NI Health & Social Care Inequalities Monitoring System Sub-regional Inequalities - HSC Trusts 2010

Transcription

1 NI Health & Social Care Inequalities Monitoring System Sub-regional Inequalities - HSC s 2010 NI Health & Social Care Inequalities Monitoring System Sub-regional Inequalities - HSC s 2010

2 Northern Ireland Health and Social Care Inequalities Monitoring System Sub-regional Inequalities - HSC s 2010 Project Support Analysis Branch, Information Analysis Directorate Department of Health, Social Services and Public Safety Castle Buildings, Belfast, BT4 3SQ Telephone: healthinequalities@dhsspsni.gov.uk For Information on other Government statistics contact: The Northern Ireland Statistics and Research Agency (NISRA) McAuley House, 2-14 Castle Street, Belfast, BT1 1SA Tel: info.nisra@dfpni.gov.uk Crown Copyright Published with the permission of the Controller of Her Majesty s Stationery Offi ce.

3 Contents Northern Ireland Health and Social Care Inequalities Monitoring System Sub-regional Inequalities - HSC s 2010 Page Number Foreword Executive Summary iv v 1 - Introduction and Methodology Health Inequalities Belfast HSC 4 Summary Belfast Health Inequalities Northern HSC 14 Summary Northern Health Inequalities South Eastern HSC 24 Summary South Eastern Health Inequalities Southern HSC 34 Summary Southern Health Inequalities Western HSC 44 Summary Western 52 Appendices 54 Appendix 1 - The most deprived areas 54 Appendix 2 - Summary comparison of inequality gaps over time 57 Appendix 3 - Indicator definitions and methodologies employed 71 iii

4 Foreword Inequalities are a matter of life and death, of health and sickness, of well-being and misery. The fact that [ ] people in different social circumstances experience avoidable differences in health, well-being and length of life is, quite simply, unfair. Creating a fairer society is fundamental to improving the health of the whole population and ensuring a fairer distribution of good health. Inequalities in health arise because of inequalities in society in the conditions in which people are born, grow, live, work and age. Fair Society, Healthy Lives The Marmot Review. While people in general over time have been able to enjoy major social, economic and health improvements that has meant being healthier and living longer than ever before not everyone has been able to avail fully of the benefits of this progress. Unfortunately, social inequality has endured to the extent that health outcomes for some groups remain poorer than for others with the result that smoking, obesity, misuse of drugs and alcohol, teenage conception rates, poor mental health are disproportionally concentrated amongst particular deprived groups. It is also a fact that health inequalities start in early life, lasting not only into old age but can carry forward into subsequent generations. Reducing health inequalities is not solely the responsibility of health departments but is seen as a multifaceted issue that requires coordinated action across government departments. For example a reduction in infant mortality may in part be achieved by better employment and less crowded housing. It is crucial therefore to understand the wider context in which health is shaped. Poor housing, neighbourhood deprivation, limited employment and educational opportunities are powerful drivers of ill health and health inequalities that if they are to be successfully redressed require collective action. The DHSSPS has developed an ambitious programme of work to provide a firm foundation to address health and social care inequality including a detailed monitoring system, the Health and Social Care Inequalities Monitoring System (HSCIMS), to establish the nature and extent of health inequality in Northern Ireland. Currently, the principal measures of health inequalities are life expectancy and infant mortality underpinned by specific measures relating to the gap between the most deprived and the population as a whole, and to mortality from the big killers of circulatory diseases, such as heart disease and stroke, as well as cancers. The regional HSCIMS produces regular annual updates on the extent of inequality experienced by those living in the 20% most deprived areas and that experienced by those living in rural areas when compared with the regional average and monitors these changes over time across a range of mortality, morbidity, accessibility and service utilisation indicators. This information is a key component used to provide evidence to assess the effectiveness of key departmental programmes designed to reduce health inequalities. There is some evidence to suggest that better targeting of evidenced based interventions across the gradient of ill health that affects all but the top group in society is required to effectively tackle inequalities. However, there is still considerable value in an area based approach to inequalities monitoring such as that followed in this report. Highlighting the health inequalities experienced by groups at Health and Social Care area level across the range of indicators included in this analysis further informs our understanding of the wider determinants of health inequality at play within these localities. This information can be used to inform policy and interventions to help create strategies that address the multiple, interconnected factors which create and reinforce inequalities across Northern Ireland. As well as providing an overall picture of health, a number of the HSCIMS indicators focus specifically on the health of children and include smoking during pregnancy, breastfeeding, child obesity, immunisation and infant mortality. This is important since the influence of health at early life and childhood can have a major and profound effect on the health of the individual throughout their life. The challenge for us as information providers is to set out clearly the information and analysis required to target action, monitor progress and shape and inform policy development. This means providing analysis to understand the spatial distribution of health and illness; the demographic and health profile, particularly health status, healthcare needs, behaviours and aspirations of the individuals or groups we are targeting and the key equality gaps experienced by different groups within the communities both in relation to similar groups across NI and within their locality (in this case HSC area). Information presented in the right way can also serve to direct attention to particular groups, areas or conditions by presenting the scale of inequalities and gaps so as to inform where action and resources need to be deployed. The progress that we expect, short, medium and long term as a result of our interventions are best informed by information that clearly sets out the trends and comparisons. I hope you find this report useful and informative and I welcome any comments you may have on the current format and content or indeed ways in which we can improve future publications. Dr Eugene Mooney Director of Information Analysis Directorate DHSSPS iv

5 Executive Summary Executive Summary Health outcomes were generally worse in the most deprived areas within a than the overall area itself. Belfast HSC The largest subregional inequality gaps between the health outcomes experienced in the most deprived areas in Belfast and the itself occurred in alcohol related mortality (103%), self-harm admissions to hospital (96%) and teenage birth rates (93%). In addition, there were still other relatively large inequality gaps cross many areas (14 of all 33 indicators examined for the Belfast showed gaps of 40% or greater). More encouragingly, gaps were relatively small for mood and anxiety disorders, cancer incidence, elective admissions (although this might be an indication of worsening access in the most deprived areas) and infant mortality rates. There were a number of noticeable improvements over recent years in the gaps that existed in Belfast the size of the infant mortality, hospital admission rates (all, emergency and elective), cancer mortality, cancer incidence, mood and anxiety disorders and dental registration rates inequality gaps all declined. Conversely some inequality gaps widened over time, most notably for male life expectancy, respiratory mortality, self-harm admissions, smoking during pregnancy and breastfeeding on discharge from hospital. Northern HSC The largest inequality gaps in the Northern occurred in teenage births (86%), alcohol related deaths (76%) and admission rates to hospital for self-harm (67%). Of the 33 health indicators analysed, 7 showed relatively large gaps (i.e. greater than 40% in magnitude) between the 20% most deprived areas in the Northern and the itself. More than two-thirds of the health indicators analysed showed only relatively small inequality gaps (i.e. less than 20% in magnitude). There were improvements in most of the Northern inequality gaps over time, for instance, the gaps for infant mortality and cancer mortality virtually disappeared. However the relative gaps for male life expectancy, lung cancer incidence, ambulance response times and mood and anxiety disorders all remained fairly consistent over time, while the gaps for suicide and teenage births both increased over the period under review. South-Eastern HSC The largest health inequality gap occurred in alcohol related mortality where the death rate in the most deprived South Eastern areas was almost double (98% higher) that in the wider. There were also large differences in health outcomes for teenage births (77%) and smoking during pregnancy (75%). In all, 6 of the 33 indicators analysed showed relatively large inequality gaps (of greater than 40%). Conversely 20 indicators had relatively small gaps of less than 20% in magnitude with the smallest gaps occurring in outcomes for life expectancy (for both males and females), mood and anxiety disorders, cancer incidence, elective admission rates and childhood immunisation. v

6 Executive Summary For most of the indicators, the inequality gap in the South Eastern area remained broadly constant over time. However there were improvements in the gaps for infant mortality, hospital admission rates (all admissions, emergency admissions, circulatory disease and self harm), cancer mortality, smoking during pregnancy and breastfeeding on discharge from hospital. Gaps for teenage births and amenable mortality actually increased over the period. Southern HSC The largest inequality gaps in the Southern area occurred in alcohol related mortality (94%), self-harm admissions (68%) and smoking during pregnancy (64%). Overall 6 of the 33 indicators analysed in this report showed relatively large inequality gaps of 40% or more whereas two-thirds of the indicators showed relatively small gaps (i.e. less than 20% in magnitude). Over time notable improvements in inequality gaps within the Southern Area occurred in teenage births, suicide and self-harm admissions to hospital. In fact, most of the inequality gaps improved with the exception of female life expectancy, cancer incidence, hospital admissions for circulatory disease, smoking during pregnancy, smoking related mortality and dental registrations which remained fairly constant. Gaps widened for circulatory deaths, alcohol related deaths, amenable deaths and ambulance response times. Western HSC The largest Western inequality gaps occurred in alcohol related mortality (112%) and selfharm admissions (89%), teenage births (76%) and smoking during pregnancy (71%). Overall 7 of the 33 indicators had gaps of 40% or greater. Irrespective of the direction, gaps in 19 of the indicators were of a magnitude of less than 20%. Within the Western, there was a narrowing of the gaps for most of the indicators over time. The most notable reduction (proportional terms) in inequality gaps occurred for circulatory admissions, cancer mortality and lung cancer incidence. The gaps for male life expectancy, elective hospital admissions and alcohol related mortality all remained broadly similar, while those for ambulance response times and suicide widened over their respective periods. vi

7 Introduction and Methodology 1 - Introduction and Methodology This is the fi rst subregional report of the Health and Social Care Inequalities Monitoring System (HSCIMS). It follows on from the third update bulletin of the HSCIMS that was published in October 2009 which presented results at a regional level. The HSCIMS comprises a basket of indicators which are monitored over time to assess area differences in mortality, morbidity, utilisation of and access to health and social care services in Northern Ireland. For the regional analyses, inequalities between the 20% most deprived areas (defi ned using the NISRA 2005 Northern Ireland Multiple Deprivation Measure (NIMDM)) and Northern Ireland as a whole are measured. Health outcomes in rural areas are also compared against Northern Ireland overall. The subregional analyses contained in this report concentrates on the health inequalities that exist at Health and Social Care area level (and also Local Commissioning Groups as their geographical boundaries are coterminous with boundaries). Health outcomes for the 20% most deprived areas (according to the NIMDM) within a are compared with those for the itself. Changes in inequalities gaps are monitored over time. The methodology used in this report follows closely that used for the recent third update bulletin ( update3-2.pdf). There are some minor differences in the calculation of some indicators due to the relatively small numbers found at the more disaggregated level. deprived areas The 20% most deprived areas within each should not be confused with those identifi ed in the regional analyses. The 2005 NISRA Multiple Deprivation Measure was used to rank the Super Output Areas (SOAs) within each area from most deprived to least deprived. The 20% most deprived areas within the were then identifi ed. Therefore in each, some of the areas that are classifi ed as the most deprived would not be included in the most deprived at the Northern Ireland area level (see also Appendix 1). Indicator stability Due to random fl uctuations in events, it is often necessary to aggregate more than one year s data for indicators in order to ensure stability. The number of years of information required to aggregate for each indicator was informed by both the number of events and also an assessment of its annual variability. A number of the indicators included in this report have been age and sex standardised to remove the effects of differences in population structure between areas and across time. The process of standardisation, in applying the demographic structure in one year to other years, or from one area to another introduces a degree of uncertainty around resultant estimates. As a way of quantifying this uncertainty, a 95% confi dence interval is calculated. More events lead to a smaller confi dence interval. Confi dence intervals around indicators are set out in the charts that accompany analysis of each indicator. Throughout this report, differences in standardised rates that are not statistically signifi cant in any given year will not be highlighted. Similarly unless there is a consistent observed trend 1 which strongly suggests a narrowing or widening of an inequality gap, no reference will be made to changes in the gap. Due to the level of disaggregation in the data that is considered in this report, even where indicators are based on an aggregation of a number of year s data, some of the area indicators display a degree of volatility that is not evident in the regional health inequalities comparisons. The reader should view such analyses with a degree of caution. Where there is no clear trend in an indicator, looking at the inequality gap in any individual year, even if that difference is statistically signifi cant, may not give a true picture of the inequalities within that area over time. 1 Even where the difference in the first and last value in a standardised series over time is not statistically signifi cant, the probability of having fi ve or six successive values, each lower (or each higher if the series is increasing) than the previous value, is relatively low. 1

8 Introduction and Methodology Inequality gap Throughout the report, reference is made to the inequality gap for each indicator. This is defi ned as the percentage difference between the health outcomes experienced in the 20% most deprived areas within the with that experienced in the wider overall. A positive gap indicates that the health outcome is relatively worse in the most deprived areas when compared with that for the overall population. Population base HSCIMS indicators are based on a reworked population due to the lack of available up-to-date and suffi ciently detailed small area population fi gures (the 2001 Census of Population being the most recent). Failure to take account of the recent likely growth in population (as witnessed at regional and various sub-regional levels by successive population mid-year estimates) in deprived or rural areas could mean that for some indicators, a problem will be overstated (although if the population in an area is declining then the opposite will be true). To overcome this, a reworked base population 2 is derived which updates the Census small area fi gures by age and gender using age-gender specifi c growth rates for each Local Government District (which have been established from Population MYEs). NISRA intend to publish detailed small area population estimates during 2010 which will be used in the future to infl uence the population base used for both the regional and sub-regional HSCIMS 3. Indicators While most of the indicators included in the last regional update bulletin are included, some indicators have been excluded or produced using a slightly different methodology: Childhood obesity this indicator is excluded due to an insuffi cient run of robust data at the subregional level to produce a meaningful longitudinal analysis Drug related deaths This indicator is currently not included as the number of deaths (even aggregated for 5 years) is too small to support a reliable analysis at the subregional level. Teenage Births In order to provide more robust comparisons, this indicator is reported as a three year average as opposed to the single year fi gure included in the regional HSCIMS. It should also be noted that some of the indicators may have changed slightly at a regional level from that published in the third update bulletin (as data had been provisional at that time). Further details of the defi nitions of all the indicators included in the HSCIMS are presented in Appendix 2. Format of the report inequality analyses are presented in separate chapters in the report. A map of the area with the most deprived areas highlighted in red is presented at the beginning of each chapter. An appendix detailing the changes in inequality gaps over time is included. Where appropriate, 95% confi dence intervals are presented on the graph (as a vertical bar) for each indicator to aid interpretation. Indirectly standardised rates (such as Standardised Mortality Ratios and Standardised Admission Ratios) for both the and its deprived areas are presented on line charts throughout the report. A dotted line representing NI is included to highlight the relative position of health outcomes in other areas (note by defi nition that NI equals ). Directly standardised rates (e.g. Standardised Death Rates) and crude rates (e.g. suicide and teenage births) are also presented throughout this report on line charts. The regional position is 2 The methodology employed in this report to estimate small area population estimates in inter-census years was validated against small area population estimates calculated and used in the production of the Northern Ireland Multiple Deprivation Measure (NISRA 2005). 3 Although initial small area population estimates were published at the end of March 2010, they were not suffi ciently disaggregated to incorperate directly into the HSCIMS. Further work will be undertaken to take account of these estimates on the population base used in the HSCIMS. 2

9 Introduction and Methodology included on each chart as a third line again to allow comparisons between the and the NI average. A summary chart of the most up-to-date inequality gaps is included at the end of each chapter. For ease of understanding, gaps are colour coded into one of six categories; less than 0% (dark green), 0-20% (green), 20-40% (light green), 40-60% (yellow), 60-% (orange) and %+ (red). Appendix 2 presents further charts which detail how the various inequality gaps for each indicator have changed over time. Care should be taken in interpreting the results in this report, for example, a narrowing of some of the gaps in health outcomes included in this report may not always be entirely positive, especially if this occurs in isolation. For instance, a reduction in admission rates to hospital in deprived areas relative to the regional rate might be interpreted as an indication of improved health outcomes in deprived areas. However, if other health outcomes have remained relatively poorer in deprived areas, a reduction in elective admission rates might be attributed, to some degree, to refl ect poorer access within these areas. Reference Year For simplicity, throughout this publication, the reference year presented for each indicator is the most recent year for the time period that it refers to. For example, the 2008 life expectancy fi gures will actually refer to the period as they are based on three year s deaths information. Similarly the Standardised Mortality Ratio is based on fi ve year s data, therefore the 2001 SMR will refer to the period Table 1.1 below sets out the length of period and most recent fi gures available for each indicator (actual reference period is provided in brackets). Table 1.1 Indicator Reference year for each indicator Standardised Mortality Ratio (U75) Infant Mortality Rate Standardised Death Rate (U75) due to Circulatory disease Standardised Death Rate (U75) due to Respiratory disease Standardised Death Rate (U75) due to Cancer Suicide Rates Standardised Death Rate for smoking related deaths Standardised Death Rate for alcohol related deaths Standardised Death Rate for causes amenable to healthcare Life Expectancy (male and female) Potential Years of Life Lost Teenage Birth rates Cancer Incidence Rate Lung Cancer Incidence Rate Reference period (years) Latest figures Five 2008 ( ) Three 2008 ( ) Seven 2006 ( ) Standardised Dental Registration Rate One 2009 Standardised Admission Rate (all, elective and emergency) One 2008/09 Respiratory and Circulatory Admissions Three (2006/ /09) Hospital Admissions for Self-harm Five (2004/ /09) Mood and Anxiety disorders Ambulance Response Times Smoking during pregnancy Breastfeeding on discharge from hospital One 2008 Childhood Immunisations One

10 Belfast HSC Area 4

11 Health Inequalities - Belfast 2.1 Standardised Mortality Ratio (SMR) under Life Expectancy at birth Female 84 SMR U Years Belfast SOAs Belfast NI= Belfast SOAs Belfast NI The likelihood of a person (aged under 75) dying in the Belfast area was consistently higher than for a similar person in NI generally. However, between 2001 and 2008, the SMR fell relative to NI overall in the most deprived areas within Belfast (from 83% to 70% higher) and also the itself (from 18% to 9% higher). The inequality gap remained fairly consistent across the period at around 56% higher in the deprived SOAs. Female life expectancy within the Belfast area grew at a similar rate to NI generally over the period. Female life expectancy within the most deprived areas in the Belfast rose sharply up to 2004 but remained fairly consistent after that. Even though the gap decreased slightly from 4.2 years in 2001 to 3.8 years lower in 2008, the gap in proportionate terms remained around 5% lower. 2.2 Life Expectancy at birth - Male 2.4 Potential Years of Life Lost (PYLL) Years Years Belfast SOAs Belfast NI Belfast SOAs Belfast NI Male life expectancy within the Belfast was consistently lower than the NI average. Although male life expectancy in the most deprived areas rose between 2001 and 2005, it fell back to a similar level to 2001 by Male life expectancy within the whole rose by 0.9 years over the period compared with an increase of 1.6 years in NI overall. The gap between the most deprived areas and the overall itself grew from 6.0 years (8%) lower in 2001 to 6.6 years (9%) in Despite a decline in the average PYLL within the most deprived Belfast areas between 2001 and 2005, it had almost increased back to its 2001 level by The average number of years lost in the wider and NI overall both remained broadly similar across the period. The PYLL in the most deprived areas was twice that in NI overall in 2008.The inequality gap increased slightly from 68% in 2001 to 71% higher in

12 Health Inequalities - Belfast 2.5 Infant Mortality Standardised Admission Rates (SAR) to hospital emergency admissions 170 Infant Mortality Rate SAR /02 02/03 03/04 04/05 05/06 06/07 07/08 08/09 Belfast SOAs Belfast NI Belfast SAOs Belfast trust NI= Despite experiencing a degree of volatility, the infant mortality rate in the most deprived SOAs in Belfast fell from 8.6 in 2001 to 6.8 infant deaths per 1,000 live births in Conversely, the infant mortality rate within the overall Belfast rose over the period from 5.6 in 2001 to 6.3 infant deaths per 1,000 live births in This meant that infant mortality within the Belfast overall went from being similar to NI to more than a fi fth higher by The inequality gap decreased substantially from 54% to 8% over the period. Source: Hospital Inpatients System / Project Support Analysis Branch The emergency SAR in the most deprived areas within the Belfast fell from being 63% higher in 2001/02 to 32% higher than in NI generally in 2008/09. Across the period, the rate within the as a whole was either broadly comparable or slightly lower than the regional SAR. The inequality gap halved from 79% to 39% higher over the period. 2.6 Standardised Admission Rates (SAR) to hospital all admissions Standardised Admission Rates (SAR) to hospital elective admissions 140 SAR /02 02/03 03/04 04/05 05/06 06/07 07/08 08/09 SAR /02 02/03 03/04 04/05 05/06 06/07 07/08 08/09 Belfast SAOs Belfast trust NI= Belfast SAOs Belfast trust NI= Source: Hospital Inpatients System / Project Support Analysis Branch The Standardised Admission Rate (SAR) to hospitals for all admissions for the most deprived areas decreased from being 54% higher than the regional rate in 2001/02 to 23% higher in 2008/09. The SAR in the overall went from 9% higher to 5% lower than in NI. This meant that the inequality gap narrowed from 41% to 29% over the period. Source: Hospital Inpatients System / Project Support Analysis Branch The elective SAR within the Belfast area declined relative to NI overall from being 4% higher in 2001/02 to 12% lower in 2008/09. Similarly, the rate in the most deprived areas within the also declined relatively from 17% higher than the regional SAR to 6% lower in 2008/09. The inequality gap reduced from 13% to 7% over the period. 6

13 Health Inequalities - Belfast 2.9 Standardised Death Rate (SDR) (under 75) circulatory disease 2.11 Standardised Death Rate (SDR) (under 75) cancer Deaths per,000 population Belfast SOAs Belfast NI Deaths per,000 population Belfast SOAs Belfast NI The Standardised Death Rate (SDR) for circulatory diseases declined in all areas over the period, albeit at a slower rate in Belfast and its most deprived areas, than in NI generally. The overall SDR went from being broadly similar to the regional rate in 2001 to 22% higher in Over the period, the inequality gap remained fairly consistent and was 55% higher in deprived areas in Cancer mortality in the most deprived SOAs in the Belfast fell by 8% between 2001 and 2008 to reach deaths per,000 population. This was broadly in line with the proportionate decrease in the cancer death rate in NI as a whole. In contrast, there was little movement in the overall SDR over the period. Therefore there was a narrowing of the inequality gap from 43% in 2001 to 30% in Standardised Death Rate (SDR) (under 75) respiratory disease Deaths per,000 population Belfast SOAs Belfast NI Respiratory mortality fell across all areas between 2001 and 2005 before seemingly levelling off thereafter. Mortality rates in the most deprived areas within the Belfast were consistently more than twice those in NI generally. Across the period the inequality gap rose from 66% higher in 2001 in deprived areas to 76% higher in Cancer incidence rates SIR All cancer Belfast SAOs Belfast trust NI= Source: Northern Ireland Cancer Registry / Project Support Analysis Branch The Standardised Incidence Rate (SIR) declined relative to NI in both Belfast and its most deprived areas over the period. The deprived SIR fell from being 50% to 24% higher than in the region generally. The overall incidence rate decreased from being 28% higher to 17% higher than in NI overall. Consequently the inequality gap reduced from 17% in 1999 to 6% higher in

14 Health Inequalities - Belfast 2.13 Lung cancer incidence rates 2.15 Teenage Births SIR Lung cancer Births per 0 females Belfast SOAs Belfast NI= Belfast SOAs Belfast NI Source: Northern Ireland Cancer Registry / Project Support Analysis Branch Lung cancer incidence continued to be substantially higher in both Belfast and its most deprived areas than in NI generally despite a relative improvement over the period. The inequality gap reduced slightly from 69% in 1999 to 65% in Between 2003 and 2008 average teenage birth rates remained fairly consistent across all areas. Across the period, the teenage birth rate in the most deprived Belfast areas was two and a half times the regional average rate and almost twice the overall rate. The inequality gap rose slightly from % in 2003 to 93% in Suicide Standardised Admission Ratio to hospital respiratory disease 1 Deaths per,000 population SAR /00 01/02 00/01 02/03 01/02 03/04 02/03 04/ /04 05/ /05 06/ /06 07/ /07 08/09 Belfast SOAs Belfast NI Belfast SOAs Belfast NI= Between 2001 and 2008, the suicide rate in the Belfast and in most deprived areas increased by a half (most noticeably from 2005 onwards). This compared with an increase of 45% in the regional death rate. The inequality gap remained fairly similar over the period at around two-thirds higher in the most deprived areas. Source: Hospital Inpatients System / Project Support Analysis Branch Over the period, the SAR for respiratory disease in the Belfast and its most deprived areas both fell relative to NI. By 2008/09, the most deprived areas was 34% higher and the overall was 6% lower than the NI average. The inequality gap remained fairly steady at around two-fifths higher in deprived areas across the period. 8

15 Health Inequalities - Belfast 2.17 Standardised Admission Ratio to hospital circulatory disease 2.19 Breastfeeding on discharge from hospital 4 SAR % /00 01/02 00/01 02/03 01/02 03/04 02/03 04/05 03/04 05/06 04/05 06/07 05/06 07/08 06/07 08/09 Belfast SOAs Belfast NI= Belfast SOAs Belfast NI Source: Hospital Inpatients System / Project Support Analysis Branch Circulatory admissions in the Belfast steadily declined from 5% higher to 12% lower than in NI. The admission rate in the most deprived Belfast SOAs declined sharply relative to the NI average up to 2005/06, but remained fairly consistent after that. This might indicate worsening access within the Belfast especially in light of its continuing higher mortality due to circulatory disease than regionally. The inequality gap remained around a quarter higher in deprived areas over the period. Source: Child Health System / Project Support Analysis Branch Although the proportion of mothers that were breastfeeding on discharge from hospital in the Belfast increased from 39.9% to 41.0% between 2005 and 2008, the rate did not grow as quickly as the regional rate. Over the same period, the proportion in the most deprived areas within the fell slightly from 18.7% to 17.6% which meant that the inequality gap increased from 53% to 57% Admissions to hospital for self-harm 2.20 Smoking during pregnancy SAR /00 03/ /01 04/ /02 05/06 02/03 06/07 03/04 07/08 04/05 08/09 Belfast SOAs Belfast NI= % Belfast SOAs Belfast NI Source: Hospital Inpatients System / Project Support Analysis Branch The self-harm SAR in both the Belfast and its most deprived areas increased relative to the NI average across the period. By 2008/09, the admission rate for self-harm in the most deprived areas in Belfast was three times the regional admission rate and almost double the overall rate. The inequality gap increased from % in 2003/04 to 94% in 2008/09. Source: Child Health System / Project Support Analysis Branch Although the proportion of mothers that smoked during their pregnancy fell in the most deprived Belfast areas from 46.3% in 2005 to 44.2% in 2008, the declines experienced in the wider and NI generally were proportionately larger. The inequality gap therefore rose over the period from 59% to 78%. 4 The 2008 fi gures have been revised since the publication of the 3rd update bulletin. 9

16 Health Inequalities - Belfast 2.21 Smoking related deaths 2.23 Deaths amenable to healthcare Deaths per,000 popula on Deaths per,000 population Belfast SOAs Belfast NI Belfast SOAs Belfast NI There was little change in smoking related mortality across all areas. As a result the Standardised Death Rate in Belfast remained more than a quarter higher than the regional rate. The Inequality gap also remained fairly steady and stood at 52% in Amenable mortality is that which could theoretically be averted by good health care. The amenable mortality rate declined across all areas between 2005 and However the death rate in Belfast increased from being 20% to 24% higher than the NI rate. The inequality gap increased from 40% in 2005 to 45% higher in Alcohol related deaths 2.24 Ambulance response times Deaths per,000 population Minutes Belfast SOAs Belfast NI Belfast SOAs Belfast NI Over the period the increase in alcohol related mortality within the Belfast and its most deprived areas (2% and 3% respectively) grew at a slower rate than in NI overall (10% increase). Despite this, the alcohol related death rate in Belfast was still 69% higher than in NI in The SDR in deprived areas was consistently double that in the overall across the period. Source: NI Ambulance Service / Project Support Analysis Branch Ambulance response times within Belfast and its most deprived areas were consistently better than the NI average. The average response time in NI improved by around a fi fth between 2004 and Average response times in both Belfast and its most deprived areas improved by around 15%. The inequality gap remained around 10% better in deprived areas over the period. 10

17 Health Inequalities - Belfast 2.25 Childhood immunisations Dental Registrations % Dip Polio Tet MenC Hib3 MMR Whp Dip Polio Tet MenC Hib3 MMR 2004/ /08 Belfast SOAs Belfast Whp Standard Dental Registration Belfast SOAs Belfast NI = Source: Child Health System / Project Support Analysis Branch With the exception of Pertussis, the proportion of children that had been fully immunised fell in the most deprived areas within the Belfast area between 2004/05 and 2007/08. In 2004/05 the immunisation rates within the most deprived areas were slightly higher than in the overall while the opposite was true in 2007/08. Source: Business Services Organisation / Project Support Analysis Branch There was relatively little difference between dental registration rates in Belfast as a whole and NI generally. The dental registration rate was consistently lower in the most deprived areas in Belfast, however the inequality gap improved from 15% in 2003 to 9% lower in Mood and Anxiety disorders 15 % Belfast SOAs Belfast NI Source: Business Services Organisation / Project Support Analysis Branch Between 2004 and 2006, the proportion of the population with a mood and anxiety disorder within the most deprived Belfast areas was substantially higher (almost a fi fth) than that in the wider overall. However, in 2007 and 2008, the proportions of persons within Belfast and its most deprived areas both converged with the rising proportion of those with a mood or anxiety disorder in NI overall. 5 The percentage of children receiving immunisation for Diphtheria (Dip), Polio, Tetanus (Tet), Pertussis or Whooping Cough (Whp), Haemophilus Infl uenzae Type b (Hib3), Meningitis C (MenC) and Measles-Mumps-Rubella (MMR) before reaching their second birthday. 11

18 Summary Health Inequalities - Belfast 2.28 Inequality gaps the relative deprived position Alcohol related deaths Self harm Teenage Births Smoking during pregnancy SDR respiratory PYLL Suicide Lung cancer incidence Breastfeeding on discharge SMR SDR circulatory Smoking related deaths Amenable mortality SAR respiratory Std Admission emergency SDR cancer Std Admission all SAR circulatory Dental registrations Life expectancy male Infant Mortality Std Admission elective Cancer incidence Life expectancy female Hib3 MMR Polio Whp Tet Dip Mood & anxiety disorder MenC Ambulance response 20% 0% 20% 40% 60% % % % The largest subregional inequality gaps between the health outcomes experienced in the most deprived areas in Belfast and the itself occurred in alcohol related mortality (103%), self-harm admissions to hospital (96%) and teenage birth rates (93%). There were also other relatively large inequality gaps cross many areas (14 of all 33 indicators (42%) examined for the Belfast showed gaps of 40% or greater). More encouragingly, gaps were relatively small for mood and anxiety disorders, cancer incidence, elective admissions (although this might be an indication of worsening access in the most deprived areas) and infant mortality rates. Although male and female life expectancy gaps were small in proportion, the gaps for the Belfast were relatively large compared with the regional inequality gap (see third update bulletin) and those in other s. Appendix 2 sets out the change in inequality gaps over time. There were a number of noticeable improvements over recent years in the gaps that existed in Belfast infant mortality, hospital admission rates (all, emergency and elective), cancer mortality, cancer incidence, mood and anxiety disorders and dental registration rates. Conversely inequality gaps widened over time, most notably for male life expectancy, respiratory mortality, self-harm admissions, smoking during pregnancy and breastfeeding on discharge from hospital. 12

19 13

20 Northern HSC Area 14

21 Health Inequalities - Northern 3.1 Standardised Mortality Ratio (SMR) under Life Expectancy at birth Female 83 SMR U Years Northern SOAs Northern NI= Northern SOAs Northern NI= The likelihood of a person (aged under 75) dying in the Northern area was consistently lower (around 6-7% between 2001 and 2008) than for a similar person in NI generally. Over the period, the SMR fell in Northern deprived areas relative to NI overall (from 25% to 17% higher). Therefore the inequality gap improved from more than a third to around a quarter higher in the most deprived SOAs. Female life expectancy within the Northern area grew at a similar rate to NI generally over the period. Female life expectancy within the most deprived areas in the Northern however rose sharply up to 2005 but levelled off afterwards. The inequality gap almost halved from 1.9 years (2%) lower in 2001 to 1.0 years (1%) in Life Expectancy at birth - Male 3.4 Potential Years of Life Lost (PYLL) 9 Years Years Northern SOAs Northern NI= Northern SOAs Northern NI Male life expectancy within the Northern was consistently higher than the NI average. Male life expectancy in the most deprived areas within the Northern rose between 2001 and 2005 but levelled off thereafter. Over the period, it increased by 1.9 years. Similarly, male life expectancy within the generally increased by 2.0 years over the period. This compared with a 1.6 year increase in NI as a whole. The inequality gap remained fairly constant over the period. The average number of life years lost within the most deprived Northern areas declined from 7.8 years lost per persons in 2001 reaching a low of 6.3 years lost in 2005, before increasing back to 7.3 years lost per persons in Whereas the trend within the wider (and also NI overall) was that the average number of years lost remained broadly similar across the period. The inequality gap decreased slightly from being 39% higher within the most deprived areas in 2001 to 35% higher in

22 Health Inequalities - Northern 3.5 Infant Mortality Standardised Admission Rates (SAR) to hospital emergency admissions 135 Infant Mortality Rate SAR /02 02/03 03/04 04/05 05/06 06/07 07/08 08/09 Northern SOAs Northern NI Northern SOAs Northern NI= Between 2001 and 2008, there was a gradual decline in the infant mortality rate in the Northern from 5.3 to 4.2 deaths per 1,000 live births. The infant mortality rate in the most deprived areas within the Northern area fell steeply over the period to reach a similar level to the overall. By 2008, the rates within both the Northern and its most deprived areas were around a fi fth lower than in NI overall. Source: Hospital Inpatients System / Project Support Analysis Branch The emergency admission rate in the Northern was lower than the regional rate up to 2005/06 but was fairly similar after that. Within the most deprived areas in the, despite some fl uctuation, the emergency SAR fell from being 17% higher than the NI rate in 2001/02 to 10% higher in 2008/09. The inequality gap narrowed from 21% to 11% over the period. 3.6 Standardised Admission Rates (SAR) to hospital all admissions Standardised Admission Rates (SAR) to hospital elective admissions 135 SAR SAR /02 02/03 03/04 04/05 05/06 06/07 07/08 08/ /02 02/03 03/04 04/05 05/06 06/07 07/08 08/09 Northern SOAs Northern NI= Source: Hospital Inpatients System / Project Support Analysis Branch Despite some fl uctuation, the Standardised Admission Ratio for all admissions in the most deprived areas in the Northern area remained reasonably steady at around 10-12% higher than in NI overall. The admission rate in the overall increased slightly over the period from being 2% lower in 2001/02 to 4% higher than the NI average in 2008/09. As a consequence, the inequality gap narrowed from 13% to 8% over the period. Northern SOAs Northern NI= Source: Hospital Inpatients System / Project Support Analysis Branch The trend in the SAR in the Northern and its most deprived areas followed broadly the same pattern with a large increase between 2005/06 and 2006/07 and a period of relative levelling off thereafter. By 2008/09, the SAR in the most deprived areas was broadly similar to that in the wider overall. 16

23 Health Inequalities - Northern 3.9 Standardised Death Rate (SDR) (under 75) circulatory disease Deaths per,000 population The Standardised Death Rate fell consistently across all areas. Circulatory mortality within the Northern was consistently slightly lower than in NI generally. The SDR declined faster in the most deprived SOAs which meant that the inequality gap fell over the period from 35% to 21% Northern SOA s Northern NI 3.11 Standardised Death Rate (SDR) (under 75) cancer Deaths per,000 population Northern SOA s Northern NI Between 2001 and 2008, cancer mortality declined by almost a quarter within the most deprived areas in the Northern. The cancer death rate also fell in NI but at a slower rate whilst the death rate in the Northern as a whole remained broadly similar over the same period. Towards the end of the period there was little difference in cancer mortality across all areas Standardised Death Rate (SDR) (under 75) respiratory disease Cancer incidence rates 125 Deaths per,000 population Northern SOA s Northern NI SIR Northern SOAs Northern NI= The standardised death rate due to respiratory disease decreased across all areas albeit at different rates. Respiratory mortality fell by 31% in NI as a whole. Within the Northern and its most deprived areas, mortality fell at a slower rate with decreases of 25% and 29% respectively. This meant that by 2008, the death rates in the Northern and NI were broadly similar. The inequality gap narrowed from 58% in 2001 to 49% in Source: Northern Ireland Cancer Registry / Project Support Analysis Branch Over the period, cancer incidence within the most deprived areas in the Northern remained broadly similar relative to NI as a whole. Whereas, by 2006, the all cancer Standardised Incidence Rate within the Northern increased from 9% to 2% lower than the regional rate. The inequality gap therefore narrowed from 19% in 1999 to 9% in

24 Health Inequalities - Northern 3.13 Lung cancer incidence rates 3.15 Teenage Births SIR Lung cancer Births per 0 females Northern SOAs Northern NI= Source: Northern Ireland Cancer Registry / Project Support Analysis Branch Over the period lung cancer incidence increased in both the Northern and its most deprived areas relative to NI generally. By 2006, incidence was 42% higher in the most deprived areas and 11% lower in the as a whole than in NI. Lung cancer incidence remained around three-fi fths higher in the most deprived areas than in the wider between 1999 and Northern SOAs Northern NI The average teenage birth rate in the most deprived Northern areas, increased over the period (mainly due to a sharp increase between 2007 and 2008) to reach 27.9 births per 1,000 females by In the wider, the average teenage birth rate declined slightly over the period from 15.4 to 15.0 births per 1,000 females. The inequality gap rose over the period from 75% to 86% Suicide Standardised Admission Ratio to hospital respiratory disease 125 Deaths per,000 population Northern SOAs Northern NI SAR /00 01/ /01 02/ /02 03/ /03 04/ Northern SOAs Northern NI = 03/04 05/ /05 06/ /06 07/ /07 08/09 Suicide within the Northern was consistently lower than in NI overall (although the rate grew at a faster rate (56%) than regionally (45%) over the period). Within the most deprived areas, a sharp increase in the rate between 2005 and 2008 (70%) meant that the inequality gap increased over the period from 15% in 2001 to 44% in Source: Hospital Inpatients System / Project Support Analysis Branch Admissions for respiratory disease followed a broadly similar pattern in the Northern and its most deprived areas, falling between 2001/02 and 2004/05, followed by a period of sharp increase before starting to level off. Admissions within the went from 11% lower than the NI rate in 2001/02 to 4% higher in 2008/09 whilst the admission rate in the most deprived areas increased relatively from 7% to 11% higher. The inequality gap narrowed from 20% to 7% over the period. 18

25 Health Inequalities - Northern 3.17 Standardised Admission Ratio to hospital circulatory disease Breastfeeding on discharge from hospital 6 55 SAR /00 01/ /01 02/03 01/02 03/ /03 04/05 03/04 05/ /05 06/07 05/06 07/08 06/07 08/09 Northern SOAs Northern NI= % Northern SOAs Northern NI Source: Hospital Inpatients System / Project Support Analysis Branch The standardised admission rate for circulatory disease decreased from 20% higher than the NI rate in 2001/02 to 7% higher in 2004/05, but by 2008/09 had risen back to 15% higher. By contrast, admissions within the Northern had moved from being 4% to 8% higher over the period. The inequality gap decreased from 15% to 6%. Source: Child Health System / Project Support Analysis Branch The proportion of mothers that were breastfeeding on discharge from hospital increased by more than a quarter over the period in the most deprived areas in the Northern. This compares with a 4% rise in the population in the overall (and an 8% increase in NI as a whole). Consequently the Inequality Gap narrowed from 33% to 18% Admissions to hospital for self-harm 3.20 Smoking during pregnancy SAR % /00 03/04 00/01 04/05 01/02 05/06 02/03 06/07 03/04 07/08 04/05 08/ Northern SOAs Northern NI= Northern SOAs Northern NI Source: Hospital Inpatients System / Project Support Analysis Branch The standardised admission rate for self-harm within the Northern remained fairly constant relative to the NI rate over the period despite a fall between 2003/04 and 2005/06. The self-harm admission rate within the most deprived areas declined relatively from 37% to 27% higher than the regional rate. The inequality gap fell slightly over the period from % to 67%. Source: Child Health System / Project Support Analysis Branch The proportion of mothers that smoked during pregnancy in the most deprived Northern areas fell from 32.8% in 2005 to 26.6% in Overall there was a small decrease in the overall. The inequality gap narrowed from 74% to 49% over the period. 6 The 2008 figures have been revised since the publication of the 3rd update bulletin. 19

26 Health Inequalities - Northern 3.21 Smoking related deaths Deaths amenable to healthcare 125 Deaths per,000 population Deaths per,000 population Northern SOAs Northern NI Northern SOA s Northern NI The smoking related death rate within the Northern remained broadly similar to that in NI as a whole. Although smoking related mortality only decreased slightly over the period across all areas, the largest proportionate fall occurred in the most deprived Northern areas. The inequality gap decreased slightly from 22% in 2005 to 18% in Amenable mortality (that which could theoretically be averted by good health care) declined across all areas between 2005 and The death rate within the most deprived areas within the Northern fell from in 2005 to 88.8 deaths per,000 population in 2008 (a decrease of nearly a fi fth). Amenable mortality rates fell by around 10% in both the Northern and NI overall. By 2008, amenable mortality was broadly similar across all areas Alcohol related deaths 3.24 Ambulance response Deaths per,000 population Minutes Northern SOAs Northern NI Northern SOAs Northern NI Alcohol related mortality increased over the period across all areas. The alcohol related death rate within the Northern grew by 19% over the period. This compared with rises of 10% and 11% respectively in the regional and most deprived area death rate. The inequality gap fell from 88% in 2005 to 76% in Source: NI Ambulance Service / Project Support Analysis Branch There were improvements in ambulance response times across all areas. The response times with deprived areas were better than in the Northern overall and were generally on a par with the regional average. Across the period the inequality gap remained fairly consistent at around 12% lower in the most deprived areas. 20

27 Health Inequalities - Northern 3.25 Childhood immunisations Dental Registrations 115 % Dip Polio Tet MenC Hib3 MMR Whp Dip Polio Tet MenC Hib3 2004/ /08 MMR Whp Standard Dental Registration Northern SOAs Northern Northern SOAs Northern NI = Source: Child Health System / Project Support Analysis Branch Over the period, with the exception of MMR (which fell from 93% to 91%) and Meningitis C (which remained broadly consistent), immunisation rates increased within the Northern. In 2004/05, immunisation rates were slightly higher in the overall Northern area than its most deprived areas however by 2007/08 the rates were broadly similar. Source: Business Services Organisation / Project Support Analysis Branch Dental registration in the overall Northern increased from 6% to 9% higher than the overall Northern Ireland average. The dental registration rate also rose for the most deprived areas from 3% lower to 4% higher than the regional registration rate. The inequality gap narrowed from 9% in 2003 to 5% in Mood and Anxiety disorders % Northern SOAs Northern NI Source: Business Services Organisation / Project Support Analysis Branch The proportion of the population that were suffering from a mood or anxiety disorder increased over the period in all areas. The proportion of the population with a mood and anxiety disorder in the most deprived areas in the Northern increased from 8.7% to 11.9%. Similarly the proportion increased in the overall (from 8.5% to 11.5%) and was on a par with the proportion in NI as a whole by the end of the period. The inequality gap remained relatively small at around 2-3% across the period 7 The percentage of children receiving immunisation for Diphtheria (Dip), Polio, Tetanus (Tet), Pertussis or Whooping Cough (Whp), Haemophilus Infl uenzae Type b (Hib3), Meningitis C (MenC) and Measles-Mumps-Rubella (MMR) before reaching their second birthday. 21

28 Summary Health Inequalities - Northern 3.28 Summary of Northern inequality gaps Teenage Births Alcohol related deaths Self harm Lung cancer incidence Smoking during pregnancy SDR respiratory Suicide PYLL SMR SDR circulatory Smoking related deaths Breastfeeding on discharge Std Admission emergency Cancer incidence Amenable mortality Std Admission all SAR respiratory SAR circulatory Dental registrations Mood & anxiety disorder Life expectancy male Std Admission elective Life expectancy female SDR cancer Infant Mortality Whp Tet Dip Polio Hib3 MMR MenC Ambulance response 20% 0% 20% 40% 60% % % % The largest inequality gaps in the Northern occurred in teenage births (86%), alcohol related deaths (76%) and admission rates to hospital for self-harm (67%). Of the 33 health indicators analysed, 7 showed relatively large gaps (i.e. greater than 40% in magnitude) between the 20% most deprived areas in the Northern and the itself. More than two-thirds of the health indicators analysed showed only relatively small inequality gaps (i.e. less than 20% in magnitude). Ambulance response times were actually better in deprived areas than the overall and therefore are reported above as a negative inequality gap. There were improvements in most of the Northern inequality gaps over time (see Appendix 2), for instance, the gaps for infant mortality and cancer mortality virtually disappeared. However the relative gaps for male life expectancy, lung cancer incidence, ambulance response times and mood and anxiety disorders all remained fairly consistent over time, while the gaps for suicide and teenage births both increased over the period under review. 22

29 23

30 South Eastern HSC Area 24

31 Health Inequalities - South Eastern 4.1 Standardised Mortality Ratio (SMR) under Life Expectancy at birth Female 84 SMR U Years South Eastern SOAs South Eastern NI= South Eastern SOAs South Eastern NI By 2008, the likelihood of a person aged under 75 dying within the most deprived areas in the South Eastern area was more than a quarter higher than for a similar person in NI generally. The SMR in the overall remained fairly consistent relative to NI as a whole (around 8 to 9% lower). The inequality gap rose from 33% to 37% over the period. With the exception of 2005 and 2006, female life expectancy in the most deprived areas was fairly similar to that in the South Eastern as a whole across the period. Between 2001 and 2008 the female life expectancy increased by 1.5 years in both the and the most deprived areas as well as NI as a whole. 4.2 Life Expectancy at birth - Male 4.4 Potential Years of Life Lost (PYLL) 9 Years Years South Eastern SOAs South Eastern NI South Eastern SOAs South Eastern NI Between 2001 and 2008, male life expectancy within the most deprived South Eastern areas increased by 2.3 years. This compared with an increase of 2.2 years in the overall and 1.6 years in NI as a whole. The inequality gap remained fairly consistent at around 3 years (4%). The PYLL, despite some fl uctuation, within the most deprived areas in the South Eastern area improved over the period from 7.5 in 2001 to 7.0 years lost per persons. The PYLL also improved in the as a whole from 5.6 to 5.2 years lost per persons. This meant that the inequality gap remained broadly similar and stood at 35% in

32 Health Inequalities - South Eastern 4.5 Infant Mortality Standardised Admission Rates (SAR) to hospital emergency admissions 135 Infant Mortality Rate SAR /02 02/03 03/04 04/05 05/06 06/07 07/08 08/09 South Eastern SOAs South Eastern NI South Eastern SOAs South Eastern NI = After a sharp rise between 2002 and 2004, the infant mortality rate declined steadily in the deprived areas to reach 5.6 infant deaths per 1,000 live births in The infant mortality rate in both the South Eastern and NI as a whole remained broadly similar decreasing steadily over the period. The inequality gap decreased from 29% in 2001 to 8% in Source: Hospital Inpatients System / Project Support Analysis Branch Emergency admission rates in both the South Eastern and its most deprived areas followed a similar pattern relative to overall emergency admissions in NI. Across the period emergency admissions in deprived areas fell from 17% in 2001/02 to 7% higher in 2008/09 than the NI rate. Despite a fall between 2001/02 and 2003/04, increases in admissions in the overall from 2006/07 onwards meant that there was little change over the period. The inequality gap narrowed from 27% to 18%. 4.6 Standardised Admission Rates (SAR) to hospital all admissions Standardised Admission Rates (SAR) to hospital elective admissions 125 SAR SAR /02 02/03 03/04 04/05 05/06 06/07 07/08 08/ /02 02/03 03/04 04/05 05/06 06/07 07/08 08/09 South Eastern SOAs South Eastern NI= South Eastern SOAs South Eastern NI= Source: Hospital Inpatients System / Project Support Analysis Branch The admission rate within the most deprived South Eastern SOAs fell relative to that in NI overall from being 9% higher in 2001 to 4% higher in By contrast the relative SAR in the overall area increased slightly from 11% to 8% lower than the regional rate. In terms of the inequality gap, it narrowed from 22% in 2001/02 to 13% in 2008/09. Source: Hospital Inpatients System / Project Support Analysis Branch Over the period the elective admission rate in both the South Eastern and its most deprived areas declined relative to the NI rate. By the end of the period the admission rates were broadly similar at around 11-12% lower than the regional elective admission rate. 26

33 Health Inequalities - South Eastern 4.9 Standardised Death Rate (SDR) (under 75) circulatory disease Deaths per,000 population Across the period, circulatory mortality has been falling in all areas. The death rate within the South Eastern overall decreased by 36% (which compared with similar declines of 38% and 36% within the most deprived areas and NI as a whole respectively). The death rate within the overall was lower than in both its most deprived areas and NI overall. The inequality gap decreased from 38% in 2001 to 35% in South Eastern SOAs South Eastern NI 4.11 Standardised Death Rate (SDR) (under 75) cancer Deaths per,000 population South Eastern SOAs South Eastern NI Cancer mortality decreased fairly steadily across all areas over the period. The death rate in the most deprived areas in the South Eastern decreased at a slightly faster rate (-12%) than in the overall (-6%) which resulted in the inequality gap falling from 22% in 2001 to 15% in Standardised Death Rate (SDR) (under 75) respiratory disease 4.12 Cancer incidence rates 115 Deaths per,000 population SIR South Eastern SOAs South Eastern NI South Eastern SOAs South Eastern NI= Respiratory mortality in the most deprived areas in the South Eastern fell across the period (most notably between 2004 and 2006) from 56.2 in 2001 to 33.1 deaths per,000 population (a decrease of 41%). The death rate in the as a whole remained broadly similar to that in NI generally. Both rates fell by nearly a third to reach 25.9 and 27.1 deaths per,000 population respectively in Overall the inequality gap almost halved from 52% to 28%. Source: Northern Ireland Cancer Registry / Project Support Analysis Branch Cancer incidence within the South Eastern and its most deprived areas remained broadly similar to the regional incidence rate across the period. 27

34 Health Inequalities - South Eastern 4.13 Lung cancer incidence rates 4.15 Teenage Births SIR Lung cancer % South Eastern SOAs South Eastern NI= South Eastern SOAs South Eastern NI Source: Northern Ireland Cancer Registry / Project Support Analysis Branch Over the period, lung cancer incidence decreased in the South Eastern from 10% to 17% lower than the regional rate. There was also a small relative decline in the lung cancer incidence rate in the most deprived areas. The inequality gap increased slightly from 52% in 1999 to 55% in There was little change in the teenage birth rates across all areas over the period. The average teenage birth rate in the South Eastern was slightly lower than the overall NI average. The inequality gap rose slightly from 72% in 2003 to 77% in Suicide Standardised Admission Ratio to hospital respiratory disease 125 Deaths per,000 population SAR South Eastern SOAs South Eastern NI 99/00 01/02 00/01 02/03 01/02 03/04 02/03 04/05 03/04 05/06 04/05 06/07 05/06 07/08 06/07 08/09 South Eastern SOAs South Eastern NI= The suicide trend within the South Eastern did not mirror that in the wider region and only increased by 14% over the period to reach 10.5 deaths per,000 population. Similarly despite some fl uctuation, the rate within the most deprived areas in the increased by 17% to reach 15.9 deaths per,000 population. In contrast, the suicide rate increased by 45% in NI between 2001 and The inequality gap remained around 50% across the period. Source: Hospital Inpatients System / Project Support Analysis Branch Respiratory admission rates remained fairly consistent across the period compared with the overall NI rate in both the and its most deprived areas. The inequality gap therefore remained relatively steady across the period at just over a fi fth higher in the most deprived areas. 28

35 Health Inequalities - South Eastern 4.17 Standardised Admission Ratio to hospital circulatory disease 4.19 Breastfeeding on discharge from hospital SAR % /00 01/02 00/01 02/03 01/02 03/04 02/03 04/05 03/04 05/06 04/05 06/07 05/06 07/08 06/07 08/09 South Eastern SOAs South Eastern NI= South Eastern SOAs South Eastern NI Source: Hospital Inpatients System / Project Support Analysis Branch Hospital admission rates for circulatory disease in the overall South Eastern increased relatively from 7% to 3% below the NI average. Within the most deprived areas the relative admission rate remained broadly similar. As a result, the inequality gap closed from 17% in 2001/02 to 10% in 2008/09. Source: Child Health System / Project Support Analysis Branch There was an 8% increase in the population of mothers that were breastfeeding when discharged from hospital in the most deprived South Eastern areas. This compared with a 2% increase in the South Eastern overall. The Inequality gap reduced from 37% in 2005 to 33% in Admissions to hospital for self-harm Smoking during pregnancy SAR % /00 03/04 00/01 04/05 01/02 05/06 02/03 06/07 03/04 07/08 04/05 08/09 South Eastern SOAs South Eastern NI= South Eastern SOAs South Eastern NI Source: Hospital Inpatients System / Project Support Analysis Branch The admission rate to hospitals for self-harm increased relatively in the overall South Eastern from 28% lower than the NI rate in 2003/04 to 12% lower in 2008/09. The admission rate in the most deprived SOAs remained fairly steady in comparison at around two-fi fths higher than the NI rate. This meant that the inequality gap closed by more than a third from % in 2003/04 to 59% in 2008/09. Source: Child Health System / Project Support Analysis Branch The proportion of mothers that smoked during their pregnancy fell in all areas over the period. The proportion in the overall South Eastern was broadly similar to that in the wider region across the period. The inequality gap reduced from 83% in 2005 to 75% in The 2008 fi gures have been revised since the publication of the 3rd update bulletin. 29

36 Health Inequalities - South Eastern 4.21 Smoking related deaths 4.23 Deaths amenable to healthcare Deaths per,000 population Deaths per,000 population South Eastern SOAs South Eastern NI South Eastern SOAs South Eastern NI There was little change in smoking related mortality levels across all areas between 2005 and The death rate for smoking related causes was continually lower in the South Eastern than in its most deprived areas and NI overall. The inequality gap remained slightly more than a fi fth higher in deprived areas. Amenable mortality (that which could theoretically be averted by good health care) decreased across all areas over the period although the proportionate decrease in the South Eastern (-7%) and its most deprived areas (-5%) was not as large as that in NI as a whole (-10%). Between 2005 and 2008, the inequality gap increased slightly from 16% to 19% Alcohol related deaths Ambulance response 10 Deaths per,000 population Minutes South Eastern SOAs South Eastern NI South Eastern SOAs South Eastern NI Alcohol related mortality increased slightly over the period within all areas. The overall death rate was similar to that in the wider region. The death rate in the most deprived South Eastern areas remained virtually double that in the overall. Source: NI Ambulance Service / Project Support Analysis Branch The average ambulance response time fell across all areas. The average response times across the period within the overall South Eastern were slightly better than those regionally. However the most deprived areas within the had almost a fi fth faster response times than in the overall itself. 30

37 Health Inequalities - South Eastern 4.25 Childhood immunisations Dental Registrations % Standard Dental Registration South Eastern SOAs South Eastern NI= Source: Child Health System / Project Support Analysis Branch Immunisation rates (with the exception of MMR) increased between 2004/05 and 2007/08 in both the South Eastern and its most deprived areas. Over the period, immunisation rates were broadly similar for both the overall and its 20% most deprived SOAs. Source: Business Services Organisation / Project Support Analysis Branch Dental registrations in the South Eastern have remained slightly higher (around 3-4%) than the regional rate across the period. There was a relative improvement in the registration rate in the most deprived South Eastern areas from 13% to 6% lower than the NI average. This has meant that the inequality gap has closed from 16% in 2003 to 9% in Mood and Anxiety disorders % Dip Polio Tet MenC Hib3 MMR Whp Dip Polio Tet MenC Hib3 MMR Whp 2004/ /08 South Eastern SOAs South Eastern South Eastern SOAs South Eastern NI Source: Business Services Organisation / Project Support Analysis Branch The proportion of the population with a mood or anxiety disorder increased across all areas. The proportion within the most deprived areas in the South Eastern area was almost identical to that in NI generally up to 2006, increasing slightly higher afterwards. Conversely the proportion in the overall was lower than that experienced regionally up to 2006, but was almost identical thereafter. The inequality gap did reduce over the period from 8% in 2004 to 3% in The percentage of children receiving immunisation for Diphtheria (Dip), Polio, Tetanus (Tet), Pertussis or Whooping Cough (Whp), Haemophilus Influenzae Type b (Hib3), Meningitis C (MenC) and Measles-Mumps-Rubella (MMR) before reaching their second birthday. 31

38 Summary Health Inequalities - South Eastern 4.28 Summary of South Eastern inequality gaps Alcohol related deaths Teenage Births Smoking during pregnancy Self harm Lung cancer incidence Suicide SMR SDR circulatory PYLL Breastfeeding on discharge SDR respiratory SAR respiratory Smoking related deaths Amenable mortality Std Admission emergency SDR cancer Std Admission all SAR circulatory Dental registrations Infant Mortality Life expectancy male Mood & anxiety disorder Cancer incidence MenC MMR Hib3 Whp Tet Dip Polio Life expectancy female Std Admission elective Ambulance response 20% 0% 20% 40% 60% % % % As with other areas, the largest health inequality gap occurred in alcohol related mortality where the death rate in the most deprived South Eastern areas was almost double (98% higher) that in the wider. There were also large differences in health outcomes for teenage births (77%) and smoking during pregnancy (75%). In all, 6 of the 33 indicators showed relatively large inequality gaps (of greater than 40%). Conversely 20 indicators had relatively small gaps of less than 20% in magnitude with the smallest gaps occurring in outcomes for life expectancy (for both males and females), mood and anxiety disorders, cancer incidence, elective admission rates and childhood immunisation. Ambulance response times were almost a fi fth lower in the most deprived South Eastern areas. For most of the indicators, the inequality gap in the South Eastern area remained broadly constant over time. However there were improvements in the gaps for infant mortality, hospital admission rates (all admissions, emergency admissions, circulatory disease and self harm), cancer mortality, smoking during pregnancy and breastfeeding on discharge from hospital. Gaps for teenage births and amenable mortality actually increased over the period. 32

39 33

40 Southern HSC Area 34

41 Health Inequalities - Southern 5.1 Standardised Mortality Ratio (SMR) under Life Expectancy at birth Female SMR U Years Southern SOAs Southern NI= Southern SOAs Southern NI The likelihood of a person dying in the Southern was similar to that in Northern Ireland generally. The SMR in the most deprived Southern areas remained broadly around 30% higher than the NI average. There was a small decrease in the inequality gap from 34% in 2001 to 29% in Over the period, female life expectancy in both the Southern and its most deprived areas grew by 1.6 years. There was a similar increase in female life expectancy in NI overall (1.5 years) over the period. There was no change to the inequality gap (1.9 years, 2%). 5.2 Life Expectancy at birth - Male 5.4 Potential Years of Life Lost (PYLL) Years Years Southern SOAs Southern NI Between 2001 and 2008, male life expectancy in the most deprived areas grew by 3.0 years. This compared with an increase of 1.9 years over the same period in the Southern as a whole and 1.6 years in NI. This caused the male life expectancy gap to narrow from 3.2 years (4%) to 2.1 years (3%). Southern SOAs Southern NI Over the period, the average potential years of life lost in the Southern overall remained fairly constant. The PYLL in the Southern was broadly similar to that in NI generally across the period. In the most deprived Southern areas, PYLL declined sharply from 8.3 in 2001 to 7.0 potential years of life lost per persons in Since then it increased slightly to reach 7.4 potential years of life lost per persons in The inequality gap reduced from 43% to 30% over the period. 35

42 Health Inequalities - Southern 5.5 Infant Mortality Standardised Admission Rates (SAR) to hospital emergency admissions 160 Infant Mortality Rate SAR /02 02/03 03/04 04/05 05/06 06/07 07/08 08/09 Southern SOAs Southern NI= Despite some volatility, the infant mortality rate within the most deprived areas in the Southern fell over the period from 7.6 to 5.5 infant deaths per 1,000 live births. The infant mortality rate both in the overall and in the wider region also fell over the period. The inequality gap fell from 27% higher in the most deprived areas to 8% higher in Source: Hospital Inpatients System / Project Support Analysis Branch The relative emergency admission rate in the most deprived areas in the Southern remained around two-fifths higher than the regional rate between 2001/02 and 2005/06 but declined quite sharply thereafter to around a quarter higher. Emergency admissions within the overall Southern area also declined from 13% higher to 8% higher than the NI rate. The inequality gap decreased from 26% to 16% over the period. 5.6 Standardised Admission Rates (SAR) to hospital all admissions Standardised Admission Rates (SAR) to hospital elective admissions SAR SAR /02 02/03 03/04 04/05 05/06 06/07 07/08 08/09 01/02 02/03 03/04 04/05 05/06 06/07 07/08 08/09 Southern SOAs Southern NI= Source: Hospital Inpatients System / Project Support Analysis Branch Over the period, the relative hospital admission rate in the most deprived Southern areas fell from 20% to 15% higher than the regional rate. Whereas, in the wider Southern, the relative admission rate increased from a position of being almost identical to the regional rate to one where it was 5% higher. This caused the inequality gap to narrow from 19% to 10% over the period. Southern SOAs Southern NI= Source: Hospital Inpatients System / Project Support Analysis Branch Over the period, the relative elective admission rate in the Southern area rose from being 7% lower than the NI rate in 2001/02 to 6% higher in 2008/09. The relative admission rate in its most deprived areas fl uctuated over the period but by2008/09 it was broadly similar to the NI average. Across the period there was little difference between the relative elective admission rates in the and its most deprived areas. 36

43 Health Inequalities - Southern 5.9 Standardised Death Rate (SDR) (under 75) circulatory disease 5.11 Standardised Death Rate (SDR) (under 75) cancer Deaths per,000 population Deaths per,000 population Southern SOAs Southern NI Southern SOAs Southern NI Across the period, there was a steady decline in circulatory mortality in all areas, falling at broadly similar rates in the most deprived areas (-34%), the Southern (-35%) and NI as a whole (-36%). The inequality gap remained fairly constant at more than a quarter higher in deprived areas. Cancer mortality declined over the period from to deaths per,000 population in the most deprived areas. The death rate in the Southern overall, despite an increase between 2001 and 2004, remained broadly similar over the period. As a consequence, the inequality gap fell from 29% in 2001 to 19% in Standardised Death Rate (SDR) (under 75) respiratory disease Cancer incidence rates 125 Deaths per,000 population SIR Southern SOAs Southern NI Southern SOAs Southern NI= Between 2001 and 2008, respiratory mortality fell from 50.9 to 30.4 deaths per,000 population in the most deprived Southern areas (a fall of 40%). This compared with a decrease of 28% in the respiratory death rate in the Southern generally. By the end of the period there was little difference between mortality in the Southern and its most deprived areas. Source: Northern Ireland Cancer Registry / Project Support Analysis Branch Cancer incidence in the Southern was broadly similar to that in the wider region. As there was little change in the relative standardised incidence rate in both the Southern and its most deprived areas across the period, the inequality gap also remained broadly similar. 37

44 Health Inequalities - Southern 5.13 Lung cancer incidence rates 5.15 Teenage Births SIR Lung cancer % Southern SOAs Southern NI= Southern SOAs Southern NI Source: Northern Ireland Cancer Registry / Project Support Analysis Branch Over the period, there was an increase in the relative incidence of lung cancer in the from 27% to 14% lower than the overall NI incidence rate. Similarly in its most deprived areas, the incidence rate also increased from 7% to 21% higher than the relative NI rate. The inequality gap decreased slightly from 47% in 1999 to 41% in Average teenage birth rates in the most deprived Southern areas decreased over the period from 25.2 in 2003 to 19.3 births per 1,000 females in By contrast the birth rate in the wider remained broadly constant across the period. This caused the inequality gap to more than halve from 84% to 41% Suicide 5.16 Standardised Admission Ratio to hospital respiratory disease Deaths per,000 population SAR /00 01/02 00/01 02/03 01/02 03/04 02/03 04/05 03/04 05/06 04/05 06/07 05/06 07/08 06/07 08/09 Southern SOAs Southern NI Suicide rates rose steeply from 2005 onwards across all areas. The suicide rate within the most deprived areas in the Southern, despite a sharp decline between 2001 and 2003, reached a peak fi gure of 23.2 deaths per,000 population in 2008 (an increase of 7% over the period). The death rate in the overall increased by two-fi fths over the period to reach 14.5 deaths per,000 population. Consequently the inequality gap narrowed substantially from 108% in 2001 to 60% in Southern SOAs Southern NI= Source: Hospital Inpatients System / Project Support Analysis Branch Hospital admissions for respiratory disease in the most deprived Southern areas fell from 28% higher than the NI rate in 2001/02 to 11% higher in 2008/09. Over the period, the admission rate in the overall went from 3% higher to 3% lower than the regional rate. The inequality gap narrowed from 24% to 14% over the period. 38

45 Health Inequalities - Southern 5.17 Standardised Admission Ratio to hospital circulatory disease Breastfeeding on discharge from hospital SAR % /00 01/02 00/01 02/03 01/02 03/04 02/03 04/05 03/04 05/06 04/05 06/07 05/06 07/08 06/07 08/09 Southern SOAs Southern NI= Southern SOAs Southern NI Source: Hospital Inpatients System / Project Support Analysis Branch Over the period, hospital admissions for circulatory disease were generally higher in both the Southern and its most deprived areas than in NI generally. Admissions followed a similar pattern in both the and its deprived areas increasing relative to the regional rate up to 2005/06 and then decreasing slightly thereafter. By 2008/09 the relative admission rates in the overall and its most deprived areas were broadly similar. Source: Child Health System / Project Support Analysis Branch The proportion of mothers that were breastfeeding on leaving hospital rose in the Southern from 39.2% in 2005 to 46.0% in 2008 (an increase of 17%). The proportion in the most deprived areas increased sharply over the period from 29.9% to 41.2% (an increase of 38%) which caused the inequality gap to narrow considerably from 31% to 10% Admissions to hospital for self-harm 5.20 Smoking during pregnancy SAR % /00 03/04 00/01 04/05 01/02 05/06 02/03 06/07 03/04 07/08 04/05 08/09 Southern SOAs Southern NI= Southern SOAs Southern NI Source: Hospital Inpatients System / Project Support Analysis Branch Between 2003/04 and 2008/09, admission rates for self-harm fell in the most deprived areas in the Southern from % to 63% higher than the regional admission rate. The admission rate for the whole remained very similar to that in Northern Ireland generally. The inequality gap therefore fell from % to 66%. Source: Child Health System / Project Support Analysis Branch The proportion of mothers that smoked during pregnancy declined over the period at a similar rate in both the Southern and its most deprived areas. The rate in the most deprived areas remained around two-thirds higher than the overall rate. 10 The 2008 figures have been revised since the publication of the 3rd update bulletin. 39

46 Health Inequalities - Southern 5.21 Smoking related deaths 5.23 Deaths amenable to healthcare Deaths per,000 population Deaths per,000 population Southern SOAs Southern NI Southern SOAs Southern NI The smoking related death rate in the Southern area as a whole remained very similar to that in the wider region. Over the period, there was little change in smoking related mortality across all areas and as a consequence the inequality gap remained fairly constant at more than a quarter higher in the most deprived areas in the Southern area. Mortality amenable to healthcare (that which theoretically could be averted by good healthcare) in the Southern area was broadly similar to that in NI as a whole. Over the period the amenable death rate fell across all areas however the decline in the most deprived Southern areas was slower than that in the wider. The inequality gap rose from 17% in 2005 to 24% by Alcohol related deaths Ambulance response 11 Deaths per,000 population Minutes Southern SOAs Southern NI Southern SOAs Southern NI The alcohol related death rate in the overall Southern was continually lower than that in the wider region. While alcohol related mortality increased for all areas over the period, it rose slightly faster in the most deprived areas in the Southern. The inequality gap therefore rose from 87% in 2005 to 94% in Source: NI Ambulance Service / Project Support Analysis Branch Between 2004 and 2008, average ambulance response times noticeably decreased for all areas. The largest improvement in response times occurred within the most deprived areas in the Southern which decreased by more than a quarter. This compared with decreases of around a fi fth in the Southern overall and the region generally. The inequality gap increased from 11% to 20% faster response times in the most deprived areas. 40

47 Health Inequalities - Southern 5.25 Childhood immunisations Dental Registrations % Dip Polio Tet MenC Hib3 MMR Whp Dip Polio Tet MenC Hib3 MMR Whp Standard Dental Registration / /08 Southern SOAs Southern Southern SOAs Southern NI= Source: Child Health System / Project Support Analysis Branch In 2004/05, apart from the MMR and Haemophilus Infl uenzae type b immunisations, the uptake rates for childhood immunisations within the Southern and its most deprived areas were broadly similar. By 2007/08 all immunisation rates for both the and its most deprived areas were similar. Source: Business Services Organisation / Project Support Analysis Branch Over the period, the dental registration rate in the Southern area decreased from being slighly higher to be broadly comparable to the NI. The dental registration rate in the most deprived areas declined relatively from 8% worse in 2003 to 14% worse in 2009 than the NI rate. As a consequence, the inequality gap increased from 10% to 14% over the period Mood and Anxiety disorders % Southern SOAs Southern NI Source: Business Services Organisation / Project Support Analysis Branch The proportion of the population with a mood or anxiety disorder has increased across all areas. However the proportion within both the Southern area and its most deprived areas went from being higher than the NI rate between 2004 and 2006 to slightly lower from 2007 onwards. The proportion with a mood and anxiety disorder within the most deprived areas fell from being 6% higher than the overall in 2004 to being identical in The percentage of children receiving immunisation for Diphtheria (Dip), Polio, Tetanus (Tet), Pertussis or Whooping Cough (Whp), Haemophilus Influenzae Type b (Hib3), Meningitis C (MenC) and Measles-Mumps-Rubella (MMR) before reaching their second birthday. 41

48 Summary Health Inequalities - Southern 5.28 Summary of Southern inequality gaps Alcohol related deaths Self harm Smoking during pregnancy Suicide Teenage Births Lung cancer incidence PYLL SMR SDR circulatory Smoking related deaths Amenable mortality SDR respiratory SDR cancer Std Admission emergency SAR respiratory Dental registrations Breastfeeding on discharge Std Admission all Cancer incidence Infant Mortality SAR circulatory Life expectancy male Life expectancy female MMR Hib3 MenC Whp Tet Polio Dip Mood & anxiety disorder Std Admission elective Ambulance response 20% 0% 20% 40% 60% % % % The largest inequality gaps in the Southern area occurred in alcohol related mortality (94%), self-harm admissions (68%) and smoking during pregnancy (64%). Overall 6 of the 33 indicators analysed in this report showed relatively large inequality gaps of 40% or more whereas two-thirds of the indicators showed relatively small gaps (i.e. less than 20% in magnitude, including both positive and negative inequality gaps). Over time notable improvements in inequality gaps within the Southern Area occurred in teenage births, suicide and self-harm admissions to hospital. In fact, most of the inequality gaps improved with the exception of female life expectancy, cancer incidence, hospital admissions for circulatory disease, smoking during pregnancy, smoking related mortality and dental registrations which remained fairly constant. Gaps widened for a small number of mortality based indicators (circulatory deaths, alcohol related deaths and amenable deaths) as well as ambulance response times. 42

49 43

50 Western HSC Area 44