Community Vulnerability Measure and information resources Introduction The Scottish Public Health Observatory (ScotPHO) has developed a community vulnerability measure to help guide the social mitigation response to the effects of COVID- 19. ScotPHO used routinely available data from the Health and Wellbeing Profiles. The criteria for selecting the indicators (in the table below) for the measure were: direct relevance to COVID-19 vulnerability (demographic or clinical), or relevance to other demands on clinical or public health services, or social factors likely to modify the impact of COVID-19 on communities. A combined vulnerability score for each geographical area (Council Area, Intermediate Zone and Data zone) has been calculated. Each area has then been assigned a quintile based on that score, with quintile 1 indicating the 20% of areas across Scotland with the highest vulnerability score and quintile 5 with the lowest vulnerability score. Table 1: Indicator from Health and Wellbeing Profiles Vulnerability Geography 1. Population income deprived Social DZ, IZ, CA 2. Children in low income families Social DZ, IZ, CA 3. Single adult dwellings Social DZ, IZ, CA 4. Working age employment deprived Social DZ, IZ, CA 5. People aged 65+ with high levels of care needs who are cared for at home Social CA 6. Children registered for free school meals Social CA 7. Children on the child protection register Social CA 8. Household with children living in fuel poverty Social CA 9. Mid-year population estimate - aged 65+ years Demographics DZ, IZ, CA 10. Mid-year population estimate - aged 75+ years Demographics DZ, IZ, CA 11. Mid-year population estimate - aged 85+ years Demographics DZ, IZ, CA 12. Alcohol-related hospital admissions Clinical DZ, IZ, CA 13. Asthma patient hospitalisations Clinical DZ, IZ, CA 14. Coronary heart disease (CHD) hospitalisations Clinical DZ, IZ, CA 15. Deaths all ages Clinical DZ, IZ, CA 16. Deaths, aged 15-44 years Clinical DZ, IZ, CA 17. Early deaths from cancer, aged <75 years Clinical DZ, IZ, CA 18. Early deaths from CHD, aged <75 years Clinical DZ, IZ, CA 19. Emergency patient hospitalisations Clinical DZ, IZ, CA 20. Life expectancy, male Clinical CA 21. Life expectancy, female Clinical CA 22. Multiple emergency hospital admissions, aged >65 years Clinical DZ, IZ, CA 23. Chronic obstructive pulmonary disease (COPD) patient hospitalisations Clinical DZ, IZ, CA 24. Drug-related hospital stays Clinical DZ, IZ, CA 25. Cancer registrations Clinical DZ, IZ, CA 26. Population prescribed drugs for anxiety/depression/psychosis Clinical DZ, IZ, CA 27. Diabetes hospitalisations Clinical DZ, IZ, CA 28. Psychiatric patient hospitalisations Clinical DZ, IZ, CA What it measures The overall vulnerability score was produced through statistical analysis that combined the indicators from the three categories in Table 1: social (indicators 1–8), demographic (indicators 9-11) and clinical (indicators 12-28). Purpose The measure, based on demographic, social and clinical indicators, can be used to identify areas of vulnerability and where to target resources in East, North and South Ayrshire. The information could aid decision making by services to reflect the varying levels of need across Ayrshire & Arran. It can be used to aid prioritisation of clinical work including in the Recovery Phase planning process. Local organisations will also be able to use the maps at intermediate and data zone level to target resources in the areas with most need. Context The Scottish Index of Multiple Deprivation already shows that there are high levels of multiple deprivation across Ayrshire and Arran. Those communities living in socio-economic disadvantage experience inequalities in health, including premature mortality, relatively more ill-health, earlier onset of long-term conditions, poorer mental wellbeing, higher levels of in- work poverty, low paid and precarious employment, low financial resilience and fuel and food poverty. COVID-19 and the essential policies associated with it such as lockdown, loss of income, debt, arrears, the threat of job losses, reduced access to health and social care services and social isolation will have a disproportionately negative impact on the 20% most vulnerable areas. This inequality is made clear from the National Records for Scotland’s analysis of all deaths and Covid-19 deaths in Scotland by deprivation quintile provided the chart below. COVID-19 death rate by SIMD quintile, March and April 2020 500 450 death rate from all causes is 1.9 400 times higher in the most 350 deprived areas death rate than the least from COVID- 300 19 is 2.3 times higher in the 250 (most most deprived depriv areas than the 200 ed) least deprived areas 150 (least depri Death rate per 100,000 rate per 100,000 population Death 100 ved) quintile 5 quintile 1 50 quintile 2 quintile 3 quintile 4 quintile 1 quintile 2 quintile 3 quintile 4 quintile 5 0 All causes COVID-19 Note on methodology Two versions of the Community Vulnerability Measure dataset are available; Unweighted quintiles Quintile 1 indicates an area with the highest vulnerability score - it represents the 20% most vulnerable areas according to the ScotPHO vulnerability measure. Quintile 5 indicates an area with the lowest vulnerability score - it represents the 20% least vulnerable areas according to the ScotPHO vulnerability measure. Population weighted quintiles: (weighted using 2018 mid-year population estimates) Quintile 1 indicates an area with the highest vulnerability score - it represents an area in which the 20% most vulnerable people live (vulnerability according to the ScotPHO vulnerability measure). Quintile 5 indicates an area with the lowest vulnerability score - it represents an areas in which the 20% least vulnerable people live (vulnerability according to the ScotPHO vulnerability measure). This weighting increased the vulnerability in terms of the size of the population affected so the population weighted quintiles data have been used where available and this is noted. Summary of findings from the Community Vulnerability Measure Figures 1 and 2 show all three local authorities in Ayrshire and Arran are identified as being at high risk to Covid-19 with South Ayrshire having the highest demographic vulnerability score in Scotland. Figure 1: Top 10 areas in Scotland with highest demographic vulnerability Demographic vulnerability Score 3.50 3.00 2.50 2.00 1.50 1.00 0.50 0.00 South Na h- North Dumfries & Orkney Angus Scottish East Argyll & Inverclyde Ayrshire Eileanan Ayrshire Galloway Islands Borders Ayrshire Bute Siar Figure 2: Top 10 areas in Scotland with highest social/clinical vulnerability Social/clinical vulnerability Score 12.00 10.00 8.00 6.00 4.00 2.00 0.00 Ayrshire and Arran has a higher proportion of older people and higher levels of multiple deprivation relative to many other areas in Scotland and the community vulnerability measure is therefore higher. The measure is an aid to decision making, other knowledge such as socio-economic data, ethnic minority and disabled communities will strengthen its use. Links to some selected resources that support the purpose of this measure are included at the back of this report. Table 2: Number of datazones in each of the ScotPHO Vulnerability Quintiles Overall Vulnerability Number Data zones Measure Quintiles East Ayrshire North Ayrshire South Ayrshire 1 Most Vulnerable 51 69 58 2 38 55 41 3 32 33 27 4 26 14 20 5 Least Vulnerable 16 15 7 Table 2 shows the high number of datazones in Quintile 1 in Ayrshire and Arran, this report highlights the top ten most vulnerable intermediate zones. More detail can be found at ScotPHO. Most Vulnerable Intermediate Zones (IZs) Tables with the overall, social/clinical and demographic vulnerability scores for the ten most vulnerable intermediate zones along with 2018 mid-year populations are presented below for North, East and South Ayrshire respectively. Not every data zone within an intermediate zone is equally impacted therefore the population totals may be an overestimate. Small areas, such as Largs South, will have a higher number of older people living in them and will therefore have a higher demographic vulnerability score. Those areas with a high social/clinical vulnerability score are likely to have higher levels of multiple deprivation and experience health inequalities across the range of indicators. North Ayrshire Table 4(a): Ten most vulnerable IZs for Covid-19 for demographic vulnerability Intermediate zone Demographic Weighted Quintile: 2018 mid-year vulnerability Demographic population Score vulnerability Largs South 6.28 1 3,675 Saltcoats Central 3.88 1 3,725 Irvine Fullarton 3.81 1 2,991 Stevenston North West 3.58 1 2,783 Largs North 3.54 1 3,981 Arran 2.97 1 4,576 Ardrossan Central 2.79 1 3,143 Largs Central & Cumbrae 2.70 1 4,781 Kilwinning West & Blacklands 1.95 1 4,146 Irvine Central 1.92 1 3,243 Total population 37,044 Table 4(b): Ten most vulnerable IZs for Covid-19 for social/clinical vulnerability Intermediate zone Social/clinical Weighted Quintile: 2018 mid-year vulnerability Social/clinical population Score vulnerability Irvine Fullarton 10.57 1 2,991 Saltcoats Central 8.81 1 3,725 Irvine Castlepark South 8.20 1 3,307 Ardrossan Central 7.90 1 3,143 Irvine Bourtreehill 6.49 1 2,275 Kilwinning West & Blacklands 6.38 1 4,146 Kilwinning Pennyburn 6.14 1 3,003 Stevenston Hayocks 5.62 1 4,061 Irvine Castlepark North 5.60 1 3,500 Ardrossan North East 5.19 1 4,304 Total population 34,455 Table 4(c): Ten most vulnerable IZs for Covid-19