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Joint Strategic Needs Assessment

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Joint Strategic Needs Assessment Joint Strategic Needs 2009 Assessment VolumeVolume 1 2 and Director of “Understanding Derby’s population, its health and its social care needs” Public Health’s Annual Report 1 Volume 2 7. Burden of Ill-Health 98 7.1. Misc 98 7.1.1. All causes 98 7.1.2. Causes considered amenable to healthcare 105 7.1.3. Due to smoking 106 7.2. Diabetes 108 7.3. Circulatory 114 7.3.1. General 114 7.3.2. Coronary Heart Disease 115 7.3.3. Stroke 120 7.4. Cancer 126 7.4.1. General 126 7.4.2. By site 127 7.5. Respiratory 140 7.6. Infectious disease 145 7.6.1. TB 145 7.6.2. STIs & HIV 146 7.7. Dental health 150 7.8. Mental health 154 7.8.1. Dementia 154 7.8.2. Suicide 159 7.8.3. Mental Illness 162 7.9. Trauma 164 7.9.1. Falls 164 7.9.2. Road accidents 167 7.9.3. Injuries 169 7.10. Musculo-skeletal 171 8. Services 177 8.1. Social care 177 8.2. Health services 188 8.2.1. Maternity 188 8.2.2. Dental health 188 8.2.3. Preventative/Screening 189 8.2.4. Sexual Health 192 8.2.5. Mental Health 196 8.2.6. Long-term conditions 196 8.3. Voice 198 8.3.1. User perspective on health care 198 2 7. Burden of Ill-Health 7.1 Misc 7.1.1 All causes What is the problem? By improving overall life expectancy and tackling health inequalities, we aim to achieve better health and well-being for everyone in Derby City. All age all cause mortality in Derby is generally improving, however, in males the gap between the East Midland and England rates is wider than for females, and in the case of premature (less than 75 years of age) mortality from all causes, this gap has widened from 2006 to 2007. Figure 91 All Age All Cause Mortality Rates 1100 1000 900 800 England Males East Midland Males Derby Males 700 England Females Standardised Rate/100,000Population East Midland Females - Derby Females 600 Directly Age 500 400 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 Year Source: ONS; National Centre for Health Outcomes Development (NCHOD) 3 Figure 92 Premature All Cause Mortality Rates 650 600 550 500 450 England Males East Midland Males Derby Males 400 England Females Standardised Standardised Rate/100,000Population East Midland Females - 350 Derby Females Directly Age 300 250 200 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 Year Source: ONS; National Centre for Health Outcomes Development (NCHOD) It is evident that all age all cause mortality in Derby is directly related to deprivation. The city’s three most deprived wards according to the IMD 2007 – Arboretum, Normanton and Sinfin Wards – equally have the highest directly age-standardised rates of mortality by 100,000 population. This is highlighted in Figure 93. All three wards have significantly higher rates of mortality than is average in Derby City. Figure 93 Directly Age Standardised Rate of All Age All Cause Mortality by Ward in Derby City (2003/07) DASR/100,000 Population LCL UCL Abbey 787.50 726.07 848.92 Allestree 393.28 359.06 427.50 Alvaston 635.22 582.48 687.95 Arboretum 949.37 879.43 1019.31 Blagreaves 439.83 397.75 481.90 Boulton 596.22 547.83 644.62 Chaddesden 594.61 545.47 643.74 Chellaston 420.02 379.44 460.60 Darley 738.80 681.58 796.02 Derwent 707.01 649.56 764.45 Littleover 427.24 383.39 471.09 Mackworth 594.90 541.53 648.27 Mickleover 459.74 420.66 498.83 Normanton 835.75 772.87 898.62 Oakwood 468.89 416.01 521.77 Sinfin 797.00 729.70 864.30 Spondon 657.67 607.59 707.75 DERBY CITY 604.23 592.04 616.41 Source: ONS Annual District Deaths files 4 Figure 94 Infant Mortality (2005/07) 7.0 6.0 5.0 4.0 Infant age under 1 year Infant age under 28 days 3.0 Rate/1000BirthsLive Infant age under 7 days 2.0 1.0 0.0 ENGLAND EAST MIDLANDS Derby UA Region Source: ONS; National Centre for Health Outcomes Development (NCHOD) Reducing the gap in infant mortality between the routine and manual socio-economic group and the England average is one of the key measures of the national health inequalities target, and tackling this will in turn contribute to the life expectancy target. In Derby, there is no significant difference in rate of mortality in infancy in those aged under 1 year (48 deaths), under 28 days (29 deaths) and in those aged less than 7 days (28 deaths), compared with the East Midlands and England where there is significant difference between each of them. Moreover, whilst the confidence intervals suggest that the rate of mortality in infants aged under 28 days could be as high as is the case nationally, the actual rate for the period 2005-2007 was much lower (Figure 94). Figure 95 displays the current trend and forecast in infant mortality (under 1 year) to 2009/11 in Derby City compared with England and the East Midlands region. As is clear from the confidence intervals that have been applied to Derby’s figures; the rate of mortality is not significantly worse nor is it better than is seen in the East Midlands and nationally. However, it is apparent from the steeper trend that there has been much success in reducing mortality in infancy in Derby in recent years (despite the slight increase in 2005/07 from 2004/06) and as a result, the forecast of mortality in 2009/11 is far lower (though potentially not significantly compared to the national picture) than it is likely to be in the East Midlands and in England (based on their current trends). Analysis undertaken of the rate of mortality in infancy in the wards of Derby has revealed that whilst rates are clearly linked to deprivation, there is no significance when applying confidence intervals to the overall Derby average, with one exception. Arboretum Ward for the period 2004/06 had an infant mortality rate of 11 per 1000 live births. This was very much higher than the average in Derby of 4.2 for the same period. 5 Figure 95 Trend and Projection of Rate of Infant Mortality (under 1 year) in Derby City 10 9 8 7 6 ENGLAND EAST MIDLANDS 5 Derby UA Expon. (ENGLAND) 4 Expon. (EAST MIDLANDS) CrudeRate/1000 Live Births Expon. (Derby UA) 3 2 1 0 1999/01 2000/02 2001/03 2002/04 2003/05 2004/06 2005/07 2006/08 2007/09 2008/10 2009/11 Source: ONS; NCHOD Current life expectancy trends in males and females in Derby are very different, though are equally very positive in terms of overall life expectancy for people in the city. Figures 96 and 97 highlight that in males, the gap in life expectancy between Derby, the East Midland and England has been narrowing since 1991/93. In fact, the projection to 2009/11 suggests that male life expectancy in Derby could potentially be as good as it is in England as a whole (approximately 78.5 years). In females, life expectancy has fluctuated above and below the national and regional expectancies for the same duration. In recent years however, females in Derby are expected to live for longer than is the case nationally (approximately 82 years), and are set to continue this trend to the year 2009/11 and potentially beyond. 6 Figure 96 Males 80 79 78 77 76 75 74 73 72 71 70 69 ENGLAND (non-resident deaths excluded) EAST MIDLANDS Derby UA Expon. (ENGLAND (non-resident deaths excluded)) Expon. (EAST MIDLANDS) Expon. (Derby UA) Source: ONS; NCHOD Figure 97 Females 83 82 81 80 79 78 77 76 ENGLAND (non-resident deaths excluded) EAST MIDLANDS Derby UA Expon. (ENGLAND (non-resident deaths excluded)) Expon. (EAST MIDLANDS) Expon. (Derby UA) Source: ONS; NCHOD 7 Current life expectancies in England are 77.7 years in males and 81.8 in females. In comparison, males in Derby can expect to live for 76.8 years and females for 81.5 years. Life expectancy though varies greatly between wards. As expected, the most deprived wards have the lowest life expectancies; females in Normanton for instance can expect to live on average only to 76.5 years. That is more than 5 years less than is expected nationally. Equally as stark are males in Arboretum who on average can expect to live only to their 70th birthday. This is more than 7 years less than nationally. Life expectancy can however, be far higher in the more affluent wards of Derby City. For instance, in Allestree females can expect to live to 87.5 years and males to 82.6. This is far higher than the national average. Figure 98 Significance Significance Life expectancy females Life expectancy males City rank City rank Ward code Ward name (compared to (compared to (females) (males) (2003-2007) Derby City) (2003-2007) Derby City) 00FKNA Arboretum 76.7 Sig. low 70.6 Sig. low 16 17 00FKNL Normanton 76.5 Sig. low 74.2 Sig. low 17 15 00FKNN Sinfin 79.1 Sig. low 73.0 Sig. low 14 16 00FKNG Derwent 81.2 74.2 Sig. low 11 14 00FKMZ Alvaston 82.7 75.4 9 12 00FKMX Abbey 79.5 Sig.
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