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2020 JSNA

Long-term Conditions and

Co-morbidities

September 2019

2

Osteoporosis

Atrial Fibrillation

Chronic Obstructive Pulmonary Disease

Chronic Kidney Disease

Cancer

Coronary Heart Disease

History of fall

Diabetes

Pre-diabetes

Asthma

Depression

Anxiety

Long term conditions in Stockport3

Long term conditions overview5

Hypertension6

7

9

10

11

12

13

14

15

16

17

18

8

Down’s syndrome

Cerebral palsy

Crohn’s disease

Rheumatoid Arthritis

Acute Macular Degeneration

Autism

Peripheral Arterial Disease

Epilepsy

Glaucoma

Mental Health

Dementia

Rickets

Stroke or Transient Ischaemic Attack19

Heart Failure20

Self-harm21

22

24

25

26

27

28

29

30

31

32

33

23

Contents

Motor neurone disease34

Multiple key conditions35

Long-term conditions ages under 2540

Long-term conditions in Stockport

Definitional noteThis report aims to give a picture of the number of people in Stockport with certain illnesses or disabilities– and the variations by gender, age and deprivation, plus the common co-morbidities.

This report is based on an anonymised data extract from Stockport GP’s clinical systems taken in August 2019 and updates the previous version from August 2017. It is a method of analysis of multiple needs in Stockport, however there are issues with data quality in the extract, in that the complexity of clinical systems may mean the extract has some over counts and undercounts for the various conditions and there maybe variations in recording processes at different GP Practices. The extract has been validated against other sources for the conditions covered, mainly the Quality and Outcomes Framework (QOF) and modelled data, and is robust enough to start analysing these conditions, how they vary across Stockport, and how they overlap. However, all numbers should be treated as indicative.

3

The illnesses and disabilities presented were selected based on their potential impact on health and social care provision and also for the robustness of the data in the extract. This report is not a comprehensive view of all factors needing health and social care, and particularly does not include back pain or headache disorders, which the Global Burden of Disease Study 2018 for England highlighted as two of the top 10 causes of death and disability, these disorders however have not yet been robustly identified through data extracts.

Long-term conditions in Stockport

Key Summary

Overall, 44% of the people registered with Stockport GPs have one or more of the conditions analysed• This increases with age, from 3% in the 0-4 age band, to 92% in those aged 85 and over • By age 55, half of the people have one or more of these conditions• There is a strong association with deprivation for most conditions

11% of the population have two or more of 9 key long term conditions (28% have at least one) this grouping excludes depression and anxiety explaining the difference to the figure above

It is important to note that the 56% of people without these conditions are not necessarily in good health

Hypertension, anxiety, depression, asthma and pre-diabetes are the most common conditions affecting more than 20,000 people each.

Asthma is the major condition affecting school aged children in the borough (more than 2,000 cases aged 5-14)

Anxiety affects those aged 15-24 in particular (more than 4,300 cases).

This is a new way of analysing the population, and the extract was not sufficiently robust to cover all possible long term health conditions. There is also the possibility that a person is not in good health, but has not brought their problem to the attention of their GP practice. Conversely, some of the people identified with long term conditions may feel they have good health, especially if they are able to manage their condition well.

4

5

Condition Number Gender Profile Age Profile Deprivation Profile

Hypertension 47,170 Increasing from mid 30s Rates increase with deprivation, number decreases

Anxiety (last 10 years) 38,445 Higher in women Highest from 25 to 50 Rates increase with deprivation

Depression 37,065 Higher in women Highest in 40s and 50s Rates increase with deprivation

Asthma 20,545 Slightly higher in women Rates increase with deprivation

Pre-diabetes 20,355 Highest in mid 50s to mid 70s Rates increase with deprivation, number decreases

Diabetes 16,950 Slightly higher in men Increases from mid 40s Rates increase with deprivation

History of Fall 14,095 Higher in women Increases from 50s, sharply in 80s Rates increase with deprivation, number decreases

Coronary Heart Disease (CHD) 12,170 Higher in men Increases from mid 40s Rates increase with deprivation, number decreases

Cancer 10,555 Earlier in women Rates and numbers decrease with deprivation

Chronic Kidney Disease (CKD) 7,670 Slightly higher in women Increase from 50s Rates increase with deprivation, numbers decrease

Chronic Obstructive Pulmonary Disease (COPD) 7,505 Increases from mid 40s Rates increase with deprivation

Atrial Fibrillation (AF) 7,015 Slightly higher in men Increases from 50s Numbers decrease with deprivation, rates vary

Osteoporosis 6,995 Higher in women Increases from mid 40s Rates increase with deprivation, numbers decrease

Stroke or Transient Ischaemic Attack (TIA) 6,645 Increases from mid 40s Rates increase with deprivation, numbers decrease

Heart Failure (HF) 3,935 Higher in men Increases from mid 50s Rates increase with deprivation

Self harm 3,060* Higher in women Highest between 15 and 34 Rates and numbers increase with deprivation

Rickets (last 10 years) 3,070 Higher in women Numbers decrease with deprivation, rates vary

Dementia 2,885 Higher in women Increases from mid 60s Rates increase with deprivation, numbers decrease

Severe mental health 2,845 Highest between 30 and 60 Rates and numbers increase with deprivation

Glaucoma 2,620 Increases from mid 50s Numbers decrease with deprivation

Epilepsy 2,285 Rates increase with deprivation

Peripheral Arterial Disease (PAD) 2,265 Higher in men Increases from mid 40s Rates increase with deprivation

Autism 1,825 Higher in men Rates increase with deprivation

Acute Macular Degeneration (AMD) 1,805* Higher in women Increases from mid 60s Numbers decrease with deprivation

Rheumatoid Arthritis 1,625* Higher in women Increases from mid 40s Numbers decrease with deprivation

Crohn’s disease 1,115 Highest between 30 and 70

Cerebral palsy 290*

Down’s syndrome 225 Higher in men

Motor neurone disease 25

* Undercount of actual prevalence

Long-term conditions overview

Hypertension: 47,170 people

Hypertension is when there is too much pressure in a person’s blood vessels which puts extra strain on their arteries and heart. This can lead to other conditions such as heart attack, heart failure, kidney disease, stroke and dementia.

Number with hypertension

All Female Male

All 47,170 23,780 23,390

Age 0-19 20 10 10

Age 20-64 17,370 7,595 9,775

Age 65+ 29,775 16,175 13,605

Most Deprived

2nd Most Deprived

Mid Deprived

2nd Least Deprived

Least Deprived

Number 5,985 8,610 7,230 10,010 13,050

Crude % 14% 14% 16% 16% 16%

DSR per 100,000* 17,499.0 16,171.4 15,605.6 14,648.7 13,618.7

* Takes into account age/sex profile of populations and is best measure for comparison

Overall, the same amount of men as women have hypertension, but it seems to develop slightly earlier in men.

Hypertension seems to develop earlier in more deprived areas.

Overall distribution is skewed by higher numbers of young people in more deprived areas, which means numbers are higher in more affluent areas because there are more older people. The age standardised DSR shows a clear deprivation profile.

Hypertension increases with age, starting from mid-30s. Prevalence reaches more than 10% after age 50, and 30% after age 60. Hypertension can be prevented by healthy eating,

maintaining a healthy weight, physical activity, drinking only in moderation and not smoking.

22% Pre-diabetes21% Diabetes20% Obese14% CHD

14% Depression13% Current smoker12% CKD

12% Anxiety10% Falls10% Cancer

Co-morbidities

% of population with hypertension

All Female Male

All 15% 15% 15%

Age 0-19 0% 0% 0%

Age 20-64 9% 8% 11%

Age 65+ 49% 49% 50%

6

Numbers with hypertension identified by GPs have increased by 3,200 in the last 5 years.

<5

5

5

10

40

105

235

510

975

2,035

3,510

4,645

5,315

6,105

7,265

5,965

5,085

5,360

0 - 4

5 - 9

10 - 14

15 - 19

20 - 24

25 - 29

30 - 34

35 - 39

40 - 44

45 - 49

50 - 54

55 - 59

60 - 64

65 - 69

70 - 74

75 -79

80 - 84

85+

Anxiety: 38,445 people diagnosed in last 10 yearsA person with generalised anxiety disorder (GAD) feels anxious on most days about a wide range of situations and issues, and often struggles to remember the last time they felt relaxed. GAD can cause both psychological and physical symptoms which vary person to person.

Number with anxiety

All Female Male

All 38,445 24,935 13,510

Age 0-19 2,080 1,370 705

Age 20-64 30,995 19,810 11,185

Age 65+ 5,370 3,755 1,615

Most Deprived

2nd Most Deprived

Mid Deprived

2nd Least Deprived

Least Deprived

Number 7,130 8,655 5,745 6,850 7,775

Crude % 16% 14% 13% 11% 9%

DSR per 100,000* 16,327.0 13,794.2 12,783.3 11,270.1 9,905.2


More women are diagnosed with anxiety than men.

Anxiety rates are higher in more deprived areas of Stockport, though the number with anxiety is similar in all areas.

The data shows a sharp raise to the late 20s, then a gradual fall to the 60s. Low rates in older ages may relate to an older generation not going to GPs for anxiety.

The data also does not indicate anxiety resolved, so older age groups may show as higher than currently afflicted.

Physical activity, drinking only in moderation, not smoking, avoiding caffeine, relaxation techniques and support groups can help treat anxiety.

54% Depression26% Current smokers

15% Hypertension11% Obesity10% Asthma

Co-morbidities

% of population with anxiety

All Female Male

All 12% 16% 9%

Age 0-19 3% 4% 2%

Age 20-64 17% 22% 12%

Age 65+ 9% 11% 6%

7

0

95

475

1,510

2,800

4,185

4,180

4,015

3,555

3,645

3,465

2,960

2,185

1,580

1,390

1,010

725

660

0 - 4

5 - 9

10 - 14

15 - 19

20 - 24

25 - 29

30 - 34

35 - 39

40 - 44

45 - 49

50 - 54

55 - 59

60 - 64

65 - 69

70 - 74

75 -79

80 - 84

85+

Depression: 37,065 with depression

Depression can affect people in different ways, but usually involves feelings of sadness and hopelessness, and loss of interest in activities that a person used to enjoy; these symptoms persist for weeks or months and are bad enough to interfere with daily life.

Number with depression

All Female Male

All 37,065 23,410 13,655

Age 0-19 570 400 170

Age 20-64 30,505 19,010 11,495

Age 65+ 5,990 4,000 1,995

Most Deprived

2nd Most Deprived

Mid Deprived

2nd Least Deprived

Least Deprived

Number 7,595 8,415 5,385 6,410 7,120

Crude % 17% 14% 12% 10% 9%

DSR per 100,000* 17,711.1 13,557.6 11,868.3 10,353.2 8,804.0


Women are more likely to have depression than men. This is thought to be due to both biological and social causes, and possible under-detection of depression in men.

Depression increases with deprivation. There is a sharp increase in the most deprived areas of Stockport.

Depression increases up to the 40s, then decreases from the mid 50s.

Depression can be resolved, but can also re-occur. This data should represent only those who are currently suffering from depression.

Moderate to severe depression is usually treated with a combination of medication and talking treatments. Physical activity, drinking less alcohol, stopping smoking, healthy eating and mindfulness can help depression.

56% Anxiety29% Current smokers

18% Hypertension13% Obesity11% Asthma

Co-morbidities

% of population with depression

All Female Male

All 12% 15% 9%

Age 0-19 1% 1% 0%

Age 20-64 17% 21% 12%

Age 65+ 10% 12% 7%

8

Numbers with depression identified by GPs have increased by 12,000 in the last 4 years.

0

<5

30

540

1,930

3,265

3,680

3,715

3,540

3,985

4,120

3,595

2,675

1,950

1,545

1,065

760

670

0 - 4

5 - 9

10 - 14

15 - 19

20 - 24

25 - 29

30 - 34

35 - 39

40 - 44

45 - 49

50 - 54

55 - 59

60 - 64

65 - 69

70 - 74

75 -79

80 - 84

85+

Asthma: 20,445 with asthma

Asthma is a long-term condition that can cause coughing, wheezing, chest tightness and breathlessness, though the symptoms and severity vary from person to person. It is caused when the bronchi, the small tubes supplying air to the lungs, become inflamed.

Number with asthma

All Female Male

All 20,445 11,545 8,900

Age 0-19 3,275 1,345 1,930

Age 20-64 12,495 7,260 5,235

Age 65+ 4,675 2,935 1,740

Most Deprived

2nd Most Deprived

Mid Deprived

2nd Least Deprived

Least Deprived

Number 3,180 4,240 2,985 3,975 4,960

Crude % 7% 7% 7% 6% 6%

DSR per 100,000* 7,578.6 6,985.6 6,619.2 6,339.0 5,964.0


Asthma rates increases with deprivation. Numbers are broadly the same in all areas.Though asthma can

develop at any age, the percentage of people with asthma remains steady throughout adulthood.

Some asthma, especially childhood asthma, can resolve itself. This data only includes patients who have a current prescription for asthma treatment as well as a diagnosis code.

Asthma is treated with medication, and self care (meaning the patient taking responsibility for their own treatment) is encouraged. Stopping smoking can significantly improve asthma symptoms.Flu vaccinations are particularly important for people with asthma.Physical activity triggering asthma usually means patients’ asthma could be better controlled in general. Some asthma can be triggered by healthy foods.

20% Hypertension20% Depression19% Anxiety

17% Obesity16% Current smoker

10% Pre diabetes

Co-morbidities

% of population with asthma

All Female Male

All 6% 7% 6%

Age 0-19 5% 4% 5%

Age 20-64 7% 8% 6%

Age 65+ 8% 9% 6%

9

Numbers with asthma identified by GPs have increased by 850 in the last 5 years.

150

920

1,235

965

835

1,055

1,310

1,370

1,470

1,715

1,775

1,605

1,360

1,350

1,225

875

645

580

0 - 4

5 - 9

10 - 14

15 - 19

20 - 24

25 - 29

30 - 34

35 - 39

40 - 44

45 - 49

50 - 54

55 - 59

60 - 64

65 - 69

70 - 74

75 -79

80 - 84

85+

Pre-diabetes: 20,355 with pre-diabetes

Pre-diabetes is when blood glucose levels are higher than normal, but not yet high enough to be classed as diabetes. Many people who have pre-diabetes will go on to develop type 2 diabetes.

Number with diabetes

All Female Male

All 20,355 10,675 9,680

Age 0-19 25 15 10

Age 20-64 8,740 4,285 4,455

Age 65+ 11,595 6,380 5,215

Most Deprived

2nd Most Deprived

Mid Deprived

2nd Least Deprived

Least Deprived

Number 2,900 3,880 3,120 4,170 5,315

Crude % 7% 6% 7% 7% 6%

DSR per 100,000* 8,175.2 7,173.0 6,765.6 6,173.4 5,605.2


Pre-diabetes rates increase with deprivation. However, because of the age profile of the disease, there are similar numbers with diabetes in all areas.

Though some young people have pre-diabetes, it increases with age. From mid-50s, over 10% of people have pre-diabetes.

Pre-diabetes is mainly treated with lifestyle interventions in order to prevent developing into diabetes.

50% Hypertension19% Obesity16% Depression

16% Current smoker15% CHD

14% Anxiety10% Asthma

Co-morbidities

% of population with diabetes

All Female Male

All 6% 7% 6%

Age 0-19 0% 0% 0%

Age 20-64 5% 5% 5%

Age 65+ 19% 19% 19%

10

More men than women have diabetes. Men seem to develop diabetes slightly earlier as well.

0

0

5

15

45

120

270

440

705

1,135

1,580

2,120

2,325

2,485

2,930

2,345

1,930

1,900

0 - 4

5 - 9

10 - 14

15 - 19

20 - 24

25 - 29

30 - 34

35 - 39

40 - 44

45 - 49

50 - 54

55 - 59

60 - 64

65 - 69

70 - 74

75 -79

80 - 84

85+

Diabetes: 16,950 with diabetes

Diabetes causes a person’s blood glucose to become too high, either because their body does not produce enough insulin or the insulin doesn’t work properly. 90% of diabetics have Type 2 diabetes which is linked to lifestyles.

Number with diabetes

All Female Male

All 16,950 7,345 9,605

Age 0-19 190 85 105

Age 20-64 7,425 3,030 4,395

Age 65+ 9,335 4,230 5,105

Most Deprived

2nd Most Deprived

Mid Deprived

2nd Least Deprived

Least Deprived

Number 2,760 3,540 2,510 3,565 3,710

Crude % 6% 6% 6% 6% 5%

DSR per 100,000* 7,871.2 6,522.7 5,452.0 5,296.7 3,957.2


Diabetes rates increases with deprivation. However, because of the age profile of the disease, there are similar numbers with diabetes in all areas.

Though some young people have diabetes, it increases with age from mid-40s, with over 10% of people having diabetes from age 60.

Diabetes is treated with medication. Maintain a healthy weight, eating a balanced diet, stopping smoking and being physically active all prevent or delay health complications associated with diabetes.Diabetic retinopathy screening programs aim to prevent diabetes related blindness.Maintaining a healthy weight lowers the risk of Type 2 diabetes.

57% Hypertension34% Obesity18% CHD

16% Depression16% Current smoker

14% CKD12% Anxiety10% Falls

Co-morbidities

% of population with diabetes

All Female Male

All 5% 5% 6%

Age 0-19 0% 0% 0%

Age 20-64 4% 3% 5%

Age 65+ 16% 13% 19%

11

15,500 people, or 91% of Stockport’s diabetics have type 2 diabetes, and type 2 diabetes has a strong age profile.

1,500 people, or 9% of Stockport’s diabetics, have type 1 diabetes, and rates of type 1 diabetes do not increase after childhood. In the diabetics under 20, 96% have type 1 diabetes.

More men than women have diabetes. Men seem to develop diabetes slightly earlier as well.

Numbers with diabetes identified by GPs have increased by 1,700 in the last 5 years. 5

30

65

90

110

140

220

345

535

865

1,345

1,885

1,980

2,055

2,340

1,960

1,570

1,410

0 - 4

5 - 9

10 - 14

15 - 19

20 - 24

25 - 29

30 - 34

35 - 39

40 - 44

45 - 49

50 - 54

55 - 59

60 - 64

65 - 69

70 - 74

75 -79

80 - 84

85+

History of fall: 14,095 with fall recorded

Any one can fall and most falls don’t result in serious injury. However, older people are particularly vulnerable to falls, and a fall can trigger high dependency on health and social care.

Number with history of fall

All Female Male

All 14,095 8,890 5,200

Age 0-19 1,850 870 980

Age 20-64 5,365 3,330 2,040

Age 65+ 6,880 4,695 2,185

Most Deprived

2nd Most Deprived

Mid Deprived

2nd Least Deprived

Least Deprived

Number 2,260 2,740 2,170 3,180 3,080

Crude % 5% 4% 5% 5% 4%

DSR per 100,000* 5,953.3 4,827.1 4,697.6 4,775.1 3,392.8


Rates of falls generally increases with deprivation. However, there are more people with a history of falls in the more affluent areas of Stockport.

The data we have does not indicate when a fall occurred or severity of injury from a fall. Further investigation would be needed to refine this information.

However, the data does show an increase from age 50, with a large increase from age 80.

Physical activity to improve strength and balance can help prevent falls. Reducing alcohol consumption, medication reviews and sight tests are also recommended.

34% Hypertension19% Depression17% Anxiety15% Current

smoker13% Pre-diabetes12% Diabetes12% CHD

11% Osteoporosis11% Obesity11% Asthma10% CKD

Co-morbidities

% of population with history of fall

All Female Male

All 4% 6% 3%

Age 0-19 3% 3% 3%

Age 20-64 3% 4% 2%

Age 65+ 11% 14% 8%

12

Over 10% of women 65+ have had a fall recorded.

260

500

585

500

415

455

460

490

440

600

765

850

890

950

1,165

1,200

1,305

2,255

0 - 4

5 - 9

10 - 14

15 - 19

20 - 24

25 - 29

30 - 34

35 - 39

40 - 44

45 - 49

50 - 54

55 - 59

60 - 64

65 - 69

70 - 74

75 -79

80 - 84

85+

CHD: 12,170 with coronary heart disease

In CHD (coronary heart disease), the blood supply to the heart muscle is blocked by a build-up of fatty substances in the coronary arteries. Angina, heart attacks and heart failure are symptoms of CHD, but not all people with CHD will have the same symptoms.

Number with CHD

All Female Male

All 12,170 4,640 7,530

Age 0-19 - - -

Age 20-64 2,960 900 2,065

Age 65+ 9,210 3,740 5,470

Most Deprived

2nd Most Deprived

Mid Deprived

2nd Least Deprived

Least Deprived

Number 1,725 2,365 1,830 2,550 3,175

Crude % 4% 4% 4% 4% 4%

DSR per 100,000* 5,290.2 4,565.4 3,924.7 3,644.6 3,215.5


CHD rates increase with deprivation. However, because of the age profile of the disease, there are more people living with CHD in the most affluent areas of Stockport.

Though some people develop CHD earlier, it increases with age from 40, with 10% of people having CHD from age 65.

Regular physical activity and stopping smoking are part of treating CHD. Medication and surgery may be needed.

Eating a balanced diet, physical activity, maintaining a healthy weight and stopping smoking reduce the risk of developing CHD.

55% Hypertension26% Diabetes25% Pre-diabetes18% Obesity18% HF

17% CKD16% AF14% Current smoker14% Depression

14% Falls13% Stroke/TIA11% Anxiety11% Cancer

Co-morbidities

% of population with CHD

All Female Male

All 4% 3% 5%

Age 0-19 0% 0% 0%

Age 20-64 2% 1% 2%

Age 65+ 15% 11% 20%

13

More men than women have CHD. Men seem to develop CHD slightly earlier as well.

Numbers with CHD identified by GPs have decreased by 180 in the last 5 years.

0

0

0

0

5

25

25

35

85

245

515

840

1,190

1,515

2,015

1,905

1,740

2,040

0 - 4

5 - 9

10 - 14

15 - 19

20 - 24

25 - 29

30 - 34

35 - 39

40 - 44

45 - 49

50 - 54

55 - 59

60 - 64

65 - 69

70 - 74

75 -79

80 - 84

85+

Cancer: 10,555 with cancer

Cancer is a condition where cells in a specific part of the body grow and reproduce uncontrollably. Cancer can start in one part of the body and spread to another. There are over 200 different types of cancer, each with different diagnosis and treatment.

Number with cancer

All Female Male

All 10,555 5,825 4,730

Age 0-19 60 25 30

Age 20-64 3,580 2,325 1,255

Age 65+ 6,915 3,475 3,445

Most Deprived

2nd Most Deprived

Mid Deprived

2nd Least Deprived

Least Deprived

Number 1,035 1,670 1,610 2,355 3,375

Crude % 2% 3% 4% 4% 4%

DSR per 100,000* 3,052.2 3,133.1 3,478.1 3,451.3 3,552.0


Cancer rates increase as deprivation decreases. Some of this is due to the age profile differences, but also cancer survival rates are better in less deprived areas, so there would be more people living with cancer.

This data is for all current patients who have been diagnosed with cancer since 01 April 2003, though it doesn’t have a date of diagnosis. It doesn’t have information on those who have died.

Numbers with cancer identified by GPs have increased by 2,500 in the last 5 years.

Healthy eating, regular exercise, stopping smoking, and drinking only in moderation reduce the risk of cancer.

43% Hypertension18% Pre-diabetes14% Depression14% Diabetes

13% Anxiety13% CHD12% Current smoker

11% Obesity10% Falls10% CKD10% AF

Co-morbidities

% of population with cancer

All Female Male

All 3% 4% 3%

Age 0-19 0% 0% 0%

Age 20-64 2% 3% 1%

Age 65+ 11% 11% 13%

14

5

10

10

15

30

65

90

120

200

315

580

730

865

1,255

1,255

1,155

970

870

0 - 4

5 - 9

10 - 14

15 - 19

20 - 24

25 - 29

30 - 34

35 - 39

40 - 44

45 - 49

50 - 54

55 - 59

60 - 64

65 - 69

70 - 74

75 -79

80 - 84

85+ More women than men are living with cancer, however the numbers in the older age group are equal. A possible contributor to this is female breast cancer which tends to develop at a younger age than most cancers. In the older age groups, men are slightly more likely to have cancer than women.

CKD: 7,670 with chronic kidney disease

CKD (Chronic Kidney Disease) is a long-term condition where the kidneys do not work effectively. It is usually caused by damage to the kidneys from other conditions, most commonly diabetes and high blood pressure.

Number with CKD

All Female Male

All 7,670 4,520 3,150

Age 0-19 5 5 -

Age 20-64 815 425 395

Age 65+ 6,850 4,090 2,755

Most Deprived

2nd Most Deprived

Mid Deprived

2nd Least Deprived

Least Deprived

Number 990 1,435 1,195 1,765 1,985

Crude % 2% 2% 3% 3% 2%

DSR per 100,000* 3,151.8 2,791.0 2,499.5 2,430.6 1,931.0


CKD rates increase as deprivation increases. However, because of the age profile, there are higher numbers in the least deprived areas.

Healthy eating, drinking only in moderation, physical activity and managing existing conditions (like diabetes and hypertension) reduce the risk of developing CKD.

75% Hypertension30% Diabetes28% CHD23% Pre-diabetes

18% Obesity15% Stroke/TIA15% HF14% Cancer

12% Osteoporosis12% Depression11% COPD

Co-morbidities

% of population with CKD

All Female Male

All 2% 3% 2%

Age 0-19 0% 0% 0%

Age 20-64 0% 0% 0%

Age 65+ 11% 12% 10%

15

CKD mainly develops in older people.

Women are slightly more likely than men to develop CKD.

Numbers with CKD identified by GPs have decreased by 500 in the last 5 years.

<5

<5

<5

<5

<5

10

20

20

30

60

135

210

330

495

1,005

1,215

1,615

2,515

0 - 4

5 - 9

10 - 14

15 - 19

20 - 24

25 - 29

30 - 34

35 - 39

40 - 44

45 - 49

50 - 54

55 - 59

60 - 64

65 - 69

70 - 74

75 -79

80 - 84

85+

COPD: 7,505 with chronic obstructive pulmonary diseaseCOPD (Chronic Obstructive Pulmonary Disease) is the name for a collection of lung diseases including chronic bronchitis, emphysema and chronic obstructive airways disease, all of which cause difficulties breathing. The main cause is smoking.

Number with COPD

All Female Male

All 7,505 3,635 3,870

Age 0-19 - - -

Age 20-64 2,250 1,105 1,140

Age 65+ 5,255 2,530 2,730

Most Deprived

2nd Most Deprived

Mid Deprived

2nd Least Deprived

Least Deprived

Number 1,905 1,795 1,110 1,190 1,190

Crude % 4% 3% 2% 2% 1%

DSR per 100,000* 5,669.8 3,466.3 2,403.0 1,714.6 1,196.1


Both rates and numbers of people with COPD increase as deprivation increases. There is a sharp increase in rates in the most deprived areas.

Stopping smoking reduces the impact of COPD. Being as physically active as the condition allows is also recommended.

Stopping smoking reduces the risk of developing COPD.

46% Hypertension34% Current smoker23% Pre-diabetes22% Asthma21% CHD

21% Depression20% Obesity18% Diabetes17% Anxiety13% Falls12% Cancer

11% CKD11% Osteoporosis11% AF10% Stroke/TIA

Co-morbidities

% of population with COPD

All Female Male

All 2% 2% 2%

Age 0-19 0% 0% 0%

Age 20-64 1% 1% 1%

Age 65+ 9% 8% 10%

16

COPD mainly develops in older people.

Men are very slightly more likely than women to develop COPD. This is related to historic smoking rates.

Numbers with COPD identified by GPs have increased by 550 in the last 5 years.

0

<5

0

<5

5

<5

5

25

60

195

445

665

845

1,130

1,385

1,110

875

760

0 - 4

5 - 9

10 - 14

15 - 19

20 - 24

25 - 29

30 - 34

35 - 39

40 - 44

45 - 49

50 - 54

55 - 59

60 - 64

65 - 69

70 - 74

75 -79

80 - 84

85+

AF: 7,015 people with atrial fibrillation

Atrial fibrillation (AF) is a condition that causes irregular and often abnormally fast heart rate, caused by the heart’s upper chambers (atria) contracting randomly. This reduces the heart’s performance at pumping blood throughout the body.

Number with AF

All Female Male

All 7,015 2,975 4,040

Age 0-19 - - -

Age 20-64 1,070 295 770

Age 65+ 5,945 2,680 3,270

Most Deprived

2nd Most Deprived

Mid Deprived

2nd Least Deprived

Least Deprived

Number 755 1,195 1,055 1,550 2,160

Crude % 2% 2% 2% 2% 3%

DSR per 100,000* 2,376.2 2,333.7 2,232.0 2,165.9 2,135.2


Generally AF rates increase with deprivation, though the pattern isn’t as clear as with other conditions. However, because of the age profile of the disease, there are more people living with AF in the most affluent areas of Stockport.

AF is treated with medication or surgery.

The causes of AF are not known, though it is associated with other heart disease and other medical conditions including: overactive thyroid gland, pneumonia, asthma, COPD, lung cancer, diabetes, pulmonary embolism and carbon monoxide poisoning. AF episodes can be triggered by excessive alcohol, overweight, lots of caffeine, illegal drugs, and smoking.

60% Hypertension28% CHD25% Pre-diabetes22% HF21% CKD

20% Diabetes18% Stroke/TIA17% Obesity17% Falls15% Cancer

11% COPD11% Osteoporosis11% Depression

Co-morbidities

% of population with AF

All Female Male

All 2% 2% 3%

Age 0-19 0% 0% 0%

Age 20-64 1% 0% 1%

Age 65+ 10% 8% 12%

17

Though some people have AF at a younger age, it increases with age from the mid 50s and reaches 10% by the mid 70s.

AF affects men more than women, and men seem to develop AF slightly earlier.

Numbers with AF identified by GPs have increased by 1,500 in the last 5 years.

0

0

0

<5

5

10

25

35

50

75

170

290

410

630

1,040

1,180

1,345

1,750

0 - 4

5 - 9

10 - 14

15 - 19

20 - 24

25 - 29

30 - 34

35 - 39

40 - 44

45 - 49

50 - 54

55 - 59

60 - 64

65 - 69

70 - 74

75 -79

80 - 84

85+

Osteoporosis: 6,995 people

Osteoporosis is a conditions that weakens bones, making them more likely to break. It develops over several years and usually goes unnoticed until a fracture occurs.

Number with stroke/TIA

All Female Male

All 6,995 5,940 1,055

Age 0-19 5 5 -

Age 20-64 1,135 880 255

Age 65+ 5,850 5,055 800

Most Deprived

2nd Most Deprived

Mid Deprived

2nd Least Deprived

Least Deprived

Number 815 1,170 1,120 1,550 2,075

Crude % 2% 2% 2% 2% 3%

DSR per 100,000* 2,560.6 2,273.9 2,370.5 2,168.5 2,071.9


Osteoporosis rates increases with deprivation. However, because of the age profile of the disease, there are more people living with osteoporosis in the most affluent areas of Stockport.

Physical activity, a healthy diet including calcium and vitamin D, not smoking, and drinking only in moderation prevents and treats osteoporosis. Medication may be advised for some people.

48% Hypertension23% Falls18% Pre-diabetes15% CHD14% Depression

14% Anxiety14% CKD13% Cancer12% COPD11% AF

11% Diabetes11% Asthma11% Current smoker11% Stroke/TIA

Co-morbidities

% of population with stroke/TIA

All Female Male

All 2% 4% 1%

Age 0-19 0% 0% 0%

Age 20-64 1% 1% 0%

Age 65+ 10% 15% 3%

18

Women are much more at risk of osteoporosis because of hormonal changes at menopause.

Though some people experience osteoporosis at a younger age, it increases sharply in the mid 50s and reaches over 10% for women in their 70s

Numbers with osteoporosis identified by GPs have increased by 350 in the last 5 years.

0

<5

<5

5

5

20

20

35

40

75

150

300

490

665

1,020

1,120

1,300

1,740

0 - 4

5 - 9

10 - 14

15 - 19

20 - 24

25 - 29

30 - 34

35 - 39

40 - 44

45 - 49

50 - 54

55 - 59

60 - 64

65 - 69

70 - 74

75 -79

80 - 84

85+

Stroke/TIA: 6,645 people

Stroke is a life-threatening medical condition where blood supply is cut off to part of the brain, most commonly by a blood clot but sometimes due to a burst blood vessel. Transient ischaemic attack (TIA) occurs when the blood supply to the brain is temporarily interrupted.Number with stroke/TIA

All Female Male

All 6,645 3,175 3,470

Age 0-19 15 5 5

Age 20-64 1,410 620 790

Age 65+ 5,225 2,550 2,675

Most Deprived

2nd Most Deprived

Mid Deprived

2nd Least Deprived

Least Deprived

Number 975 1,285 1,050 1,345 1,735

Crude % 2% 2% 2% 2% 2%

DSR per 100,000* 2,951.3 2,477.9 2,234.4 1,909.0 1,736.1


Stroke or TIA rates increases with deprivation. However, because of the age profile of the disease, there are more people living with stroke or TIA in the most affluent areas of Stockport.

Not smoking, maintaining a healthy weight, physical activity and eating a balanced diet reduce the risk of stroke or TIA.

61% Hypertension23% CHD23% Diabetes22% Pre-diabetes19% AF

18% CKD18% Falls16% Depression15% Current smoker

14% Obesity13% Anxiety12% Cancer11% Osteoporosis10% HF

Co-morbidities

% of population with stroke/TIA

All Female Male

All 2% 2% 2%

Age 0-19 0% 0% 0%

Age 20-64 1% 1% 1%

Age 65+ 9% 8% 10%

19

Though some people experience stroke/TIA at a younger age, it increases with age from the mid 50s and reaches over 10% at age 80. The brain injuries caused by stroke are a major cause of adult disability.

Though there is little difference in the gender profile, though stroke or TIA affects men slightly earlier than women.

Numbers with stroke/TIA identified by GPs have increased by 350 in the last 5 years.

5

0

0

5

5

15

30

55

65

130

225

395

490

705

930

1,090

1,060

1,440

0 - 4

5 - 9

10 - 14

15 - 19

20 - 24

25 - 29

30 - 34

35 - 39

40 - 44

45 - 49

50 - 54

55 - 59

60 - 64

65 - 69

70 - 74

75 -79

80 - 84

85+

HF: 3,935 with heart failure

Heart failure (HF) is where the heart is not able to pump enough blood around the body at the right pressure, usually because the heart muscle has become too weak or stiff to function properly.

Number with HF

All Female Male

All 3,935 1,615 2,320

Age 0-19 15 5 10

Age 20-64 670 215 455

Age 65+ 3,250 1,395 1,860

Most Deprived

2nd Most Deprived

Mid Deprived

2nd Least Deprived

Least Deprived

Number 590 800 605 775 1,005

Crude % 1% 1% 1% 1% 1%

DSR per 100,000* 1,821.4 1,550.1 1,292.7 1,091.3 993.6


HF rates increase with deprivation. However, because of the age profile of the disease, there are more people living with Heart Failure in the most affluent areas of Stockport.

Treatment for HF usually involves lifestyle changes as well as medicines, and in some cases surgery.

Stopping smoking, eating healthily, physical activity, and drinking only in moderation decrease the risk of developing HF, as does keeping hypertension and cholesterol levels under control.

60% Hypertension54% CHD39% AF30% CKD27% Diabetes26% Pre-diabetes

19% Obesity18% COPD17% Falls17% Stroke/TIA13% Depression13% Cancer

13% Current smoker12% Osteoporosis11% Anxiety10% Asthma

Co-morbidities

% of population with HF

All Female Male

All 1% 1% 1%

Age 0-19 0% 0% 0%

Age 20-64 0% 0% 0%

Age 65+ 5% 4% 7%

20

Though some people experience HF at a younger age, it increases with age from the mid 60s and 11% of people aged 85+ have HF.

HF affects men slightly more than women, and men seem to develop HF slightly earlier.

Numbers with HF identified by GPs have increased by 850 in the last 5 years.

5

5

5

<5

5

10

10

20

40

60

110

165

255

390

555

630

720

960

0 - 4

5 - 9

10 - 14

15 - 19

20 - 24

25 - 29

30 - 34

35 - 39

40 - 44

45 - 49

50 - 54

55 - 59

60 - 64

65 - 69

70 - 74

75 -79

80 - 84

85+

Self-harm: 3,275 people have record of self-harm in last 10 yearsSelf-harm is when someone intentionally damages or injures their body. It is usually a way of coping with or expressing overwhelming emotional distress.

Number with self-harm record

All Female Male

All 3,275 2,060 1,210

Age 0-19 550 435 110

Age 20-64 2,600 1,555 1,050

Age 65+ 125 70 50

Most Deprived

2nd Most Deprived

Mid Deprived

2nd Least Deprived

Least Deprived

Number 1,020 825 440 415 395

Crude % 2% 1% 1% 1% 0%

DSR per 100,000* 2,219.8 1,321.9 1,011.5 736.9 545.3


Self-harm is higher in more deprived areas of Stockport. Rates increase sharply with deprivation.

Treatment for self-harm usually involves seeing a therapist. Self-harm is linked to anxiety and depression, so similar life-style changes may help self-harm treatment (physical activity, drinking only in moderation, not smoking, avoiding caffeine, mindfulness, relaxation techniques and support groups).

55% Depression47% Anxiety

46% Current smoker11% Asthma

10% Obesity10% Mental health

Co-morbidities

% of population with self-harm record

All Female Male

All 1% 1% 1%

Age 0-19 1% 1% 0%

Age 20-64 1% 2% 1%

Age 65+ 0% 0% 0%

21

The data on self-harm from GP clinical systems is only a subset of the actual number of people who self-harm. NICE has estimated 4.9% of adults have self-harmed without suicidal intent, with highest rate of 17% in women aged 16-24.

The data does not indicate the type of harm inflicted. Further investigation would be needed to refine this information.

More women have self-harm recorded than men.

5

10

90

440

520

455

355

275

240

245

260

170

85

40

30

25

15

15

0 - 4

5 - 9

10 - 14

15 - 19

20 - 24

25 - 29

30 - 34

35 - 39

40 - 44

45 - 49

50 - 54

55 - 59

60 - 64

65 - 69

70 - 74

75 -79

80 - 84

85+

Rickets: 3,070 with rickets diagnosed in last ten yearsRickets affects bone development in children, causing the bones to become soft and weak. It is usually caused by a lack of vitamin D and calcium. In adults, rickets is also known as osteomalacia or soft bones.

Number with rickets

All Female Male

All 3,070 2,165 905

Age 0-19 300 170 130

Age 20-64 1,990 1,445 540

Age 65+ 780 550 230

Most Deprived

2nd Most Deprived

Mid Deprived

2nd Least Deprived

Least Deprived

Number 435 535 405 865 615

Crude % 1% 1% 1% 1% 1%

DSR per 100,000* 1,047.1 886.1 881.9 1,368.5 741.6


Rickets does not have a definite deprivation profile in Stockport.

Rickets is treated by eating more foods high in vitamin D and calcium, taking daily supplements, or a yearly vitamin D injection. Increasing exposure to sunshine may also be advised. Note that supplements can have side effects, and excess sun exposure can be a health risk.

24% Hypertension21% Depression20% Anxiety15% Diabetes

14% Obesity13% Current smoker12% Fall

12% Pre-diabetes10% Asthma

Co-morbidities

% of population with rickets

All Female Male

All 1% 1% 1%

Age 0-19 0% 0% 0%

Age 20-64 1% 2% 1%

Age 65+ 1% 2% 1%

22

Rickets develops in all age groups, but increases for those aged 30-60.

15

75

85

130

120

165

215

295

260

240

260

240

190

170

160

130

130

195

0 - 4

5 - 9

10 - 14

15 - 19

20 - 24

25 - 29

30 - 34

35 - 39

40 - 44

45 - 49

50 - 54

55 - 59

60 - 64

65 - 69

70 - 74

75 -79

80 - 84

85+

Dementia: 2,885 diagnosed

Dementia is a syndrome associated with ongoing decline of the brain, including problems with memory loss, thinking speed, mental agility, language, understanding and judgement. People with dementia can become apathetic and may have problems controlling emotions.Number with Dementia

All Female Male

All 2,885 1,795 1,085

Age 0-19 - - -

Age 20-64 90 50 40

Age 65+ 2,795 1,745 1,050

Most Deprived

2nd Most Deprived

Mid Deprived

2nd Least Deprived

Least Deprived

Number 510 595 465 575 690

Crude % 1% 1% 1% 1% 1%

DSR per 100,000* 1,649.8 1,179.0 958.7 770.0 654.6


Dementia rates are higher in more deprived areas of Stockport. However because of the age profile, more people with dementia live in the areas with lower deprivation.

Healthy eating, maintaining a healthy weight, physical activity, drinking only in moderation, stopping smoking and managing hypertension reduce the risk of developing some types of dementia.

55% Hypertension33% Fall22% CKD21% Osteoporosis21% CHD

21% Pre-diabetes20% Stroke/TIA19% Diabetes17% AF16% Depression

12% Cancer12% Anxiety10% COPD

Co-morbidities

% of population with Dementia

All Female Male

All 1% 1% 1%

Age 0-19 0% 0% 0%

Age 20-64 0% 0% 0%

Age 65+ 5% 5% 4%

23

Dementia mainly occurs in older age groups, though some working age people are diagnosed with dementia.

More women are diagnosed with dementia than men, but this is driven by those aged 85+.

0

0

0

0

0

0

0

0

0

5

10

25

40

100

255

485

640

1,290

0 - 4

5 - 9

10 - 14

15 - 19

20 - 24

25 - 29

30 - 34

35 - 39

40 - 44

45 - 49

50 - 54

55 - 59

60 - 64

65 - 69

70 - 74

75 -79

80 - 84

85+

Numbers with dementia identified by GPs have increased by 400 in the last 5 years.

Mental Health: 2,845 diagnosed with severe mental health problemPeople with schizophrenia, bipolar affective disorder, other psychoses and other patients on lithium therapy were selected in line with the QOF indicator definition. These people have complex mental health problems requiring health service treatment, and are very vulnerable.

Number with mental health

All Female Male

All 2,845 1,370 1,470

Age 0-19 35 15 20

Age 20-64 2,200 980 1,220

Age 65+ 610 380 235

Most Deprived

2nd Most Deprived

Mid Deprived

2nd Least Deprived

Least Deprived

Number 765 630 440 445 425

Crude % 2% 1% 1% 1% 1%

DSR per 100,000* 1,849.7 1,047.0 959.5 709.6 513.8


Both numbers and rates of these severe mental health problems are highest in Stockport’s most deprived areas. There is a sharp increase in the most deprived areas.

A combination of medication and psychological treatments is the usual way to treat mental health conditions; some people also benefit from group therapy.

Bipolar disorder sufferers are recommended to have regular physical activity and have a healthy diet.

42% Current smoker36% Depression30% Anxiety

19% Obesity18% Hypertension13% Pre-diabetes13% Diabetes

11% Self harm10% Asthma

Co-morbidities

% of population with mental health

All Female Male

All 1% 1% 1%

Age 0-19 0% 0% 0%

Age 20-64 1% 1% 1%

Age 65+ 1% 1% 1%

24

These severe mental health problems are not age related, though very few people are diagnosed under the age of 20.

For more analysis see the full JSNA analysis of Mental Health and Wellbeinghttp://www.stockportjsna.org.uk/2016-jsna-analysis/mental-health-and-wellbeing/

Numbers with severe mental health identified by GPs have increased by 400 in the last 5 years.

0

0

<5

30

95

190

230

270

270

295

335

300

215

185

165

115

80

65

0 - 4

5 - 9

10 - 14

15 - 19

20 - 24

25 - 29

30 - 34

35 - 39

40 - 44

45 - 49

50 - 54

55 - 59

60 - 64

65 - 69

70 - 74

75 -79

80 - 84

85+

http://www.stockportjsna.org.uk/2016-jsna-analysis/mental-health-and-wellbeing/

Glaucoma: 2,620 diagnosed

Glaucoma is where there is a build up of pressure within the eye; if untreated, it can cause visual impairment.

Number with glaucoma

All Female Male

All 2,620 1,435 1,190

Age 0-19 10 5 5

Age 20-64 460 215 245

Age 65+ 2,150 1,210 940

Most Deprived

2nd Most Deprived

Mid Deprived

2nd Least Deprived

Least Deprived

Number 235 400 385 605 870

Crude % 1% 1% 1% 1% 1%

DSR per 100,000* 721.3 778.8 819.2 857.6 872.9


Glaucoma rates do not have a strong deprivation profile. This may be due to unmet need in more deprived areas, though the age profile may contribute to more people with glaucoma living in the areas with lower deprivation.

Medication is the main treatment for glaucoma.

Early detection of glaucoma can prevent visual impairment. Tests are free to all those over 60, and to those over 40 with a direct relative who has glaucoma.

53% Hypertension20% Pre-diabetes17% Diabetes17% CHD15% CKD

14% Falls12% AF12% Depression11% Osteoporosis11% Stroke/TIA

11% Cancer10% Anxiety10% Obesity10% Current smoker

Co-morbidities

% of population with glaucoma

All Female Male

All 1% 1% 1%

Age 0-19 0% 0% 0%

Age 20-64 0% 0% 0%

Age 65+ 4% 4% 3%

25

Though some young people develop glaucoma, most people with glaucoma are over 65

0

<5

5

5

5

5

20

10

25

35

80

120

160

200

395

455

420

680

0 - 4

5 - 9

10 - 14

15 - 19

20 - 24

25 - 29

30 - 34

35 - 39

40 - 44

45 - 49

50 - 54

55 - 59

60 - 64

65 - 69

70 - 74

75 -79

80 - 84

85+

Epilepsy: 2,285 diagnosed

Epilepsy affects the brain and causes repeated seizures. It is usually diagnosed after a person has had more than one seizure. Seizures can vary in severity from person to person. Often, it isn’t possible to find the cause of epilepsy, but it can be caused by damage to the brain.

Number with epilepsy

All Female Male

All 2,285 1,065 1,225

Age 0-19 195 85 110

Age 20-64 1,490 695 795

Age 65+ 600 285 320

Most Deprived

2nd Most Deprived

Mid Deprived

2nd Least Deprived

Least Deprived

Number 440 500 335 420 485

Crude % 1% 1% 1% 1% 1%

DSR per 100,000* 1,081.0 834.2 734.1 662.4 581.3


Rates of epilepsy are highest in the most deprived areas of Stockport, though numbers are broadly similar in all areas.

Epilepsy is usually treated with medication.

Regular physical activity, getting enough sleep, a healthy diet and avoiding excessive drinking help manage epilepsy.

21% Hypertension20% Current Smoker

18% Depression16% Anxiety12% Obesity

12% Falls12% LD10% Asthma

Co-morbidities

% of population with epilepsy

All Female Male

All 1% 1% 1%

Age 0-19 0% 0% 0%

Age 20-64 1% 1% 1%

Age 65+ 1% 1% 1%

26

Epilepsy usually starts in childhood but can start at any age.

Numbers with epilepsy identified by GPs have increased by 150 in the last 5 years.

20

50

55

65

110

135

135

155

175

195

235

190

160

155

155

135

85

70

0 - 4

5 - 9

10 - 14

15 - 19

20 - 24

25 - 29

30 - 34

35 - 39

40 - 44

45 - 49

50 - 54

55 - 59

60 - 64

65 - 69

70 - 74

75 -79

80 - 84

85+

PAD: 2,270 with peripheral arterial disease

PAD (peripheral arterial disease) is when a build-up of fatty deposits in the arteries restricts blood supply to leg muscles.

Number with PAD

All Female Male

All 2,270 790 1,475

Age 0-19 - - -

Age 20-64 470 115 355

Age 65+ 1,795 675 1,120

Most Deprived

2nd Most Deprived

Mid Deprived

2nd Least Deprived

Least Deprived

Number 430 495 410 370 465

Crude % 1% 1% 1% 1% 1%

DSR per 100,000* 1,464.2 1,056.2 783.0 593.9 482.1


Rates of PAD are highest in the most deprived areas of Stockport. However because of the age profile of the condition, numbers are more evenly distributed.

PAD is usually treated through lifestyle changes and medication. Regular physical activity, stopping smoking, and managing hypertension, cholesterol and diabetes are part of treating PAD.

68% Hypertension35% CHD30% Diabetes29% Current Smoker24% Pre-diabetes

23% COPD21% CKD18% Stroke/TIA16% Obesity15% AF15% Depression

15% Falls13% HF13% Cancer11% Anxiety

Co-morbidities

% of population with PAD

All Female Male

All 1% 1% 1%

Age 0-19 0% 0% 0%

Age 20-64 0% 0% 0%

Age 65+ 3% 2% 4%

27

PAD increases with age, with only a few people diagnosed before 55, and 4% of the oldest age group has PAD.

More men than women have PAD.

0

0

<5

<5

0

<5

<5

0

10

30

70

145

210

340

340

405

350

360

0 - 4

5 - 9

10 - 14

15 - 19

20 - 24

25 - 29

30 - 34

35 - 39

40 - 44

45 - 49

50 - 54

55 - 59

60 - 64

65 - 69

70 - 74

75 -79

80 - 84

85+

Numbers with PAD identified by GPs have remained steady over the last 5 years.

Autism: 1,825 with autism

Autism is a condition that affects social interaction, communication, interests and behaviours. Our data includes 400 people who also have Asperger syndrome. Autism symptoms and severity vary from person to person. Most people are diagnosed in childhood.

Number with autism

All Female Male

All 1,825 435 1,385

Age 0-19 1,080 245 835

Age 20-64 730 190 540

Age 65+ 15 - 10

Most Deprived

2nd Most Deprived

Mid Deprived

2nd Least Deprived

Least Deprived

Number 375 425 275 310 355

Crude % 1% 1% 1% 0% 0%

DSR per 100,000* 754.2 665.2 629.0 541.6 475.9


Autism rates do not have a strong deprivation profile.

A range of specialist education and behavioural programmes can help people with autism. Carers are usually part of the support needed by people with autism.

20% Anxiety 15% Depression 14% LD

Co-morbidities

% of population with autism

All Female Male

All 1% 0% 1%

Age 0-19 2% 1% 2%

Age 20-64 0% 0% 1%

Age 65+ 0% 0% 0%

28

Autism is usually diagnosed in childhood. Our data shows a decline in numbers from the 20s. However, it is possible that there are undiagnosed people in the older age groups.

Men are much more likely than women to be diagnosed with autism. There is some evidence that the condition is under diagnosed in women.

35

285

395

370

255

155

120

50

50

30

30

25

10

5

5

5

<5

0

0 - 4

5 - 9

10 - 14

15 - 19

20 - 24

25 - 29

30 - 34

35 - 39

40 - 44

45 - 49

50 - 54

55 - 59

60 - 64

65 - 69

70 - 74

75 -79

80 - 84

85+

AMD: 1,805 with age-related macular degenerationAge related Macular Degeneration (AMD) is a painless condition that causes central vision loss because the part of the eye responsible for central vision (the macula) is not functioning effectively. It does not affect peripheral vision.

Number with AMD

All Female Male

All 1,805 1,110 695

Age 0-19 - - -

Age 20-64 80 45 40

Age 65+ 1,725 1,070 655

Most Deprived

2nd Most Deprived

Mid Deprived

2nd Least Deprived

Least Deprived

Number 180 270 275 415 615

Crude % 0% 0% 1% 1% 1%

DSR per 100,000* 572.6 532.5 571.0 562.8 594.0


Highest numbers with AMD are in the least deprived areas of Stockport, where rates are also slightly higher. This may indicate unmet need in them more deprived areas.

Treatment for AMD is usually medication.

Smoking increases the risk of developing AMD. Eating a balanced diet including leafy green vegetables, drinking only in moderation and maintaining a healthy weight can reduce the risk of developing AMD.

61% Hypertension23% CKD22% Pre-diabetes22% CHD22% Falls20% Diabetes

19% Osteoporosis18% AF16% Stroke/TIA15% Cancer12% COPD11% Depression

11% Anxiety10% HF10% Glaucoma10% Obesity

Co-morbidities

% of population with AMD

All Female Male

All 1% 1% 0%

Age 0-19 0% 0% 0%

Age 20-64 0% 0% 0%

Age 65+ 3% 3% 2%

29

The 1,805 people with AMD on GP clinical systems is around half the amount expected, though the age and gender profile are as expected. Further investigation would be needed to determine the nature of the undercount.

The large majority of people with AMD are over 65.

More women than men have AMD, though some of this is due to gender differences in the older age bands.

0

0

0

0

0

0

0

0

5

5

15

20

40

75

155

270

395

830

0 - 4

5 - 9

10 - 14

15 - 19

20 - 24

25 - 29

30 - 34

35 - 39

40 - 44

45 - 49

50 - 54

55 - 59

60 - 64

65 - 69

70 - 74

75 -79

80 - 84

85+

Rheumatoid arthritis: 1,625

Rheumatoid arthritis is where the immune system attacks the cells that line the joints, causing pain, swelling and stiffness.

Number with rheumatoid arthritis

All Female Male

All 1,625 1,150 480

Age 0-19 - - -

Age 20-64 705 510 195

Age 65+ 920 635 285

Most Deprived

2nd Most Deprived

Mid Deprived

2nd Least Deprived

Least Deprived

Number 220 285 250 355 435

Crude % 0% 0% 1% 1% 1%

DSR per 100,000* 629.1 522.8 535.4 528.3 469.9


Rheumatoid arthritis rates increase with deprivation in Stockport, however because of the age profile, more people with arthritis are in the less deprived areas.

Appropriate physical activity to strengthen muscles that support the joints and keep joints as flexible as possible is highly recommended for people with rheumatoid arthritis. Losing excess weight that may put pressure on the joints is also recommended.

Smoking increases the risk of developing rheumatoid arthritis.

38% Hypertension17% Depression16% Osteoporosis16% Current smoker

14% Pre-diabetes14% Anxiety13% Obesity12% Fall12% CHD

11% Diabetes11% COPD10% Asthma10% CKD

Co-morbidities

% of population with rheumatoid arthritis

All Female Male

All 1% 1% 0%

Age 0-19 0% 0% 0%

Age 20-64 0% 1% 0%

Age 65+ 2% 2% 1%

30

More women than men have rheumatoid arthritis.

Rheumatoid arthritis increases with age, though it does affect a few young people.

Numbers with rheumatoid arthritis identified by GPs have increased by 100 in the last 5 years.

0

0

<5

<5

5

15

25

50

55

80

140

155

180

205

225

205

180

110

0 - 4

5 - 9

10 - 14

15 - 19

20 - 24

25 - 29

30 - 34

35 - 39

40 - 44

45 - 49

50 - 54

55 - 59

60 - 64

65 - 69

70 - 74

75 -79

80 - 84

85+

Crohn’s disease: 1,115

Crohn’s disease is a long term condition that causes inflammation of the lining of the digestive system, usually the intestines. The causes of Crohn’s disease are unknown, but most researchers think a combination of factors may be involved, including genetics, smoking, previous infections and environmental factors.

Number with Crohn’s disease

All Female Male

All 1,115 595 520

Age 0-19 45 20 25

Age 20-64 790 410 380

Age 65+ 285 165 115

Most Deprived

2nd Most Deprived

Mid Deprived

2nd Least Deprived

Least Deprived

Number 135 230 140 230 315

Crude % 0% 0% 0% 0% 0%

DSR per 100,000* 345.7 379.2 304.3 371.2 381.4


Crohn’s disease rates do not have a distinct deprivation profile.

Treatment for Crohn’s disease usually involves putting it into remission with medication, but surgery is sometimes necessary. Stopping smoking reduces symptoms. Some people find certain foods worsen some symptoms, but elimination of entire food types isn’t usually recommended.Children and young people are sometimes given special diets to provide nutrients for growth and development.

21% Hypertension19% Current smoker

18% Depression16% Anxiety11% Asthma

Co-morbidities

% of population with Crohn’s disease

All Female Male

All 0% 0% 0%

Age 0-19 0% 0% 0%

Age 20-64 0% 0% 0%

Age 65+ 0% 1% 0%

31

Crohn’s disease may develop at any age. In the UK most cases develop before age 30, but large numbers also develop between 60 and 80.

Women are slightly more likely than men to develop Crohn’s disease, but this is only in adults.

<5

<5

5

35

40

70

95

90

85

105

120

95

90

80

75

65

30

30

0 - 4

5 - 9

10 - 14

15 - 19

20 - 24

25 - 29

30 - 34

35 - 39

40 - 44

45 - 49

50 - 54

55 - 59

60 - 64

65 - 69

70 - 74

75 -79

80 - 84

85+

http://www.google.co.uk/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwi5_J_M0r3JAhVDOxQKHTAOBF8QjRwIBw&url=http://www.cirugialaparoscopicamadrid.com/&psig=AFQjCNE8gkTCcpso_CbXxiJD0TlZw3z6nQ&ust=1449161779983689

Cerebral palsy: 290 people

Cerebral palsy is the term for problems in the parts of the brain responsible for controlling muscles, causing problems with movement and co-ordination. The condition can occur if the brain develops abnormally or is damaged before, during or shortly after birth.

Number with cerebral palsy

All Female Male

All 290 135 155

Age 0-19 70 35 35

Age 20-64 195 85 110

Age 65+ 20 10 10

Most Deprived

2nd Most Deprived

Mid Deprived

2nd Least Deprived

Least Deprived

Number 60 60 40 50 65

Crude % 0% 0% 0% 0% 0%

DSR per 100,000* 129.9 88.0 93.4 85.8 80.1


Cerebral palsy rates do not have a strong deprivation profile, though rates are higher in the most deprived areas.

Cerebral palsy treatment plans usually involve a variety of health professionals and social care. Carers are usually part of the support plan.

34% LD22% Epilepsy13% Anxiety

12% Depression12% Falls11% Hypertension

11% Current smoker

Co-morbidities

% of population with cerebral palsy

All Female Male

All 0% 0% 0%

Age 0-19 0% 0% 0%

Age 20-64 0% 0% 0%

Age 65+ 0% 0% 0%

32

Cerebral palsy is usually diagnosed before the age of 3. It does not become worse with age, but can cause further problems later in life. The large majority of people with cerebral palsy in Stockport are under 60.

5

10

25

30

25

35

25

25

25

25

15

15

10

10

5

<5

5

<5

0 - 4

5 - 9

10 - 14

15 - 19

20 - 24

25 - 29

30 - 34

35 - 39

40 - 44

45 - 49

50 - 54

55 - 59

60 - 64

65 - 69

70 - 74

75 -79

80 - 84

85+

Down’s syndrome: 240 people

Down’s syndrome is a genetic condition that typically causes some level of learning disability and characteristic physical features.

Number with Down’s syndrome

All Female Male

All 255 90 130

Age 0-19 85 35 50

Age 20-64 135 55 80

Age 65+ 5 - -

Most Deprived

2nd Most Deprived

Mid Deprived

2nd Least Deprived

Least Deprived

Number 35 45 30 45 60

Crude % 0% 0% 0% 0% 0%

DSR per 100,000* 70.6 72.7 70.1 71.8 75.1


Down’s syndrome rates do not have a strong deprivation profile.

Educational, social care and health professionals can be part of the support for people with Down’s syndrome. Carers are usually part of the support needed by people with Down’s syndrome.

68% LD 14% Obesity

Co-morbidities

% of population with Down’s syndrome

All Female Male

All 0% 0% 0%

Age 0-19 0% 0% 0%

Age 20-64 0% 0% 0%

Age 65+ 0% 0% 0%

33

Down’s syndrome is usually diagnosed before or at birth. It does not become worse with age. The large majority of people with Downs syndrome in Stockport are under 60.

25

25

20

15

20

20

15

10

15

15

20

15

10

<5

0

0

<5

0

0 - 4

5 - 9

10 - 14

15 - 19

20 - 24

25 - 29

30 - 34

35 - 39

40 - 44

45 - 49

50 - 54

55 - 59

60 - 64

65 - 69

70 - 74

75 -79

80 - 84

85+

MND: 25 people with motor neurone diseaseMotor neurone disease progressively damages parts of the nervous system leading to muscle wasting and increasing difficulties with gripping, walking, speaking, swallowing and breathing. It is a severely life-shortening condition.

Number with MND

All Female Male

All 25 10 15

Age 0-19 - - -

Age 20-64 15 5 5

Age 65+ 10 - 10

Most Deprived

2nd Most Deprived

Mid Deprived

2nd Least Deprived

Least Deprived

Number 5 5 5 5 5

Crude % 0% 0% 0% 0% 0%

DSR per 100,000* 13.2 8.1 8.8 6.2 6.6


MND rates do not have a strong deprivation profile.

Treatment of MND involves a multidisciplinary team of healthcare professionals. Carers are also usually involved.

29% Hypertension21% Anxiety

17% Asthma17% Depression

13% Current smoker

Co-morbidities

% of population with MND

All Female Male

All 0% 0% 0%

Age 0-19 0% 0% 0%

Age 20-64 0% 0% 0%

Age 65+ 0% 0% 0%

34

MND can develop in adults of all ages, but most diagnoses are in people over 40. It affects slightly more men than women.

0

<5

0

<5

0

0

0

<5

0

0

5

5

5

5

5

0

<5

0

0 - 4

5 - 9

10 - 14

15 - 19

20 - 24

25 - 29

30 - 34

35 - 39

40 - 44

45 - 49

50 - 54

55 - 59

60 - 64

65 - 69

70 - 74

75 -79

80 - 84

85+

Multiple key conditions

35

In addition to looking at each of the conditions individually it is also useful to understand trends in the number of conditionspeople are living with, and how this varies over the life course – as this gives some measure of the complexity of issues and treatments patients and health carers may be dealing with. To do this we have focussed our analysis on 9 groups of diagnoses, excluding some conditions where data quality is lower or where people may not need clinical management permanently (such as depression).

These 9 key condition groups are: • Cardiovascular disease (CVD) defined as a diagnosis of CHD, stroke, TIA, AF, HF or PAD• Hypertension• Respiratory Disease , defined as a diagnosis of asthma or COPD• Diabetes• Epilepsy• Cancer• Chronic Kidney Disease (CKD)• Severe Mental Health, defined as psychosis, schizophrenia or bipolar disorder• Dementia. This analysis counts the number of these 9 conditions each person in Stockport has been diagnosed with and presents the information by age and deprivation. Again this analysis should also be treated as indicative.

Number of key conditions

Number of people % of people

0 227,842 72%

1 53,309 17%

2 21,701 7%

3 9,039 3%

4 3,106 1%

5 650 0%

6 82 0%

7 3 0%

Patients in Stockport have between 0 and 7 of these key conditions, no one has 8 or 8 of these.

For this analysis, those with 4 to 7 conditions were considered together, making a group of 3,841 people with 4 or more key conditions.

Multiple key conditions by age

36

These multiple key conditions are strongly age related.• At age 65, 59% of the population have at least one of the key conditions, with 26% having two or more of the conditions.• In the oldest age group, 87% have at least one condition, with 64% having two or more of the conditions

0 - 4 '05 - 9 10 - 14 15 - 19 20 - 24 25 - 29 30 - 34 35 - 39 40 - 44 45 - 49 50 - 54 55 - 59 60 - 64 65 - 69 70 - 74 75 -79 80 - 84 85+

4+ of 8 key conditions 0 0 0 0 0 0 2 4 4 13 56 106 166 303 534 722 808 1123

3 of 8 key conditions 0 0 0 0 1 8 12 35 56 123 283 469 703 1045 1457 1464 1517 1866



None of 8 key conditions 17350 18282 17043 14768 14091 18209 19692 19622 17107 16851 15959 12904 9241 6498 5044 2598 1465 1113

0

5,000

10,000

15,000

20,000

25,000

Po

pu

lati

on

Age Group

Multiple Long Term Conditions - by age

Multiple key conditions by age

37

These key conditions are strongly age related.• 72% of those aged 65+ have at least one of the key conditions, with 41% having two or more of the conditions.• Only 5% of those age under 20 have any of the key conditions, and almost all of them have only one of the conditions.

Because there are so few young people with these conditions, their characteristics tend to be masked by the numbers of older people.

Number with 1 key conditions

All Female Male

All 53,310 27,315 25,990

Age 0-19 3,735 1,555 2,180

Age 20-64 31,000 15,470 15,530

Age 65+ 18,575 10,290 8,285

% of population with 1 key conditions

All Female Male

All 17% 17% 17%

Age 0-19 5% 4% 6%

Age 20-64 17% 17% 17%

Age 65+ 31% 31% 30%

with 2 key conditions

All Female Male

21,700 10,675 11,025

35 15 20

7,580 3,330 4,250

14,085 7,330 6,755


All Female Male

9,040 4,430 4,610

- - -

1,690 730 960

7,350 3,700 3,645

with 4+ key conditions

All Female Male

3,840 1,855 1,985

- - -

350 155 195

3,490 1,700 1,790


All Female Male

7% 7% 7%

0% 0% 0%

4% 4% 5%

23% 22% 25%


All Female Male

3% 3% 3%

0% 0% 0%

1% 1% 1%

12% 11% 13%

with 4+ key conditions

All Female Male

1% 1% 1%

0% 0% 0%

0% 0% 0%

6% 5% 7%

190

1020

1360

1165

1165

1590

2065

2445

2895

4030

5335

5930

5545

53355360

3565

2365

1945

0 - 4

5 - 9

10 - 14

15 - 19

20 - 2425 - 29

30 - 34

35 - 39

40 - 44

45 - 49

50 - 54

55 - 59

60 - 64

65 - 69

70 - 74

75 -79

80 - 84

85+

0

5

15

15

35

75

140

225

440

840

1405

2005

2425

2835

3455

2900

2440

2455

0

0

0

0

0

10

10

35

55

125

285

470

705

1045

1455

1465

1515

1865

0

0

0

0

0

0

0

5

5

15

55

105

165

305

535

720

810

1125

Multiple key conditions by deprivation

38

Most Deprived

2nd Most Deprived Mid Deprived

2nd Least Deprived Least Deprived

One key condition

Number 7,070 9,975 7,940 10,800 14,690

Crude % 16% 16% 18% 17% 18%

DSR per 100,000* 17,820.75 17,116.18 17,439.03 16,725.33 16,665.74

Two key conditions

Number 3,060 4,060 3,255 4,575 5,705

Crude % 7% 7% 7% 7% 7%

DSR per 100,000* 8,879.65 7,637.92 7,031.83 6,674.96 5,898.64

Three key conditions

Number 1,425 1,785 1,400 1,890 2,145

Crude % 3% 3% 3% 3% 3%

DSR per 100,000* 4,390.10 3,474.58 2,974.77 2,668.55 2,119.09

Four or more key conditions

Number 675 835 605 780 811

Crude % 2% 1% 1% 1% 1%

DSR per 100,000* 2,156.75 1,655.58 1,271.19 1,075.86 780.81


The rates of these key conditions show a strong deprivation profile. As the number of conditions increase, the deprivation profile becomes more pronounced.

However, excepting the group with four or more conditions, there are more people diagnosed with these key conditions in the more affluent areas of Stockport due to the older and larger population size.

Multiple key conditions: those with none of these conditions

39

Almost three quarters of Stockport patients have not been diagnosed with any of the selected key conditions.

Most Deprived

2nd Most Deprived

Mid Deprived

2nd Least Deprived

Least Deprived

Number 31,870 45,495 32,010 44,255 58,545

Crude % 72% 73% 71% 71% 71%

DSR per 100,000* 66,752.8 70,115.7 71,283.2 72,855.3 74,535.7


Rates by deprivation show a clear inverse deprivation profile. The number of people without any of these key conditions increases as deprivation decreases.

Number with no key conditions

All Female Male

All 227,835 114,815 113,025

Age 0-19 67,445 32,990 34,450

Age 20-64 143,675 72,060 71,615

Age 65+ 16,720 9,765 6,955

% of population with no key conditions

All Female Male

All 72% 72% 72%

Age 0-19 95% 95% 94%

Age 20-64 78% 79% 77%

Age 65+ 28% 30% 25%

There is a steady decline in those without any of the key conditions by age.

Over 90% of those aged under 35 have none of these conditions.

By age 65, under half of the population have none of the key conditions.

Rates of these conditions continue increasing with age.By age 85+ only 13% of the population have none of the key conditions.

17350

18280

17045

14770

14090

18210

19690

19620

17105

16850

15960

12905

9240

6500

5045

2600

1465

1115

0 - 4

5 - 9

10 - 14

15 - 19

20 - 24

25 - 29

30 - 34

35 - 3940 - 44

45 - 49

50 - 54

55 - 59

60 - 64

65 - 69

70 - 74

75 -79

80 - 84

85+

Long-term conditions ages under 25

40

Although the previous analysis includes children and young people, the patterns of long term conditions for these age groups are not easily apparent, as they get masked by older adults.

The table below identifies the conditions where there are more than 50 registered patients with a condition aged under 25 years, and shows the age profile.

Asthma is the most common condition and begins in early life, so that there are significant numbers of cases in both primary and secondary school aged children.

Anxiety and depression are the next most common, but effect children and young people aged 15-24 more than younger children.

ConditionTotal

Number

Age bands

0-4 5-9 10-14 15-19 20-24

Asthma 4,110 150 920 1,235 965 835

Anxiety 4,880 - 95 475 1,510 2,800

Depression 2,500 - - 30 540 1,930

Autism* 1,335 35 285 395 370 255

Self harm* 1,065 5 10 90 440 520

Attention DeficitHyperactivity Disorder

1,035 5 90 325 330 290

Rickets 420 15 75 85 130 120

Epilepsy 305 20 50 55 65 110

Diabetes 285 5 30 65 90 90

Mental health 130 - - - 30 95

Down’s syndrome 105 25 25 20 15 20

Cerebral palsy * 95 5 10 25 30 25

Crohn’s disease 85 - - 5 35 40

Cancer 85 5 15 20 25 30

Pre-diabetes 65 - - 5 20 40

Hypertension 60 5 5 5 10 40

* Undercount of actual prevalence

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