Transcript Learning Objectives

Profiling populations
www.empho.org.uk
The students have to submit a profile of the area in
which they do their practice placement. This usually
relates to the geographical area, but can be based on
the practice population with some specific work
relating to public health issues within the area
population where applicable e.g. ethnic minorities,
smoking, deprivation etc.
The comments from previous years have focused on
the problems of finding and interpreting data to
inform the compilation of the profile and
recommendations for services/practice within the
area.
The session will cover:
• measuring health and determinants of health
in populations – some basic principles
• sources of information relating to:
– geographical areas
– practices
• example profiles
measuring health and determinants of health
in populations
some dimensions of health/ill health
 mood/mental well-being
 ability to carry out ordinary daily activities
 physical fitness – cardiovascular, musculoskeletal
 trauma/injury
 symptoms
 diagnosed disease
 [death]
derived measures of health in populations
e.g.:
 prevalence
 incidence
 % of population above or below a particular threshold
 average
Census 2001
% saying health is “not good”
England & Wales 9.2%
East Midlands
9.1%
Bolsover
13.7%
South Northants 5.8%
Erewash Health
Survey
Erewash Health Survey
Inequalities among people aged 65-74
Representative
Deprived
excellent or very good health (men)
24%
14%
not very happy/very unhappy (women)
12%
24%
smoking (women)
14%
23%
symptoms of angina - Grade 2 (men)
7%
14%
28%
37%
5%
12%
problem(s) with condition of house/flat
overall quality of life poor/v.poor
Lung cancer incidence in the East Midlands and England
by sex - numbers of new cases in 2004
Males
Females
East Midlands
1,674
1,022
England
18,105
12,354
Mortality from all circulatory diseases
Directly standardised rates for females (ages <75)
by Strategic Health Authorities in England, 1999 and 2001
Age-standardised rate
(per 100,000) (Number of SHAs )
< 43.70
43.70 - 58.26
58.27 - 65.55
65.56 - 72.83
72.84 - 80.11
80.12 - 91.04
91.05 - 127 .46
> 127.46
Northumberland,
Tyne and Wear
County Durham
and Tees Valley
Cumbria
and
Lancashire
North and East Yorkshire
and Northern Lincolnshire
West Yorkshire
Greater Manchester
South Yorkshire
Cheshire and
Merseyside
Trent
Shropshire
and
Staffordshire
Greater London
Birmingham
and
The Black Country
North Central London
Leicestershire,
Northamptonshire
and Rutland
Norfolk, Suffolk
and Cambridgeshire
North East London
Coventry, Warwickshire,
Herefordshire and Worcestershire
North West London
Bedfordshire
and
Hertfordshire
South East London
Essex
Thames Valley
South West London
Avon,
Gloucestershire
and Wiltshire
Hampshire
and
Isle of Wight
Dorset and Somerset
South West Peninsula
Kent and Medway
Surrey and Sussex
(0)
(2)
(8)
(6)
(3)
(7)
(2)
(0)
measuring inequalities in health
• population health measures ....
• analysed by e.g.:
–
–
–
–
–
–
area of residence
ethnicity
occupation/social class
disability status
gender
age
In the UK, infant mortality among babies of
mothers born in Pakistan is more than
double the national average
Infant mortality rates by Social Class
EAST MIDLANDS
12
10
Rate per 1,000 live births
8
6
4
2
0
I
II
IIIN
IIIM
IV
V
Male life expectancy in Manchester
is 10 years less than in Dorset
data sources
• routinely collected data, e.g. death registrations
• disease registers, e.g. re cancer
• research studies/surveys
• records of NHS health care
– general practice
– A&E
– hospital admissions
• can we use records of NHS health care for measuring
population health and describing inequalities in health?
Quality and Outcomes Framework (QOF) for April 2004 - March 2005, England
Numbers on practice disease registers and derived prevalence (unadjusted)
Selected Practices in Nottingham City
Practice
Code
Practice List
Size
Coronary
Heart
Disease
Register
Count
Coronary
Heart
Disease
Prevalence
Diabetes
Register
Count
Diabetes
Prevalence
C84060
8,676
480
5.5%
320
3.7%
C84046
7,667
395
5.2%
306
4.0%
C84004
5,645
287
5.1%
237
4.2%
C84043
7,207
320
4.4%
267
3.7%
C84011
9,101
361
4.0%
297
3.3%
C84018
7,438
276
3.7%
252
3.4%
C84034
10,760
391
3.6%
386
3.6%
C84044
5,379
177
3.3%
146
2.7%
C84064
6,141
200
3.3%
208
3.4%
The main determinants of health
different population groups have different
patterns of exposure to these
factors/determinants ....
... generating inequalities in health
Is your service equitable?
Use: Need Ratios by Ward
Ward Name
Population
Estimated Smoking
Estimated
No. Fresh Start
Use/Need
Prevalence %
No. Smokers
Users
Ratio
Little Eaton and Breadsall
2954
15.7
464
16
3.45%
Sandiacre North
3493
25.7
898
32
3.56%
Ockbrook And Borrowash
5888
17.8
1048
37
3.53%
Old Park
3218
35.7
1147
46
4.01%
Draycott
3165
21.5
680
29
4.26%
Ilkeston Central
3550
35.4
1257
63
5.01%
Sandiacre South
3532
17.3
612
32
5.23%
Sawley
5368
25.2
1353
76
5.62%
Nottingham Road
5030
28.0
1407
81
5.75%
Derby Road East
3777
29.8
1124
72
6.41%
Long Eaton Central
4825
25.0
1204
77
6.39%
Kirk Hallam
5057
29.0
1468
98
6.68%
West Hallam and Dale Abbey
4121
14.2
587
41
6.99%
Cotmanhay
3494
35.4
1236
88
7.12%
Stanley
1728
20.0
346
27
7.80%
Breaston
3713
14.9
554
48
8.67%
Ilkeston North
3095
36.1
1117
106
9.49%
Little Hallam
3309
17.6
584
81
13.88%
Finding the information
• raw data ...?
• .... or information/intelligence?
EMPHO’s Small Area Database
• Small area data available on EMPHO website –
www.empho.org.uk
• Data Sets available at Lower Layer Super
Output Area Level:

Standardised Mortality Ratios (SMR), 2001-05 for:
-

All Age, All Cause Mortality
Under 75, All Cause Mortality
Under 75, All Cancer Mortality
Under 75, All Circulatory Disease Mortality
Low Birth Weight percentages, 2001-05
Small Area Database
• Data available at Ward level:

Life Expectancy, 2001-05
-

Males
Females
Synthetic Estimates of Healthy Lifestyle Behaviours,
2000-02
Smoking Prevalence in adults
- Obesity Prevalence in adults
- Binge Drinking Prevalence in adults
- Consumption of Fruit and Vegetables in adults and children
(Due to be updated with 2003-05 data at Middle Layer Super
Output Area level– All indicators except Fruit and Vegetable
consumption in Children)
-

Under 18 Conception rates, 2002-04
-
Difference to national (England) rate
Ward Level Teenage Pregnancy Maps
EMPHO Small Area
Inequalities Reports
•
•
•
Report for each County / UA in
East Midlands
Provide an overview of the
data
Available on the EMPHO
website
Reports contain:
• Map and information about All
Age, All Cause Mortality.
• Other Key Findings from the
other data sets
• Other useful sources of Small
Area information (on reverse)
• Directions to access EMPHO’s
Small Area Data –
www.empho.org.uk
Enter postocde here for
neighbourhood.statistics.gov.uk
summary
Click the tabs for summaries by theme
For more detailed search
enter postcode here
Indicators grouped by theme
Or Search by key word
Theme:
Health & Care
Search for population
www.audit-commission.gov.uk
Creating a Practice Profile
Age, Sex, Postcode
– Practice population breakdown available from national
databases (NHS Strategic Tracing Service, Exeter system)
Deprivation
– Use patient postcodes to apply IMD2004 scores
Ethnicity
– Some incentives to improve data collection by GPs but coverage
and quality still poor (ie unusable)
– Census ethnicity data can be used to estimate ethnic
distributions by mapping patient postcodes to Census output
areas
QOF Data
Disease Prevalence
– CHD, Hypertension, Asthma, COPD, Diabetes . . .
– Crude rates unadjusted for age/sex/deprivation/ethnicity
– Discrepancies between reported and modelled prevalence
Reliability
– Inconsistent data capture at GP practice level
– New data source – quality improving with time
Smoking
– QOF data shows whether a practice recorded a patient’s
smoking status but not what their smoking status was!
2006/07 QOF data:
http://www.ic.nhs.uk/our-services/improving-patient-care/the-quality-and-outcomes-framework-qof-2006-07
Modelling
National surveys
– Indication of national prevalence for a specific condition
– Sample sizes too small to determine prevalence for lower
geographical levels
BUT …
– Can determine prevalence by socio-economic and demographic
categories
– Use these to create models which can be used to estimate
prevalence within a population based on socio-economic and
demographic distributions of that population (eg practice profile)
Some prevalence models for QOF disease areas:
http://www.doncasterhealth.co.uk/phiu/QOF_userguides.asp
Finding the information
• raw data ...?
• .... or information/intelligence?
sources of information/intelligence
potentially useful websites
•
ONS neighbourhood.statistics.gov.uk/
•
Audit Commission Area profiles www.areaprofiles.auditcommission.gov.uk
•
Neighbourhood Renewal Unit www.renewal.net
•
EMPHO www.empho.org.uk
local specialists in health information
•
Public Health Analysts in PCTs
significant others
•
Local observatories
•
Local authority information departments
•
Local academic departments