Cardiovascular Disease in Lincolnshire

Transcription

1 Cardiovascular Disease in This report provides an overview of cardiovascular disease in through the latest available health data and has been produced by the Public Health Intelligence Team. The intention of this report is to provide comparative prevalence, hospital admission and mortality rates for County and the four Clinical Commissioning Groups (CCG's) shown in Figure 1. Figure 1: Location of Clinical Commissioning Groups within Crown Copyright and database right Ordnance Survey

2 Definition of cardiovascular disease Public Health England (PHE) classifies cardiovascular disease (CVD) as a group of diseases that share a common set of risk factors resulting from atherosclerosis, particularly coronary heart disease (CHD), stroke and peripheral arterial disease (PAD). The term cardiovascular disease includes conditions such as vascular dementia, chronic kidney disease (CKD), cardiac arrhythmias, sudden cardiac death and heart failure. These conditions share common contributory risk factors or have a significant impact on CVD mortality or morbidity 1. There are a number of contributing factors associated with cardiovascular disease. Factors such as age, ethnicity and family history cannot be altered; however many factors are considered modifiable lifestyle risks, including, stress, high blood pressure (hypertension), smoking, high cholesterol, obesity, diabetes, physical inactivity, excessive alcohol consumption and a poor diet 2. Cardiovascular diseases are strongly correlated with these risk factors and are more likely to occur when one or more are present. Prevalence In epidemiology, prevalence refers to the current scale of a specific disease in a given population at a given time. This report looks at two national sources that are used to determine prevalence of CVD, the Health Survey for England (HSE) and the Quality and Outcomes Framework (QOF). Both have different methodologies and definitions of CVD and are co-ordinated by the Health and Social Care Information Centre (HSCIC). In addition to HSE and QOF, modelled CHD prevalence rates 3, based on 2003/04 HSE data, is available from Public Health England. The HSE collects information from a representative sample of the national population around areas such as health, social care and lifestyles. For the 2011 survey, participants were classified as having any CVD if they had reported having any of the following conditions confirmed by a doctor: angina, heart attack, stroke, heart murmur, or irregular heart rhythm. The 2011 survey is the most recent survey to collect information on CVD 4. Page 2 of 23

3 England Midlands and East England East West South South West Table 1: Health Survey for England CVD prevalence rates for England, applied to 2013 mid-year population estimates for Sex Total All ages National prevalence rates CVD Male 13.9% 3.3% 3.8% 6.1% 11.9% 17.8% 33.3% 43.6% 53.8% prevalence Female 13.4% 4.8% 6.4% 6.0% 9.3% 18.1% 24.6% 38.3% 31.1% Modelled estimated population East West South South West Male 49,100 1,300 1,500 2,500 6,100 8,100 14,700 10,200 3,700 Female 49,700 1,800 2,600 2,700 5,000 8,800 11,100 10,500 4,000 Male 15, ,800 2,800 5,500 3,800 1,300 Female 15, ,600 3,100 4,100 3,700 1,400 Male 15, ,900 2,400 4,000 2,800 1,000 Female 15, ,500 2,500 3,100 3,000 1,100 Male 9, ,200 1,600 2,800 2, Female 9, ,000 1,700 2,200 2, Male 8, ,100 1,400 2,400 1, Female 8, ,500 1,800 1, Source: HSCIC (HSE), ONS Figures have been rounded to the nearest 100 The QOF is a voluntary, indicator-based incentive scheme for general practices (GP) and measures achievement across a number of clinical registers. Analysis of comorbidity is not possible using QOF data because information is collected at an aggregate level for each practice; there is no patient-specific data. Therefore, QOF cannot be used to determine overall prevalence of CVD; instead raw QOF prevalence rates for individual cardiovascular conditions have been used, taken from available practice disease registers 5. Table 2: National, regional and local comparison of QOF prevalence rates for cardiovascular conditions: 2013/14 Clinical register Chronic Kidney Disease (18+) Coronary Heart Disease Stroke Atrial Fibrillation Heart Failure Peripheral Arterial Disease Source: HSCIC (QOF), ONS Page 3 of 23

4 To model the estimated prevalence of people in with CVD, HSE prevalence rates have been applied to ONS mid-year population figures and rounded to the nearest hundred. Unless stated otherwise, published HSE and QOF prevalence data accounts for all people aged 16 and over and it is assumed that prevalence for those under 16 is nil. At present, neither source utilise methods of clinical coding such as the International Classification of Diseases (ICD) to more accurately identify and group cardiovascular diseases, due to the systems by which the data is collected. Prevalence summary Using 2011 HSE prevalence rates, modelled 2013 population estimates in show that overall more women than men are estimated to have a diagnosis of CVD, due to having a higher ratio of women to men in its resident population. While national prevalence rates for over 65's are higher in men than in women, modelled estimates for show that both men and women are more likely to be diagnosed with a cardiovascular condition between the ages of /14 QOF data shows that prevalence rates of cardiovascular conditions are higher in than regionally and nationally. CKD (18+), CHD and stroke are most predominant. Within the county, prevalence of all cardiovascular conditions across all CCG areas is higher than regional and national rates. Comparatively, CVD prevalence is greatest in East, particularly for CKD (6.37%) and CHD (5.15%), while it is lowest in West. More than a third of the population of who are estimated to have a cardiovascular condition live in East. Hospital admissions Details of hospital admission rates for CHD, heart failure and stroke have been taken from the PHE Cardiovascular Disease Fingertips Profile 6. Data is presented at CCG level and shown as the total number of patient admissions from the Hospital Episodes Statistics (HES) database, per 100,000 residents within the population, based on the latest ONS population estimates. In addition, the CVD Profiles also contain modified HES data to show both elective and non-elective admission rates for revascularisation (PCI and CABG) procedures. Percutaneous coronary Page 4 of 23

5 DASR per 100,000 population intervention (PCI) and coronary artery bypass grafting (CABG) are two techniques used to treat angina, acute coronary syndromes and narrowed or blocked arteries. An elective admission is one that has been arranged in advance, while a nonelective admission is one that is unpredictable and at short notice because of a clinical need 7. Directly age standardised hospital admissions are shown as a rate per 100,000 population, where ONS mid-year population estimates are used as the denominator and the standard population used was is the 2013 European Standard Population. Table 4: Comparison of all-age, all-person hospital admission rates in, by CCG: 2012/13 Area Name Coronary heart disease DASR Lower Upper DASR Stroke Lower Upper DASR Heart failure Lower Upper East West Total England Source: HSCIC (HES), ONS Figure 2: All-age hospital admission rates for CHD and stroke in, by CCG: 2012/ East West South West CHD Stroke Source: HSCIC (HES), ONS CHD England (575 per 100,000) Stroke England (179 per 100,000) Page 5 of 23

6 East West England East West England East West DASR per 100,000 population England East West East West East West DASR per 100,000 population Figure 3: All-age hospital admission rates for heart failure in, by CCG and gender: 2012/13 England Source: HSCIC (HES), ONS Persons Males Females Figure 4: All-age hospital admission rates for revascularisation (PCI and CABG) procedures, by CCG and gender: 2012/13 Non-elective Elective Source: HSCIC (HES), ONS Persons Males Females Page 6 of 23

7 2008/ / / / /13 DASR per 100,000 population 2008/ / / / /13 DASR per 100,000 population Figure 5: Comparison of CHD admission rates, for CCG's and England: 2008/09 to 2012/ East England West Source: HSCIC (HES), ONS Figure 6: Comparison of stroke admission rates, for CCG's and England: 2008/09 to 2012/ East England West Source: HSCIC (HES), ONS Page 7 of 23

8 2008/ / / / /13 DASR per 100,000 population 2008/ / / / /13 DASR per 100,000 population Figure 7: Comparison of heart failure admission rates, for CCG's and England: 2008/09 to 2012/ East England West Source: HSCIC (HES), ONS Figure 8: Comparison of elective hospital admission rates, per 100,000 for CCG's and England: 2008/09 to 2012/ East England West Source: HSCIC (HES), ONS Page 8 of 23

9 2008/ / / / /13 DASR per 100,000 population Figure 9: Comparison of non-elective hospital admission rates, per 100,000 for CCG's and England: 2008/09 to 2012/ East England West Source: HSCIC (HES), ONS Hospital admissions summary East has the highest CHD hospital admission rates in 2012/13, at 699 per 100,000. West has 583 admissions per 100,000 and is significantly lower than the other CCG areas. Hospital admissions for stroke are much lower than those for CHD, and in 2012/13, no variations between CCG's are statistically significant. When we compare heart failure admissions by gender, rates are considerably greater for men than for women. There is no significant difference between CCG's when we look at the rates for all persons, males or females. When we compare both elective and non-elective admissions in due to revascularisation procedures, rates are higher for men than for women. West has the highest admission rates for revascularisation procedures across. is the only area where elective admission rates are higher than non-elective rates. The other three CCG areas have noticeably greater non-elective admissions, suggesting that many are urgent and indicative of a clinical emergency. Page 9 of 23

10 Between 2008/09 and 2012/13 CHD admission rates have fluctuated within, resulting in net decreases across all four CCG's. National rates by comparison have seen a more linear decline over the same period. There were reductions in heart failure admission rates in West and of 11.8% and 12.7% since 2008/09. Rates for East and however have risen by 17% and 6.8% respectively. Stroke admission rates across all CCG's are below the national average in 2012/13; however rates in South and have seen a net increase of 24.4% and 21.9% respectively since 2008/09. Despite a marked decrease since 2010/11, East has the highest stroke admission rates in. Elective admission rates across have seen a net decrease since 2008/09 in line with national rates. Despite an overall decline, rates have been steadily rising in East, West and South West since 2009/10. Nationally, non-elective admissions have risen by 22.9% since 2008/09; however in rates have more than doubled over the same period in East, West and South West. The increase in South is comparably lower at 49.5% but is still double the national rate. Mortality The Primary Care Mortality Database (PCMD) contains monthly and annual extracts of individual record level data on deaths supplied directly by ONS. Annual PCMD data is obtained by the Public Health Intelligence team directly from NHS via a secure access site. Directly age standardised mortality is shown as a rate per 100,000 population, with ONS mid-year population estimates being used as the denominator to calculate the rates. The Public Health Outcomes Framework (PHOF) includes objectives for reducing numbers of people dying prematurely from cardiovascular diseases. The rates for Figures 10 and 11 have been taken from the PHOF objectives 4.04i and 4.04ii and are pooled over a three-year period; therefore population estimates have also been aggregated by gender and quinary age bands to align with mortality figures. Page 10 of 23

11 For all internally analysed data, the following underlying causes of death and ICD-10 codes have been used to query mortality data and to differentiate between CVD, CHD and Stroke 8. Category All circulatory diseases All cardiovascular diseases Coronary heart disease Stroke (Transient Ischaemic Attack or TIA) Cerebrovascular disease Congenital heart disease Vascular dementia Source: WHO ICD-10 code (3-digit) I00 - I99 I00 - I99, plus other codes below I20 - I25 I60 - I69 G45 Q20 - Q26 F01 Numbers of deaths that are considered preventable from all cardiovascular diseases, as shown in Figure 10, are classified by underlying cause of death recorded with ICD codes I20-I26, I42.6, I71, I80.1-I80.3, I80.9 and I82.9. Deaths up to and including 2010 have been adjusted where appropriate to account for the ICD coding change introduced in When analysing mortality data, we use 95% confidence intervals to measure the probability that the range of values between the lower and upper confidence interval limits will contain the true population value, in this case mortality rate. A statistical correlation was undertaken to look at the potential relationship between the number of deaths related to CVD during 2010 and 2013, and the average deprivation score, taken from the 2010 Indices of Multiple Deprivation (IMD 2010). Data for both variables have been aggregated to electoral ward level. Pearson s correlation coefficient method was used to measure the strength of association between the two continuous variables and a two-tailed technique was used. The resulting correlation coefficient, represented by a number between -1 and 1 is used to determine if the relationship is statistically significant. Page 11 of 23

12 DASR per 100,000 population DASR per 100,000 population Figure 10: Under 75 mortality from all cardiovascular diseases in, by gender: Source: Public Health Outcomes Framework, indicator 4.04i Persons Male Female Figure 11: Under 75 mortality that is considered preventable from all cardiovascular diseases in, by gender: Source: Public Health Outcomes Framework, indicator 4.04ii Persons Male Female Page 12 of 23

13 DASR per 100,000 population DASR per 100,000 population Figure 12: All-age mortality from all cardiovascular diseases in, by CCG: East West Source: PCMD (Open Exeter), ONS Figure 13: Under 75 mortality from all cardiovascular diseases in, by CCG: East West Source: PCMD (Open Exeter), ONS Page 13 of 23

14 Figure 14: Statistical correlation between the number of deaths due to CVD and the average IMD score in, by electoral ward (n=180): Source: PCMD (Open Exeter), DCLG Page 14 of 23

15 Table 5: Comparison of directly age standardised early mortality (under 75) for cardiovascular conditions in, by gender and CCG: 2013 Gender Persons Males Females Area Name Cardiovascular disease DASR Lower Upper Circulatory disease DASR Lower Upper Coronary heart disease Total Source: PCMD (Open Exeter), ONS DASR Lower Upper DASR Stroke Lower Upper East West Total East West Total East West Page 15 of 23

16 Table 6: Comparison of directly age standardised mortality rates (all ages) for cardiovascular conditions in, by gender and CCG: 2013 Gender Persons Males Females Area Name Cardiovascular disease Circulatory disease Coronary heart disease Stroke DASR Lower Upper DASR Lower Upper Total Source: PCMD (Open Exeter), ONS DASR Lower Upper DASR Lower Upper East West Total East West Total East West Page 16 of 23

17 Mortality summary East has the highest rate of CVD mortality compared to other CCG s. has the highest rate of CHD mortality in. By gender, early mortality (under 75) from cardiovascular diseases is greatest in men; however for all ages, rates are higher in women. This indicates that women aged over 75 are more likely to die from cardiovascular diseases than those under 75. More people in die from coronary heart disease than from stroke. More men die from coronary heart disease than women; however all-age mortality rates show that more women die from stroke than men. Under 75 mortality from cardiovascular diseases show a decline in between 2001/03 to 2011/13 of 39% for men and 43% for women. Between 2010 and 2013, under 75 mortality from cardiovascular diseases has fallen by 6% and all-age mortality by 4%. There is a significant but weak positive correlation (0.19) at electoral ward level between the number of deaths due to CVD and the level of socioeconomic deprivation. Evidence shows that deaths are more likely to occur in areas where average IMD scores are lower, and therefore deprivation is higher. What we are doing Joint Health and Wellbeing Strategy for County Council s Joint Health and Wellbeing Strategy (JHWS) is based on priorities identified in the Joint Strategic Needs Assessment (JSNA) and sets out the commissioning direction and priorities for the population of between 2013 and Cardiovascular disease features heavily within the JHWS, both as a priority and as supporting measures. The theme 'Delivering high quality systematic care for major causes of ill health and disability' includes key priorities for the reduction of CHD mortality rates and to improve care and treatment for patients who have suffered either a heart attack or stroke. Page 17 of 23

18 The strategy also associates CVD with healthy lifestyles, where an observed reduction in excess weight and obesity in adults should contribute towards a decline in CVD mortality within Annual Report of the Director of Public Health The 2014 Annual Report of the Director of Public Health was published in March The report contains a chapter on circulatory disease that covers further definition, causes and risk factors. A data compendium is also available and provides data from the report at CCG and District level. The Annual Report and data compendium can be accessed via the Research Observatory (LRO) 11. Primary prevention messages Smoking cessation Smoking, including passive smoking, is a major cause of cardiovascular diseases, such as CHD and stroke. Stopping smoking can help reduce arterial damage and lower blood pressure, and therefore help lower the risk of angina, heart attack or stroke occurring % of adults aged 18 and over in currently smoke 13, with indicative tobacco sales in the county of 221 million in Between 2011 and 2013, there were 36.8 smoking attributable deaths from heart disease per 100,000 population aged 35 and over in 14. Healthy diet Reducing the amount of total fat intake to less than 30% of total energy intake helps prevent unhealthy weight gain in the adult population. In addition, reducing saturated fat intake to less than 10% of total energy intake and trans fats to less than 1% will reduce the risk of developing non-communicable diseases (NCD's) 15. County Council's Food and Growing Programme offered 102 cooking courses to over 2,200 participants in 2013/14 and delivered 104 healthy eating and growing awareness events, reaching over 8,000 people. Consumption of fresh fruit and vegetables Consumption of at least 400g or five portions of fresh fruit and vegetables a day is recommended to maintain a healthy, balanced diet and reduce the risk of developing non-communicable diseases 14. Nationally, 25% of men and 28% of women consumed five or more portions of fruit and vegetables a day. Fewer children consumed the recommended amount (16% of boys and 17% of girls) 16. Page 18 of 23

19 Intake of salt Latest guidance states that 'high levels of salt in the diet are linked with high blood pressure which, in turn, can lead to stroke and coronary heart disease.' Cardiovascular disease can be prevented by lowering daily salt intake for adults to 6g and ensuring children's intake does not exceed age-appropriate guidelines 17. Latest studies show that nationally, adults on average consume 8.1g of salt daily, with men consuming more (9.3g) than women (6.8g) 18. Alcohol consumption Alcohol consumption should be limited to three units per day for men and two per day for women 19. Excessive alcohol consumption can lead to stretching and thinning of the heart muscle (dilated cardiomyopathy), which can lead to heart failure. In 2013/14, PHE reported 947 hospital admissions (per 100,000 population) for alcohol-related cardiovascular disease in, with higher rates seen among district authorities located along the east coast (East Lindsey, Boston and South Holland) 20. Regular exercise Exercise training has been shown to slow the progression or partially reverse the severity of coronary atherosclerosis 21. In in 2010, 1,954 adults aged 40 to 79 were admitted to hospital due to coronary heart disease; however 211 (11.3%) could have been prevented if 100% of the population were active 22. 's Exercise Referral Programme referred 4,640 people for personalised exercise programming and support in 2013/14, with 70% completing a 12 week course. Weight control Overweight or obese patients should be encouraged to lose weight through a combination of diet and exercise % of adults (aged 16 and over), 24% of younger children i and 33.4% of older children ii in are classed as overweight or obese (BMI equal to or greater than 25kg/m 2 ) 24. Further information for CCG's around contributory risk factors as well as care processes and treatments for CVD can be obtained from the NCVIN CVD profiles 25. i National Child Measurement Programme: Reception year children aged 4 to 5 years ii National Child Measurement Programme: Year 6 children aged 10 to 11 years Page 19 of 23

20 Further information and data on a range of health topics such as CVD, NHS Health Check, tobacco and alcohol is available from Public Health England Health Profiles (Fingertips) ( National context National headlines In England women are as likely as men to develop CVD. In 2011, 13.9% of men were diagnosed with CVD, compared to 13.4% of women 26. Cardiovascular diseases are the main cause of death in England and Wales, with 28.3% of all deaths (of all ages) being from circulatory diseases, equating to around 141,500 deaths in Around 45% of all deaths from CVD are from coronary heart disease (CHD) and more than a quarter from stroke (27%). All-age all-person mortality from CVD has decreased in England by 53% between 1996 and 2012, while mortality rates for all people under 75 years of age have decreased by 59%. National Cardiovascular Disease Outcomes Strategy Published in March 2013 by the Department of Health (DoH), the CVD Outcomes Strategy 27 highlights people with or at risk of CVD and recommends viable, practical solutions for local authorities and NHS commissioning services to: Reduce premature mortality rates for CVD by improving prevention, diagnosis and treatment; Manage CVD as a single family of diseases and develop a standardised template for community and hospital care; Support better identification of families or individuals at high risk of CVD and improve its management in primary care; Improve intelligence, monitoring and research into CVD and publish comparative data on the quality of care provided for patients with CVD. National Cardiovascular Health Intelligence Network The National Cardiovascular Health Intelligence Network (NCVIN) 28 was identified and established as an action from the National CVD Outcomes Strategy and is coordinated by Public Health England (PHE). NCVIN provide a wealth of resources, from prevalence models, to intelligence packs and outcome vs expenditure tools; all Page 20 of 23

21 of which allow commissioners and health care providers to better understand the needs of their populations and commission services more effectively. NHS Health Check programme The NHS Health Check programme aims to improve early diagnosis and subsequent treatment of heart disease, stroke, diabetes, kidney disease and certain types of dementia. Everyone between the ages of 40 and 74, who has not already been diagnosed with one of these conditions or have certain risk factors, will be invited (once every five years) to have a check to assess their risk of heart disease, stroke, kidney disease and diabetes and will be given support and advice to help them reduce or manage that risk 29. Vascular diseases are the biggest cause of death in the UK, and the NHS Health Check programme could prevent 1,600 heart attacks and strokes and save at least 650 lives each year 30. Since the beginning of the programme in August 2009, GP practices in have assessed over 86,000 patients and diagnosed nearly 5,000 cases of vascular disease as well as providing support for health related services such as weight management, smoking cessation, exercise on referral and volunteer lead health walk programmes 31. Created by the Public Health Intelligence Team, May 2015 PH_Intelligence@lincolnshire.gov.uk Public Health Intelligence Team County Council Orchard House Orchard Street Lincoln LN1 1BA This document had been created in line with Public Health Charter 2014 Page 21 of 23

22 References 1 Source: PHE. The National Cardiovascular Intelligence Network - Cardiovascular Disease Key Facts. Available at 2 Source: World Heart Federation. Cardiovascular disease risk factors. Available at 3 Source: PHE. CHD Prevalence Modelling Briefing Document. Available at 4 Source: HSCIC. Health survey for England 2011: Trend tables. Available at 5 Source: HSCIC. Quality and Outcomes Framework 2013/14 Technical Annex. Available at 6 Source: PHE. Cardiovascular disease profile. Available at 7 Source: HSCIC. NHS Data Dictionary - Admission methods. Available at 8 Source: NHS. Deaths from cardiovascular diseases Implications for end of life care in England. Available at 9 Source: ONS. Definition of avoidable mortality. Available at 10 Source: County Council. Joint Health and Wellbeing Strategy. Available at 11 Source: Research Observatory. Annual Report of the Director of Public Health on the health of the people of Available at 12 Source: British Heart Foundation. Available at 13 Source: ONS, Integrated Household Survey Available at 14 Source: PHE, Tobacco Control Profiles. Available at 15 Source: WHO, Healthy diet Fact sheet. Available at 16 Source: HSCIC, Health Survey for England Available at nd%22&sort=relevance&size=10&page=1#top 17 Source: NICE. Prevention of cardiovascular disease (PH25). Available at 18 Source: PHE, Assessment of dietary sodium levels among adults (aged 19-64) in England, Available at 19 Source: Department of Health. Alcohol advice. February Available at 20 Source: PHE, Local Alcohol Profiles for England. Available at 21 Source: Department of Health. Evidence on the impact of physical activity and its relationship to health. Available at Page 22 of 23

23 981.pdf 22 Source: PHE, Health Impact of Physical Inactivity. Available at 23 Source: NHS Choices. Treating obesity. Available at 24 Source: PHE, Public Health Outcomes Framework. Available at 25 Source: PHE. Cardiovascular Disease Profiles. Available at 26 Source: HSCIC. Health survey for England 2011: health social care and lifestyles: Cardiovascular Disease, Available at 27 Source: Gov.uk. Cardiovascular Disease Outcomes Strategy. Available at 28 Source: PHE. National Cardiovascular Intelligence Network. Available at 29 Source: NHS. NHS Health Check. Available at 30 Source: Department for Health. Putting Prevention First, Vascular Checks: Risk Assessment and Management Next Steps Guidance for Primary Care Trusts, November Source: County Council. NHS Health Check Annual Report 2013/14, Clinical Commissioning Groups. Page 23 of 23