Fewer people with coronary heart disease are being diagnosed as compared to the expected figures.

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1 JSNA Coronary heart disease 1) Key points 2) Introduction 3) National picture 4) Local picture of CHD prevalence 5) Mortality from coronary heart disease in Suffolk County 6) Trends in mortality rates 7) Mortality from coronary heart disease in county districts in Suffolk 8) Mortality from coronary heart disease in wards in Suffolk 9) Deprivation and mortality from coronary heart disease in NHS Suffolk 10) References 1) Key points Crude prevalence of coronary heart disease is significantly higher in NHS Suffolk and NHS Great Yarmouth and Waveney than in East of England and England as a whole. NHS Great Yarmouth and Waveney has the highest crude prevalence of coronary heart disease (4.3%) in the East of England whilst NHS Suffolk (3.7%) is ranked fourth. Fewer people with coronary heart disease are being diagnosed as compared to the expected figures. Coronary heart disease is a main cause of death among residents of Suffolk county. Mortality rates from coronary heart disease in Suffolk are relatively low and decreasing. There is some variation in mortality rates for coronary heart disease between county districts in Suffolk. No ward in Suffolk had a significantly raised standardised mortality ratio for coronary heart disease in In NHS Suffolk, mortality from coronary heart disease is higher in the most deprived quintile of the population compared to the rest of the population. 2) Introduction Coronary heart disease (CHD) is usually caused by a build-up of fatty deposits on the walls of the coronary arteries. The fatty deposits, called atheroma, are made up of cholesterol and other waste substances. The buildup of atheroma on the walls of the coronary arteries makes the arteries 1

2 narrower and restricts the flow of blood to the heart. This process is called atherosclerosis. This can result in a number of clinical conditions including angina (chest pain), acute myocardial infarction (heart attack), heart failure and sudden death. The risk factors for CHD are as follows: Age: older people Sex: men in their 40s have a higher risk than women. But as women get older (especially after they reach menopause), their risk increases to almost equal that of a man's risk Genetics (heredity): for men, the likelihood of developing atherosclerosis is increased if a close family member (father or brother) has had a heart attack or angina before the age of 55. For women, the risk is increased if a close family member (mother or sister) has had a heart attack or angina before the age of 65 Ethnicity: South Asian Tobacco abuse (including smoking) High blood pressure High bad cholesterol (LDL) Low good cholesterol (HDL) Lack of sufficient physical activity High-fat diet Obese or overweight Higher than normal levels of inflammation-related substances, such as C-reactive protein and fibrinogen Increased levels of a chemical called homocysteine, an amino acid Thrombosis Diabetes Chronic kidney disease Emotional stress Type A personality (impatient, aggressive, competitive) Alcohol abuse 3) National picture CHD is the UK's biggest killer, with one in every four men and one in every six women dying from the disease. In addition, it can cause years of disability and ill health. In the UK, approximately people have a heart attack each year. Angina affects about one in 50 people, and in the UK there are an estimated 1.2 million people with the condition (NHS 2009). However, mortality rates from CHD have been falling in the UK since the late 1970s. For people under 65 years, they have fallen by 46% in the last ten years. In 2003 CHD was responsible for deaths in the UK annually, but by 2005 this number had decreased to (National Heart Forum 2006). 4) Local picture of CHD prevalence 2

3 In 2008/09 the crude prevalence of CHD in the East of England was 3.3% (QMAS 2008/09). In NHS Great Yarmouth and Waveney and NHS Suffolk in 2008/ and 22,529 people were recorded on GP s CHD registers, giving a prevalence of 4.3% and 3.7% respectively. Among the fourteen PCTs in the East of England, NHS Great Yarmouth and Waveney had the highest prevalence of CHD (4.3%) and NHS Suffolk (3.7%) was ranked fourth. From modelled estimates, estimated prevalence of CHD in 2009 was 7.7% (13,805 persons with CHD) in NHS Great Yarmouth and Waveney and 5.4% (26469 persons with CHD) in NHS Suffolk (ERPHO 2008). Therefore, fewer people with CHD are being diagnosed compared to expected figures Estimated CHD Prevalence Suffolk County ERPHO Model, % 8.0% 7.0% 6.0% 5.0% 4.0% 3.0% 2.0% 1.0% 0.0% Waveney Suffolk Coastal Ipswich Babergh Mid Suffolk St. Edmundsbury Forest Heath The estimated prevalence of CHD in the seven county districts in Suffolk County in 2009 is shown above. Estimated prevalence of coronary heart disease by sex and age 2009 NHS Great Yarmouth and Waveney NHS Suffolk Male Female years years years 75+ years 9.5% 6.1% 0.5% 6.6% 17.0% 23.4% 6.6% 4.2% 0.3% 4.9% 13.3% 18.7% In 2009 the estimated prevalence of CHD in NHS Great Yarmouth and Waveney and NHS Suffolk was higher in males compared to females and increased with age, as is evident above (ERPHO 2008). Estimated prevalence of coronary heart disease by ethnic group 3

4 2009 Persons of all ages NHS Great Yarmouth and Waveney NHS Suffolk White Mixed Black Asian Other 7.9% 1.6% 2.7% 5.3% 1.4% 5.6% 0.9% 1.8% 2.5% 0.9% The estimated prevalence of CHD in NHS Great Yarmouth and Waveney and NHS Suffolk in 2009 was higher in Whites as compared to the Asian, Black and Mixed ethnic groups. Estimated CHD Prevalence ERPHO Model, % 9.0% 8.0% 7.0% 6.0% 5.0% 4.0% 3.0% 2.0% 1.0% 0.0% Yr-2009 Yr-2010 Yr-2015 Yr-2020 NHS Great Yarmouth & Waveney NHS Suffolk CHD prevalence among residents of NHS Great Yarmouth and Waveney is projected to increase from 7.7% in 2009 to 8.8% in CHD prevalence among residents of NHS Suffolk is estimated to increase from 5.4% in 2009 to 6.1% in ) Mortality from coronary heart disease in Suffolk County Coronary heart disease is a main cause of death among residents of Suffolk. In 2007 deaths from CHD amounted to 16.4% (1140/6972) of all deaths among residents of Suffolk (ONS 2007). In 2007 a total of 273 deaths among residents of Suffolk aged under 75 years were registered as due to CHD (males: 211; females: 62). In 2007 premature deaths from CHD in Suffolk amounted to 23.9% (273/1140) of all deaths from this disease and 13.5% (273/2018) of deaths from all causes in this age group. 4

5 The chart below shows age-specific mortality rates for CHD among males and females in Suffolk in Mortality rates increased with age from age years. Mortality rates were more than twice as high among males compared to females until age 85 years and over. Age-specific mortality rates Deaths from coronary heart disease Residents of Suffolk County 2007 Males Females 3500 Deaths per residents Age (years) In the age-standardised mortality rate for CHD among males and females of all ages and under 75 years was lower than but not significantly different from the rate in the East of England and significantly lower than the rate in England and Wales. 6) Trends in mortality rates Trend data for the period show that for males of all ages, mortality rates for CHD in Suffolk have been in steady decline and remained below mortality rates in East of England and England and Wales. For females of all ages in , mortality rates for CHD in Suffolk declined, generally remained in line with rates in East of England but were lower than rates in England and Wales as shown below. 5

6 Age-standardised mortality rates Three-year moving means of rates Deaths from coronary heart disease Residents of Suffolk County Males of all ages Suffolk County East of England England and Wales 300 Age-standardised mortality rate Deaths per residents Age-standardised mortality rates Three-year moving means of rates Deaths from coronary heart disease Residents of Suffolk County Females of all ages Suffolk County East of England England and Wales 300 Age-standardised mortality rate Deaths per residents Trends in mortality rates for CHD among males and females aged under 75 years in Suffolk, East of England and England and Wales in show similar patterns to mortality rates for males and females of all ages but at lower levels (Figures 11 and 12). 6

7 Age-standardised mortality rates Three-year moving means of rates Deaths from coronary heart disease Residents of Suffolk County Males aged under 75 years Suffolk County East of England England and Wales 180 Age-standardised mortality rate Deaths per residents Age-standardised mortality rates Three-year moving means of rates Deaths from coronary heart disease Residents of Suffolk County Females aged under 75 years Suffolk County East of England England and Wales 180 Age-standardised mortality rate Deaths per residents ) Mortality from coronary heart disease in county districts in Suffolk In mortality rates for CHD among males of all ages in county districts in Suffolk ranged from deaths per residents in Babergh to in Waveney: a difference of 11.2%. Among females the district and borough 7

8 rates ranged from 46.1 deaths per residents in St. Edmundsbury to 67.3 in Ipswich: a difference of 46.0%. In mortality rates for CHD among males aged under 75 years in county districts in Suffolk ranged from 52.1 deaths per residents in Babergh to 70.7 in Forest Heath: a difference of 35.7%. Among females the district and borough rates ranged from 10.7 deaths per residents in St. Edmundsbury to 19.5 in Forest Heath: a difference of 82.2%. 8) Mortality from coronary heart disease in wards in Suffolk The most recent available mortality data for CHD in wards in Suffolk relate to the period (NHS Suffolk 2008). For this period, standardised mortality ratios (SMRs) were calculated. The SMRs were standardised to Suffolk County as a whole. During there were no wards in Suffolk with significantly raised or significantly low standardised mortality ratios for CHD among persons of all ages. During there were no wards in Suffolk with significantly raised or significantly low SMRs for CHD among persons aged under 75 years. For males aged under 75 years, one ward in Suffolk had a significantly low SMR for CHD in : Kesgrave West (Suffolk Coastal) (SMR: 11; 99.9% confidence interval: 4, 99). 9) Deprivation and mortality from coronary heart disease in NHS Suffolk (The data presented in this section relate to NHS Suffolk. They will be replaced with data for Suffolk County as a whole as soon as available.) In NHS Suffolk, mortality from CHD is higher in the most deprived quintile of the population compared to the rest of the population. 8

9 Rate ratios for most deprived 20% of MSOAs compared to other 80% of MSOAs Age-standardised mortality rates for coronary heart disease Residents of NHS Suffolk Rate ratio most deprived 20% of MSOAs/other 80% of MSOAs Males of all ages Females of all ages Males aged under 75 years Females aged under 75 years The chart above show ratios of age-standardised mortality rates for CHD in the most deprived 20% of middle-layer Super Output Areas (MSOAs) compared to the other 80% of MSOAs in NHS Suffolk in (NHS Suffolk 2009). For all groups there is significantly higher mortality rates for CHD in the most deprived quintile of the population compared to the rest of the population. 10) References Eastern Region Public Health Observatory (ERPHO) (2008) Modelled estimates of prevalence of coronary heart disease among persons aged 16 years and over National Health Service (NHS) (2009) Coronary Heart Disease. (accessed 16 November 2009) NHS Clinical and Health Outcomes Knowledge Base (NCHOD) (2009) Mortality from coronary heart disease. (accessed 16 November 2009) 9

10 NHS Quality Management and Analysis System (QMAS) (2008/09) Coronary heart disease NHS Suffolk (2008) Data relating to mortality from coronary heart disease in wards in Suffolk NHS Suffolk (2009) Data relating to deprivation and mortality from coronary heart disease National Heart Forum (2006) Coronary Heart Disease. (accessed 16 November 2009) Office for National Statistics (ONS) (2008) VS3 tables: mortality by cause

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