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ANNUAL PUBLIC HEALTH REPORT 2011

Extending life in Islington

Harriet MurrellPublic Health Strategist.on behalf of Islington’s Public Health team

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To look at what more could be done to improve population health outcomes, and particularly early death, in people aged 18-74 living with long term conditions in Islington.

Four main sections:

– Description of the burden of ill-health from long term conditions

– Finding the undiagnosed

– Lifestyles and behaviour change in those with long term conditions

– Management and care of long term conditions in primary care

Case for change and recommendations on what more could be done to reduce early deaths and other outcomes in people living with long term conditions.

Purpose and outline

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High quality information to inform commissioning and service delivery

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Long term conditions in Islington: key areas for public health action

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Factors impacting on the prevalence of long term conditions

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SETTING THE SCENE: THE BURDEN OF ILL-HEALTH FROM LONG TERM CONDITIONS IN ISLINGTON

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Causes of death: 2006-08

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Numbers of long term conditions

Number of diagnosed long term conditions by condition, Islington’s registered population (18+), March 2011

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People living with multiple conditions

Number of diagnosed long term conditions per person aged 18-74 years, Islington’s registered population, March 2011

One condition(18,864)

Two conditions(6,277)

Three conditions

(2,078)

Four conditions

(664)

Five conditions(186)

Six or more conditions

(80)

Four or more conditions

(930)

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Comorbidity and order of diagnosis

SECOND DIAGNOSIS

FIR

ST

DIA

GN

OS

IS

n=

75

2

CHD

n=

3,8

02

42% 11% 10% 37%High blood pressure

n=

1,5

10

Diabetes 65% 8% 6% 21%

n=

33

4Stroke/TIA 56% 10% 8% 25%

n=

16

5

Atrial fibrillation 41% 13% 10% 36%

48% 19% 7% 27%

Other*

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Conditions with higher prevalence in deprived areas

Odds ratios and numbers of people diagnosed with long term conditions by type of condition and local deprivation quintiles, Islington’s registered population aged 18-74, March 2011

0

1

2

3

Psychotic disorders

CHD Chronic depression

Diabetes COPD

Od

ds

rati

o w

hen

co

mp

are

d w

ith

the

leas

t dep

rive

d (1

)

Long term condition

Least deprived

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This section looks at which lifestyle risk factors are important in contributing to the development of long term conditions in Islington with comparisons to early deaths. It also looks at differences by deprivation.

LIFESTYLES AND THE DEVELOPMENT OF LONG TERM CONDITIONS

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Contribution of lifestyle risk factors to long term conditions and early death

Contribution of lifestyle risk factors to the prevalence of and early deaths from diagnosed long term conditions, Islington’s registered population aged 18-74, March 2011

Smoking 18%

Overweight/obesity36%

Smoking6% Physical inactivity

4%

Low fruit& vegetable intake2%

Alcohol 2%

Smoking16%

Overweight/obesity10%

Low fruit& vegetable intake7%

Physical inactivity 5%

Alcohol2%

Impact on prevalence of long term conditions Impact on premature deaths due to long term conditions

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Smoking prevalence by ethnicity

Indirectly standardised ratio of smoking prevalence in those with diagnosed long term conditions by ethnic group, Islington’s registered population aged 18-74, March 2011

0

20

40

60

80

100

120

140

White Black Asian Other

Ind

irec

tly

stan

dar

dis

ed r

atio

of

smo

kin

g p

reva

len

ce in

tho

se w

ith

d

iag

no

sed

lon

g te

rm c

on

dit

ion

s

Ethnic group

Average

5,117 650 262 1,538

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Current lifestyle risk factors

Indirectly standardised prevalence of smoking, obesity and high and increasing risk drinking* among people with a diagnosed long term condition, Islington’s registered population aged 18-74, March 2011

*Increasing risk drinking is defined as usual consumption of between 22 and 50 units of alcohol per week for men, and between 15 and 35 units of alcohol per week for women. High risk drinking is defined as usual consumption of over 50 units of alcohol per week for men, and over 35 units of alcohol per week for women (APHO, 2010)

0

20

40

60

80

100

120

140

160

180

Smoking Ex-smoking Obesity Overweight High and increasing risk

drinking

Ind

irec

tly

stan

dar

dis

ed r

atio

of

pre

vale

nce

of r

isk

fact

or

Risk Factor

Persons with no long term condition Persons with one or more long term conditions

Average

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Diabetes and obesity

Indirectly standardised diagnosed prevalence of type II diabetes by BMI classification in adults aged 18-74, Islington registered population, March 2011

0

50

100

150

200

250

300

350

Underweight Healthy weight

Overweight Obesity Class I

Obesity Class II

Obesity Class III

Ind

irec

tly

stan

dar

dis

ed r

atio

of

dia

bet

es p

reva

len

ce

BMI group

Average

36 1,196 2,173 1,730 855 572

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Smoking and COPD

Current smoking status by MRC breathlessness scale in people aged 18-74 years diagnosed with COPD, Islington’s registered population, March 2011

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Grade 1 Grade 2 Grade 3 Grade 4 Grade 5

Per

cen

tag

e o

f peo

ple

wit

h C

OP

D

MRC Breathlessness Scale

Ex-smoker Smoker

100 148 298 312 243 267 133 124 24 22

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Missed opportunities to help to close prevalence gaps, better manage conditions, and to reduce early deaths.

SYSTEMATIC TARGETING OF THE POPULATION ‘AT RISK’ USING COST-EFFECTIVE INTERVENTIONS

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Follow-up of people with a high blood pressure reading but no diagnosis

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

0

200

400

600

800

1,000

1,200

1,400

35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74

Per

cen

tag

e o

f peo

ple

wit

h a

hig

h b

loo

d

pre

ssu

re r

ead

ing

(lin

e)

Nu

mb

er o

f peo

ple

wit

h a

hig

h b

loo

d

pre

ssu

re r

ead

ing

(bar

s)

Age group

Dec 10 - Feb 11

Sep 10 - Nov 10

Dec 09 - Aug 10

Prior to Dec 09

% of total population

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NHS Health Checks and Cardiovascular risk assessments

Excludes Partnership Primary Care Centre because the clinical system uses Framingham CVD rather than QRisk2

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

<10% 10-14% 15-19% ≥20% Not calculated

Per

cen

tag

e o

f peo

ple

in e

ach

ris

k b

and

Risk of heart attack or stroke/TIA in the next 10 years (QRisk2)

CVD risk assessment NHS Health Check CVD risk not assessed

50,634 7,335 3,593 4,590 8,648

931

667

965

3,152937

866

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Depression screening

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

CHD and/or diabetes Long term condition other than CHD or diabetes

Per

cen

tag

e o

f peo

ple

wit

h a

dia

gn

ose

d

lon

g te

rm c

on

dit

ion

Depression screen only PHQ9 score

4,992

1,664

1,051607

Number and percentage of people with at least one diagnosed long term condition (excluding chronic depression and psychotic disorders) that have a record of

screening for depression or PHQ9 questionnaire, Islington’s registered population aged 18-74, March 2011

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Smoking advice offered to those with COPD

Smoking advice offered to people aged 18-74 with diagnosed COPD by MRC breathlessness scale, Islington’s registered population, March 2011

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Grade 1 Grade 2 Grade 3 Grade 4 Grade 5

Per

cen

tag

e o

f peo

ple

wit

h C

OP

D

off

ered

sm

oki

ng

hel

p

MRC Breathlessness Scale

169 378 342 161 36

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Prescribing

62129%

1,50771%

Not prescribedPrescribed

Antihypertensives

1,00161%

64739%

Not prescribedPrescribed

Statins

Percentage of eligible populations aged 18-74 years prescribed antihypertensives or statins in 2010/11, March 2011

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EXAMPLES OF SUCCESSES

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In 2010/11, Islington had the fourth highest rate of quits among all London boroughs, at 1,232 per 100,000 persons aged 16+.

There were a total of 5,940 attempts to quit with the Islington Stop Smoking Service, an increase on the 2009/10 figure (5,339).

The total number of quitters was 2,225, which exceeded the target number for this year (2,218).

Most quits (95%, 2,115) were achieved among GPs.

Only three Islington GP practices achieved lower quit rates per 1,000 practice population than the previous year. Five practices achieved a significantly higher rate.

Quit rates were significantly higher among the most deprived 20% of persons living in Islington than the least deprived 20%.

Smoking quits in Islington, 2010/11

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Overview of Health Checks in Islington, 2010/11

6,455 Health Checks (HCs) were carried out in Islington in 2010/11 in persons aged between 35 and 74, and with no previous relevant diagnosis.

7,637 HCs were offered (15% of the eligible population).

Most HCs were carried out at GP practices (62%, n=3,992), followed by the community outreach programme (27%, n=1,742) and pharmacies (n=721 HCs, 11%).

Islington was the only PCT in the NCL sector to achieve the target number of Health Checks delivered, and one of 8 PCTs in London to achieve this target. Source: EMIS (June 2011), NHS Health Checks in persons aged 35-74; Health

Smart (May 2011); TeleHealth Solutions (June 2011).

0

500

1000

1500

2000

2500

3000

3500

4000

4500

GP practices Community Pharmacy

Nu

mb

er

of

He

alt

h C

he

ck

s

Number of NHS Health Checks, persons aged 35-74, Islington, 2010/11

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New diagnoses following Health Checks, 2010/11

Source: EMIS (June 2011), NHS Health Checks in persons aged 35-74, Islington registered population.

0

20

40

60

80

100

120

140

Hypertension Diabetes High cholesterol Other

Nu

mb

er

of

ne

w d

iag

no

se

s

Number of new diagnoses following HCs in Islington by sex, persons aged 35-74, Apr 2010 - Mar 2011

Women Men

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Time period

Recorded prevalenceExpected

prevalence

Undiagnosed prevalence

Number % Number %

2010/11 2,966 1.6%

3.7%

3,750 2.1%

2009/10 2,651 1.4% 4,240 2.3%

2008/09 2,579 1.4% 4,160 2.3%

Increase in diagnosed COPD

453 new diagnoses in the LES target population (patients aged >35, who were current smokers or ex-smokers) between April 2010 and March 2011.

The overall recorded prevalence has increased by 0.2 percentage points, thus reducing the gap of between expected and recorded prevalence by 13%.

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Next Steps

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Determining health and wellbeing priorities

Strategic fit (Must do’s; political influence)

Numbers of people affected by the issue and effect on health and wellbeing and health inequalities

Projected future position if no action taken

Benchmarking – how do we compare to other areas

Resource impact or cost to the community

Local views

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Current approaches to evidence in Islington

• The JSNA has been developed in two formats; a short version and a long version publicly available on the NHS Islington internet site http://www.islington.nhs.uk/jsna.htm

• PH intelligence pages contain quantitative data (NHS only)

• LBI webpages include top-line “borough statistics”

• Other information and performance reporting within internal systems, held by individual teams within different organisations

• Other evidence available from a range of different external organisations (e.g. PH observatories, NHS IC, Local Communities and Government

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Islington Evidence Hub

• Would include different types and levels of evidence to try and meet wide-ranging need for information – people can drill down for the level they require

• At a top-level: summary “factsheets” (e.g. Health Islington: the Facts; ward profiles; develop others for key themes); overarching performance metrics

• At bottom-level: access to spreadsheets with population counts

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Relationship with the Islington Health and Wellbeing Board

The evidence provided through the Joint Strategic Needs Assessment and other documents will support the work of the Islington Health and Wellbeing Board by clarifying the health and wellbeing needs of the local population.

Understanding the needs of the local population is important for informing the health and wellbeing priorities for the borough which in turn will influence strategy and commissioning decisions.