NHS Outcomes Framework

Transcription

1 NHS Outcomes Framework Doman 1 Preventng people from dyng prematurely Indcator Specfcatons Verson: 1.21 Date: May 2018 Author: Clncal Indcators Team

2 NHS Outcomes Framework: Doman 1 Preventng people from dyng prematurely Document Management Revson hstory Verson Date Indcator Summary of Changes 1.0 Aprl Indcator ntroduced November b. & 1b. Indcator ntroduced 1c 1.2 March Indcator ntroduced 1.3 June Indcator ntroduced 1.4 March a. Indcator ntroduced 1.5 September Release wth dsaggregaton by condton 1a. Indcator ntroduced 1.6 December a. Person-level ndcator values added for all breakdowns and years 1a. Age bands <1 and 1 to 4 were combned to 0 to February a. 1a v May a. 1a Age bands <1 and 1 to 4 were combned to 0 to 4 Numerator and denomnator values added Change of ndcator value to Standard Mortalty Rato (SMR) Change of confdence ntervals from 99% to 95% Addton of lve brths and nfant death fgures for all years Update of ndcator values across the whole tme seres usng the 2013 European Standard Populaton (ESP), revsed ONS md-year populaton estmates for years 2003 to 2010 based on the 2011 Census and 2012 perod lfe expectances Revsed data for all years wth revsed ONS populaton estmates based on the 2011 Census Indcator ntroduced Update of confdence nterval methodology for all years 2 Copyrght 2018, Health and Socal Care Informaton Centre. NHS Dgtal s the tradng name of the Health and Socal Care Informaton Centre.

3 NHS Outcomes Framework: Doman 1 Preventng people from dyng prematurely 1a. Addton of regon breakdown 1.5. Publcaton of upper ter local authorty breakdown 1.9 August a. Addton of deprvaton breakdown c Addton of regon breakdown for 2011 to Addton of regon breakdown 1.10 November c Addton of regon breakdown for 1999 to 2010 Relaxaton of suppresson rules 1.6. Addtonal detals about data lnkage ncluded n the specfcaton 1.11 February a Combnaton of ndcator values for Cornwall and Isles of Sclly and Hackney and Cty of London for 2013 data n order to avod suppresson of the ndvdual fgures May a. 1a. Update of confdence nterval methodology for all years 1.13 November 2015 All Revson hstory has been consoldated Precson column removed from output fles snce all estmates have hgh precson 1.5. Descrpton of ndcator updated 1.14 February 2016 All Changed lnk to Indcator Portal 1.15 May c Updated lnks to ONS publcatons August 2016 All Updated formattng and lnks 1.17 November b Removal of LA breakdown from data fles, update to dsclosure control and clarfcaton of verson of IMD used. Health nequalty (area deprvaton) and populaton data ntroduced 1.18 February b Updated data source and constructon sectons. 1a Updated deprvaton breakdown to gve greater clarty 1.19 May b Update of health nequalty (area deprvaton) secton wth new confdence nterval methodology. Updated populaton feld wth change of age group (from 75 to 79 to 75 and over) 1a. 1a. 1.1 Mnor changes to wordng 3 Copyrght 2018, Health and Socal Care Informaton Centre. NHS Dgtal s the tradng name of the Health and Socal Care Informaton Centre.

4 NHS Outcomes Framework: Doman 1 Preventng people from dyng prematurely Updated lnks to ONS publcatons Indcator constructon ntroducton updated. Appendx Updated wth data ponts for a Appendx 2b 1.20 February b Updated lnks 1.21 May 2018 All Updated to reflect new name for Mnstry of Housng, Communtes & Local Government 4 Copyrght 2018, Health and Socal Care Informaton Centre. NHS Dgtal s the tradng name of the Health and Socal Care Informaton Centre.

5 NHS Outcomes Framework: Doman 1 Preventng people from dyng prematurely Contents 1a. Potental years of lfe lost (PYLL) from causes consdered amenable to healthcare adults 6 1a. Potental years of lfe lost (PYLL) from causes consdered amenable to healthcare chldren and young people 14 1b. and 1b. Lfe expectancy at age 75 for males and females 20 1c Neonatal mortalty and stllbrths (formerly ndcator 1.6.) Under 75 mortalty rate from cardovascular dsease Under 75 mortalty rate from respratory dsease Under 75 mortalty rate from lver dsease Under 75 mortalty rate from cancer One-year survval from all cancers Fve-year survval from all cancers One-year survval from breast, lung and colorectal cancer v Fve-year survval from breast, lung and colorectal cancer Excess under 75 mortalty rate n adults wth serous mental llness (formerly ndcator 1.5) Infant mortalty Fve-year survval from all cancers n chldren (formerly ndcator 1.6.) 85 Doman 1 Appendces 88 5 Copyrght 2018, Health and Socal Care Informaton Centre. NHS Dgtal s the tradng name of the Health and Socal Care Informaton Centre.

6 NHS Outcomes Framework: 1a. - Potental years of lfe lost (PYLL) from causes consdered amenable to healthcare - adults 1a. Potental years of lfe lost (PYLL) from causes consdered amenable to healthcare adults Indcator assurance Status Date Methodology Revew Group (MRG) recommended July 2013 Indcator Governance Board (IGB) assured August 2013 Overvew Indcator ttle 1a. Potental years of lfe lost from causes consdered amenable to healthcare adults Indcator famly name NHS Outcomes Framework: Doman 1 Preventng people from dyng prematurely Overarchng ndcator Outcome sought Reduced premature mortalty from causes amenable to healthcare. Detaled Descrptor Plan Englsh descrpton The number of years of lfe lost by every 100,000 adults aged 20 and over dyng from condtons whch are usually treatable, measured n a way whch allows for comparsons between populatons wth dfferent age profles and over tme. Techncal descrpton Drectly age-standardsed potental years of lfe lost (PYLL) rate from amenable causes for adults. Data sources Denomnator Offce for Natonal Statstcs (ONS) md-year populaton estmates of the relevant age group and gender based on the 2011 Census - Natonal Statstcs. Publshed annually (calendar years) by the ONS. Usually avalable n June followng year-end. 6 Copyrght 2018, Health and Socal Care Informaton Centre.

7 NHS Outcomes Framework: 1a. - Potental years of lfe lost (PYLL) from causes consdered amenable to healthcare - adults Numerator Avodable mortalty data by cause - Natonal Statstcs (Used to determne amenable condtons - see appendx 1) Publshed annually by the ONS. Avalable n autumn followng year-end. Prmary care mortalty database (PCMD) - Managed by NHS Dgtal. Bespoke extract taken annually, usually n September each year Perod lfe expectancy tables - Natonal Statstcs. Publshed every two years by ONS. See appendces 2a and 2b for the most recently publshed lfe expectancy tables. Standard populaton: 2013 European standard populaton. See appendx 3. Constructon Introducton The PYLL rate s calculated by weghtng the number of amenable deaths n a gven year by the number of addtonal years the person who ded mght have been expected to lve n the presence of tmely and effectve healthcare. The average age-specfc lfe expectances for each fve-year age band are used to weght the number of deaths n that age band to gve the average number of years of lfe lost for that age band. The lfe expectancy for the 90+ age band s calculated as an average of the sngle-year lfe expectances for ages 90 to 100. Ths s then appled to the number of deaths for people aged 90 or over. The age-specfc perod lfe expectancy s dfferent for each year and gender and can be found n appendces 2a and 2b. The total number of years of lfe lost for males and females s summed for each age band and the result s expressed as a European age-standardsed rate per 100,000 populaton. For person-level PYLL values the total number of years of lfe lost for males and females s added up to get a years of lfe lost (YLL) value for all persons. Ths s then expressed as a European age-standardsed rate per 100,000 populaton as for males and females. The 2013 European standard populaton s used, whch can be seen n appendx 3. Data felds The data felds and flters used wthn the ONS mortalty data are as follows: CALCULATED_AGE_UNIT CALCULATED_AGE SEX DATE_OF_REGISTRATION LSOA_OF_RESIDENCE_CODE UNDERLYING_CAUSE_OF_DEATH Data Flters 1. Feld Name CALCULATED_AGE_UNIT 7 Copyrght 2018, Health and Socal Care Informaton Centre.

8 NHS Outcomes Framework: 1a. - Potental years of lfe lost (PYLL) from causes consdered amenable to healthcare - adults Condtons Ratonale: When CALCULATED_AGE_UNIT equals 2, 3 or 4 recode age to zero years The calculated age unt s used to specfy whether the CALCULATED_AGE feld refers to years (1), months (2), weeks (3) or days (4) of lfe. 2. Feld Name CALCULATED_AGE Condtons Is greater than 19. For upper age lmt please see appendx 1. Ratonale Selects all adults over the age of 19. The relevant upper age lmts for each condton group are presented n appendx Feld Name DATE_OF_REGISTRATION Condtons Ratonale Is between 1 January and 31 December of the respectve calendar year nclusve. Selects only those deaths regstered durng the relevant calendar year. 4. Feld Name SEX Condtons Is equal to 1 or 2 Ratonale A vald sex feld s requred when drectly standardsng by age and sex. 5. Feld Name LSOA_OF_RESIDENCE_CODE Condtons Ratonale Is equal to a vald Englsh Lower Super Output Area (LSOA). Ths restrcts data to patents resdent n England. A vald. Englsh LSOA starts wth the letter E. 6. Feld Name UNDERLYING_CAUSE_OF_DEATH Condtons See appendx 1 Ratonale A lst of ICD-10 codes, whch defne causes consdered amenable to healthcare for ths ndcator and the relevant age lmts can be seen n appendx 1. Calculaton Denomnator ONS md-year populaton estmates of the populaton aged 20 years and over. 8 Copyrght 2018, Health and Socal Care Informaton Centre.

9 NHS Outcomes Framework: 1a. - Potental years of lfe lost (PYLL) from causes consdered amenable to healthcare - adults Numerator Number of deaths, where the ndvdual was aged 20 years and over, from causes consdered amenable to healthcare multpled by the age-specfc lfe expectancy for the relevant age group and gender. European age-standardsed PYLL calculaton PYLL Rate ad w n w 100,000 s the age group (20-24, 25-29, 30-34,, 70-74, 75-79, 80-84, 85-89, 90+); d s the observed number of deaths n the subject populaton age group ; a s the weght, or average age-specfc lfe expectancy, for that age-group and that gender n that year; n s number of ndvduals n the subject populaton n age group ; w s the number of ndvduals n the standard populaton n age group. Confdence Intervals for Drectly Standardsed Rates (DSRs) 95% confdence ntervals are calculated usng Dobson's 1 and Byar's 2 methods. Byar s method s recommended for larger counts whereas for smaller numerators (less than 389) a more exact method based on the Posson dstrbuton (Dobson s method) s used: DSR lower = DSR + Var(DSR) Var(O) (O lower O) DSR upper = DSR + Var(DSR) Var(O) (O upper O) O s the total number of years of lfe lost n the subject populaton. 1 Dobson A et al. Confdence ntervals for weghted sums of Posson parameters. Stat Med 1991;10: Breslow NE, Day NE. Statstcal methods n cancer research, volume II: The desgn and analyss of cohort studes. Lyon: Internatonal Agency for Research on Cancer, World Health Organzaton; 1987: Copyrght 2018, Health and Socal Care Informaton Centre.

10 NHS Outcomes Framework: 1a. - Potental years of lfe lost (PYLL) from causes consdered amenable to healthcare - adults a 2 w 2 O n 2 Var(DSR) = ( w ) 2 a s the lfe expectancy for age group w s the reference (standard) populaton for age group O s the observed number of deaths n age group n s the denomnator populaton for age group Var(O) = O Olower and Oupper are the lower and upper confdence lmts for the observed number of events; When O < 389 then, O lower = χ 2 lower 2 O upper = χ 2 upper 2 χ 2 lower s the 97.5 th percentle value from the χ 2 dstrbuton wth 2O degrees of freedom; χ 2 upper s the 2.5 th percentle value from the χ 2 dstrbuton wth 2O+2 degrees of freedom. When O >= 389 then, O lower = O (1 1 9O z 3 3 O ) O upper = (O + 1) ( (O + 1) + z 3 O + 1 ) z s the 97.5 th percentle value from the Standard Normal dstrbuton. Confdence Intervals for Crude Rates Where the ndcator values are broken down by age and gender drect standardsaton s not possble and crude rates are calculated nstead. Although stll based on the Dobson s and Byar s method, n these cases 95% confdence ntervals are calculated usng a dfferent methodology: r lower = O lower n 10 Copyrght 2018, Health and Socal Care Informaton Centre.

11 NHS Outcomes Framework: 1a. - Potental years of lfe lost (PYLL) from causes consdered amenable to healthcare - adults r upper = O upper n r s the crude rate and r lower and r upper are the lower and upper confdence lmts for the crude rate; O s the total number of years of lfe lost n the subject populaton and O lower and O upper are the lower and upper confdence lmts for the total number of years of lfe lost; n s the number of ndvduals n the subject populaton. The confdence ntervals for the total number of years of lfe lost are gven by the followng formulas. When O < 389 then, O lower = χ 2 lower 2 O upper = χ 2 upper 2 χ 2 lower s the 97.5 th percentle value from the χ 2 dstrbuton wth 2O degrees of freedom; χ 2 upper s the 2.5 th percentle value from the χ 2 dstrbuton wth 2O+2 degrees of freedom. When O >= 389 then, O lower = O (1 1 9O z 3 3 O ) O upper = (O + 1) ( (O + 1) + z 3 O + 1 ) z s the 97.5 th percentle value from the Standard Normal dstrbuton. Deprvaton breakdown The deprvaton breakdowns for ths ndcator have all been derved usng the 2015 Index of Multple Deprvaton (IMD) scores whch are based on 2011 lower super output area (LSOA) boundares. These data are publshed by the Mnstry of Housng, Communtes & Local Government (MHCLG) department, the latest publcaton can be found here: 11 Copyrght 2018, Health and Socal Care Informaton Centre.

12 NHS Outcomes Framework: 1a. - Potental years of lfe lost (PYLL) from causes consdered amenable to healthcare - adults To create the deprvaton breakdowns, both numerator and denomnator data need to be avalable at LSOA level. Between 2009 and 2011, the numerator (mortalty) data were sourced drectly from ONS and a postcode of resdence was ncluded but LSOA of resdence was not. For these data, NHS Dgtal used a reference table from ONS s open geography portal to derve the LSOA from the postcode. From 2012 onwards, the numerator data were sourced from the NHS Dgtal PCMD, from whch the LSOA of resdence s already ncluded. For the denomnator (populaton) values, data for all years are sourced from ONS at LSOA level. Once all numerator and denomnator data have LSOAs allocated, NHS Dgtal then uses the IMD data publshed by MHCLG to derve the deprvaton decles from the LSOAs. Presentaton Breakdowns Tme perods Annual data from Demographc Gender: Age: Deprvaton: Males, females and all persons for England, age, lower ter local authorty, regon and condton (by calendar year) 5-year age bands from age 20 for males, females and all persons (by calendar year) Decles from 1- Most deprved to 10 Least deprved for males, females and all persons (by calendar year from 2009) Geographc England: Local authorty: Regon: Male, female and all persons (by calendar year) Male, female and all persons (by calendar year) Male, female and all persons (by calendar year) Other Condton: Male, female and all persons by amenable cause group (by calendar year) Dsclosure control From 2013 onwards, combned ndcator values have been calculated for Cornwall and Isles of Sclly and Hackney and Cty of London. These were prevously suppressed. For calendar years 2003 to 2012 the suppresson has been relaxed to reflect the new dsclosure rules, however, where ether Isles of Sclly or Cty of London have a numerator of 0,1 or 2 for ths 12 Copyrght 2018, Health and Socal Care Informaton Centre.

13 NHS Outcomes Framework: 1a. - Potental years of lfe lost (PYLL) from causes consdered amenable to healthcare - adults tme perod they have remaned suppressed along wth another local authorty wthn the regon. Ths s to reduce the rsk of one suppressed number beng dentfable n solaton. All other local authorty values wth a numerator between 0 and 2 (nclusve) that have prevously been suppressed have been publshed for the frst tme n November Ths s due to an update of the ONS dsclosure control rules: Further, denomnator fgures sourced from the relevant ONS md-year populaton estmates are rounded to the nearest 100. Excel and CSV output Column name Year Perod of coverage Breakdown Level Level descrpton Gender Indcator value Lower CI Upper CI Years of lfe lost Populaton Observed deaths Output Calendar year Perod of coverage for the calendar year (1/1 to 31/12 for the respectve year) England, age, lower ter local authorty, regon, condton, deprvaton decle Level of breakdown (LA codes, regon codes, condton groups) Descrpton of breakdown level Person, male, female Drectly European age-standardsed rate of the potental years of lfe lost due to causes consdered amenable to healthcare Lower lmt of 95% confdence nterval Upper lmt of 95% confdence nterval Years of lfe lost due to deaths amenable to healthcare (numerator) Populaton count (denomnator) Number of observed deaths amenable to healthcare 13 Copyrght 2018, Health and Socal Care Informaton Centre.

14 NHS Outcomes Framework: 1a. Potental years of lfe lost (PYLL) from causes consdered amenable to healthcare chldren and young people 1a. Potental years of lfe lost (PYLL) from causes consdered amenable to healthcare chldren and young people Indcator assurance Status Date Methodology Revew Group (MRG) recommended January 2013 Indcator Governance Board (IGB) assured August 2013 Overvew Indcator ttle 1a. Potental years of lfe lost from causes consdered amenable to healthcare chldren and young people Indcator famly name NHS Outcomes Framework: Doman 1 Preventng people from dyng prematurely Overarchng ndcator Outcome sought Reduced premature mortalty from causes amenable to healthcare. Detaled Descrptor Plan Englsh descrpton The number of years of lfe lost by every 100,000 persons aged 0 to 19 dyng from condtons whch are usually treatable, measured n a way whch allows for comparsons between populatons wth dfferent age profles and over tme. Techncal descrpton Drectly age-standardsed potental years of lfe lost (PYLL) rate from amenable causes for chldren. 14 Copyrght 2018, Health and Socal Care Informaton Centre.

15 NHS Outcomes Framework: 1a. Potental years of lfe lost (PYLL) from causes consdered amenable to healthcare chldren and young people Data sources Denomnator Offce for Natonal Statstcs (ONS) md-year populaton estmates of the relevant age group and gender based on the 2011 Census - Natonal Statstcs. Publshed annually (calendar years) by the ONS. Usually avalable n June followng year-end. Numerator Avodable mortalty data by cause - Natonal Statstcs (Used to determne amenable condtons - see appendx 1). Publshed annually by the ONS. Avalable n autumn followng year-end. Prmary care mortalty database (PCMD) - Managed by NHS Dgtal. Bespoke extract taken annually, usually n September each year Perod lfe expectancy tables - Natonal Statstcs. Publshed every two years by the ONS. See appendces 2a and 2b for the most recently publshed lfe expectancy tables. Standard populaton 2013 European standard populaton. See appendx 3. Constructon Introducton The PYLL rate s calculated by weghtng the number of amenable deaths n a gven year by the number of addtonal years the person who ded mght have expected to lve n the presence of tmely and effectve healthcare. The average age-specfc lfe expectances for each fve-year age band are used to weght the number of deaths n that age band to gve the average number of years of lfe lost for that age band. The age-specfc perod lfe expectancy s dfferent for each year and gender and can be found n appendces 2a and 2b. The total number of years of lfe lost for males and females s summed for each age band and the result s expressed as a European agestandardsed rate per 100,000 populaton. For person-level PYLL values the total number of years of lfe lost for males and females s added up to get a years of lfe lost (YLL) value for all persons. As for males and females, ths s then expressed as a European agestandardsed rate per 100,000 populaton. The 2013 European standard populaton s used, whch can be seen n appendx 3. Data felds The data felds and flters used wthn the ONS mortalty data are as follows: CALCULATED_AGE_UNIT CALCULATED_AGE SEX 15 Copyrght 2018, Health and Socal Care Informaton Centre.

16 NHS Outcomes Framework: 1a. Potental years of lfe lost (PYLL) from causes consdered amenable to healthcare chldren and young people DATE_OF_REGISTRATION UNDERLYING_CAUSE_OF_DEATH Data Flters 1. Feld Name CALCULATED_AGE_UNIT Condtons Ratonale: When CALCULATED_AGE_UNIT equals 2, 3 or 4 recode age to zero years The calculated age unt s used to specfy whether the CALCULATED_AGE feld refers to years (1), months (2), weeks (3) or days (4) of lfe. 2. Feld Name CALCULATED_AGE Condtons See appendx 1 Ratonale Combned wth the recoded zero ages from CALCULATED_AGE_UNIT selects the relevant age lmts for each condton group as presented n appendx Feld Name DATE_OF_REGISTRATION Condtons Ratonale Is between 1 January and 31 December of the respectve calendar year nclusve. Selects only those deaths regstered durng the relevant calendar year. 4. Feld Name SEX Condtons Is equal to 1 or 2 Ratonale A vald sex feld s requred when drectly standardsng by age and sex. 5. Feld Name UNDERLYING_CAUSE_OF_DEATH Condtons See appendx 1 Ratonale A lst of ICD-10 codes, whch defne causes consdered amenable to healthcare for ths ndcator and the relevant age lmts can be seen n appendx Copyrght 2018, Health and Socal Care Informaton Centre.

17 NHS Outcomes Framework: 1a. Potental years of lfe lost (PYLL) from causes consdered amenable to healthcare chldren and young people Calculaton Denomnator ONS md-year populaton estmates of the populaton aged 19 years and under. Numerator Number of deaths, where the ndvdual was aged 19 years and under, from causes consdered amenable to healthcare multpled by the age-specfc lfe expectancy for the relevant age group and gender. European age-standardsed PYLL calculaton PYLL Rate w ad n w 100,000 s the age group (0-4, 5-9, 10-14, 15-19); d s the observed number of deaths n the subject populaton age group ; a s the weght, or average age-specfc lfe expectancy, for that age group and that gender n that year; n s number of ndvduals n the subject populaton n age group ; w s the number of ndvduals n the standard populaton n age group. Confdence Intervals for Drectly Standardsed Rates (DSRs) 95% confdence ntervals are calculated usng Dobson's 3 and Byar's 4 methods. Byar s method s recommended for larger counts whereas for smaller numerators (less than 389) a more exact method based on the Posson dstrbuton (Dobson s method) s used: DSR lower = DSR + Var(DSR) Var(O) (O lower O) DSR upper = DSR + Var(DSR) Var(O) (O upper O) 3 Dobson A et al. Confdence ntervals for weghted sums of Posson parameters. Stat Med 1991;10: Breslow NE, Day NE. Statstcal methods n cancer research, volume II: The desgn and analyss of cohort studes. Lyon: Internatonal Agency for Research on Cancer, World Health Organzaton; 1987: Copyrght 2018, Health and Socal Care Informaton Centre.

18 NHS Outcomes Framework: 1a. Potental years of lfe lost (PYLL) from causes consdered amenable to healthcare chldren and young people O s the total number of years of lfe lost n the subject populaton. a 2 w 2 O n 2 Var(DSR) = ( w ) 2 a s the lfe expectancy for age group w s the reference (standard) populaton for age group O s the observed number of deaths n age group n s the denomnator populaton for age group Var(O) = O Olower and Oupper are the lower and upper confdence lmts for the observed number of events; When O < 389 then, O lower = χ 2 lower 2 O upper = χ 2 upper 2 χ 2 lower s the 97.5 th percentle value from the χ 2 dstrbuton wth 2O degrees of freedom; χ 2 upper s the 2.5 th percentle value from the χ 2 dstrbuton wth 2O+2 degrees of freedom. When O >= 389 then, O lower = O (1 1 9O z 3 3 O ) O upper = (O + 1) ( (O + 1) + z 3 O + 1 ) z s the 97.5 th percentle value from the Standard Normal dstrbuton. 18 Copyrght 2018, Health and Socal Care Informaton Centre.

19 NHS Outcomes Framework: 1a. Potental years of lfe lost (PYLL) from causes consdered amenable to healthcare chldren and young people Presentaton Breakdowns Tme perods Annual data from Demographc Gender: Males, females and all persons for England (by calendar year) Dsclosure control Suppresson rules are currently not applcable as the ndcator values are only publshed at natonal level and broken down by gender. Denomnator fgures sourced from the relevant ONS md-year populaton estmates are rounded to the nearest 100. Excel and CSV output Column name Year Perod of coverage Breakdown Level Level descrpton Gender Indcator value Lower CI Upper CI Years of lfe lost Populaton Observed deaths Output Calendar year Perod of coverage for the calendar year (1/1 to 31/12 for the respectve year) England, gender Level of breakdown Descrpton of breakdown level Person, male, female Drectly European age-standardsed rate of the potental years of lfe lost due to causes consdered amenable to healthcare Lower lmt of 95% confdence nterval Upper lmt of 95% confdence nterval Years of lfe lost due to deaths amenable to healthcare (numerator) Populaton count (denomnator) Number of observed deaths amenable to healthcare 19 Copyrght 2018, Health and Socal Care Informaton Centre.

20 NHS Outcomes Framework: 1b - Lfe expectancy at age 75 for. males and. females 1b. and 1b. Lfe expectancy at age 75 for males and females Indcator assurance Status Date Methodology Revew Group (MRG) recommended Indcator Governance Board (IGB) assured Aprl 2011 Aprl 2011 September 2016 revewed and health nequalty measure ntroduced Overvew Indcator ttle 1b Lfe expectancy at 75:. males and. females Indcator famly name NHS Outcomes Framework: Doman 1 Preventng people from dyng prematurely Overarchng ndcator Outcome sought Increased lfe expectancy at age 75, for males and females separately. Detaled Descrptor Plan Englsh descrpton The average number of addtonal years a man or woman aged 75 can be expected to lve f they contnue to lve n the same place and the death rates n ther area reman the same for the rest of ther lfe. Techncal descrpton Perod expectaton of lfe at age 75. Data sources The three-year average lfe expectances at natonal, regonal and local authorty level come drectly from the pvot table released wth the ONS publcaton Health state lfe expectancy - All ages, UK : pectances/datasets/healthstatelfeexpectancyallagesuk The three-year average lfe expectances for the deprvaton breakdowns are provded fully calculated by ONS n a bespoke fle but are derved usng the same methodology as above. 20 Copyrght 2018, Health and Socal Care Informaton Centre.

21 NHS Outcomes Framework: 1b - Lfe expectancy at age 75 for. males and. females The deprvaton breakdowns are based on the 2015 Index of Multple Deprvaton (IMD) scores for England whch use the Lower Super Output Area (LSOA) boundares created n These data are produced by the Mnstry of Housng, Communtes & Local Government (MHCLG) department roughly every three years: The one-year average lfe expectances for ths ndcator, avalable at natonal level only, are sourced drectly from the ONS publcaton "Expectaton of Lfe, Prncpal Projecton, England": nces/datasets/expectatonoflfeprncpalprojectonengland Constructon Perod lfe expectances use mortalty rates from a sngle year (or group of years) and assume that those rates apply throughout the remander of a person s lfe. Ths means that any future changes to mortalty rates would not be taken nto account. In practce, death rates are lkely to change n the future so perod lfe expectancy does not therefore gve the number of years someone could actually expect to lve. Also, when lookng at specfc geographcal areas, the method makes no allowance for the dfferent areas people may lve n for at least some part of ther lves whch may have dfferent mortalty rates. However, perod lfe expectances are used n ths ndcator because they provde a useful measure of mortalty rates actually experenced over a gven perod and, for past years, provde an objectve means of comparson of the trends n mortalty over tme, between areas of a country and wth other countres. A cohort lfe expectancy s calculated usng a combnaton of observed mortalty rates for past years and projectons about mortalty rates for a group of people born n a certan year n future years. Cohort lfe expectances are thus regarded as a more approprate measure of how long a person would be expected to lve than perod lfe expectances. Cohort lfe expectances are commonly found n ONS publcatons but they are not used n the NHS OF ndcator fles. For example, perod lfe expectancy at age 75 n 2013 would be worked out usng the mortalty rate for age 75 n 2013, for age 76 n 2013, for age 77 n 2013, and so on. Cohort lfe expectancy at age 75 n 2013 would be worked out usng the mortalty rate for age 75 n 2013, for age 76 n 2014, for age 77 n 2015, and so on. Calculaton Lfe tables are calculated for males and females separately. Combned tables are not calculated as the mortalty experence s suffcently dfferent between genders. The fgures are calculated usng the deaths regstered n each calendar year and the md-year populaton estmates. Further nformaton about the methodologes used to create the data sources can be found on the ONS webste usng the lnks above. Users reproducng ONS content should nclude a source accredtaton to ONS Source: Offce for Natonal Statstcs lcensed under the Open Government Lcence v3.0. Deprvaton-related nequalty n lfe expectances Usng the ndcator values for deprvaton decles suppled by ONS, a set of summary measures descrbng deprvaton-related nequalty have been calculated. 21 Copyrght 2018, Health and Socal Care Informaton Centre.

22 NHS Outcomes Framework: 1b - Lfe expectancy at age 75 for. males and. females The slope ndex of nequalty (SII) s a measure of the socal gradent for lfe expectancy,.e. how much do lfe expectances vary between people lvng n dfferent deprvaton decles. It takes account of nequalty across the range of deprvaton decles and summarses ths n a sngle number. Ths represents the dfference n lfe expectancy across the socal gradent from most to least deprved, based on a statstcal analyss of the relatonshp between lfe expectancy and deprvaton across all deprvaton decles. An SII value of 3.0 n the context of ths ndcator shows that the range n lfe expectancy at age 75 across the socal gradent from most to least deprved s 3.0 years. Reducng the SII value s desrable; a value of zero ndcates equalty. SII calculaton The SII s calculated usng populaton-weghted lnear regresson. To allow for dfferences n populaton sze between deprvaton decles, each s gven a rank score based on the mdpont of ts range n the cumulatve dstrbuton of the populaton. The decles are frst ordered from most deprved to least deprved. If decle 1 contans 12% of the populaton, ts rank score would be 12/2=6. If decle 2 ncludes 10% of the populaton, ts rank score would be 12+(10/2)=17. Lfe expectancy s plotted aganst ths rank score and a populatonweghted regresson lne s ftted to the data by the least squares method. The SII s the gradent of the resultng ftted lne. The calculaton of the SII s performed usng the nequaltes calculaton tool suppled by the Assocaton of Publc Health England (PHE) 5. Explctly, the SII s calculated as: Where: SII = wxy ( wx. wy) wx 2 ( wx) 2 w s the percentage of the populaton n the deprvaton group x s the cumulatve proporton of the populaton at the md-pont of the deprvaton group y s the ndcator value of the deprvaton group SII confdence nterval calculaton Confdence ntervals for the slope ndex values are calculated by a smulaton method. The slope ndex value s calculated many tmes, and the confdence ntervals are selected from the resultng dstrbuton of SII values. The lfe expectances for each deprvaton decle for each tme perod and gender are generated 1,000,000 tmes, and SIIs are then calculated for each of these smulatons gvng 1,000,000 SII values for each tme perod and gender combnaton. These are then ranked and the 25,000 th and 975,000 th values are selected as the 95% lower and upper confdence ntervals for the SII respectvely. In order to generate the lfe expectances on whch the SII are based, the standard error of each lfe expectancy ndcator value s calculated as follows: Copyrght 2018, Health and Socal Care Informaton Centre.

23 NHS Outcomes Framework: 1b - Lfe expectancy at age 75 for. males and. females SE = UCI LCI z 2 Where UCI and LCI are the 95% upper and lower confdence ntervals of the lfe expectancy ndcator value respectvely z s the 97.5 percentle pont of the normal dstrbuton A random number generator s then used to generate 1,000,000 random values from a normal dstrbuton wth mean 0 and standard devaton 1. These values b are then used to calculate 1,000,000 lfe expectances LEsm for each deprvaton decle as follows: Where LEsm 1 1,000,000 = LE + SE b 1...1,000,000 LE s the lfe expectancy ndcator value for the respectve deprvaton decle SE s the standard error for the lfe expectancy value An SII s then calculated for each lfe expectancy set usng the SII formula descrbed earler n ths secton. RII calculaton The SII measures the absolute extent of dfference n lfe expectancy between the most and least deprved decles. For example, f lfe expectancy for all deprvaton decles ncreased by 10 per cent, then the SII would ncrease by 10 per cent,.e. the absolute dfference between the most and least deprved decle has wdened. The Relatve Index of Inequalty (RII) provdes a dfferent perspectve on the level of health nequalty by consderng how the level of health nequalty compares wth the overall level of the ndcator. In the example above, where all values ncrease by 10 per cent, the RII would reman constant, ndcatng that although there s a growng nequalty t s the case that the extent of the nequalty s stable when compared to the mean lfe expectancy. An ncrease n the RII value ndcates that the extent of the nequalty s ncreasng as a proporton of the overall ndcator value. A reducton of the RII over tme s therefore desrable. The relatve ndex s calculated as the slope ndex dvded by the mean weghted ndcator value (Y): RII = SII wy Where: 23 Copyrght 2018, Health and Socal Care Informaton Centre.

24 NHS Outcomes Framework: 1b - Lfe expectancy at age 75 for. males and. females w s the percentage of the populaton n the deprvaton group y s the ndcator value The confdence ntervals of the RII are calculated from the SII confdence ntervals as: CI lower RII CI lower = wy CI upper RII CI upper = wy Presentaton Breakdowns Tme perods One-year estmates from 1990 onwards Three-year estmates from onwards Demographc Deprvaton decle: Male and female Geographc England: Local authorty: Regon: Slope ndex of nequalty: Male and female Male and female Male and female Male and female Relatve ndex of nequalty: Male and female Dsclosure control Lfe expectancy fgures are not calculated for Cty of London or Isles of Sclly due to small numbers of deaths and populatons. Ths s denoted by the symbol *. Excel and CSV output Column name Year Perod of coverage Breakdown Level Level descrpton Gender Output Calendar year and 3-year perod 1/1 to 31/12 of respectve perod England, local authorty, regon, deprvaton decle Level of breakdown Descrpton of breakdown category Male or female 24 Copyrght 2018, Health and Socal Care Informaton Centre.

25 NHS Outcomes Framework: 1b - Lfe expectancy at age 75 for. males and. females Indcator value Lower CI Upper CI Populaton SII CI Lower SII CI Upper - SII RII CI Lower RII CI Upper - RII Perod expectatons of lfe (years) Lower lmt of 95% confdence nterval where applcable Upper lmt of 95% confdence nterval where applcable Populaton count aged 75 and over Slope Index of Inequalty 95% lower confdence nterval of SII 95% upper confdence nterval of SII Relatve Index of Inequalty 95% lower confdence nterval of RII 95% upper confdence nterval of RII 25 Copyrght 2018, Health and Socal Care Informaton Centre.

26 NHS Outcomes Framework: 1c Neonatal mortalty and stllbrths 1c Neonatal mortalty and stllbrths (formerly ndcator 1.6.) Indcator assurance Status Date Methodology Revew Group (MRG) recommended Aprl 2011 Indcator Governance Board (IGB) assured Aprl 2011 Overvew Indcator ttle 1c Neonatal mortalty and stllbrths Indcator famly name NHS Outcomes Framework Doman 1: Preventng people from dyng prematurely Overarchng ndcator Outcome sought Reduced neonatal mortalty and stllbrths. Detaled Descrptor Plan Englsh descrpton The number of babes stllborn or dyng before 28 days old for every 1,000 that were born alve or stllborn. Techncal descrpton The number of stllbrths and deaths under 28 days, per 1,000 lve brths and stllbrths. Data sources The natonal and regonal data for England are publshed annually (calendar years) by the Offce for Natonal Statstcs (ONS) n the Chldhood Mortalty publcaton (Natonal Statstcs), avalable approxmately 14 months after the end of the reportng year. The latest data and publcaton can be found here: ulletns/chldhoodnfantandpernatalmortaltynenglandandwales/prevousreleases The age of mother, local authorty and deprvaton data for England are not routnely publshed by ONS and are provded separately n a bespoke fle. 26 Copyrght 2018, Health and Socal Care Informaton Centre.

27 NHS Outcomes Framework: 1c Neonatal mortalty and stllbrths Constructon Introducton Data for ths ndcator are sourced from ONS. Data flters The England numbers excludng non-resdents of England and Wales are selected for the natonal ndcator. Calculaton The raw data are sourced from ONS and the ndcator rates are calculated by NHS Dgtal. The rate s per thousand lve brths and stllbrths. The numerator s the number of stllbrths and deaths under 28 days occurrng durng the year. The denomnator s the number of lve brths and stllbrths occurrng durng the year. A full defnton of each can be found n the orgnal ONS publcatons. The ndcator values are rounded to one decmal place. Neonatal deaths at local authorty, regon, mother s age and deprvaton quntle level whch make up part of ths ndcator s numerator are sourced from a lnked dataset whch ascertans these characterstcs from the brth record. The lnked dataset s a lve system whch s contnuously updated. Users reproducng ONS content should nclude a source accredtaton to the ONS Source: Offce for Natonal Statstcs lcensed under the Open Government Lcence v3.0. Presentaton Breakdowns Tme perods Annual data from 1/1/1999 to 31/12/1999 onwards Demographc Gender: Age: Deprvaton: Male and female level data from 1/1/1999 to 31/12/1999 onwards Age of mother n age bands under 20, 20 to 24, 25 to 29, 30 to 34, 35 to 39 and 40 and over from 1/1/1999 to 31/12/1999 onwards Deprvaton quntles from 1/1/1999 to 31/12/1999 onwards Geographc England: Local authorty: England level data from 1/1/1999 to 31/12/1999 onwards Local authorty level data from 1/1/1999 to 31/12/1999 onwards 27 Copyrght 2018, Health and Socal Care Informaton Centre.

28 NHS Outcomes Framework: 1c Neonatal mortalty and stllbrths Regon: Regon level data from 1/1/1999 to 31/12/1999 onwards Dsclosure control Values for Cornwall and Isles of Sclly and Hackney and Cty of London have been combned and no values are currently suppressed. Ths s n lne wth the ONS Chldhood Mortalty publcaton. Stllbrth values between 0 and 2 (nclusve) and the neonatal mortalty and stllbrth rates based on these, whch were prevously suppressed, were publshed for the frst tme n November Ths s due to an update of the ONS dsclosure control rules: trol/gudanceforbrthanddeathsstatstcs Excel and CSV output Column name Year Perod of coverage Breakdown Level Level descrpton Indcator value Lve brths Stllbrths Neonatal deaths Output The year of coverage The exact dates of coverage England, gender, age of mother, local authorty, regon, deprvaton quntle The level of each breakdown Descrpton of each level Neonatal mortalty and stllbrth rate per 1,000 lve brths and stllbrths The number of lve brths n the tme perod The number of stllbrths n the tme perod The number of neonatal deaths n the tme perod 28 Copyrght 2018, Health and Socal Care Informaton Centre.

29 NHS Outcomes Framework: Under 75 mortalty rate from cardovascular dsease 1.1 Under 75 mortalty rate from cardovascular dsease Indcator assurance Status Date Methodology Revew Group (MRG) recommended Aprl 2011 Indcator Governance Board (IGB) assured Aprl 2011 Overvew Indcator ttle 1.1 Under 75 mortalty rate from cardovascular dsease Indcator famly name NHS Outcomes Framework Doman 1: Preventng people from dyng prematurely Improvement area Reducng premature mortalty from the major causes of death Outcome sought Reduced premature mortalty from cardovascular dsease. Detaled Descrptor Plan Englsh descrpton A measure of the lkelhood of dyng of heart dsease under the age of 75, whch allows for comparsons between populatons wth dfferent age profles and over tme. Techncal descrpton Drectly age-standardsed mortalty rate from cardovascular dsease for people aged under 75. Algnment wth other Outcomes Frameworks Shared wth Publc Health Outcomes Framework Indcator Copyrght 2018, Health and Socal Care Informaton Centre.

30 NHS Outcomes Framework: Under 75 mortalty rate from cardovascular dsease Data sources Denomnator Md-year populaton estmates of the relevant age group and gender, based on the 2011 Census Natonal Statstcs Publshed annually (calendar years) by the Offce for Natonal Statstcs (ONS). Usually avalable n June followng year-end. Numerator Prmary care mortalty database (PCMD) - Managed by NHS Dgtal Bespoke extract taken annually, usually n September each year Standard populaton 2013 European standard populaton, see appendx 3. Constructon Introducton The method used for ths ndcator s drect standardsaton. The mortalty rates are drectly standardsed to the 2013 European Standard Populaton to allow nternatonal comparson. Data felds The data felds and flters used wthn the ONS mortalty data are as follows: CALCULATED_AGE_UNIT CALCULATED_AGE SEX DATE_OF_REGISTRATION LSOA_OF_RESIDENCE_CODE UNDERLYING_CAUSE_OF_DEATH Data Flters 1. Feld Name CALCULATED_AGE_UNIT Condtons Ratonale: When CALCULATED_AGE_UNIT equals 2, 3 or 4 recode age to zero years The calculated age unt s used to specfy whether the CALCULATED_AGE feld refers to years (1), months (2), weeks (3) or days (4) of lfe. 2. Feld Name CALCULATED_AGE 30 Copyrght 2018, Health and Socal Care Informaton Centre.

31 NHS Outcomes Framework: Under 75 mortalty rate from cardovascular dsease Condtons Is between (nclusve): 0 and 74 Ratonale Combned wth the recoded zero ages from CALCULATED_AGE_UNIT selects only those aged under 75 years at the tme of death 3. Feld Name DATE_OF_REGISTRATION Condtons Ratonale Is between 1 January and 31 December of the respectve calendar year nclusve. Selects only those deaths regstered durng the relevant calendar year. 4. Feld Name SEX Condtons Is equal to 1 or 2 Ratonale A vald sex feld s requred when drectly standardsng by age and sex. 5. Feld Name LSOA_OF_RESIDENCE_CODE Condtons Ratonale Is equal to a vald Englsh Lower Super Output Area (LSOA). Ths restrcts data to patents resdent n England. A vald. Englsh LSOA starts wth the letter E. 6. Feld Name UNDERLYING_CAUSE_OF_DEATH Condtons Ratonale ICD-10 codes I00-I99 Selects those whose underlyng cause of death was coded on the death certfcate as cardovascular dsease. Calculaton Denomnator 2011 Census-based md-year populaton estmates for all calendar years. Numerator Number of deaths for whch cardovascular dsease s gven as the underlyng cause of death (ICD-10 I00-I99), regstered n the respectve calendar year(s). The data are based on the orgnal causes of death recorded on the death certfcate rather than the fnal amended causes. Drect Standardsaton The drectly age-standardsed rate s the rate of events that would occur n a standard populaton f that populaton were to experence the age-specfc rates of the subject populaton. Explctly: 31 Copyrght 2018, Health and Socal Care Informaton Centre.

32 NHS Outcomes Framework: Under 75 mortalty rate from cardovascular dsease DSR w r w 100,000 (expressed per 100,000 populaton) w s the number, or proporton, of ndvduals n the standard populaton n age group ; r s the crude age-specfc rate n the subject populaton n age group, gven by: O r n O s the observed number of events n the subject populaton n age group ; n s the number of ndvduals n the subject populaton n age group. The standard populaton used for the drect standardsaton method s the 2013 European Standard Populaton. The age groups used are: 0-4, 5-9,, (for ths ndcator ages 75 and above are not needed). The 2013 European Standard Populaton s detaled n appendx 3. The same standard populaton s used for males, females and persons. Ths means that rates can be compared across gender but also that rates for persons are standardsed for age only, and not for sex. Age group ndcator values are crude rates and not drectly standardsed. Drect standardsaton to the European Standard Populaton s not possble at ths level. Confdence Intervals for Drectly Standardsed Rates (DSRs) 95% confdence ntervals are calculated usng Dobson's 6 and Byar's 7 methods. Byar s method s recommended for larger counts whereas for smaller numerators (less than 389) a more exact method based on the Posson dstrbuton (Dobson s method) s used: 6 Dobson A et al. Confdence ntervals for weghted sums of Posson parameters. Stat Med 1991;10: Breslow NE, Day NE. Statstcal methods n cancer research, volume II: The desgn and analyss of cohort studes. Lyon: Internatonal Agency for Research on Cancer, World Health Organzaton; 1987: Copyrght 2018, Health and Socal Care Informaton Centre.

33 NHS Outcomes Framework: Under 75 mortalty rate from cardovascular dsease DSR lower = DSR 100,000 + Var(DSR) Var(O) (O lower O) DSR upper = DSR 100,000 + Var(DSR) Var(O) (O upper O) O s the total number of observed deaths n the subject populaton w 2 O n 2 Var(DSR) = ( w ) 2 Olower and Oupper are the lower and upper confdence lmts for the observed number of events; When O < 389 then, O lower = χ 2 lower 2 O upper = χ 2 upper 2 χ 2 lower s the 97.5 th percentle value from the χ 2 dstrbuton wth 2O degrees of freedom; χ 2 upper s the 2.5 th percentle value from the χ 2 dstrbuton wth 2O+2 degrees of freedom. When O >= 389 then, Var(O) = O O lower = O (1 1 9O z 3 3 O ) O upper = (O + 1) ( (O + 1) + z 3 O + 1 ) z s the 97.5 th percentle value from the Standard Normal dstrbuton. Confdence Intervals for Crude Rates Where the ndcator values are broken down by age and gender drect standardsaton s not possble and crude rates are calculated nstead. Although stll based on the Dobson s and 33 Copyrght 2018, Health and Socal Care Informaton Centre.

34 NHS Outcomes Framework: Under 75 mortalty rate from cardovascular dsease Byar s method, n these cases 95% confdence ntervals are calculated usng a dfferent methodology: r lower = O lower n r upper = O upper n r s the crude rate and r lower and r upper are the lower and upper confdence lmts for the crude rate; O s the total number of observed deaths n the subject populaton and O lower and O upper are the lower and upper confdence lmts for the total number of observed deaths; n s the number of ndvduals n the subject populaton. The confdence ntervals for the total number of observed deaths are gven by the followng formulas. When O < 389 then, O lower = χ 2 lower 2 O upper = χ 2 upper 2 χ 2 lower s the 97.5 th percentle value from the χ 2 dstrbuton wth 2O degrees of freedom; χ 2 upper s the 2.5 th percentle value from the χ 2 dstrbuton wth 2O+2 degrees of freedom. When O >= 389 then, O lower = O (1 1 9O z 3 3 O ) O upper = (O + 1) ( (O + 1) + z 3 O + 1 ) z s the 97.5 th percentle value from the Standard Normal dstrbuton. Deprvaton breakdown The deprvaton breakdowns for ths ndcator have all been derved usng the 2015 Index of Multple Deprvaton (IMD) scores whch are based on 2011 lower super output area (LSOA) 34 Copyrght 2018, Health and Socal Care Informaton Centre.

35 NHS Outcomes Framework: Under 75 mortalty rate from cardovascular dsease boundares. These data are publshed by the Mnstry of Housng, Communtes & Local Government (MHCLG) department, the latest publcaton can be found here: To create the deprvaton breakdowns, both numerator and denomnator data need to be avalable at LSOA level. Between 2009 and 2011, the numerator (mortalty) data were sourced drectly from ONS and a postcode of resdence was ncluded but LSOA of resdence was not. For these data, NHS Dgtal used a reference table from ONS s open geography portal to derve the LSOA from the postcode. From 2012 onwards, the numerator data were sourced from the NHS Dgtal PCMD, from whch the LSOA of resdence s already ncluded. For the denomnator (populaton) values, data for all years are sourced from ONS at LSOA level. Once all numerator and denomnator data have LSOAs allocated, NHS Dgtal then uses the IMD data publshed by MHCLG to derve the deprvaton decles from the LSOAs. Presentaton Breakdowns Tme perods Annual data from 2003 Demographc Age: 5-year age bands from age 0 to 74 for males, females and all persons (by calendar year) Gender: Male, female and all persons for England and regon from 2003 Deprvaton: Decles from 1- Most deprved to 10 Least deprved for males, females and all persons (by calendar year from 2009) Geographc England: Male, female and all persons from 2003 Male and female by 5-year age bands from age 0 from 2003 Regon: Male, female and all persons from 2003 Dsclosure control No dsclosure control s currently appled to these data, the lowest geography presented s regon level and therefore counts are suffcently large. 35 Copyrght 2018, Health and Socal Care Informaton Centre.