10 10 9 9 9 8 8 8 8 8 8 7 7 7

6

Powys Powys

Cardiff

Conwy

Torfaen

Newport

Cwm Taf Cwm

Swansea

Bridgend

Flintshire

Gwynedd

Wrexham

Caerphilly

Hywel Dda Hywel

Ceredigion

Denbighshire

Merthyr Tydfil Merthyr

AneurinBevan

Blaenau GwentBlaenau

Pembrokeshire

Monmouthshire

Isle of AngleseyIsleof

BetsiCadwaladr

Carmarthenshire

Neath Port Talbot NeathPort

RhonddaTaf Cynon

The Vale ofGlamorgan Vale The

Cardiff & Vale University&Vale Cardiff Abertawe Bro MorgannwgAbertaweBro

Areas ordered geographically from north west to south east

63

Director of Public Health Annual Report: Chart Book 5.3 Mortality from specific conditions

5.3.1 Mortality from circulatory disease, all ages

Middle super output areas

Numbers on map indicate MSOAs with a rate statistically significantly higher than the all Wales rate.

64

Director of Public Health Annual Report: Chart Book

Mortality from circulatory disease in Abertawe Bro Morgannwg UHB area, all persons, 2004- 08, European age-standardised rates per 100,000 Produced by Public Health Wales Observatory, using data from ONS (ADDE, MYE)

MSOA EASR with 95% confidence interval

Swansea Neath Port Talbot

016 294 012 255 001 293 008 254 019 286 011 245 021 279 014 245 011 275 016 241 017 014 272 239 002 025 265 233 013 256 001 231 006 252 005 230

008 245 010 229 MSOA 024 241 013 228 010 231 018 221 018 229 004 215 020 222 019 214 009 005 218 213 003 017 216 179

MSOA 015 029 211 169 Neath Port Talbot 009 007 159 209 EASR = 219 006 002 207 153 007 205 EASR per 100,000 015 204 003 199 Bridgend 022 194 006 297 012 183 004 288 028 180 010 287 026 179 001 261 004 177 007 261 030 154 012 256 027 153 Swansea 005 246 031 150 EASR = 216 003 239 023 143 014 EASR per 100,000 239 002 232

MSOA 016 219 019 219 008 218 009 208 018 196 015 187 013 181 Bridgend 017 166 EASR = 226 011 149 EASR per 100,000

65

Director of Public Health Annual Report: Chart Book

Local authorities

Mortality from circulatory disease by local authority, all persons, 2004- 95% confidence 08, European age-standardised rates per 100,000 interval Produced by Public Health Wales Observatory, using data from ONS (ADDE, MYE)

Wales = 213.9

259.6

251.0

239.4

238.8

234.5

225.9

218.9

215.9

215.6

215.5

213.0

212.3

210.4

210.0

207.1

203.8

197.9

194.1

191.1

189.9

177.5

176.3

Powys

Cardiff

Conwy

Torfaen

Newport

Swansea

Bridgend

Flintshire

Gwynedd

Wrexham

Caerphilly

Ceredigion

Denbighshire

Merthyr Tydfil Merthyr

Pembrokeshire

Blaenau GwentBlaenau

Monmouthshire

Isle of AngleseyofIsle

Carmarthenshire

Neath Port Talbot NeathPort RhonddaTaff Cynon

Areas ordered geographically from north west to south east ofGlamorgan Vale The

66

Director of Public Health Annual Report: Chart Book

5.3.2 Mortality from circulatory disease, under 75s

Middle super output areas

Numbers on map indicate MSOAs with a rate statistically significantly higher than the all Wales rate.

67

Director of Public Health Annual Report: Chart Book

Mortality from circulatory disease in Abertawe Bro Morgannwg UHB area, all persons aged under 75, 2004-08, European age-standardised rates per 100,000 Produced by Public Health Wales Observatory, using data from ONS (ADDE, MYE)

Swansea Neath Port Talbot

025 161 012 136 016 152 017 131 019 150 013 131 021 146 008 122 011 137 016 117 001 136 011 113 008 110 018 105 010 107 014 103 024 107 002 102 014 103 005 102

013 97 MSOA 010 99 017 96 003 84 002 92 004 83 029 91 001 76 006 86 019 71 004 81 009 70

MSOA 009 80 015 68 Neath Port Talbot 015 79 006 63 EASR = 96 005 79 007 49 007 79 EASR per 100,000 003 78 026 77 Bridgend 018 76 006 020 70 133 028 66 012 127 012 61 004 121 022 57 001 120 023 57 014 119 027 54 003 99 Swansea 031 49 010 99 EASR = 90 030 35 016 97 EASR per 100,000 019 96 007 96

MSOA 005 94 008 85 002 80 017 77 011 76 009 76 015 69 Bridgend 018 66 EASR = 92 013 52 EASR per 100,000

68

Director of Public Health Annual Report: Chart Book

Local authorities

Mortality from circulatory disease by local authority, all persons aged 95% confidence under 75, 2004-08, European age-standardised rates per 100,000 interval Produced by Public Health Wales Observatory, using data from ONS (ADDE, MYE)

Wales = 89.5

123.3

116.9

112.3

112.2

96.0

94.5

91.5

91.4

89.9

87.6

87.1

87.0

86.7

85.1

81.8

81.4

78.7

77.5

72.9

72.1

71.0

66.5

Powys

Cardiff

Conwy

Torfaen

Newport

Swansea

Bridgend

Flintshire

Gwynedd

Wrexham

Caerphilly

Ceredigion

Denbighshire

Merthyr Tydfil Merthyr

Blaenau GwentBlaenau

Pembrokeshire

Monmouthshire

Isle of AngleseyofIsle

Carmarthenshire

Neath Port Talbot PortNeath RhonddaTaff Cynon

Areas ordered geographically from north west to south east The Vale ofGlamorgan Vale The

69

Director of Public Health Annual Report: Chart Book

5.3.3 Mortality from coronary heart disease

Middle super output areas

Numbers on map indicate MSOAs with a rate statistically significantly higher than the all Wales rate.

70

Director of Public Health Annual Report: Chart Book

Mortality from coronary heart disease in Abertawe Bro Morgannwg UHB area, all persons, 2004-08, European age-standardised rates per 100,000 Produced by Public Health Wales Observatory, using data from ONS (ADDE, MYE)

Swansea Neath Port Talbot

014 163 011 141 025 157 002 139 019 156 008 138 001 154 017 138 011 151 014 133 016 021 149 131 012 016 144 129 008 133 019 125 006 124 005 124

013 124 013 122 MSOA 002 120 001 120 017 117 010 116 007 114 018 116 009 114 009 115 004 015 113 107 003 010 111 103

MSOA 006 003 107 89 Neath Port Talbot 028 007 88 106 EASR = 118 015 005 104 74 020 103 EASR per 100,000 026 102 012 101 Bridgend 018 98 004 160 024 94 007 155 004 94 001 149 029 90 003 136 022 89 006 136 023 81 014 132 031 76 Swansea 012 129 027 75 EASR = 111 010 124 030 72 002 119 EASR per 100,000 008 112

MSOA 005 106 019 104 018 99 016 87 013 85 009 85 015 81 Bridgend 011 80 EASR = 113 017 74 EASR per 100,000

71

Director of Public Health Annual Report: Chart Book

Local authorities

Mortality from coronary heart disease by local authority, all persons, 95% confidence 2004-08, European age-standardised rates per 100,000 interval Produced by Public Health Wales Observatory, using data from ONS (ADDE, MYE)

Wales = 108.4

142.1

134.6

130.1

128.7

118.9

117.9

115.7

112.9

111.7

111.3

106.7

106.3

105.5

97.7

97.4

101.9

94.6

93.7

93.5

92.0

87.7

86.8

Powys

Cardiff

Conwy

Torfaen

Newport

Swansea

Bridgend

Flintshire

Gwynedd

Wrexham

Caerphilly

Ceredigion

Denbighshire

Merthyr Tydfil Merthyr

Pembrokeshire

Blaenau GwentBlaenau

Monmouthshire

Isle of AngleseyofIsle

Carmarthenshire

Neath Port Talbot NeathPort RhonddaTaff Cynon Areas ordered geographically from north west to south east The Vale ofGlamorgan Vale The

72

Director of Public Health Annual Report: Chart Book

5.3.4 Mortality from cancer

Middle super output areas

Numbers on map indicate MSOAs with a rate statistically significantly higher than the all Wales rate.

73

Director of Public Health Annual Report: Chart Book

Mortality from all cancers in Abertawe Bro Morgannwg UHB area, all persons, 2004-08, European age-standardised rates per 100,000 Produced by Public Health Wales Observatory, using data from ONS (ADDE, MYE)

Swansea Neath Port Talbot

011 259 012 240 019 247 016 237 025 243 011 233 021 237 002 225 004 229 014 218 001 220 005 202 014 216 004 201 012 216 013 199 013 206 008 195

016 205 010 185 MSOA 009 203 019 185 026 202 001 184 018 201 018 182 017 195 003 175 002 186 007 173 005 185 017 172

MSOA 010 183 015 164 Neath Port Talbot 008 178 009 153 EASR = 192 007 175 006 145 015 174 EASR per 100,000 029 172 003 172 Bridgend 022 171 001 261 006 169 014 240 020 164 010 220 024 163 003 212 030 137 017 210 027 131 007 209 023 129 Swansea 019 209 031 128 EASR = 184 015 206 028 125 002 EASR per 100,000 206 005 188

MSOA 004 188 008 187 006 187 011 180 016 167 018 162 009 161 Bridgend 013 148 EASR = 193 012 142 EASR per 100,000

74

Director of Public Health Annual Report: Chart Book

Local authorities

Mortality from all cancers by local authority, all persons, 2004-08, 95% confidence European age-standardised rates per 100,000 interval Produced by Public Health Wales Observatory, using data from ONS (ADDE, MYE)

Wales = 185.5

215.4

202.8

195.5

195.0

193.6

193.4

193.2

192.2

191.2

189.6

189.2

187.2

186.4

186.3

184.5

184.3

184.1

176.9

174.4

162.2

157.4

154.2

Powys

Cardiff

Conwy

Torfaen

Newport

Swansea

Bridgend

Flintshire

Gwynedd

Wrexham

Caerphilly

Ceredigion

Denbighshire

Merthyr Tydfil Merthyr

Blaenau GwentBlaenau

Pembrokeshire

Monmouthshire

Isle of AngleseyIsleof

Carmarthenshire

Neath Port Talbot NeathPort RhonddaTaff Cynon

Areas ordered geographically from north west to south east ofGlamorgan Vale The

75

Director of Public Health Annual Report: Chart Book

5.3.5 Mortality from respiratory disease

Middle super output areas

Numbers on map indicate MSOAs with a rate statistically significantly higher than the all Wales rate.

76

Director of Public Health Annual Report: Chart Book

Mortality from respiratory disease in Abertawe Bro Morgannwg UHB area, all persons, 2004- 08, European age-standardised rates per 100,000 Produced by Public Health Wales Observatory, using data from ONS (ADDE, MYE)

Swansea Neath Port Talbot

016 113 011 112 019 106 017 110 014 105 018 104 010 99 009 101 021 99 008 98 016 013 99 94 005 011 97 93 012 93 013 92 018 90 001 88

015 89 007 86 MSOA 026 88 010 81 008 87 019 79 001 83 002 77 005 82 003 76 004 029 81 75 012 024 80 72

MSOA 014 025 79 68 Neath Port Talbot 017 006 65 79 EASR = 86 015 004 78 56 009 74 EASR per 100,000 031 72 002 71 Bridgend 007 71 003 123 022 70 006 122 030 59 007 114 006 56 010 110 028 55 005 107 003 53 001 104 027 50 Swansea 009 97 023 49 EASR = 78 004 020 38 96 008 85 EASR per 100,000 002 83

MSOA 019 73 016 72 017 71 012 69 018 68 014 66 011 59 Bridgend 013 57 EASR = 85 015 51 EASR per 100,000

77

Director of Public Health Annual Report: Chart Book

Local authorities

Mortality from respiratory disease by local authority, all persons, 95% confidence 2004-08, European age-standardised rates per 100,000 interval Produced by Public Health Wales Observatory, using data from ONS (ADDE, MYE)

Wales = 77.0

99.1

97.7

94.9

93.5

89.8

85.5

85.1

81.7

79.5

77.7

77.5

76.7

74.3

72.9

71.4

71.1

64.8

64.0

62.9

58.7

55.1

54.2

Powys

Cardiff

Conwy

Torfaen

Newport

Swansea

Bridgend

Flintshire

Gwynedd

Wrexham

Caerphilly

Ceredigion

Denbighshire

Merthyr Tydfil Merthyr

Pembrokeshire

Blaenau GwentBlaenau

Monmouthshire

Isle of AngleseyofIsle

Carmarthenshire

Neath Port Talbot PortNeath RhonddaTaff Cynon Areas ordered geographically from north west to south east The Vale ofGlamorgan Vale The

78

Director of Public Health Annual Report: Chart Book

5.3.6 Cancer survival

One year relative survival, all cancer (excluding non melanoma skin cancer), males, Wales regions, all persons, 1994/6-2006/8 Produced by the Welsh Cancer Intelligence and Surveillance Unit

100

95

90

85

80

75

70 One year Onerelative survival (%) 65

60

55

50 1994-1996 1997-1999 2000-2002 2003-2005 2006-2008 Wales 53.07 56.24 60.98 64.45 66.93 North Wales 54.26 56.20 62.52 65.26 68.74 South Wales 52.69 56.26 60.46 64.19 66.34

79

Director of Public Health Annual Report: Chart Book

One year relative survival, all cancer (excluding non melanoma skin cancer), females, Wales regions, all persons, 1994/6-2006/8 Produced by the Welsh Cancer Intelligence and Surveillance Unit

100

95

90

85

80

75

70 One year Onerelative survival (%) 65

60

55

50 1994-1996 1997-1999 2000-2002 2003-2005 2006-2008 Wales 62.00 64.20 66.21 68.65 70.18 North Wales 62.01 64.06 64.97 68.36 71.61 South Wales 61.99 64.25 66.61 68.74 69.71

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Director of Public Health Annual Report: Chart Book

One year and five year relative survival, by cancer site Abertawe Bro Morgannwg UHB area, males and females, 2000-2004 (95% confidence intervals) Produced by the Welsh Cancer Intelligence and Surveillance Unit

Male 1 year relative survival Cancer Site ABM All Wales Prostate 90.84 (88.72, 92.58) 88.80 (87.95, 89.59) Lung 24.63 (21.83, 27.52) 22.84 (21.71, 24.00) Colorectal 73.55 (70.08, 76.69) 71.51 (70.12, 72.85) Bladder 86.85 (82.63, 90.10) 86.10 (84.51, 87.53) All malignancies (excl NMSC) 62.85 (61.54, 64.12) 62.11 (61.57, 62.63)

5 year relative survival Cancer Site ABM All Wales Prostate 79.64 (76.19, 82.65) 77.17 (75.83, 78.45) Lung 4.68 (3.38, 6.28) 5.36 (4.73, 6.04) Colorectal 49.78 (45.60, 53.81) 48.59 (46.91, 50.24) Bladder 74.39 (68.51, 79.34) 72.34 (70.04, 74.50) All malignancies (excl NMSC) 45.99 (44.52, 47.45) 45.39 (44.79, 45.99)

Female 1 year relative survival Cancer Site ABM All Wales Breast 93.66 (92.15, 94.89) 93.41 (92.83, 93.94) Lung 26.42 (22.90, 30.06) 25.53 (24.09, 26.99) Colorectal 68.73 (64.64, 72.45) 68.80 (67.19, 70.36) Ovary 67.12 (61.39, 72.19) 63.92 (61.50, 66.24) Corpus Uteri 93.81 (88.87, 96.59) 89.83 (87.90, 91.46) All malignancies (excl NMSC) 67.83 (66.54, 69.08) 67.24 (66.71, 67.76)

5 year relative survival Cancer Site ABM All Wales Breast 83.64 (81.32, 85.70) 82.06 (81.14, 82.94) Lung 4.52 (3.02, 6.45) 6.85 (6.00, 7.76) Colorectal 49.79 (45.17, 54.23) 49.18 (47.31, 51.01) Ovary 49.53 (43.31, 55.44) 39.29 (36.78, 41.80) Corpus Uteri 82.72 (75.70, 87.87) 77.77 (75.02, 80.25) All malignancies (excl NMSC) 53.85 (52.39, 55.28) 52.76 (52.17, 53.36)

Significantly higher than Wales Significantly lower than Wales

ABM: Abertawe Bro Morgannwg UHB. Excl NSCM: Excluding non melanoma skin cancer

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Appendix A: Original source reports and further information

The original reports for the data included in this chart book, together with further information and, in some cases, methodological information and other guides to interpretation can be found through the producers of the charts, tables or data included:

Demography Public Health Wales Observatory www.publichealthwalesobservatory. wales.nhs.uk

Determinants of Public Health Wales Observatory www.publichealthwalesobservatory. health wales.nhs.uk

Use of prevention Vaccine Preventable Disease http://www.wales.nhs.uk/sitesplus/ services: Programme 888/page/43510 vaccination uptake

Use of prevention Public Health Wales Screening http://www.screeningservices.org.u services: screening Services k/

Use of primary care Welsh Assembly Government, http://new.wales.gov.uk/ by adults Welsh Health Survey

Use of secondary Public Health Wales Observatory www.publichealthwalesobservatory. and tertiary care wales.nhs.uk

Health status Public Health Wales Observatory www.publichealthwalesobservatory. wales.nhs.uk

Cancer survival Welsh Cancer Surveillance and http://www.wales.nhs.uk/sites3/ho Intelligence Unit me.cfm?OrgID=242

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Director of Public Health Annual Report: Chart Book Appendix B: Glossary

Middle Super Middle super output areas (MSOAs) were released by the Office Output Areas for National Statistics (ONS) in 2004. In contrast with administrative boundaries such as electoral divisions (wards), super output areas were created for the purpose of showing statistical data. MSOAs have a mean population of 7,500 and a minimum of 5,000. There are 413 MSOAs in Wales and 69 in the Abertawe Bro Morgannwg University Health Board area. These are shown on the maps in Appendix 2. The ONS have stated that super output area geographies will be fixed for at least 10 years. The advantage of using these statistical geographies is stability and homogeneity. However, the main drawback is that they do not conform to known administrative boundaries such as electoral divisions (wards); this makes them less amenable to the public and local government.

Age- Age-standardisation allows comparison of rates across different standardised populations while taking account of the different age structures of rate those populations. This chart book uses the direct standardisation method, which produces the rate you would get if the population had the same age-structure as a particular ‘standard’ population. The Wales standard population has been used for the Welsh Health Survey indicators and the theoretical European standard population (ESP) has been used for all other age-standardised indicators included in this chart book. An age-standardised rate only allows for comparison between the rates which have been standardised to the same standard population.

Confidence Confidence intervals are indications of the random variation that intervals would be expected around a rate. Confidence intervals must be considered when assessing or interpreting a rate. The 95% confidence interval represents a range which has a 95% probability of including the underlying population rate. The range of the confidence interval is dependent on the size of the population from which the events came. Rates based on small populations are likely to have wider confidence intervals and rates based on large populations are likely to have narrower confidence intervals.

Statistical A result may be deemed statistically significant if it is considered significance unlikely to have occurred by chance alone. The basis for such judgements is a predetermined and arbitrary cut-off, usually taken as 5% or 0.05. A result may be clinically significant whilst not being statistically significant and vice versa.

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Appendix C: Maps showing Middle Super Output Areas in the Abertawe Bro Morgannwg UHB area

The Public Health Wales Observatory has also produced a web-based interactive map showing MSOA boundaries, with the added facility of background Ordnance Survey mapping. Follow this link: http://www2.nphs.wales.nhs.uk/InstantAtlas/GeographyTool/atlas.html

Swansea

A Swansea 001 L Swansea 012 W Swansea 023 B Swansea 002 M Swansea 013 X Swansea 024 C Swansea 003 N Swansea 014 Y Swansea 025 D Swansea 004 O Swansea 015 Z Swansea 026 E Swansea 005 P Swansea 016 AA Swansea 027 F Swansea 006 Q Swansea 017 AB Swansea 028 G Swansea 007 R Swansea 018 AC Swansea 029 H Swansea 008 S Swansea 019 AD Swansea 030 I Swansea 009 T Swansea 020 AE Swansea 031 J Swansea 010 U Swansea 021 K Swansea 011 V Swansea 022

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Neath Port Talbot

A Neath Port Talbot 001 B Neath Port Talbot 002 C Neath Port Talbot 003 D Neath Port Talbot 004 E Neath Port Talbot 005 F Neath Port Talbot 006 G Neath Port Talbot 007 H Neath Port Talbot 008 I Neath Port Talbot 009 J Neath Port Talbot 010 K Neath Port Talbot 011 L Neath Port Talbot 012 M Neath Port Talbot 013 N Neath Port Talbot 014 O Neath Port Talbot 015 P Neath Port Talbot 016 Q Neath Port Talbot 017 R Neath Port Talbot 018 S Neath Port Talbot 019

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Bridgend

A Bridgend 001 B Bridgend 002 C Bridgend 003 D Bridgend 004 E Bridgend 005 F Bridgend 006 G Bridgend 007 H Bridgend 008 I Bridgend 009 J Bridgend 010 K Bridgend 011 L Bridgend 012 M Bridgend 013 N Bridgend 014 O Bridgend 015 P Bridgend 016 Q Bridgend 017 R Bridgend 018 S Bridgend 019

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