West Suffolk Clinical Commissioning Group Equality and diversity information – January 2013 This document outlines some of the key demographic information about west Suffolk’s communities, where this information is available. Information and data is collated from: Equality and diversity data summary for West Suffolk CCG (Public Health), October 2012, West Suffolk CCG Equality and Diversity Strategy 2012-15 and NHS Suffolk Diversity toolkit to support commissioning, December 2011. Age This refers to a person belonging to a particular age. This protected characteristic can apply to anyone, although younger people and older people are proven to be most at risk of discrimination. Age discrimination can be direct when a person is treated less favourably because of their age, or indirect where care is offered in such a way that a particular age group is more heavily disadvantaged than people in other age groups. West Suffolk Clinical Commissioning Group Distribution of registered patients by age As at quarter 4 financial year 2011/12 Persons 20000 18000 16000 14000 12000 10000 8000 Number Number of patients 6000 4000 2000 0 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+ Persons 12806 12668 12770 13088 12299 13184 14214 14752 17583 18307 16018 14677 16315 15485 11214 8891 6612 6213 Age (years) Source: Open Exeter Page 1 of 20 West Suffolk Clinical Commissioning Group Distribution of registered patients by age and rural/urban classification As at September 2011 Persons 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 0-19 20-64 65+ All ages Rural 26.3% 26.7% 31.0% 27.5% Urban 73.6% 73.2% 69.0% 72.5% Age (years) Source: NHS Suffolk, Diversity toolkit to support commissioning (December 2011) As of March 2012, 237,096 people were registered with a GP in west Suffolk. 51,332 (21.7%) of the population was aged 0 to 19 years and 48,415 (20.4%) was aged over 65 years. Red Lodge, Newmarket, Culford and Haverhill particularly, had high proportions of people aged 19 years and under. Lakenheath, Red Lodge and Bury St Edmunds had the highest proportions of people aged 65 years and over. Disability A person has a disability if he or she has a physical or mental impairment which has a substantial and long-term adverse effect on that person’s ability to carry out normal day-to-day activities. Disability can arise from many health problems including hearing and visual impairment, physical disabilities, both congenital and acquired, and learning difficulties. People’s needs vary greatly and many people will experience several Page 2 of 20 disabilities or be caring for another family member or friend with health problems (NHS Suffolk & Arana Ltd, 2009). Physical disability The Department of Health defines physical disability as a physical impairment, which has a substantial and long-term effect on individuals’ ability to carry out day-to-day activities. People with physical disability may experience difficulties with access to care, and communication as well as poorer levels of self reported health and an increased risk of depression. Projecting Adult Needs and Service Information (PANSI) have produced prevalence estimates for moderate (e.g. unable to manage stairs, and need aids or assistance to walk) and serious (e.g. unable to walk and dependent on a carer for mobility ) physical disability in England based on the Health Survey for England 2001. The estimates show a clear relationship between physical disability and age, with the prevalence of moderate physical disability increasing by a factor of 4 between the ages of 18 and 64 and serious disability increasing by a factor of 7 (see graph below). Prevalence of moderate and serious physical disability by age in England (Source: Health Survey for England 2001) 16 14 12 10 8 6 % prevalence % 4 2 0 18-24 25-34 35-44 45-54 55-64 % moderate 4.1 4.2 5.6 9.7 14.9 % serious 0.8 0.4 1.7 2.7 5.8 % moderate % serious Page 3 of 20 West Suffolk Clinical Commissioning Group Distribution of estimated numbers of registered patients with physical disability by disability severity and age As at September 2011 Persons aged 18-64 years 5000 4697 4500 4000 3500 3292 3000 2500 2000 1840 1828 1500 1146 Estimated numberof patients 916 1000 709 559 500 138 109 0 18-24 25-34 35-44 45-54 55-64 18-24 25-34 35-44 45-54 55-64 Moderate Severe Severity and age (years) In September 2011 it was estimated that in west Suffolk there were 11,685 people with a moderate physical disability, and 3551 people with a severe physical disability. Mental health People with mental health disorders and disabilities have a higher risk of poor physical health and premature mortality than the general population (Phelan et al , 2001). Reasons for this include the impact on physical health of deprivation and poverty, but also associated lifestyle behaviours with poor nutrition, obesity, higher levels of smoking, heavy alcohol use and lack of exercise contributing to higher rates of morbidity and life expectancy among people with mental health problems (Friedli and Dardis, 2002). The prevalence of different types of mental health disorders experienced by the population can be seen below (PANSI 2011). There are large variations in prevalence between disorders and gender (see graph below). Page 4 of 20 Prevalence of adult Psychiatric Morbidity in England Source: Adult psychiatric morbidity in England 2007. 20 18 16 14 12 10 8 6 4 2 0 Borderline Antisocial Tw o or more Common mental Psychotic personality personality psychiatric disorder disorder disorder disorder disorders % males 12.5 0.3 0.6 0.3 6.9 % females 19.7 0.6 0.1 0.5 7.5 West Suffolk Clinical Commissioning Group Estimated distribution of adult registered patients with mental disorders by type of disorder As at September 2011 Persons 25000 20000 15000 10000 5000 Estimatednumber of adult patients 0 Common mental Borderline personality Anti-social personality Psychotic disorders Psychiatric comorbidity disorders disorder disorder Number of patients 23002 643 501 571 10289 Mental disorder Source: NHS Suffolk, Diversity toolkit to support commissioning (December 2011) Page 5 of 20 In west Suffolk it is estimated that there are approximately 35,006 people with some form of adult psychiatric morbidity (this includes common mental disorders, borderline personality disorders, antisocial personality disorders, psychotic disorders and psychiatric co-morbidity). Learning disability The term learning disability (LD) is used to describe a significant, lifelong experience that has three components: • significantly reduced ability to understand new or complex information, to learn new skills (significantly impaired intelligence), and • reduced ability to cope independently (impaired social/adaptive functioning), and • onset before the age of 18 years, with a lasting effect on development (National Institute for Health and Clinical Excellence, 2009) People with LD have higher rates of mental health problems, respiratory and heart disease, higher levels of obesity and may have additional physical disability (Royal College of Nursing, 2011) and therefore shorter life expectancy and higher risk of premature death. Evidence suggests that nationally the number of people with severe LD may increase by around 1% per annum for the next 15 years as a result of: • increased life expectancy, especially among people with Down’s syndrome • growing numbers of children and young people with complex and multiple disabilities who survive into adulthood • a sharp rise in the reported numbers of school-aged children with autistic spectrum disorders, some of whom will have learning disabilities • greater prevalence among some populations of South Asian origin. (Emerson and Hatton, 2004) By applying prevalence estimates from research to numbers of registered patients in West Suffolk CCG it is estimated that as at September 2011 there were 4660 persons aged 15 years and over with all types of learning disabilities and 976 persons aged 15 years and over with moderate or severe learning disabilities in West Suffolk CCG. Dementia The term ‘dementia’ is used to describe a collection of symptoms, including a decline in memory, reasoning and communication skills, and a gradual loss of skills needed to carry out daily activities. These symptoms are caused by Page 6 of 20 structural and chemical changes in the brain as a result of physical diseases such as Alzheimer’s disease. Dementia can affect people of any age, but is most common in older people. Dementia is a progressive condition and has a disproportionate impact on capacity for independent living (LSE; KCL & Alzheimer’s Society 2007). West Suffolk Clinical Commissioning Group Estimated numbers of patients with dementia (excluding early-onset dementia) As at September 2011 Persons aged 60 years and over 900 800 700 600 500 400 300 Estimated number of patients 200 100 0 60-69 70-74 75-79 80-84 85-89 90-94 95+ Number of patients 411 321 518 803 815 489 150 Age (years) Source: NHS Suffolk, Diversity toolkit to support commissioning (December 2011) Dementia beginning before the age of 65 is known as early onset dementia and although rare does affect people in their 30s. The graph below shows the prevalence of early onset dementia by age in the UK. Page 7 of 20 Rate of early onset dementia per 100,000 population in the UK Source: Dementia UK (2007) 200 180 160 140 120 100 80 60 40 20 0 30-34 35-39 40-44 45-49 50-54 55-59 60-64 Per 100,000 males 8.9 6.3 8.1 31.8 62.7 179.5 198.9 Per 100,000 females 9.5 9.3 19.6 27.3 55.1 97.1 118 Estimated number of people with early onset dementia in west Suffolk, as of September 2011: West Age group Suffolk 30-34 1 35-39 1 40-44 2 45-49 5 50-54 9 Total 18 It should be noted that 6.1% of all people with dementia among BME groups in the UK are early onset, compared with only 2.2% for the UK population as a whole, reflecting the younger age profile of BME communities.