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Edinburgh Health Information, March 2015

Edinburgh Health Information

Key public health issues for Edinburgh

Life expectancy has increased steadily in the last ten years in Edinburgh. Edinburgh is

more affluent than other parts of Lothian and its population generally has better

health.

Public policy and the actions of public bodies such as health and social care

partnerships need to address shortcomings in determinants of health as well as

lifestyle and behavioural factors.

There are differences in life expectancy which reflect the social and economic

inequalities across the city.

There are pockets of poor health throughout the city, often in areas of multiple

deprivation.

Health is poorest in the East locality, predictably as it is the most deprived of the

new Edinburgh localities. Health is the three other localities is broadly similar.

The existence and width of health inequalities cannot be attributed to a single

clinical or behavioural risk factor. They are the result of social circumstances. Health

will improve if people are supported to be physically active, eat and drink healthily

and not smoke. However, the drivers of these behaviours are social circumstances

such as income, housing, education, employment and transport.

As people live longer, they live with chronic conditions. Multimorbidity will become

the norm for the Edinburgh population. Preventive actions can ensure people live

healthily in their own homes rather than frequenting hospitals and other acute care

services.

Edinburgh’s population is increasing. Projections show that in 2037 the percentage

working age population in Edinburgh will still be higher than other Scottish local

authorities.

More GPs, nurses and social care staff will be needed to provide community-based

services that serve the population throughout the lifecourse. Filling these key posts

will be challenging given the current age and career profile of these staff groups.

Edinburgh’s population is ageing. More older people will mean an increase in

absolute demand for health and care.

1


1. Health Inequalities

Life expectancy for a child born in Edinburgh in 2013 was between 78 years and 81 years

depending on its sex.

Life expectancy at birth 2001-2003 2006-2008 2011-2013

Male Female Male Female Male FemaleEast Lothian 75.6 80.1 76.7 81.3 78.5 81.6Edinburgh, City of 74.8 80.1 76.3 81.2 77.6 81.9Midlothian 74.7 78.6 76.4 80.5 77.3 81.7West Lothian 73.5 77.7 75.9 79.2 77.5 80.2Lothian 74.7 79.5 76.3 80.8 77.7 81.6Scotland 73.5 78.8 75.1 79.9 76.9 81.0

Source: NRS Life Expectancy 2001-2013

However, life expectancy, like most measures of health, is directly correlated to

socioeconomic status. More affluent people tend to live longer lives and are more healthy

during their lives. These health inequalities are ‘systematic, unfair differences in the health

of the population that occur across social classes or population groups’. Mortality increases

with greater inequality and there is evidence of pronounced variation in mortality rates in

Edinburgh. People living in the least deprived communities in Edinburgh can expect to live

21 years longer than people living in the most deprived communities: boys born in

Greendykes and Niddrie Mains between 2005 and 2009 had a life expectancy more than 25

years less than girls born in Barnton and Cammo.

2


Highest and lowest l ife expectancy at birth in Edinburgh neighbourhoods, 2005-2009

0

10

20

30

40

50

60

70

80

90

100

Greendykes andNiddrie Mains

New Town West Great JunctionStreet

Barnton andCammo

Neighbourhood (Intermediate Zone)

Life

Expe

ctan

cy (y

ears

)

Male

Female

Figure 1: Highest and lowest life expectancies in Edinburgh, 2005-2009 (Source: NRS Life

Expectancy and Intermediate Zones, 2005-2009)

There are also differences in death rates within localities. The mortality rate in the East

locality is the highest in the city, and is higher than both the Lothian and Scotland average

(see Figure 2). Greater socio-economic disadvantage in the East of the city is the most likely

explanation for the higher death rate in this sector. People living in the most deprived

communities also have poorer physical and mental health throughout their lives (Figure 3).

[1-4] Unsurprisingly, perhaps, people from these communities are most likely to have

unscheduled hospital admissions.[4] Many of these hospitals admissions are potentially

preventable. Although older adults live with many chronic conditions, it is feasible for most

care to be delivered in community settings or at home.[5-9]

Health inequalities usually develop over a lifecourse. Differences in individual experiences

affect people’s health in three main ways:

Differential exposure to environmental, cultural, socio-economic and educational

influences that impact on health.

The psychosocial consequences of differences in social status. There is now strong

evidence that ‘status anxiety’ leads to psychological and physiological changes that

affect health.[10]

3


Accumulation of these effects over the lifecourse. The inequalities in health that are

observed now will reflect not only current status but also differences in experiences at

earlier stages in life. This is why interventions targeting families and the early years are

so important.

Health inequalities can also be attributable to ethnicity, disability or sexuality. Although

overall mortality for people from black and minority ethnic populations is similar or better

than the white Scottish population, there are aspects of health – notably cardiovascular and

diabetes – where access to services and outcomes are worse, particularly for people from

south Asian populations.[11] In part the better health of migrants may be attributable to the

‘healthy migrant effect’ although there is also evidence that this health dividend disappears

for second and third generation minority ethnic residents. Comparisons of population sub-

groups’ health needs to bear in mind that health in Scotland is generally poorer than almost

all other Western European countries.[12, 13]

People experiencing physical disability also tend to have poorer health.[14] Limiting long

term conditions reduce people’s healthy life expectancy ie. the period of life lived in good

health. There is strong evidence that learning disability is associated with very poor health.

[15] There is also very strong evidence of health inequalities associated with social

determinants of health. Low income[16, 17], unemployment and insecure work, [18-29]

homelessness[30-32] and low educational attainment[22, 33-35] have particularly strong

influences.

4


All Cause Mortality - Edinburgh CHP, NHS Lothian and Scotland

1,000.0

1,100.0

1,200.0

1,300.0

1,400.0

2006-2008 2007-2009 2008-2010 2009-2011 2010-2012 2011-2013

Aggregated Year of Death Registration

Age-

sex

Sta

ndar

dise

d R

ate

per 1

00,0

00 P

opul

atio

n Edinburgh (East)

Edinburgh (North West)

Edinburgh (South Central)

Edinburgh (South West)

Edinburgh CHP

NHS Lothian

Scotland

Figure 2: Mortality rates for Edinburgh health and social care localities with comparator geographies (Source: Lothian Analytical Services, 2015)

5


Figure 3: Physical and Mental Health disorders by socioeconomic status[36]

6


The pattern of health inequalities mirrors the distribution of deprivation across Edinburgh. Mortality and morbidity are highest where there is greatest

deprivation

7


But health inequalities are not restricted to areas of multiple deprivation. Research suggests

that up to 50% of people experiencing poor health do not live in the most deprived

communities.

Edinburgh is home to 62% of the Lothian residents who live in Scotland’s most deprived 20%

datazones. Compared to other parts of Lothian, Edinburgh has the highest number of people

living in the least deprived SIMD quintiles as a proportion of local population.

SIMD 2012 share as percentage of local population

0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

40.0

45.0

50.0

East Lothian Edinburgh Midlothian West Lothian Lothian

SIMD quintile (1 = Most Deprived)

Perc

enta

ge

SIMD Q1

SIMD Q2

SIMD Q3

SIMD Q4

SIMD Q5

Figure 4: Share of population grouped by SIMD 2012 datazone rankings (Source: NHS

Lothian Public Health and Health Policy, 2014)

Mid-year 2010 populations

Most deprived

SIMD 2012

rankings Least deprived

Area 1 2 3 4 5 Total

East Lothian 3916 19871 20662 35083 17968 97500

Edinburgh 57134 67336 77236 75771 208643 486120

8


Midlothian 5819 22504 20465 18916 13346 81050

West Lothian 24954 49605 37908 29870 29743 172080

Lothian 91823 159316 156271 159640 269700 836750

Scotland 992973

101754

9

105154

8

108527

1

107475

9

522210

0

Health inequalities are not only related to socio-economic position. People who are

disadvantaged by race, migration status, disability, gender and other factors also have

poorer health. The existence and width of health inequalities cannot be attributed to a single

clinical or behavioural risk factor. They are the result of social circumstances and reflect the

underlying distribution of power and resources in the population. The underlying roots of

health inequalities relate to the unfair distribution of power, money and resources. The

social and political forces that maintain this unfair distribution are termed the ‘fundamental

causes’ of health inequalities. These fundamental causes affect the distribution of wider

environmental influences such as the availability of jobs, good quality housing, education

and learning opportunities, access to services, social status. This results in differences in

individual experiences of, for example, discrimination, prejudice, low income, poor

opportunities. This is illustrated in the model below.

Figure 6: Fundamental Causes of Health Inequalities [37]

It is as important to tackle major non-medical causes of ill health, like social isolation,

homelessness and worklessness as it is to tackle the significant individual level factors that

lead to poor health: smoking; high blood pressure; obesity; poor diet; lack of exercise; and

9


excessive alcohol consumption. Tackling health inequalities requires work on prevention as

well as treatment services and mitigation. Making links between health outcomes and work

in policy areas such as planning, housing, education, transport, employability, sport and

leisure will be crucial if population health is going to be improved for the people whose

health is currently worst.

A key role for organisations delivering health and social care is to mitigate and prevent

health inequalities by providing healthcare and health improvement interventions in

proportion to need. High quality, universal healthcare that is available to everyone with no

or minimal cost barriers is in itself important to mitigate and reduce health inequalities. But

within the universal service there are often other barriers that prevent some disadvantaged

groups of people from receiving care. These include physical, social, environmental and

practical barriers such as mismatch between service design and patient need, cultural

differences between patients and staff, low expectations, poor experience, transport costs

and lack of capacity where the need is highest. These all contribute to what is termed the

‘inverse care law’ – that quantity and quality of care may be poorest for those with the

highest needs. There is evidence in Scotland that resources in our poorest communities are

not sufficient for need.[1, 3, 38] The ‘Deep End’ group of general practices serving

populations living in deprived areas has identified the increased workload for these practices

and advocates that practices in deprived areas should have a package of additional support

to meet the health needs of their populations. The package includes additional GP time;

attached specialist workers; link workers to improve joint working with other services

including the third sector. Future health and social care services need to be designed to deal

with the complexities presented by an ageing population, a population that will live with

multiple morbidities. Episodic, disease-focused or client-specific care will not work in future.

More holistic care focusing on what people need rather than services designed to meet the

requirements of health care systems and bureaucracies. [9, 39, 40]

2. Ageing population

In projections to 2037, the increase in the 75 years and over population is notable due to the

relatively small proportion of this group currently. There will be a marked increase in the

absolute number of very old people living the area. Edinburgh will still have a young

population relative to other parts of Lothian and Scotland. It is important to note that

10


current definitions of age, notably the working age population of 16-64 years, may change in

future as changes to pension eligibility, changing work patterns and longer healthy life

expectancy mean that public policymakers need to re-think how and why they think about

services to an older population.[41]

Projected population change within age groupings

-20 0

20406080

100120140160

2017

2022

2027

2032

2037

2017

2022

2027

2032

2037

2017

2022

2027

2032

2037

2017

2022

2027

2032

2037

Children (0-15)

WorkingAges2

PensionableAges2

75+

Age groupings

Pop

ulat

ion

chan

ge East Lothian EdinburghMidlothian West Lothian Lothian

Figure 7: Lothian population projections by age group 2012-2037 (Source: NRS Population

Projections 2012-2037)

Between 2012 and 2037, the number of households in Edinburgh is projected to increase by

88,158 from 224,875 to 313,033, which is an increase of 39%. Edinburgh already has the

highest proportion of single person households in Lothian and this trend continues.

Edinburgh’s proportion of single person households will continue to be above the Scotland

average. Isolation and loneliness are common health determinants for older people. These

are associated with higher all cause mortality for both sexes,[42-44] as well as lifestyle

factors such as poorer dietary intake.[45]

11


2012 2037

Council

area

1

adult

1 adult,

1+

children

2

adults

2+

adults,

1+

children

3+

adults

1

adult

1 adult,

1+

children

2

adults

2+

adults,

1+

children

3+

adults

East

Lothian 31% 6% 32% 22% 8% 36% 8% 32% 19% 6%

Edinburgh,

City of 40% 5% 30% 16% 9% 44% 6% 30% 13% 7%

Midlothia

n 28% 7% 33% 22% 10% 33% 8% 34% 19% 6%

West

Lothian 30% 8% 30% 23% 9% 36% 10% 31% 17% 7%

Scotland 36% 6% 31% 19% 9% 41% 7% 31% 14% 6%

(Source: NRS Population Projections 2012-2037)

The North West Sector contains significantly higher numbers of older people (aged over 75

years

3. Mortality and Morbidity

a. Quality Outcomes Framework (QOF)-- People with Long-term conditions

General Practices record information about specific conditions as part of the nationally

agreed quality outcomes framework. This provides a snap-shot of the total number of

patients with particular conditions, or risk factors. There are limitations to this data, notably

as no patient identifiable information is included to compile the prevalence figures. That

means we are unable to break down the numbers into age groups or by sex. This data is not

available at locality level.

Number of patients and raw prevalence rates for selected long-term conditions: QOF

2012/13. Source: Lothian Analytical Services

12


Number of patients with Diabetes

Raw Prevalence (Diabetes)

Number of patients with Dementia

Raw Prevalence (Dementia)

Number of patients with COPD

Raw Prevalence (COPD)

Edinburgh CHP 16430 3.32 3507 0.71 6781 1.37East Lothian CHP 4274 4.25 904 0.90 1898 1.89Midlothian CHP 4173 4.76 766 0.87 1942 2.21West Lothian CHCP 8296 4.85 1108 0.65 3696 2.16NHS Lothian 33173 3.88 6285 0.74 14317 1.68

Scotland252599 4.60 41655 0.76

115974 2.11

(Source: Lothian Analytical Services: September 2014)

In 2014, the Scottish Diabetes Group analysed the national diabetes register. The Edinburgh

data shows how prevalence of diabetes is correlated with area level socioeconomic

deprivation. The highest rates are in Craigmillar, Wester Hailes and Granton and Muirhouse.

It is notable that Type 1 diabetes which is genetic is not correlated with socioeconomic

status whereas Type 2 diabetes, which is associated with diet, obesity and physical inactivity,

is more common in most deprived areas.

People from certain black and minority ethnic groups are up to six times more likely to have

diabetes, and develop complications at a younger age in comparison with white ethnic

groups. In relation to other minority groups, people of South Asian origin seem to have

poorer glycaemic control than the white population, although they are not more likely to

have hypertension or hypercholesterolaemia and are less likely to smoke.

Key point: Although Edinburgh has the highest absolute numbers of patients with each of

the selected long-term conditions, raw prevalence rates are lower than in other Lothian local

authority areas. This is likely to reflect the younger, more affluent population resident in

Edinburgh in comparison to other areas. Diabetes, COPD and dementia are all diagnosed

more often among older age groups.

13


Figure 8: Diabetes rate per 10,000

14


Smoking is strongly associated with a number of long-term conditions including chronic

obstructive pulmonary disease, as well as lung cancer. Promotion of smoking cessation is

therefore a crucial step in our ability to improve the health of the Edinburgh population. It is

estimated that approximately 72,300 people in Edinburgh are smokers. Data from the

Scottish Public Health Observatory suggests 17.7% of the Edinburgh population were active

smokers, compared to 22.9% in Scotland overall. Smoking rates are much higher in

disadvantaged areas. NHS and council services and premises will be smoke free from April

2015.

b. Mortality

All data from this point on is supplied for this report by NHS Lothian Analytical Services:

January 2015

The number of deaths observed in Edinburgh were analysed in three year rolling averages

between 2006/8 (12,690) and 2011/13 (12,683 deaths). There was very little change in the

total number of deaths across Edinburgh over this time period.

Absolute numbers of deaths don’t allow us to make easy comparisons. The data were

standardised to adjust for changes in age and sex of the Edinburgh population. This shows a

noticeable downward trend in mortality rates over the whole time period.

This trend is apparent across most of the city although there is some suggestion of a levelling

off in the East Sector. There are pronounced difference in death rates within sectors. The

mortality rate in the East sector is the highest in the city, and is higher than both the Lothian

and Scotland average. Greater socio-economic disadvantage in the East of the city is the

most likely explanation for the higher death rate in this sector. It should be noted that

mortality increases with greater inequality and we know that at smaller geographies, there is

evidence of even more pronounced variation in mortality rates in Edinburgh.

15


All Cause Mortality - Edinburgh CHP, NHS Lothian and Scotland

1,000.0

1,100.0

1,200.0

1,300.0

1,400.0

2006-2008 2007-2009 2008-2010 2009-2011 2010-2012 2011-2013


Age-

sex

Sta

ndar

dise

d R

ate

per 1

00,0

00 P

opul

atio

n Edinburgh (East)




Edinburgh CHP

NHS Lothian

Scotland

Figure 9: All Cause Mortality by Edinburgh Locality

Key point: There has been a steady decline in all cause mortality across Edinburgh between 2006/8 and 2011/13. But there are stark differences between

sectors with the East sector having consistently higher death rates.

16


A similar pattern of decline is seen with mortality rates for coronary heart disease, standardised by age and sex. Again, the East sector has the highest death

rates and the North West has the lowest death rates.

17


All CHD Mortality - Edinburgh CHP, NHS Lothian and Scotland

120.0

140.0

160.0

180.0

200.0

220.0

240.0

2006-2008 2007-2009 2008-2010 2009-2011 2010-2012 2011-2013


Age-

sex

Sta

ndar

dise

d R

ate

per 1

00,0

00 P

opul

atio

n Edinburgh (East)




Edinburgh CHP

NHS Lothian

Scotland

Figure 10: All CHD Mortality by Edinburgh Locality

Key point: There has been a steady decline in all Coronary Heart Disease mortality between 2006/8 and 2011/13.

18


There is a slightly different pattern evident for stroke mortality in Edinburgh. Although the East sector has in recent years had the highest mortality rate

from stroke, mortality in South Central is now highest for stroke related deaths. The lowest stroke mortality rate is in South West Edinburgh. All Edinburgh

sectors are close to or below the Scotland rate for stroke mortality.

All Stroke Mortality - Edinburgh CHP, NHS Lothian and Scotland

20.0

30.0

40.0

50.0

60.0

70.0

80.0

2006-2008 2007-2009 2008-2010 2009-2011 2010-2012 2011-2013


Age-

sex

Sta

ndar

dise

d R

ate

per 1

00,0

00 P

opul

atio

n Edinburgh (East)




Edinburgh CHP

NHS Lothian

Scotland

Figure 11: All Stroke Mortality by Edinburgh Locality

19


Deaths under the age of 75 years are described as ‘early’ and analysed separately, (in 2006/8 there were 4,627 deaths in Edinburgh, in 2011/13 there were

4,400). Again the East sector has the highest mortality rate and North West has the lowest early mortality rate.

Early (<75) All Cause Mortality - Edinburgh CHP, NHS Lothian and Scotland

300.0

350.0

400.0

450.0

500.0

550.0

600.0

2006-2008 2007-2009 2008-2010 2009-2011 2010-2012 2011-2013


Age-

sex

Sta

ndar

dise

d R

ate

per 1

00,0

00 P

opul

atio

n Edinburgh (East)




Edinburgh CHP

NHS Lothian

Scotland

Figure 12: Early all-cause mortality by Edinburgh Locality

Key point: Early mortality in the East sector is above Lothian and Scottish rates. All other Edinburgh sectors have lower early mortality rates than Lothian

and Scotland.

20


We examined the mortality rates in those under 75 years of age by specific cause of death. The standardised mortality rates for cardiovascular disease show

a downward trend in across the time period but again the East sector has the highest mortality (although absolute numbers of deaths are relatively small in

each sector in each three year period).

Early (<75) CHD Mortality - Edinburgh CHP, NHS Lothian and Scotland

40.0

50.0

60.0

70.0

80.0

90.0

100.0

110.0

2006-2008 2007-2009 2008-2010 2009-2011 2010-2012 2011-2013


Age-

sex

Sta

ndar

dise

d R

ate

per 1

00,0

00 P

opul

atio

n Edinburgh (East)




Edinburgh CHP

NHS Lothian

Scotland

Figure 13: Early CHD mortality by Edinburgh Locality

21


Key point: The standardised mortality rates for cardiovascular disease show a downward trend for people aged less than 75 years between 2006/8 and

2011/13. But mortality rates are highest in the East sector while all other Edinburgh sectors have rates better than the Scotland or Lothian comparator.

22


Stroke mortality in the under 75 age group shows a similar pattern to stroke mortality across all ages. But absolute numbers of deaths from this cause

among under 75s are low. A summary figure is available on request.

23


Alcohol mortality involves much smaller numbers making interpretation difficult (there were between 237 and 312 deaths in Edinburgh in each three year

period between 2006/8 to 2011/13). Edinburgh has an alcohol mortality rate above the Lothian rate. The East sector has a markedly higher alcohol

mortality rate. There does appear to be a downward trend in the age standardised rates across Edinburgh. A similar picture is seen when we analyse deaths

caused by liver cirrhosis (again very small numbers, between 196 and 216 across the whole of Edinburgh in each three year period). Liver cirrhosis is

strongly associated with harmful consumption of alcohol.

Research has shown that there is a significant relationship between alcohol-related hospitalisations and alcohol outlet densities.[46, 47] In Scotland,

Edinburgh and Glasgow have the highest number of on-sales and off-sales licenses per datazone – Figure 15 shows the distribution of licensed

premises in Edinburgh. This research shows that alcohol-related death rates in neighbourhoods with the most alcohol outlets are more than double the

rates in those with the fewest outlets. There were 34 alcohol-related deaths per 100,000 people in neighbourhoods with the most off-sales outlets,

compared with 13 per 100,000 in neighbourhoods with the fewest.[46]

Key point: There appears to be a downward trend in the age standardised rates in both localities and across Edinburgh but the city rate is above the Lothian

rate and considerably higher in the East sector. The standardised mortality rates for all alcohol related mortality and liver cirrhosis are based on relatively

small numbers of cases.

24


All Alcohol Mortality - Edinburgh CHP, NHS Lothian and Scotland

10.0

20.0

30.0

40.0

50.0

2006-2008 2007-2009 2008-2010 2009-2011 2010-2012 2011-2013


Age-

sex

Sta

ndar

dise

d R

ate

per 1

00,0

00 P

opul

atio

n Edinburgh (East)




Edinburgh CHP

NHS Lothian

Scotland

Figure 14: All Alcohol Mortality by Edinburgh Locality

25


Figure 15: Total alcohol outlet density by Edinburgh datazone, 2011-2012 (Darker shading is higher density) Source: CRESH, 2014

26


We analysed the total number of cancer deaths, standardising by age and sex as before. We also looked in more detail at mortality rates for breast, lung

and colorectal cancers. As before the deaths were aggregated into three yearly groupings. Overall there were between 3,490-3,693 deaths from all cancers

in each three yearly grouping across Edinburgh. Lung cancer deaths were between 931 and 972 per 3 yearly grouping; Colorectal between 342-392; Breast

between 219-261. With smaller numbers there will be more background variation in the standardised rates, even when these are aggregated into three

yearly groupings and caution must be used interpreting. Overall, deaths from breast cancer are most affected by smaller numbers in the analysis. Looking at

the overall picture, mortality from breast cancer has generally remained constant over the time period with some fluctuation within sectors. The East sector

has the highest rate of cancer mortality, above Lothian and Scotland rates. The cancer death rate shows some sign of increasing in South West Edinburgh

over the time period.

27


All Cancer Mortality - Edinburgh CHP, NHS Lothian and Scotland

250.0

300.0

350.0

400.0

450.0

2006-2008 2007-2009 2008-2010 2009-2011 2010-2012 2011-2013


Age-

sex

Sta

ndar

dise

d R

ate

per 1

00,0

00 P

opul

atio

n Edinburgh (East)




Edinburgh CHP

NHS Lothian

Scotland

Figure 16: All Cancer Mortality by Edinburgh Locality

28


Edinburgh East again has a higher death rate from lung cancer while other sectors have rates below Lothian and Scotland.

All Lung Cancer Mortality - Edinburgh CHP, NHS Lothian and Scotland

70.0

80.0

90.0

100.0

110.0

120.0

130.0

2006-2008 2007-2009 2008-2010 2009-2011 2010-2012 2011-2013


Age-

sex

Sta

ndar

dise

d R

ate

per 1

00,0

00 P

opul

atio

n Edinburgh (East)




Edinburgh CHP

NHS Lothian

Scotland

Figure 17: All Lung Cancer Mortality by Edinburgh Locality

29


Colorectal cancer death rates are again highest in the East sector. There is some suggestion of a slight upward trend in deaths in other sectors across the

city though rates are still below national and Lothian comparators for most areas.

All Colorectal Cancer Mortality - Edinburgh CHP, NHS Lothian and Scotland

20.0

30.0

40.0

50.0

2006-2008 2007-2009 2008-2010 2009-2011 2010-2012 2011-2013


Age-

sex

Sta

ndar

dise

d R

ate

per 1

00,0

00 P

opul

atio

n Edinburgh (East)




Edinburgh CHP

NHS Lothian

Scotland

Figure 18: All Colorectal Cancer Mortality by Edinburgh Locality

30


Breast cancer mortality rates seem to show a general upward trend. While the East sector has high mortality from breast cancer so too does the North

West sector. Both of these sectors have breast cancer death rates above Lothian and Scotland rates

All Breast Cancer Mortality - Edinburgh CHP, NHS Lothian and Scotland

10.0

15.0

20.0

25.0

2006-2008 2007-2009 2008-2010 2009-2011 2010-2012 2011-2013


Age-

sex

Sta

ndar

dise

d R

ate

per 1

00,0

00 P

opul

atio

n Edinburgh (East)




Edinburgh CHP

NHS Lothian

Scotland

Figure 19: All Breast Cancer Mortality by Edinburgh Locality

Key Point: Edinburgh East has consistently higher cancer mortality levels and fares worse than Scotland and Lothian. There is some suggestion that breast

and colorectal cancers are increasing in other sectors of the city. Overall, all cancer mortality rates seem consistent rather than reducing over the time

period.

31


Suicide is a leading cause of death among those aged 35 years and under (between 202-278 deaths in each 3 year grouping in Edinburgh between 2006/8

and 2011/13). NHS Lothian issues reports on suicide rates annually and this is broken down by sex at individual local authority level. Changes to coding in

2011 mean that the number of deaths coded as suicide have increased. This means that it is difficult to compare trends before and after 2011 because

different diagnostic categories have been included. Overall, suicide rates in Edinburgh are above the Scotland rate. The East and South Central sectors have

the highest suicide mortality rates whereas North West Edinburgh has a lower rate of deaths from suicide.

All Suicide Mortality - Edinburgh CHP, NHS Lothian and Scotland

5.0

10.0

15.0

20.0

25.0

30.0

2006-2008 2007-2009 2008-2010 2009-2011 2010-2012 2011-2013


Age-

sex

Sta

ndar

dise

d R

ate

per 1

00,0

00 P

opul

atio

n Edinburgh (East)




Edinburgh CHP

NHS Lothian

Scotland

Figure 20: All Suicide Mortality by Edinburgh Locality

32


Key point: There has been an apparent increase in the standardised mortality rates from suicide in Edinburgh in recent years. Changes in coding of deaths

will have contributed in part to this rise. Further monitoring will be necessary before any definitive conclusion can be drawn but there is evidence of higher

death rates in Edinburgh East and Edinburgh South Central.

33


4. Health service use in Edinburgh

a. Unplanned inpatient admissions from Edinburgh accounted for just over half of all unplanned admissions in Lothian between 2008/9 and 2012/13. The

admission rate is highest from the Edinburgh East sector. All other sectors are below the Lothian rate. Admission rates per 100,000 people are relatively

stable over the time period.

Unplanned Inpatient Admissions by Edinburgh Sector and CHP with NHS Lothian Total (2008/09 - 2013/14)

6,000

7,000

8,000

9,000

10,000

11,000

12,000

13,000

2008/09 2009/10 2010/11 2011/12 2012/13 2013/14

Financial Year

Age

-sex

Sta

ndar

dise

d R

ate

per 1

00,0

00 P

opul

atio

n

Edinburgh (East) Edinburgh (North Wes t) Edinburgh (South Central ) Edinburgh (South West) Edinburgh CHP NHS Lothian

Figure 21: Age-standardised Unplanned Inpatient Admissions by Edinburgh Locality

34


It should be noted that unplanned admissions from Edinburgh are among the lowest of the Lothian CHPs and have remained constant over a number of

years.

Unplanned Inpatient Admissions by Lothian CHP with NHS Lothian Total (2008/09 - 2013/14)

6,000

7,000

8,000

9,000

10,000

11,000

12,000

13,000

2008/09 2009/10 2010/11 2011/12 2012/13 2013/14

Financial Year

Age

-sex

Sta

ndar

dise

d R

ate

per 1

00,0

00 P

opul

atio

n

East Lothian CHP Edinburgh CHP Midlothian CHP West Lothian CHCP NHS Lothian

Figure 22: Age-standardised Unplanned Admission Rates by Lothian CHP

35


Crude admission rates show a consistently higher figure for the most deprived quintile of the population.

Crude Rates per 100,000 Population by SIMD Quintile (City of Edinburgh): 2008/09 - 2012/13

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

2008/09 2009/10 2010/11 2011/12 2012/13

1 - Most Deprived 2 3 4 5 - Least Deprived

Figure 23: Crude admission rates by Edinburgh SIMD quintile

Key point: Emergency admission rates have remained consistent over the five years. Deprivation is associated with highest admission rates so Edinburgh

East has most residents being hospitalised in this way. Edinburgh has fewer unplanned hospital admissions than other parts of Lothian.

36


b. Primary Care workforce

Only headcount figures are routinely available for general practitioners working in Scotland

and Edinburgh. This means we are unable to describe the total amount of doctor-time

available within Edinburgh. The number of GPs working in Edinburgh has increased slightly

between 2008/9 and 2012/13. Working practices are changing over time, with increasing

numbers of younger GPs choosing to work less than full-time hours. Increasing population

will place greater pressure on GP services also. We are currently unable to use routine data

to monitor the impact of these changing working practices.

Number of General Practitioners in post by CHP area, 2008-2013

2006 2007 2008 2009 2010 2011 2012

East Lothian CHP 92 89 93 95 96 97 97

Edinburgh CHP 461 476 487 490 495 498 498

Midlothian CHP 86 85 90 95 89 90 91

West Lothian CHCP 144 138 147 148 144 158 155

NHS Lothian 782 787 815 827 821 842 838

Figure 24: GP headcount rates for Lothian

There is a similar difficulty with the information available about the number of practice

nurses. The only routine data source available to us is the NHS Scotland National Primary

37


Care Workforce Planning Survey in 2007. Only 74% of practices completed the survey and

again, only headcount information is available. Data from the survey is available but likely to

be out of date and of limited value so not included in this summary.

Headcount and wholetime equivalent information is available for community nurses, but

only at NHS Lothian level at present. The total number of community nurses and whole-time

equivalent working have both increased in the last year. This information is available from

the Information and Statistics Division of NHS Scotland.

Figure 25: Community Nurse headcount rate in Lothian

Key point: There is limited routinely information available to describe the primary care

workforce. This is not currently broken down to locality level. Available information suggests

little change in the number of GP’s working in Edinburgh and an increase in the number of

community nurses working in Lothian overall.

38


c. Road Traffic Accidents

The number of emergency admissions following road traffic accidents fluctuates around 200

in Edinburgh. This means small changes can cause large swings in the admission rates.

Overall, emergency admissions following road accidents have stabilised from a high point in

2008/2009.

RTA Emergency Admissions per 10,000 Population by Edinburgh Sector and CHP with NHS Lothian Total (2008/09 - 2013/14)

0

1

2

3

4

5

6

7

2008/09 2009/10 2010/11 2011/12 2012/13 2013/14

Financial Year

RTA

Adm

issi

ons

per 1

0,00

0 Po

pula

tion

Edinburgh (Eas t) Edinburgh (North Wes t) Edinburgh (South Centra l ) Edinburgh (South West) Edinburgh CHP NHS Lothian

Figure 26: Road Traffic Accident Emergency Admission Rates by Edinburgh Locality

39


d. Falls

The number of falls resulting in emergency admissions to patients over 75 has increased

slightly over the last five years. Admissions reflect the age profile of the sectors. Crude

admission rates suggest an increase in falls admissions. It is worth noting that this summary

information records the number of episodes, rather than a headcount of the number of

patients who are falling. Further analysis would be necessary to explore whether recent

increases are the result of a small number of ‘frequent fallers’ or an increase in the absolute

numbers of people falling.

Area

Falls Emergency Admissions

Financial Year

2008/09 2009/10 2010/11 2011/12 2012/13 2013/14

Edinburgh (East) 245 277 250 260 258 280

Edinburgh (North West) 391 439 420 401 443 457

Edinburgh (South

Central)346 310 335 327 399 362

Edinburgh (South West) 227 226 251 244 268 319

Edinburgh CHP 1,209 1,252 1,256 1,232 1,368 1,418

NHS Lothian 1,980 2,027 2,101 2,143 2,313 2,359

Key point: It appears that there is an increasing trend in admissions of people aged 75 years

or older for falls, but further analysis would be needed to establish whether this is as a result

of a few individuals falling frequently or whether a larger number of individuals are affected.

Dr Dermot Gorman, Martin Higgins, Public Health and Health Policy, NHS LothianDuncan Sage, Lothian Analytical Services, NHS Lothian

31 March 2015

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