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East Profile

A summary of public health in the region: 2017

Public Health includes the local authority areas of City, County, City, County, City, County, County, County and County. The population of the area in 2016 was over 4.7 million people.

East Midlands Profile: A summary of public health in the region 2016

About Public Health England

Public Health England exists to protect and improve the nation’s health and wellbeing, and reduce health inequalities. We do this through world-leading science, knowledge and intelligence, advocacy, partnerships and the delivery of specialist public health services. We are an executive agency of the Department of Health and Social Care, and a distinct delivery organisation with operational autonomy. We provide government, local government, the NHS, Parliament, industry and the public with evidence-based professional, scientific and delivery expertise and support.

Public Health England Wellington House 133-155 Waterloo Road SE1 8UG Tel: 020 7654 8000 www.gov.uk/phe Twitter: @PHE_uk Facebook: www.facebook.com/PublicHealthEngland

Prepared by Natalie Cantillon, Principal Public Health Intelligence Analyst and Stephen Spreadborough, Public Health Analyst For queries relating to this document, please contact: [email protected]

© Crown copyright 2018 You may re-use this information (excluding logos) free of charge in any format or medium, under the terms of the Open Government Licence v3.0. To view this licence, visit OGL. Where we have identified any third party copyright information you will need to obtain permission from the copyright holders concerned.

Published February 2018 PHE publications PHE supports the UN gateway number: 2017815 Sustainable Development Goals

2 East Midlands Profile: A summary of public health in the region 2017

Contents

About Public Health England 2 Executive summary 4 The East Midlands 5

Child and maternal health 9 Adult health 14 Older people 19

Mortality 21 Health inequalities 23 Appendix 24 Health profile indicators: overview of the East Midlands 26

3 East Midlands Profile: A summary of public health in the region 2017

Executive summary

Indicators where the East Midlands is significantly better than England:

 children in low income families (under 16s)  statutory homelessness  violent crime (violent offences)  long term unemployment  obese children (year 6)  incidence of Tuberculosis (TB)  new sexually transmitted infections (STI)

Indicators where the East Midlands is similar to England:

 under 18 conceptions  smoking prevalence in adults  percentage of physically active adults  hip fractures in people aged 65 and over  dementia diagnosis rate  suicide rate  smoking related deaths  under 75 mortality rate: cancer  excess winter deaths

Indicators where the East Midlands is significantly worse than England:

 GCSEs achieved  smoking status at time of delivery  breastfeeding initiation  excess weight in adults  hospital stays for self-harm  hospital stays for alcohol-related harm  recorded diabetes  life expectancy at birth (males)  life expectancy at birth (females)  infant mortality  killed and seriously injured on roads  under 75 mortality rate: cardiovascular disease

4 East Midlands Profile: A summary of public health in the region 2017

The East Midlands

East Midlands Region: The East Midlands has borders with 5 other regions; and The , the North West, the , the South East and , and is bordered by the North Sea coastline to the east.

In area, it is 15,600 square km making it the fourth largest English region, smaller than the South West, East of England and the South East.

The region covers 12% of the total area of England. It contains 5 counties, Derbyshire, Leicestershire, Lincolnshire, Northamptonshire and Nottinghamshire, and four unitary authorities, Derby, Leicester, Rutland and Nottingham.

There are 36 districts contained within the counties in the region, figure 1.

Figure 1. East Midlands region and local district and unitary authorities

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Population (2016) The population of the East Midlands is 4.7 million people, one of the smallest regions, in terms of population, in England.

The population is estimated to increase to 5.3 million in the next twenty years, an increase of 12%.

The East Midlands population is ageing. It is estimated that there are around 896,000 people in the East Midlands aged 65 or over. By 2036 this is projected to rise by almost half a million to over 1.3 million resulting in over a quarter of the population being 65 or over, figure 2.

Figure 2. East Midlands population pyramid, 2015 and 2039

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Deprivation (2015) In relation to other , the East Midlands has lower levels of deprivation; however, 18.4% (861,545) of the population still live in the most deprived quintile.

The relative position of the region, in terms of percentage of persons living in the most deprived areas, masks the inequalities occurring within the region, and within different groups, with many health challenges linked to socio-economic factors.

The poorest performing areas for health outcomes tend to be areas with high levels of deprivation: in large cities (Nottingham, Leicester, and Derby); on the coastal strip of Lincolnshire; and in areas of industrial decline, eg Nottinghamshire and Derbyshire, figures 3 and 4.

Figure 3. Deprivation in the East Midlands, Indices of Multiple Deprivation (2015)

Contains data © Crown copyright and database right 2017. Contains National Statistics data © Crown copyright and database right 2017.

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Figure 4. Percentage of people living in the 20% most deprieved areas in England, 2015

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Child and maternal health

Maternal health

There were 53,299 babies born in the East Midlands in 2016, the General Fertility Rate is 60.9 per 100,000 compared to 62.5 in England.

Rates of stillbirth in 2015 in the East Midlands are higher than the national average (4.7 compared to 4.4 nationally).

Teenage conception is lower than England in 2015 (20.2 in the East Midlands compared to 20.8 nationally), figure 5.

Figure 5. East Midlands and England rate of teenage conceptions, 1998 to 2015

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However, smoking at time of delivery (SATOD) is significantly higher in the East Midlands compared to England with 13.9% of pregnant women continuing to smoke during pregnancy compared to 11.0% in England (2015 to 2016), figure 6. The SATOD figure has however fallen significantly since 2010 to 2011 (from 15.8%) but at a slower rate than England.

Breastfeeding initiation rates are also significantly worse than England with 71.6% of women initiating breastfeeding, compared to 74.3% nationally (2015 to 2016). This drops to 44.4% of women continuing to breastfeed at 6 to 8 weeks after birth (2014 to 2015), which is significantly higher than England (43.8%).

Figure 6. Percentage of women smoking during pregnancy in the East Midlands, 2015 to 2016.

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Poverty

19.1% of children under the age of 16 live in low income families in the East Midlands (2014) which is better than the England value of 20.1%. Data from the “Public Health Outcome Framework” shows that the trend in the East Midlands as a whole and for each upper tier authority in the East Midlands over recent years (2006 to 2014) has been decreasing (getting better) but has increased significantly in Lincolnshire.

1 in 5 children under the age of 16 live in low income families in the East Midlands (2014) This equates to 160,280 children.

Education

Child development and attainment is poor with only 67.6% of 5 year olds reaching a good level of development at the end of their first year at school (2015 to 2016). GCSE attainment is also poor with 55.1% of pupils in the East Midlands achieving 5 or more grades A* to C (including English and maths), the lowest in the country (2015 to 2016), figure 7.

Figure 7. Percentage of children reaching expected levels of development at age 5 and achieving 5 or more GCSEs (A* to C) including English and maths

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Obesity

21.9% of reception (age 4 to 5 years) children are overweight (including obese) in the East Midlands, increasing to 33.3% in Year 6 (age 10 to 11 years) (2015 to 16). Although these figures are similar to or better than England, this still means that one in five children in reception and one in three children in Year 6 are overweight.

One in five children in reception (4 to 5 yrs) is overweight or obese

One in three children in year 6 (10 to 11 yrs) is overweight or obese

Image taken from PHE Obesity slide set https://www.noo.org.uk/slide_sets

General health and wellbeing

According to the What About Youth Survey (2014/15), the health of 15 year olds in the region is generally good, with 30% reporting their own health as excellent and 52% eating the recommended 5 or more portions of fruit and vegetables each day. 7.6% are current smokers, significantly lower than England (8.2%) but 20% have tried an electronic cigarette, significantly higher than England (18.4%), figure 8.

Figure 8. General health of 15 year olds, What About Youth survey 2014/15

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Vaccinations and Immunisations

Overall, the East Midlands is achieving the target of over 90% of the target population receiving their appropriate vaccinations, with trends increasing across the indicators.

In 2015 to 2016, the East Midlands regional uptake of the MMR (measles, mumps and rubella) vaccination was 90.5%, significantly higher than the England average (88.2%) and an increase from 86.7% in 2010 to 2011.

The East Midlands has among the highest Dtap/IPV/Hib (a combined vaccine that protects children against 5 diseases ― diphtheria, tetanus, pertussis, polio and meningitis) vaccination rates in the country (95.6% and 97.0% of children immunised at one and two years respectively).

In 2016 to 2017, 71.9% of eligible East Midlands adults aged 65+ years received the flu vaccine, a significantly higher proportion than the England average (70.5%). However, the proportion of at risk individuals receiving the flu vaccine in the East Midlands (47.9%) was lower than the England average (48.6%). The trend in uptake among those at risk within the East Midlands has gradually decreased from 50.6% in 2010 to 2011.

Figure 9. Vaccination coverage in the East Midlands

Screening

In the East Midlands in 2015/16: • 99.2% of newborn babies completed hearing screening within four weeks, significantly higher than the England average of 98.7% • newborn blood spot screening coverage was 93.4%, significantly lower than the England average of 95.6% • antenatal sickle cell and thalassaemia screening coverage was 99.3%, significantly higher than the England average of 99.1% • 99.3% of eligible women received antenatal screening for HIV • antenatal screening rates for Hepatitis B (94.9%) and syphilis (94.8%) were both lower than England averages (2014) 13 East Midlands Profile: A summary of public health in the region 2017

Adult health

Life expectancy (2013 to 2015) at birth for males and females in the East Midlands is significantly lower than England (79.3 for males and 82.9 for females) with healthy life expectancy lower at 62.5 for males and 63.5 for females.

There is a difference of 8.2 years in life expectancy for males between the most deprived areas of the East Midlands and the most affluent. For females this difference is 6.9 years, figure 10. The difference in life expectancy between the most deprieved areas and the most affluent areas also differs between local authorities, figure 11.

Figure 10. Difference in life expectancy in the East Midlands by deprivation and gender, 2013 to 2015

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Figure 11. Slop index of inequality in life expectancy at birth within East Midlands local authorities, 2013 to 2015.

Two thirds of adults in the East Midlands in 2013 to 2015 have excess weight, significantly higher than England, and over a quarter of a million adults are recorded as having diabetes in 2014 to 2015 (264,330). In 2015 to 2016, 65.1% of adults in the region are physically active which is similar to England; however, only 18.5% of the population utilise our outdoor space for exercise/health reasons.

In 2016, 16.1% of the adult population in the East Midlands smoke (figure 11), similar to England (15.5%), this figure has fallen significantly from 19.7% in 2012. Smoking prevalence in the routine and manual category is 25.7%, again similar to England (26.5%).

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Figures 11, 12 and 13 - Smoking prevalence in adults – current smokers, 2016

Proportion of adults smoking by district in the East Midlands

5% to 10% 10% to 15% 15% to 20% 20% to 25% 25% to 30%

Smoking prevalence in males – Smoking prevalence in females - current smokers, 2016 current smokers, 2016

Contains Ordnance Survey data © Crown copyright and database right 2017. Contains National Statistics data © Crown copyright and database right 2017.

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There were 31,280 alcohol related admissions to hospital in the East Midlands in 2015 to 2016, a rate of 686 per 100,000, which is significantly higher than England. Rates for both males and females are also significantly higher than England.

Around 6,000 people were killed or seriously injured on the roads in the East Midlands in 2013 to 2015 (41.9 per 100,000, significantly higher than the national rate of 38.5 per 100,000). The rate has fallen since 2009 to 10 in the East Midlands and has fallen at a faster rate than England.

In 2016, in the East Midlands screening rates for breast cancer (79.8%), cervical cancer (75.9%) and bowel cancer (59.0%) are all significantly higher than the England average, figure 14.

Figure 14. Screening rates for breast, vervical and bowel cancer.

51.6% of cancer patients in 2015 were diagnosed at an early stage in the East Midlands, which is similar to England (52.4%).

In 2013 to 2014 – 2016 to 2017, 71.2% of the eligible East Midlands population aged 40 to 74 years received a Health Check, significantly lower than the England average of 74.1%. However, of those offered a Health Check 54.8% received one, significantly higher than England (48.9%) and the highest in the country, figure 15.

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Figure 15. Percentage of eligible populations offered and reciving NHS Health check (2013 to 2014 – 2015 to 2016)

The East Midlands 2015 to 2016 rate of preventable sight loss from diabetic eye disease is 3.0 per 100,000 population, this equates to 120 people. The rate is similar to England (2.9). Rates in the East Midlands have decreased from 4.1 per 100,000 in 2010 to 2011 to 3.0 per 100,000 in 2015/16.

In the East Midlands in 2016, there were 16,897 cases of new STI diagnoses among people aged 15 to 64 years (excluding Chlamydia in those aged under 25 years). The diagnosis rate of 565 per 100,000 population is the lowest of all the English regions. In addition, in the East Midlands in 2016, there were 276 diagnosed cases of syphilis. The syphilis diagnosis rate (5.9 per 100,000 population) is significantly lower than the England rate of 10.6 per 100,000 and has more than doubled since 2013, from 2.6 to 5.9 per 100,000.

PHE recommends that local authorities should be working towards achieving a chlamydia detection rate of at least 2,300 per 100,000 population. In 2016, 27 out of the 40 local authorities in the East Midlands were below target.

The prevalence of opiate and/ or crack use (2011 to 2012) is significantly lower in the East Midlands compared to England, at 8.1 and 8.4 per 1,000 populations respectively. East Midlands drug treatment completion rates in 2015 for both opiate and non-opiate users are similar to the England average.

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Older people

Life expectancy at age 65 for males and females in the East Midlands is significantly lower than England (18.5 yrs for males and 20.9 yrs for females). Since 2001 to 2003, there has been an increasing trend for both male and female life expectancy at 65 in the East Midlands. However, there is great variation in years lived in poor health across the region, figure 16.

The East Midlands has significantly lower rates for injuries due to falls in older people compared to England (2,104 in the East Midlands compared to 2,169 nationally); however, 18,053 older people were admitted to hospital due to a fall in 2015 to 2016.

The East Midlands has a higher recorded prevalence compared to England for dementia in people aged 65 years and over (4.42% and 4.29% respectively). In 2017, a total of 40,274 people aged 65 years and over were included on GP prevalence registers in the East Midlands.

During 2015 to 2016, there were 31,565 emergency hospital admissions of East Midlands residents where mention of dementia was recorded as either a primary or a secondary diagnosis.

In 2014 to 2015, 82.5% of men aged 65 years eligible for abdominal aortic aneurysm screening were offered the service, significantly higher than the England average of 79.9%.

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Figure 16. Years lived in poor health in the East Midlands by gender, 2009 to 2013.

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Mortality

24,870 people died in the East Midlands between 2013 to 2015 due to causes considered preventable, a rate of 186.3 per 100,000, which is not significantly different to England (184.5 per 100,000). In line with the trend across England, the East Midlands rate has fallen significantly from 257.2 per 100,000 population in 2001 to 2003, figure 17.

Figure 17. Mortality rates from preventable causes, 2001 to 2003 to 2013 to 2015

Source: http://www.phoutcomes.info/

The East Midlands has a similar excess winter deaths rate to England (Aug 2012 to Jul 2015) with 20.7% more deaths from all causes in winter than would be expected based on the average number of non-winter deaths. The region has the highest rate of excess winter deaths in England when compared to other regions.

The premature mortality rate from cardiovascular disease (CVD) in 2013 to 2015 in the East Midlands (76.2 per 100,000) is significantly higher than England (74.6 per 100,000) The rate of premature deaths from CVD which are considered preventable have almost halved between 2001 to 2003 and 2013 to 2015 from 140.7 to 76.2 per 100,000.

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In the East Midlands in 2013 to 2015, almost 10,000 people aged under 75 died from cancer considered preventable. The rate (80.5 per 100,000) is slightly lower than the England rate (81.1 per 100,000). In 2013 to 2015, the under 75 mortality rates for liver disease (17.7 per 100,000) and respiratory disease (33.0 per 100,000) were similar in the East Midlands compared to England (18.0 and 33.0 per 100,000 respectively).

The East Midlands suicide rate for the years 2013 to 2015 (9.9 per 100,000) is similar to that for England (10.1 per 100,000). During this period, 1,210 East Midlands residents died from suicide.

Suicide in the East Midlands is over 3 times as common among males as females. Between 2001 to 2003 to 2008 to 2010 in the East Midlands there was a decrease in the suicide rate from 10.2 to 8.7 since then, however, in common with England, the region has slightly increased, figure 18.

Figure 18. Suicide rate in East Midlands and England, 2001-3 to 2013-15

In 2013 to 15, 1,272 East Midlands residents died from a range of specified communicable disease including influenza and the rate of 9.8 per 100,000 population is significantly lower than the England rate of 10.5 per 100,000 population.

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Health inequalities

There is a gap in life expectancy between the East Midlands and England as a whole, this gap is 0.2 years for both males and females meaning that those born in the East Midlands can expect to live 0.2 years less than the average for England.

Excess deaths are the number of 'extra' deaths that occur in the East Midlands area because it has a higher mortality rate for that cause of death than England. If these deaths were prevented, then the contribution of that cause of death to the overall life expectancy gap would be eliminated, figure 19. There is also a large gap in life expectancy between those in the least deprived areas of the East Midlands to the most deprived areas, figure 20.

Figure 19. Number of excess deaths in the East Midlands compared to England, 2012 to 2014

Circulatory 267 66

Cancer 28 174 Respiratory 251 Digestive 184 214 External causes 100 10 Mental & behavioural 180 259 Other 286 Deaths under 28 days 28 15

Figure 20. Number of excess deaths in the East Midlands in the most deprived quintile compared with the least deprived quintile, by broad cause of death, 2012 to 2014

Circulatory 1680 1100 Cancer 1069 831 Respiratory 1083 890 Digestive 480 339

External causes 361 151

Mental & behavioural 284 499

Other 420 465

Deaths under 28 days 28 33

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Appendix

Local Authorities in the East Midlands that appear in the best 10 nationally

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Local Authorities in the East Midlands that appear in the worst 10 nationally

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Health profile indicators: overview of the East Midlands

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