TABLE OF CONTENTS TABLE OF FIGURES... 7 FOREWARD EXECUTIVE SUMMARY CHAPTER 1: DEMOGRAPHIC PROFILE Population structure...

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2 TABLE OF CONTENTS TABLE OF FIGURES... 7 FOREWARD EXECUTIVE SUMMARY CHAPTER 1: DEMOGRAPHIC PROFILE Population structure Population projections by local authority and year All cause mortality Ethnicity Life expectancy Deprivation Childhood deprivation Mortality by cause of death Cardiovascular disease Coronary heart disease Smoking attributable Alcohol specific Chronic liver disease and cirrhosis Stroke Respiratory disease Asthma Chronic obstructive pulmonary disease Interstitial lung disease Cancer Chronic liver disease including cirrhosis CHAPTER 2: CHRONIC CONDITIONS Page 2 of 264

3 2.1 Cardiovascular disease Stroke Diabetes Variations in incidences of complications of diabetes Hospital admission for diabetes HbA1c Target Respiratory disease Person-based hospital admissions: Chronic obstructive pulmonary disease (COPD) Emergency hospital admissions: Asthma Emergency hospital admissions: Chronic obstructive pulmonary disease GP practice registers Cancer Incidence of cancer Incidence of cancer, and trend, by age Incidence of cancer by site Proportion of cancer incidence by site and sex Survival from cancer Survival from cancer by sex Survival by cancer site Projected future need Projected future need by cancer site Admissions Regular day admissions Day case admissions Elective inpatient admissions Emergency inpatient admissions Page 3 of 264

4 Palliative care emergency admissions to other locations within HDUHB Outpatients Liver disease Non-alcoholic fatty liver disease (NAFLD) Alcoholic liver disease Liver transplants procedures Endoscopic retrograde cholangiopancreatography (ERC) procedures Paracetamol overdose hospital admissions Liver disease hospital admissions Hepatitis B related end-stage liver disease/ hepatocellular carcinoma hospital admissions Hepatitis C related end-stage liver disease/ hepatocellular carcinoma hospital admissions Pancreatic cancer Paracetamol poisoning Chronic liver disease including cirrhosis, all ages Chronic liver disease including cirrhosis, aged under 75 years Neurology Estimated need within population Service utilisation CHAPTER 3: WIDER DETERMINANTS Income Housing Economic activity Education CHAPTER 4: HEALTHY LIFE STAGES AND LIFE STYLE EARLY YEARS, CHILDREN AND YOUNG PEOPLE Childhood health surveillance Page 4 of 264

5 4.1.2 Low birth rates Breast fed at birth Uptake rate for primary MMR vaccine at age two Uptake of routine immunisations by 4 years of age Healthy eating Physical activity Overweigh and obesity Smoking Alcohol Substance misuse Sexual health Immunisations General health & well being Use of services Cancer Oral heath HEALTH OF ADULT POPULATIONS Smoking Physical activity Blood pressure Hypertension Obesity Alcohol Substance misuse Suicide and self harm Emotional and mental well being OLDER PEOPLE Page 5 of 264

6 4.3.1 Emergency admissions and hip fractures Palliative care Quality of life indicators Selected chronic conditions Uptake of bowel screening programme Uptake of breast screening programme Cervical screening coverage Excess winter deaths CHAPTER 5: LINKS TO SINGLE INTEGRATED PLANS Carmarthenshire: Ceredigion: Pembrokeshire: Page 6 of 264

7 TABLE OF FIGURES Figure 1: Population pyramid percentage by age and sex in Hywel Dda UHB and Wales Figure 2: Percentage of population by age and sex, Hywel Dda UHB and Wales, Figure 3: Count of population by age and sex, Hywel Dda UHB and Wales, Figure 4: Population pyramid percentage by age and sex in Ceredigion and Wales, Figure 5: Percentage of population by age and sex, Ceredigion and Wales, Figure 6: Count of population by age and sex, Ceredigion and Wales, Figure 7: Population pyramid percentage by age and sex, Pembrokeshire and Wales, Figure 8: Percentage of population by age and sex, Pembrokeshire and Wales, Figure 9: Count of population by age and sex, Pembrokeshire and Wales, Figure 10: Population pyramid percentage by age and sex, Carmarthenshire and Wales, Figure 11: Percentage population by age and sex, Carmarthen, Figure 12: Count of population by age and sex, Carmarthenshire and Wales, Figure 14: Projected population counts by age group, Hywel Dda UHB, Figure 15: population percentage Hywel Dda UHB, Local authorities and Wales, % aged 65 and over, Figure 16: Population density (persons per square kilometre) by Local Authority and year.. 39 Figure 17: Total fertility and general fertility rates by local authority and year Figure 18: Live births by area and age of mother (2013) Figure 19: Live births with low birth weight by area (2013) Figure 20: Still births by area Figure 21: All cause mortality, EASR per 100,000, count and crude rate, female and male aged under 75, Wales, Wales local authorities and health boards, Figure 22: All cause mortality and excess deaths, females under 75 Ceredigion and Wales, Figure 23: All cause mortality and excess deaths in males under 75, Ceredigion and Wales, Page 7 of 264

8 Figure 24: All cause mortality and excess deaths in Males under 75, Pembrokeshire and Wales, Figure 25: All cause mortality and excess deaths in females under 75, Pembrokeshire and Wales, Figure 26: All cause mortality and excess deaths in males under 75, Carmarthenshire and Wales, Figure 27: All cause mortality and excess deaths in females under 75, Carmarthenshire and Wales Figure 28: Population by ethnic group percentage, Wales, Figure 29: Percentage of the population who do not define themselves as White British or Irish, by local authority, Figure 30: Changes in the ethnic make-up of Wales between the 2011 and 2011 Census.. 47 Figure 31: Measures in life expectancy in Males and Females, Figure 32: Healthy life expectancy at birth, Wales, Figure 33: Welsh Index of Multiple Deprivation, Wales Figure 34: Welsh Index of Multiple Deprivation, Hywel Dda UHB, Figure 35: Population by deprivation fifths, Wales, Figure 36: Percentage of the populations in the most deprived fifth, Wales, Health Board and Local authority, Figure 37: Number of lower super output areas by deprivation fifths, by health board and local authorities, Figure 38: Percentage of lower super output areas in the most deprived fifth in Wales and Local authorities, Figure 39: Welsh Index of Multiple Deprivation 2011, Child Index Figure 40: % LSOAs in the most deprived tenth, Welsh Index of Multiple Deprivation, 2011 Child Index Figure 41: Mortlity in males under 75, European age-standardised arte per 100,000 population Figure 42: Mortality in females under 75 European age-standardised rates per 100,000 population Page 8 of 264

9 Figure 43: Mortality from cardiovascular disease, European age-standardised rate per per 100,000, all persons aged under 75, Hywel Dda UHB middle super output areas (MSOAs), Figure 44: Mortality from cardiovascular disease, all persons aged under 75, Hywel Dda UHB, Figure 45: Cardiovascular disease mortality, EASR per 100,000, persons aged under 75, Wales health Boards, Figure 46: Cardiovascular disease mortality (ICD ), annual average and EASR per 100,000, persons, all ages Hywel Dda UHB, Wales & England, Figure 47: Cardiovascular disease mortality (ICD ), EASR per 100,000 persons, all ages, Hywel Dda UHB, Wales and England, Figure 48: Mortality from coronary heart disease, EASR per 100,000, all persons, all ages, Hywel Dda UHB Middle, Super Output Areas, Figure 49: Coronary heart disease mortality, persons all ages, Hywel Dda UHB, Figure 50: Coronary heart disease mortality (ICD ), EASR per 100,000, persons under 75, Wales health boards, Figure 51: Coronary heart disease mortality, EASR per 100,000, persons under 75, Wales health boards, Figure 52: Smoking attributable mortality in males aged 35+ in Hywel Dda UHB (EASR per 100,000 population) Figure 53: Smoking-attributable mortality in females aged 35+in Hywel Dda UHB (EASR per 100,000 population) Figure 54: Alcohol-specific mortality, 3 year rolling EASR per 100,000, persons, all ages, Hywel Dda UHB and Wales, to Figure 55: Alcohol-specific mortality, EASR rate per 100,000, persons, all ages, Wales health boards, Figure 56: Alcohol-specific mortality, persons all ages, Hywel Dda UHB, Figure 57: Alcohol-specific mortality, persons all ages, Hywel Dda UHB, Figure 58: Mortality from chronic liver and cirrhosis, 3 year rolling EASR per 100,000*, persons, all ages, Hywel Dda UHB and Wales, and Figure 59: Morality from Chronic liver disease and cirrhosis, EASR per 100,000*, persons all ages, Page 9 of 264

10 Figure 60: Mortality from cerebrovascular disease (stroke), EASR rate per 100,000 persons, , Wales local authorities Figure 61: Mortality from cerebrovascular disease (Stroke), EASR per 100,000 persons, , Wales local authorities Figure 62: Respiratory disease mortality*, average annual deaths, crude rate and EASR per 100,000, persons aged under 75, Wales local authorities, Figure 63: Respiratory disease mortality*, EASR per 100,000 persons aged under 75, Wales local authorities, Figure 64: respiratory disease mortality*, average deaths, crude rate and EASR per 100,000, persons aged under 75, Wales health boards, Figure 65: respiratory disease mortality*, EASR per 100,000, persons aged under 75, Wales health boards, Figure 66: Asthma mortality*, average annual deaths, crude rate and EASR per 100,000 persons aged under 75, Wales health boards, Figure 67: Asthma mortality*, average annual deaths, crude rate and EASR per 100,000, persons under 75, Wales health boards, Figure 68: Chronic obstructive pulmonary disease mortality*, EASR per 100,000, persons aged under 75, Wales local authorities, Figure 69 Chronic pulmonary disease mortality*, EASR per 100,000, persons aged under 75, Wales local authorities, Figure 70: Chronic obstructive pulmonary disease mortality*, average annual deaths, crude rate and EASR per 100,000, persons aged under 75, Wales health boards, Figure 71: Chronic obstructive pulmonary disease mortality*, EASR per 100,000, persons aged under 75 y, Wales health boards, Figure 72: Interstitial lung disease mortality*, average annual deaths, crude rate and EASR per 100,000, persons aged under 75, Wales local authorities, Figure 73: Interstitial lung disease mortality*, average deaths, crude rate and EASR per 100,000, persons aged under 75, Wales health boards, Figure 74: Interstitial disease mortality*, EASR per 100,000, persons aged under 75, Wales health boards, Figure 75: Trends in mortality (EASR) for cancers (excluding non-malignant melanomas), Wales, all ages, Figure 76: Trends in mortality for cancers (excluding non-malignant melanomas), annual number of cancer deaths by age group, Wales, all persons, , aged Page 10 of 264

11 Figure 77: Trends in mortality for cancers (excluding non-malignant melanomas), EASR of cancer deaths by sex, Wales and Hywel Dda, all ages, Figure 78: Mortality for chronic liver disease including cirrhosis is identified when ICD-10 codes K70, K73 or K74 appear as the underlying cause of death. Aged Figure 79: Mortality from chronic liver disease including cirrhosis*, crude rate, all persons aged 75+, Wales health boards, and Figure 80: Mortality from chronic liver disease including cirrhosis*, 3 year rolling rate (EASR), all persons, all ages, Wales health boards, and Figure 81: Mortality from chronic liver disease including cirrhosis*, annual average deaths by age group, all persons aged 20 and over, Wales death boards, to Figure 82: Mortality from all liver disease*, AESR per 100,000, males, females and persons aged 75, Wales health boards, Figure 83: Mortality from liver cancer*, EASR per 100,000, all persons aged under 75, Wales health boards, Figure 84: Emergency admissions for cardiovascular disease by primary condition (ICD-10 I00-I99), persons, all ages, Wales, 2011/ Figure 85: Cardiovascular disease emergency hospital admissions, EASR per 100,000, persons, all ages, Wales local authorities, financial year Figure 86: Cardiovascular disease emergency hopiatl admissions, EASR per 100,000, persons, all ages, Wales health boards, financial year Figure 87Patients on GP practice registers with coronary heart disease, age aged standardised percentage, Wales health boards, Figure 88: Emergency hospital admissions with primary diagnosis Diagnosis of cerebrovascular disease (stroke), EASR per 100,000 persons, , Hywel Dda UHB, local authorities and Wales Figure 89: Emergency hospital admissions with primary diagnosis of cerebrovascular disease (stroke) EASR per 100,000 persons, , Wales local authorities Figure 90: Retinopathy screening map indicating high and low areas of diabetes prevalence Figure 91: Diabetes prevalence rate, QOF disease registers Figure 92: Age and gender of patients with Type 1 diabets, Hywel Dda UHB Figure 93: Age and gender of patients with Type 2 diabetes, Hywel Dda UHB Figure 94: Percentage of population with Type 2 diabetes in Hywel Dda UHB compared to England and Wales Page 11 of 264

12 Figure 95: Complications - Stroke , additional risk of complication among people with diabetes Figure 96: Complication - Myocardial infarction , additional risk of complication among people with diabetes Figure 97: Complication - Angina, additional risk of complication among people with diabetes Figure 98: Complication Heart failure, additional risk of complication among people with diabetes Figure 99: Hywel Dda UHB emergency admissions for diabetes Figure 100: Readmission within 30 days of previous discharge for diabetes Figure 101: Average length of stay Figure 102: Hywel Dda UHB percentage target HbA1c < Figure 103: Hywel Dda UHB paediatric percentage target for HbA1c >=7.5 < Figure 104: Hywel Dda UHB paediatric percentage target HbA1c > Figure 105: Percentage patients recieving eigth care processes (excluding eye screening) Figure 106: Percentage patients meeting all treatment targets Figure 107: Percentage patients offered or attended structured education Figure 108: Percentage with a record of retinal screening examination the preceding 15 months Figure 109: Percentage patients with a record of a foot examination and risk classification within the preceding 15 months Figure 110: People admitted to hospital with a primary diagnosis of chronic obstructive pulmonary disease*, count, crude and EASR per 100,000, persons aged 35+, Wales local authorities, financial year Figure 111: People admitted to hospital with a primary diagnosis of chronic obstructive pulmonary disease*, count crude and EASR per 100,000, persons aged 35+, Wales health boards, financial year Figure 112: Person based hospital admissions with a primary diagnosis of chronic obstructive pulmonary disease*, EASR per 100,000, persons aged 35+, Wales local authorities, financial year Page 12 of 264

13 Figure 113: Person based hospital admissions with a primary diagnosis of chronic obstructive pulmonary disease*, EASR per 100,000, persons aged 35+, Wales health boards, financial year Figure 114: Person based hospital admissions with a primary diagnosis of chronic obstructive pulmonary disease*, EASR per 100,000, persons aged 35+, Wales by deprivation fifth, financial year Figure 115: Emergency hospital admissions with a primary diagnosis of asthma*, EASR per 100,000, persons aged 18+, Wales local authorities, financial year Figure 116: Emergency hospital admissions with a primary diagnosis of asthma*,easr per 100,000, persons aged 18+, Wales health boards, financial year Figure 117: Emergency hospital admissions with a primary diagnosis of asthma*, EASR per 100,000, persons aged 18+, Wales by deprivation fifths, financial year Figure 118: Emergency hospital admissions with a primary diagnosis of chronic obstructive pulmonary disease*, count, crude and EASR per 100,000, persons aged 18+, Wales local authorities, financial year Figure 119: Emergency hospital admissions with a primary diagnosis of chronic obstructive pulmonary disease*, count, crude and EASR per 100,000, persons aged 18+, Wales health boards, financial year Figure 120: Emergency hospital admissions with a primary diagnosis of chronic obstructive pulmonary disease*, count, crude and EASR per 100,000, persons aged 18+, Wales by deprivation fifth, financial year Figure 121: Emergency hospital admissions with a primary diagnosis of chronic obstructive pulmonary disease*, EASR per 100,000, persons aged 18+, Wales local authorities, financial year Figure 122: Emergency hospital admissions with a primary diagnosis of chronic obstructive pulmonary disease*, EASR per 100,000, persons aged 18+, Wales health boards, financial year Figure 123: Patients on GP practice registers with asthma, EASR per 100,000, Wales health boards, Figure 124; Patients on GP practice registers with COPD, EASR per 100,000, Wales health boards, Figure 125: Incidence of all malignant cancers (excluding non-melanoma skin cancer), Hywel Dda UHB Figure 126: EASR per 100,000 for all malignant cancer incidences excluding non-melanoma skin cancer) by county: Males Page 13 of 264

14 Figure 127: EASR for all malignant cancer incidence (excluding non-melanoma skin cancer) by county: females Figure 128: Trends in annual numbers of cancer by age groups (40 years and over) Figure 129: EASR per 100,000 population for site specific cancer in Hywel Dda UHB and Wales, Figure 130: Proportion of cancers by site in men 2012 in Hywel Dda UHB Figure 131: Proportion of cancers by site in women in 2012 in Hywel Dda UHB Figure 132: One year relative survival from Cancer in Wales, all persons all ages Figure 133: Five year relative survival from cancer in Wales, all persons all ages Figure 134: relative cancer survival in men and women in Wales, all persons all ages Figure 135: One year survival rates (percentage) by cancer site, males Figure 136: One year relative rates (percentage) by cancer site, , females Figure 137: Five year relative rates (percentage by cancer site , males Figure 138: Five year relative rates (percentage) by cancer site, , females Figure 139: Current level of hospital activity, primary diagnosis of malignant neoplasm excluding non-melanoma skin cancer on discharge, Hywel Dda UHB resident population, all ages, Figure 140: Application of current level of hospital activity to population projections up to 2036, primary diagnosis of malignant neoplasm excluding non- skin cancer (ICD10 C00-C97 excl C44) on discharge, Hywel Dda UHB resident population, all persons Figure 141: Application of current level of hospital activity to population projection up to 2036, primary diagnosis of lung cancer (ICD10 C33-C34) on discharge,, Hywel Dda UHB resident population, all persons Figure 142: application of current level of hospital activity to population projections up to 2036, primary diagnosis of bowel cancer (ICD 10 C18-20)) on discharge, Hywel Dda UHB residents population, all persons Figure 143: Application of current level of hospital activity to population projections up to 2036, primary diagnosis of breath cancer (ICD 10 C50), o on discharge, Hywel Dda UHB resident population, all females Figure 144: Application of current level of hospital activity to population projections up to 2036, primary diagnosis of prostate cancer (ICD 10 C61) on discharge, Hywel Dda UHB resident population, all males Figure 145: Hospital admissions for cancer patients Page 14 of 264

15 Figure 146: Number of regular day admissions, Bronglais General Hospital Figure 147: Number of regular day admissions, Glangwilli General Hospital Figure 148: Number of regular day admissions, Prince Philip General Hospital Figure 149: Number of regular day admissions, Withybush General Hospital Figure 150: Day case admissions for non surgical oncology care, Hywel Dda UHB 2013/ Figure 151: Number of elective admissions, Bronglaiis General Hospital Figure 152: Number of elective admissions, Glangwilli General Hospital Figure 153: Number of elective admissions, Withybush General Hospital Figure 154: Number of emergency admissions, Bronglais General Hospital Figure 155: Number of emergency admisions, Glangwilli General Hospital Figure 156: Number of emergency admissions, Prince Philip General Hospital Figure 157: Number of emergency admissions, Withybush General Hospital Figure 158: Number of palliative care admissions out with general hospitals, 2013/ Figure 159: Outpatient activity, by hospital, Figure 160: Hospital admissions due to non-alcoholic fatty liver disease* EASR per 100,000, all persons all ages, Wales health boards 2009/2010 to 2013/ Figure 161: Hospital admissions due to alcohol liver disease*, EASR per 100,000, all persons, all ages, Wales health boards, 2011/12 to 2013/ Figure 162: Liver transplant procedures*, EASR per 100,000, persons all ages, Wales health boards, 2004/05 to 2013/ Figure 163: Endoscopic retrograde cholangionpan creatography (ERC) procedures*, EASR per 100,000, persons all ages, Wales health boards, 2013/ Figure 164: Hospital admissions due to paracetamol overdose*, EASR per 100,000, all persons all ages, Wales health boards, 2013/ Figure 165: Hospital admissions due to liver disease*, EASR per 100,000, all persons all ages, Wales health boards, 2013/ Figure 166: Hospital admissions due to hepatitis B related end stage liver disease/ hepatocellular carcinoma*, EASR per 100,000, all persons all ages, Wales health boards, 2004/05 to 3013/ Page 15 of 264

16 Figure 167: Hospital admission due to hepatitis C related end stage liver disease/hepatocellular carcinoma* EASR per 100,000, all persons all ages, Wales health boards, 2004/05 to 2013/ Figure 168: Pancreatic cancer mortality*, EASR per 100,000, all persons aged under 75, Wales health boards, Figure 169: Paracetamol overdose mortality*, EASR age-per 100,000, alls all ages, Wales health boards, Figure 170: Mortality from chronic liver disease including cirrhosis*, EASR per 100,000 and persons all ages, Wales health boards, Figure 171: Mortality from chronic liver disease including cirrhosis*, EASR per 100,000 all persons aged under 75, Wales health boards, Figure 172: Travel time to specialist neurology services Figure 173: estimated prevalence of Alzheimer's disease in population Figure 174: Estimated prevalence and incidence of Parkinson's disease in the population Figure 175: Patients on the primary care epilepsy register and estimated prevalence and incidence of epilepsy in the population Figure 176: Estimated prevalence and incidence of multiple sclerosis in the population Figure 177: Estimated prevalence of cerebral palsy in the population Figure 178: District general hospital inpatient admissions with a primary diagnosis of all diseases of the nervous system (G00-G99) Figure 179: District general hospital inpatient admissions with a primary diagnosis of cerebral palsy and other paralytic syndromes (G80-G83) Figure 180: District general hospital inpatient admissions with a primary diagnosis of Epilepsy (G40-G41) Figure 181: district general hospital inpatient admissions with a primary diagnosis of Parkinson s disease (G20) Figure 182: District general hospital inpatient admissions with a primary diagnosis of Alzheimer s disease (G30) Figure 183: District general hospital inpatient admissions with a primary diagnosis of Multiple sclerosis (G35) Figure 184: Districts general hospital inpatient admissions with a primary diagnosis of Cerebral palsy Page 16 of 264

17 Figure 185: Percentage of households living in poverty, 2007/ Figure 186: Percentage of all people living in households with no central heating, Figure 187: Percentage of all residents aged 16 to 74 who have never worked or are longterm unemployed, Wales, England and English regions, March Figure 188: Percentage of all Welsh residents aged 16 to 74 who have never worked or are long term unemployed, Wales and local authorities, March Figure 189: Residents aged 16 to 74 who have never worked or are long term unemployed, March Figure 190; Percentage of working-age population claiming employment related benefits, November Figure 191: Percentage of all residents aged 16 to 74 who have academic or professional qualifications, Wales, England and English regions, March Figure 192: Percentage of all Welsh residents aged 16 to 74 who have no academic or professional qualifications, Wales and local authorities, March Figure 192: residents aged years who have no academic or professional qualifications, March Figure 193: Childhood health surveillance for Ceredigion, Figure 194: Childhood health surveillance for Carmarthenshire, Figure 195: Childhood health surveillance for Pembrokeshire, Figure 194: Singleton live births, low birth weight (less than 2500g), percentage, Hywel Dda UHB and Wales, Figure 195: Percentage of babies breast fed at birth, Figure 196: Uptake rate for primary MMR vaccine at age two, to Figure 197: Uptake rate for primary MMR vaccine at age two, to Figure 198: Uptake rate for primary MMR vaccine at age two, to Figure 199: Percentage of children up to date with routine immunisations by 4 years of age, Figure 200: Percentage of children up to date with immunisations by 4 years of age, Wales MSOA's, Figure 201: Percentage of persons aged 11-16* who reported who reported eating at least one piece of fruit, daily, 2009/ Page 17 of 264

18 Figure 202: Percentage of persons aged 11-16* who reported eating at least one piece of fruit, daily, Figure 203: Percentage of persons aged 11-16*, who reported eating vegetables every day, Figure 204: Persons aged who reported breakfast five days a week, Figure 205: Percentage of children aged years who reported undertaking physical activity for an hour or more every day, Figure 206: Proportion of children aged 4 to 5 years, who are a healthy weight or underweight, Child Measurement Programme, Wales and local authorities, 2012/ Figure 207: Proportion of children aged 4 to 5 who are overweight or obese, Wales and local authorities, Child measurement Programme 2012/ Figure 208: Percentage of year olds who were reported as being overweight / obese, Figure 209: Percentage of persons aged who are overweight or obese, stratified by Family Affluence Scale (FAS), Wales*, 2009/ Figure 210: Percentage of persons aged who reported smoking at least once a week, stratified by Family Affluence Scale (FAS), Wales, 2009/ Figure 211: Percentage aged who reported currently being a smoker (daily or occasionally), Figure 212: Percentage of year olds who reported they smoke at least once a week, Figure 213: Percentage of persons aged year olds who have tried e-cigar on a few occasions/ regularly, Figure 214: Percentage of persons aged 11-16* years who reported being drunk the last 30 days, Figure 215: Percentage of persons aged years old who reported drinking alcohol at least once a week, Figure 216: Percentage of persons aged who reported drinking alcohol at least once a week, stratified by Family Affluence Scale (FAS), Wales, 2009/ Figure 217: Persons aged who reported drinking above the recommended guidelines on at least one day in the previous week, Figure 218: Percentage of persons aged who reported using any illicit drug (even if only once), Page 18 of 264

19 Figure 219: Percentage of persons aged years who have taken cannabis, Figure 220: Percentage of persons aged who reported using any illicit drug in the last year, stratified by Family Affluence Scale (FAS), Wales, 2009/ Figure 221: Number of referrals for substance misuse, persons aged 0-24, Wales, 2008/ / Figure 222: Referrals for substance misuse, persons aged 0-24, incidence rate per 1000,000, 2011/ Figure 223: Alcohol-specific hospital admissions (person-based), 3-year rolling crude rate per 100,000, persons aged under 18, Hywel Dda UHB and Wales, financial years 2003/ / Figure 224: Alcohol-specific hospital admissions (person-based), crude rate per 100,000, persons aged under 18, Wales health boards, financial years 2010/ / Figure 223: Conception in females aged under 18, Hywel Dda UHB, Figure 224: Conception rate per 1,000 female aged under 18*, local authorities within Hywel Dda UHB, Figure 225: Conception rates per 1,000 female under 18*, health boards within Wales, Figure 226: Conception rates per 1,000 females aged under 18*, Wales Local Authorities Figure 227: Teenage conception rates per 1,000 female, Figure 228: Teenage conception, females aged under 18, Wales, Figure 229: Conception in females aged under 16 years by fifth of deprivation, Wales, rate per 10,000 population aged 13-15, Figure 230: Abortion rate per 1,000 females aged under 18*, Wales local authorities, Figure 231: Legal abortions, females, crude rate per 1,000, Figure 232: Legal abortions, females, crude rate per 1,000, Figure 233: tests for gonorrhoea and Chlamydia in persons aged y by area of residence, rate per 1,000 population Figure 234: % of children up to date with routine immunisations by 4 years of age, Figure 235: Percentage of children up to date with immunisations by 4 years of age, Wales MSOA's, Page 19 of 264

20 Figure 236: Percentage of children who are up to date with their routine immunisations at 4 years of age by deprivation fifths, Wales, Figure 237: Percentage of persons aged 16 who have completed a dose course of the MMR vaccine, Figure 238: Percentage of girls completing a 3 dose course of HPV vaccine, school year 9, Figure 239: Percentage of persons aged had a long-term illness, disability or medical condition (such as, diabetes, arthritis, allergy or cerebral palsy) that had been diagnosed by a doctor Figure 240: Percentage of persons aged years who rated their health as fair / poor, Figure 241: Percentage of persons aged who reported having 2 or more health complaints more than once a week, Figure 242: Percentage of persons aged scoring 6 or higher on self-rated life satisfaction, Figure 243: Percentage of persons aged years who have reported being bullied at least a couple of times in the past month, Figure 244: Persons aged admitted to hospital with a primary diagnosis of eating disorder, Wales, Figure 245: Persons aged admitted to hospital with a primary diagnosis of eating disorder, Wales, Figure 246: Estimated number of children and young people aged 5-16 with any mental health disorder, Figure 247: Estimated number of children and young people aged 5-16 with any mental health disorder, Figure 248: Emergency admissions*, persons aged 0-24, EASR per 1,000, Figure 249: Emergency admissions for persons aged 0-24, Figure 250: Emergency admissions* by main cause for persons aged 0-24 years, Wales Figure 251: Admissions for pedestrian injuries by fifth of deprivation, children aged 5-14, Wales, rate per 100, Figure 252: Admissions for pedestrian injuries by fifth of deprivation, children aged 5-14, Wales, rate per 100,000, Figure 253: Number of road traffic casualties, persons aged 0-24, Wales, Page 20 of 264

21 Figure 254: Number of road traffic casualties, persons aged 0-24, Wales, Figure 255: Number of road traffic causalities by casualty type, persons aged 25 and under, Wales, Figure 256: Number of road traffic casualties by casualty type, persons aged 25 and under, Wales, Figure 257: Percentage of patients on primary care chronic conditions register with asthma, persons aged under 25, Figure 258: Incidence of cancer*, persons aged 0-24, EASR per 100,000 population, Figure 259: Cancer registration rates by cancer site for persons aged 0-24, Wales, Figure 260: Cancer registration rates by cancer site for persons aged 0-24, Wales Figure 261: Cancer registration rates by age and sex, Wales, Figure 262: Cancer registration rates by age and sex, Wales, Figure 263: Cases of congenital anomalies EUROCAT definition, Figure 264: Average decay, missing and filled teeth (dmft) for 5 year olds, Welsh local health boards, 2007/08 compared with 2011/ Figure 265: Average dmft for 5 year olds, in unitary authorities within Hywel Dda UHB, 2007/08 compared with 2011/ Figure 266: Percentage of 5 year olds with caries experience 9%dmft>0), Welsh health boards, 2007/098 compared with 2011/ Figure 267: Percentage of 5 year olds with caries experience (%dmft>0) in unitary authorities within Hywel Dda UHB, 2007/08 compared with 2011/ Figure 268: Average dmft of those with caries experience for 5 year olds, Welsh health boards, 2007/08 compared with 2011/ Figure 269: Average dmft of those with caries expereince for 5 year olds, in unitary authorities within Hywel Dda UHB, 2007/08 compared with 2011/ Figure 270: Average dt for 5 years olds, Welsh health boards, 2007/07 compared with 201/ Figure 271: Average dt for 5 year olds, in unitary authorities within Hywel Dda UHB, 2007/08 compared with 2011/ Page 21 of 264

22 Figure 272: Average dt of those with any experience of caries (dmft) for 5 year olds, Welsh health boards, 2007/08 compared with 2011/ Figure 273: Average dt of those with any experience of caries (dmft) for 5 year olds, in unitary authorities within Hywel Dda UHB, 2001/08 compared with 2011/ Figure 274: Average number of decayed, missing or filled teeth, children aged 5 years, 2011/ Figure 275: Percentage of persons p aged years who reported brushing their teeth more than once a day, Figure 276: Smoking prevalence in Hywel Dda UHB (20083/ Figure 277: Percentage of adults reporting to be current smoker, aged standardised percentage, persons, Hywel Dda UHB and Wales, 2003/ Figure 278: Percentage of adults reporting to be a current smoker, age-standardised percentage, persons, Hywel Dda UHB and Wales, 2003/ Figure 279: Percentage currently smoking, Hywel Dda UHB Figure 280: Percentage of smoking-attributable admissions by disease, Wales and Hywel Dda UHB, Figure 281: (Experimental) Smoking prevalence estimated by General Practice Figure 282: Average number of days of 30 minutes moderate or vigorous physical activity (capped) reported by adults, aged-standardised, Wales local authorities, Figure 283: Percentage of adults reporting to be physically active on no days in the past week, age-standardised percentage, persons, Hywel Dda UHB and Wales, 2009/ Figure 284: Percentage of adults reporting to be physically active on 5+ days in the past week, age-standardised percentage, persons, Hywel Dda UHB and Wales, 2003/ Figure 285: Average number of days of physical activity (capped) reported by adults in the past week, age-standardised, persons, Hywel Dda UHB and Wales, 2003/ Figure 286: QOF Public Health Domain Summary - Blood Pressure (BP) Figure 287: QOF Clinical Summary - Blood pressure (Hypertension) Figure 288: Number of survey respondents (weighted) and observed percentage with a BMI of 30 and over or 35 and over, persons aged over 16, Wales health boards, Figure 289: QOF public health domain summary obesity, Page 22 of 264

23 Figure 290: Number of survey respondents (weighted) and observed percentage with a BMI of 30 and over 35 and over, persons aged over 16, Wales health boards, Figure 291: Number of survey respondents (weighted) and observed percentage with a BMI of 40 and over and 50 and over, persons aged over 16, Wales health boards, Figure 291: Age-standardised percentage of adults reporting to be obese (BMI 30+), persons aged 16 and over, Welsh health boards, Figure 292: Age-standardised percentage of adults reporting to be overweight or obese (BMI 25+): Males in Hywel Dda UHB Figure 293: Age-standardised percentage of adults reporting to be overweight or obese (BMI 25+): Females in Hywel Dda UHB Figure 294: Age-standardised percentage of adults reporting to be overweight or obese, males, Ceredigion and Wales Figure 295: Age-standardised percentage of adults reporting to be overweight or obese, females, Ceredigion and Wales Figure 296: Age-standardised percentage of adults reporting to be overweight or obese, males, Pembrokeshire and Wales Figure 297: Age-standardised percentage of adults reporting to be overweight or obese, females, Pembrokeshire and Wales Figure 298: Age-standardised percentage of adults reporting to be overweight or obese, males, Carmarthenshire and Wales Figure 299: Age-standardised percentage of adults reporting to be overweight or obese, Carmarthenshire and Wales Figure 300: Age-standardised percentage of adults reporting to be obese (BMI 30+), males, Hywel Dda UHB and Wales Figure 301: Age-standardised percentage of adults reporting to be obese (BMI 30+), females, Hywel Dda UHB and Wales Figure 302: Age-standardised percentage of adults reporting to be obese (BMI 30+), males, Ceredigion and Wales Figure 303: Age-standardised percentage of adults reporting to be obese, (BMI 30+) females, Ceredigion and Wales Figure 304: Age-standardised percentage of adults reporting to be obese(bmi 30+), males, Pembrokeshire and Wales Figure 305: Age-standardised percentage of adults reporting to be obese (BMI 30+), females, Pembrokeshire and Wales Page 23 of 264

24 Figure 306: Age-standardised percentage of adults reporting to be obese (BMI 30+), males, Carmarthenshire and Wales Figure 307: Age-standardised percentage of adults reporting to be obese (BMI 30+), females, Carmarthenshire and Wales Figure 308: Percentage of adults reporting to be overweight or obese, age group, all persons, Hywel Dda UHB and Wales Figure 309: Percentage of adults reporting to be obese, age group, all persons, Hywel Dda UHB and Wales Figure 310: Percentage of adults reporting to be overweight or obese, by board, age group, all persons, Ceredigion and Wales Figure 311: Percentage of adults reporting to be obese, by broad age group, all persons, Ceredigion Figure 312: percentage of adults reporting to be overweight or obese, by broad age group, all persons, Pembrokeshire and Wales Figure 313: Percentage of adults to be obese, by broad age group, all persons, Pembrokeshire and Wales Figure 314: Percentage of adults reporting to be overweight or obese, age group, all persons, Carmarthenshire and Wales Figure 315: Percentage of adults reporting to be obese, by broad age group, all persons, Carmarthenshire and Wales Figure 316: Percentage of adults reporting to be overweight or obese, by deprivation fifth, all persons, Hywel Dda UHB Figure 317: Percentage of adults reporting to be obese, by deprived fifth, all persons, Hywel Dda UHB Figure 320: Percentage of adults reporting drinking above guidelines (males over 4 units, females over 3 units) on the heaviest drinking day in the past week, aged-standardised percentage*, persons, Wales health boards, Figure 321: Percentage of adults reporting drinking above guidelines (males over 4 units, females over 3 units) on the heaviest day in the past week, age, Hywel Dda UHB Figure 322: Percentage of adults reporting drinking above guidelines (males over 4 units, females over 3 units) on the heaviest drinking day in the past week, Hywel Dda UHB, Page 24 of 264

25 Figure 323: Percentage of adults reporting heavy (Binge) drinking (males over 8 units, females over 6 units) on the heaviest day in the past week, age-standardised percentage*, persons, Wales health boards, Figure 324: Percentage of adults reporting heavy (binge) drinking (males over 8 units, females over 6 units) on the heaviest drinking day in the past week, age-standardised percentage*, persons, Wales local authorities, Figure 325: Percentage of adults reporting heavy (binge) drinking (males over 8 units, females over 6 units) on the heaviest drinking day in the past week, Hywel Dda UHB, Figure 326: Percentage of adults reporting heavy (binge) drinking (males over 8 units, females over 6 units) on the heaviest drinking day in the past week, Hywel Dda UHB, Figure 327: Percentage of adults reporting very heavy drinking (males over 12 units, females over 9 units), Figure 328: Percentage of adults reporting very heavy drinking (males over 12 units, females over 9 units) on the heaviest drinking day in the past week, age-standardised percentages*, persons, Wales local authorities, Figure 329: Percentage of adults reporting very heavy drinking (males over 12 units, females over 9 units) on the heaviest drinking day in the past week, Hywel Dda UHB, Figure 330: Percentage of adults reporting very heavy drinking (males over 12 units, females over 9 units) on the heaviest drinking day in the past week, Hywel Dda UHB, Figure 331: Alcohol -specific hospital admissions (person-based), EASR per 100,000*, persons, all ages, Hywel Dda UHB and Wales, Financial years 2003/ / Figure 332: Alcohol-specific (person-based) EASR per 100,000*, persons, all ages, Wales health boards, financial year 2012/ Figure 333: alcohol-specific hospital admissions (person-based), EASR per 100,000, persons, all ages, Wales local authorities, financial year 2012/ Figure 334: Alcohol-specific hospital admissions (person-based), persons, all ages, Hywel Dda UHB, financial years 2010/ / Figure 337: Months of life lost due to alcohol, males aged under 75, Wales health boards, Figure 338: Months of life lost due to alcohol, females aged under 75, Wales health boards, Figure 339: Estimated incidence rates by region (year: ) Page 25 of 264

26 Figure 340: Suicides, ranked local authorities, EASR per 100,000, persons aged 15+, Figure 341: Individual patients having an emergency hospital admission with any mention of self harm in the admitting episode*, rate per 100,000 of males and females, aged 10+, Wales residents, Figure 342: Suicides, 3 year rolling trends, EASR per 100,000, males and females, Wales, Figure 343: QOF clinical summary - learning disabilities Figure 344: Percentage of adults free from a common mental disorder (as measured by a Mental Health Inventory 5 score > 60), age-standardised, Wales local authorities, Figure 345: Emergency hospital admissions with a primary diagnosis of hip fracture. EASR per 100,000, persons aged 65 and over, Hywel Dda UHB, local authorities and Wales, financial years 2003/ / Figure 346: Emergency hospital admissions with a primary diagnosis of hip fracture, EASR per 100,000, persons aged 65 and over, Hywel Dda UHB, local authorities and Wales, financial years 2003/ / Figure 348: Emergency hospital admissions with a primary diagnosis of hip fracture, EASR per 100,000, persons aged 65 and over, Wales health boards, local authorities, financial year 2012/ Figure 349: Emergency hospital admissions with a primary diagnosis of hip fracture, EASR per 100,000, persons aged 65 and over, Wales health boards, local authorities, financial years 2012/ Figure 350: Emergency hospital admissions with a primary diagnosis of hip fracture, EASR per 100,000, persons aged 65 and over, Hywel Dda UHB, local authorities and Wales, financial years 2003/ / Figure 351: Emergency hospital admissions with a primary diagnosis of hip fracture, EASR per 100,000, persons aged 65 and over, Hywel Dda UHB, local authorities and Wales, financial years 2003/ / Figure 361: Emergency hospital admissions with a diagnosis of fractured neck of femur, EASR per 100,000 persons, Hywel Dda UHB, Local authorities and Wales, persons aged 65 and over, 2003 to Figure 347: QOF clinical summary - palliative care Figure 352: Welsh Health Survey results (observed) from selected quality of life indicators, Hywel Dda he UHB residents by local authority, health board and Wales, persons aged 65 and over, Page 26 of 264

27 Figure 353: Welsh health Survey results (observed) for selected conditions, Hywel Dda UHB residents by local authority, health board and Wales, persons aged 65 and over, Figure 354: Uptake of bowel screening programme*, local authorities, health boards and Wales, persons aged year old, Figure 355: Uptake of breast screening programme*, local authorities, health boards and Wales, females aged 50 to 70 years, Figure 356: Coverage of cervical screening programme*, local authorities, health boards and Wales, females aged 50 to 64 years, Figure 357: Excess winter deaths (EWD) index, Wales health boards, residents aged 65 and over, Figure 358: Excess winter deaths (EWD) index, Wales health boards, residents aged 65 and over, Figure 359: Excess winter deaths (EWD) index, Hywel Dda UHB and Wales, residents aged 65 and over, Figure 360: Excess winter deaths (EWD) index, Hywel Dda UHB and Wales, residents aged 65 and over, rolling 3 years periods Page 27 of 264

28 FOREWARD We are delighted to present the Hywel Dda UHB Health Needs Assessment. This is the first Health Needs Assessment document to be developed for the Health Board and should be referred to as a transitional report, as it is anticipated more sophisticated tools and interactive methods will be developed over the coming years, in conjunction with the Public Health Wales Observatory. It is anticipated that this document will help inform the Public Service Board and will support the development of the Integrated Medium Term Plan for 2016/17. This document is a shortened version of a more detailed technical document, which covers a range of key health issues and is set out as follows: Chapter One: Describes the demographic profile of residents living in the Hywel Dda locality. It provides detailed information on the population structure by age, sex and gender, ethnicity, fertility, births and mortality rates, deprivation and life expectancy. Chapter Two: Highlights the incidence and prevalence of various chronic conditions such as cardiovascular disease, diabetes, respiratory disease, cancer, liver disease and neurology. Chapter Three: Briefly describes the wider determinants of health and highlights the impact of income, housing, economic activity, employment and education. Chapter Four: Provides an overview of the various lifestyle risk factors and life stages from early years to older people. Chapter Five: Provides links to the local Single Integrated Plans for Carmarthenshire, Ceredigion and Pembrokeshire. We are most grateful to Ms Kerry Morgan for leading on the production of this document, and also members from the Public Health Wales Observatory and the Public Health Team for their contributions and support. We hope you find this document informative and useful. Teresa Owen Director of Public Health Dr Michael Thomas Consultant in Public Health January 2016 Page 28 of 264

29 EXECUTIVE SUMMARY This Health Needs Assessment (HNA) has been produced by the Public Health Directorate to provide evidence about our population in order to plan services and address health inequalities amongst our local communities. The purpose of this HNA is to gather the information required to bring about changes beneficial to the health of the population. It is generally accepted that this occurs within the context of finite resources. The subjects of this HNA are the populations and patients who are healthcare recipients or potential beneficiaries of health care within Hywel Dda UHB. Hywel Dda UHB provides healthcare services to a total population of around 384,000 people across the three counties of Carmarthenshire, Ceredigion and Pembrokeshire. Approximately 13% of the total population of Wales live in Hywel Dda, although the area covers roughly a quarter of the landmass of Wales. Within the Hywel Dda area almost 47.9% of the population live in Carmarthenshire, just over 20.7% in Ceredigion and just over 31.4% in Pembrokeshire. The table below outlines some key statistics for Wales and Hywel Dda UHB: Key Statistics Wales HDUHB Total population 3,092, ,000 Population aged 75 and over (%) Life expectancy at birth males (years) Life expectancy at birth females (years) Adults who are overweight or obese (%) Adults who smoke (%) Adults who drink above guidelines (%) MMR uptake (%) Live birth per 1,000 women aged Emergency hospital admissions (European age standardized rate per 1,000 population) When assessing health needs it s important to be able to draw upon epidemiological, comparative and corporate information. This document provides detailed public health data on various health needs, however it must be noted that some data sources have more comprehensive data collection methods and are easier to access. This document is a shortened version of a more detailed technical document which provides further data on a wide range of public health issues. Page 29 of 264

30 Page 30 of 264

31 CHAPTER 1: DEMOGRAPHIC PROFILE 1.1 Population structure Hywel Dda Health Board covers three local authority areas: Carmarthenshire; Ceredigion and Pembrokeshire. The population of Hywel Dda is estimated 383,900 1 Hywel Dda Health Board, covering a quarter of the landmass of Wales 2, is the second most sparsely populated health board area percent, 47.9 per cent and 20.7 per cent of the population live in the local authority areas of Pembrokeshire, Carmarthenshire and Ceredigion respectively. There are, however, notable differences with fewer people aged and more people aged In rural Pembrokeshire and Ceredigion, there are relatively high numbers of older people. With 13% of Wales population the area s age and sex profile is similar to that of Wales as a whole, as shown in figure 1: Figure 1: Population pyramid percentage by age and sex in Hywel Dda UHB and Wales. 1 Public Health Wales Observatory: 2 Office of National Statistics, 2007 geography Page 31 of 264

32 Figure 2: Percentage of population by age and sex, Hywel Dda UHB and Wales, Figure 3: Count of population by age and sex, Hywel Dda UHB and Wales, Page 32 of 264

33 Figure 4: Population pyramid percentage by age and sex in Ceredigion and Wales, Figure 5: Percentage of population by age and sex, Ceredigion and Wales, Page 33 of 264

34 Figure 6: Count of population by age and sex, Ceredigion and Wales, Figure 7: Population pyramid percentage by age and sex, Pembrokeshire and Wales, Page 34 of 264

35 Figure 8: Percentage of population by age and sex, Pembrokeshire and Wales, Figure 9: Count of population by age and sex, Pembrokeshire and Wales, Page 35 of 264

36 Figure 10: Population pyramid percentage by age and sex, Carmarthenshire and Wales, Figure 11: Percentage population by age and sex, Carmarthen, Page 36 of 264

37 Figure 12: Count of population by age and sex, Carmarthenshire and Wales, Page 37 of 264

38 1.2 Population projections by local authority and year Current population projections suggest that the total population of Hywel Dda will rise to 425,400 by 2033, with a rise in those aged over 65 years from 88,200 in 2013 to 127,700 by It is important to highlight the predicted rise in the number of older people over the next 20 years. Projections suggest by 2030, the population of over 65 year olds will increase by 60% in Hywel Dda. In particular the number of the very elderly (85+) will increase by 6%. Current projections see a rise in the older population (75 years and over) from 35,000 (10% of the total population) in 2006 to 70,000 (16% of the total population) in These estimates are based on assumptions about births, deaths and migration. In the current economic climate, the relative (and absolute) increase in economically dependent and, in some cases, care-dependent populations will pose particular challenges to communities. The increase in the number of older people is also likely to lead to a rise in chronic conditions such as circulatory and respiratory diseases and cancers. Meeting the needs of these individuals will be a key challenge for the Health Board and its local authority partners. Figure 13: Projected population counts by age group, Hywel Dda UHB, Page 38 of 264

39 Figure 14: population percentage Hywel Dda UHB, Local authorities and Wales, % aged 65 and over, Figure 15: Population density (persons per square kilometre) by Local Authority and year. Midyear Midyear Midyear Midyear Midyear Midyear 2014 Wales Ceredigion Pembrokeshire Carmarthenshire ONS, 2015 Page 39 of 264

40 Figure 16: Total fertility and general fertility rates by local authority and year. General Fertility Rates* Total Fertility Rates** HDUHB Ceredigion Pembrokeshire Carmarthenshire ONS, 2015 *Live births per 1,000 women aged ** TFR is the average number of children that would be born to a woman if current patterns of fertility persisted throughout her childbearing life Figure 17: Live births by area and age of mother (2013). All ages < > All ages HDUHB , ,589 Ceredigion Pembrokeshire ,136 Carmarthenshire ,815 Births Registration, ONS (2015) Page 40 of 264

41 Figure 18: Live births with low birth weight by area (2013). Live Singleton Number Rate Number Rate Wales 2, , HDUHB Ceredigion Pembrokeshire Carmarthenshire Births Registration, ONS (2015) Figure 19: Still births by area Number Rate Number Rate Number Rate Number Rate Wales HDUHB Ceredigion Pembrokeshire Carmarthenshire Births Registration, ONS (2015) Page 41 of 264

42 1.3 All cause mortality Figure 20: All cause mortality, EASR per 100,000, count and crude rate, female and male aged under 75, Wales, Wales local authorities and health boards, Males: Females: Males in Ceredigion and Pembrokeshire have statistically lower all cause mortality than the Welsh average. Whereas, females in Ceredigion and Carmarthenshire have statistically lower all cause mortality than the Welsh average. Page 42 of 264

43 Figure 21: All cause mortality and excess deaths, females under 75 Ceredigion and Wales, Figure 22: All cause mortality and excess deaths in males under 75, Ceredigion and Wales, Page 43 of 264

44 Figure 23: All cause mortality and excess deaths in Males under 75, Pembrokeshire and Wales, Figure 24: All cause mortality and excess deaths in females under 75, Pembrokeshire and Wales, Page 44 of 264

45 Figure 25: All cause mortality and excess deaths in males under 75, Carmarthenshire and Wales, Figure 26: All cause mortality and excess deaths in females under 75, Carmarthenshire and Wales Page 45 of 264

46 1.4 Ethnicity The total population of Wales at the time of the 2011 Census was 3,063,456, with the greatest percentage of the population (93.7%) reporting to be White British or Irish. The White British or Irish population in Wales is 2,869,536. Of the populations excluding White British or Irish, the Asian/Asian British population has the highest number of people, representing 2.3% (70,128) of the total population. The White other group, including White Gypsy or Irish Traveller, represents 1.9% of the population with 58,717 persons reporting as belonging to this group. The Mixed/multiple ethnic group represents 31,521 people, which corresponds to 1.0% of the population. The Black/African/Caribbean/Black British population is made up of 18,276 people, representing 0.6% of the population of Wales. Finally, the other ethnic group has a population of 15,278, approximately 0.5% of the total population. Figure 27: Population by ethnic group percentage, Wales, Page 46 of 264

47 Figure 28: Percentage of the population who do not define themselves as White British or Irish, by local authority, Cardiff (19.0%) and Newport (12.5%) have the highest percentage defining themselves as not being White British or Irish followed by Swansea, Wrexham and Ceredigion (8.1%, 6.6% and 6.2%, respectively). The remaining local authorities have a percentage of 5.2% or less, with Caerphilly and Blaenau Gwent being the least ethnically diverse local authorities in Wales, both 2.5%. Figure 29: Changes in the ethnic make-up of Wales between the 2011 and 2011 Census. Page 47 of 264

48 Although each of the ethnic groups has seen a rise in numbers, the percentage increases vary greatly. The White British or Irish population saw an increase of 65,242 persons; however, this is the smallest percentage increase (2.3%). The Asian/Asian British population increased from 31,715 to 70,128 (121.1% increase), however changes in recording persons of Chinese origin from the Other ethnicities category in 2001 to Asian/Asian British in 2011 results in a loss of comparability for the Asian/Asian British group. The largest percentage increase is seen in the Other ethnic group. The population almost trebled from 5,135 to 15,278 during the period, an increase of 197.5%. Although the percentage increase has been large, this group only accounts for 0.5% of the total population. Page 48 of 264

49 1.5 Life expectancy Life expectancy is the number of years a person can expect to live, on average, in a given population. The length of people s lives will differ substantially and life expectancy can be used to measure or compare death rates between and within communities and countries overtime. It is also important to consider quality of life, which can now be calculated using the Healthy Life Expectancy (HLE) measure. The HLE at birth represents the number of years a person can expect to live in good health. It is perhaps a better indicator of overall health, since it looks at the period lived in good health and excludes the period when quality of life may be poor. Disability-Free Life Expectancy at birth (DFLE), also estimates the number of years of life expected to be free from a limiting long-term illness or disability. National Data suggests that whilst there are increases in overall life expectancy, the increases in the measures relating to quality of life experienced are falling behind. Life expectancy has therefore improved more than the quality of life and health. Life expectancy at birth is a statistical measure of the average expected years of life for a newborn based on currently observed mortality rates and is a measure of mortality across all ages. In addition to general life expectancy it is important to consider quality of life and so two further measures are represented here. Healthy life expectancy at birth (HLE) represents the number of years a person can expect to live in good health. Disabilityfree life expectancy at birth (DFLE) estimates the number of years of life expected to be free from a limiting long-term illness or disability. Figure 30: Measures in life expectancy in Males and Females, Page 49 of 264

50 Figure 31: Healthy life expectancy at birth, Wales, Page 50 of 264

51 1.6 Deprivation The Welsh Index of Multiple Deprivation (WIMD) is the official measure of relative deprivation for small areas in Wales. The Index was developed as a tool to identify and understand deprivation in Wales, so that funding, policy and programmes can be effectively focussed on the most disadvantages communities. The following indicators are included in this measure: employment, income, education, health, community safety, geographical access to services, housing and physical environment. Figure 32: Welsh Index of Multiple Deprivation, Wales Page 51 of 264

52 Local deprivation fifths for Hywel Dda Health Board have been produced by ranking all Lower Super Output Areas (LSOAs) within the area and grouping them into fifths, based on the Welsh Index of Multiple Deprivation (2008). Each health board therefore has its own local fifths depending on the deprivation distribution within that area which are shown below: The association between deprivation and health is clearly apparent.. Many health outcomes are statistically significantly worse than Wales as a whole in the following areas of high deprivation: Carmarthenshire: Glanymor, Tyisha, Lliedi Pembrokeshire: Parts of Pembroke, Pembroke Dock and Haverfordwest. Ceredigion is not significantly worse than the Welsh Average Figure 33: Welsh Index of Multiple Deprivation, Hywel Dda UHB, Page 52 of 264

53 Figure 34: Population by deprivation fifths, Wales, Figure 35: Percentage of the populations in the most deprived fifth, Wales, Percentage of the population in the most deprived fifth, Wales health Health Board and Local authority, boards and local authorities, 2013 Produced by Public Health Wales Observatory, using WIMD 2014 (WG) and MYE (ONS) Besti Cadwaladr UHB Powys thb Hywel Dda UHB Abertawe Bro Morgannwg UHB Cardiff & Vale UHB Cwm Taf UHB Aneurin Bevan UHB Isle of Anglesey Gwynedd Conwy Denbighshire Flintshire Wrexham Powys Ceredigion Pembrokeshire Carmarthenshire Swansea Neath Port Talbot Bridgend Vale of Glamorgan Cardiff Rhondda Cynon Taf Merthyr Tydfil Caerphilly Blaenau Gwent Torfaen Monm outhshire Newport Page 53 of 264

54 Figure 36: Number of lower super output areas by deprivation fifths, by health board and local authorities, Figure 37: Percentage of lower super output areas in the most deprived fifth in Percentage of Lower Super Output Areas in the most deprived fifth, Wales and Local authorities, Wales health boards and local authorities, 2014 Produced by Public Health Wales Observatory, using WIMD 2014 (WG) Besti Cadwaladr UHB Powys thb Hywel Dda UHB Abertawe Bro Morgannwg UHB Cardiff & Vale UHB Cwm Taf UHB Aneurin Bevan UHB Isle of Anglesey Gwynedd Conwy Denbighshire Flintshire Wrexham Powys Ceredigion Pembrokeshire Carmarthenshire Swansea Neath Port Talbot Bridgend Vale of Glamorgan Cardiff Rhondda Cynon Taf Merthyr Tydfil Caerphilly Blaenau Gwent Torfaen Monm outhshire Newport Page 54 of 264

55 1.7 Childhood deprivation Deprivation is part of a wider notion of poverty than measures of income alone. The Welsh Index of Multiple Deprivation 2011 Child Index is a measure of relative deprivation for small areas in Wales for children. It is constructed of 7 domains: income, health, education, geographical access to services, community safety, physical environment and housing. These domains included in the Child Index are focused on the child population and the types of deprivation which might be expected to affect them. Figure 38: Welsh Index of Multiple Deprivation 2011, Child Index. Page 55 of 264

56 Figure 39: % LSOAs in the most deprived tenth, Welsh Index of Multiple Deprivation, 2011 Child Index. % LSOAs in the most deprived tenth, Welsh Index of Multiple Deprivation 2011 Child Index Produced by Public Health Wales Observatory, using WIMD 2011 (WG) Betsi Cadwaladr Powys Hywel Dda ABM Cardiff & Vale Cwm Taf Aneurin Bevan Wales =10.0% Number Isle of Anglesey Gwynedd Conwy Denbighshire Flintshire Wrexham Powys Ceredigion Pembrokeshire Carmarthenshire Swansea Neath Port Talbot Bridgend Vale of Glamorgan Cardiff Rhondda Cynon Taf Merthyr Tydfil Caerphilly Blaenau Gwent Torfaen Monmouthshire Newport The percentage of LSOAs in the most deprived tenth in Hywel Dda UHB ranges from 2 in Ceredigion, 8 in Pembrokeshire and 11 in Carmarthenshire. Page 56 of 264

57 1.8 Mortality by cause of death Figure 40 shows the mortality trend between and for all causes of death in males under 75 in the health board. The mortality rate in the most and the least deprived fifths is shown together with the rates for Wales and the health board as a whole as a comparison. Figure All-cause 40: mortality, Mortality under in 75, males, under European 75, age-standardised European age-standardised rate (EASR) per 100,000, rates Hywel per Dda HB and Wales, ,000 population. Produced by Public Health Wales Observatory, using ADDE/MYE (ONS), WIMD 2008 (WG) Most deprived within Hywel Dda (95% CI) Least deprived within Hywel Dda Wales EASR Hywel Dda overall Rate Ratio - most deprived divided by least deprived Produced by the Public Health Wales Observatory, using ADDE/MYE (ONS), WIMD 2008 (WG) Figure 41 shows the mortality trend between and for all causes of death in females under 75 in the health board. The mortality rate in the most and the least deprived fifths is shown together with the rates for Wales and the health board as a whole as a comparison. Figure All-cause 41: mortality, Mortality under in 75, females, European under 75 age-standardised European age-standardised rate (EASR) per 100,000, rates Hywel per Dda HB and Wales, ,000 population. Produced by Public Health Wales Observatory, using ADDE/MYE (ONS), WIMD 2008 (WG) Most deprived within Hywel Dda (95% CI) Wales EASR Least deprived within Hywel Dda Hywel Dda overall Rate Ratio - most deprived divided by least deprived Produced by the Public Health Wales Observatory, using ADDE/MYE (ONS), WIMD 2008 (WG) Page 57 of 264

58 1.8.1 Cardiovascular disease Figure 42: Mortality from cardiovascular disease, European age-standardised rate per 100,000, all persons aged under 75, Hywel Dda UHB middle super output areas (MSOAs), Rates from 2 MSOAs (Ceredigion 002 & 003 and Carmarthen 001) are calculated from fewer than 20 events. Their reliability may be affected by the small numbers of events and they should therefore be interpreted with caution. Page 58 of 264

59 Figure 43: Mortality from cardiovascular disease, all persons aged under 75, Hywel Dda UHB, Deaths were assigned to a valid MSOA using the postcode field within the Public Health Mortality (PHM) file extract. Page 59 of 264

60 Figure 44: Cardiovascular disease mortality, EASR per 100,000, persons aged under 75, Wales health Boards, Hywel Dda UHB is not statistically significant worse than the Welsh Score. The rates presented here differ to those published on our cardiovascular disease topic page for the following reasons: - CVD topic page uses 2001 based MYEs, this analysis uses 2011 based MYEs - CVD topic page has adjusted the EASRs to account for coding changes, this analysis has not (affects data from 2011 onwards) - CVD topic page uses the 1976 European Standard Population (ESP), this analysis uses the 2013 ESP Figure 45: Cardiovascular disease mortality (ICD ), annual average and EASR per 100,000, Cardiovascular persons, disease all mortality ages Hywel (ICD Dda I00 UHB, - I99), Wales annual & average England, and European age-standardised rate per 100,000 persons, all ages, Hywel Dda UHB, Wales & England, Annual average EASR (95% confidence interval) Hywel Dda UHB 1, ( ) Wales 10, ( ) England 151, ( ) Produced by Public Health Wales Observatory, using PHM and MYE (ONS) Please note that all deaths by cause analyses exclude neonates. Page 60 of 264

61 Figure 46: Cardiovascular disease mortality (ICD ), EASR per 100,000 persons, all ages, Hywel Dda UHB, Wales and England, The below shows that Hywel Dda is following the Welsh and English declining trend in numbers of CVD mortalities per population. Please note that all deaths by cause analyses exclude neonates. Page 61 of 264

62 1.8.2 Coronary heart disease Figure 47: Mortality from coronary heart disease, EASR per 100,000, all persons, all ages, Hywel Dda UHB Middle, Super Output Areas, Deaths were assigned to a valid MSOA using the postcode field within the Public Health Mortality (PHM) file extract. Page 62 of 264

63 Figure 48: Coronary heart disease mortality, persons all ages, Hywel Dda UHB, Page 63 of 264

64 Coronary heart disease mortality (ICD-10 I20-I25), Figure 49: Coronary heart disease mortality (ICD ), EASR per European age-standardised rate per 100,000, persons aged 100,000, persons under 75, Wales health boards, under 75, Wales health boards, Annual average deaths EASR (95% confidence interval) Betsi Cadwaladr UHB (43-49) Powys thb (32-44) Hywel Dda UHB (47-56) Abertawe Bro Morgannwg UHB (56-65) Cardiff & Vale UHB (34-42) Cwm Taf UHB (59-71) Aneurin Bevan UHB (52-60) Wales (49-53) Produced by Public Health Wales Observatory, using PHM and MYE (ONS) 2013 European standard population. No adjustments have been made for the ICD-10 coding changes. Figure 50: Coronary heart heart disease disease mortality mortality, (ICD-10 EASR I20-I25), per 100,000, European persons under 75, Wales age-standardised health boards, rate per 100,000, persons aged under 75, Wales health boards, Produced by Public Health Wales Observatory, using PHM and MYE (ONS) 95% confidence interval Wales = 51 Betsi Cadwaladr UHB 46 Powys thb 37 Hywel Dda UHB 51 ABM UHB 60 Cardiff and Vale UHB 38 Cwm Taf UHB 65 Aneurin Bevan UHB European standard population. No adjustments have been made for the ICD-10 coding changes. Please note that all deaths by cause analyses exclude neonates. Page 64 of 264

65 1.8.3 Smoking attributable The below shows the mortality trend between and for smokingattributable deaths in males aged 35 and over in the health board. The mortality rate in the most and the least deprived fifths is shown together with the rates for Wales and the health board as a whole as a comparison. Figure Smoking-attributable 51: mortality, attributable males, mortality aged 35 in and males over, European aged 35+ age-standardised in Hywel Dda rate UHB (EASR) per 100,000, Hywel Dda HB and Wales, population). Produced by Public Health Wales Observatory, using ADDE/MYE (ONS), WHS/WIMD 2008 (WG) Most deprived within Hywel Dda (95%CI) Wales EASR Least deprived within Hywel Dda Hywel Dda overall Rate Ratio - most deprived divided by least deprived Produced by the Public Health Wales Observatory, using ADDE/MYE (ONS), WHS/WIMD 2008 (WG) The below shows the mortality trend between and for smokingattributable deaths in females aged 35 and over in the health board. The mortality rate in the most and the least deprived fifths is shown together with the rates for Wales and the health board as a whole as a comparison. Figure Smoking-attributable 52: Smoking-attributable mortality, females, mortality aged 35 and in over, females European aged age-standardised 35+in Hywel Dda rate (EASR) per 100,000, Hywel Dda HB and Wales, UHB per 100,000 population). Produced by Public Health Wales Observatory, using ADDE/MYE (ONS), WHS/WIMD 2008 (WG) Most deprived within Hywel Dda (95%CI) Wales EASR Least deprived within Hywel Dda Hywel Dda overall Rate Ratio - most deprived divided by least deprived Produced by the Public Health Wales Observatory, using ADDE/MYE (ONS), WHS/WIMD 2008 (WG) Page 65 of 264

66 1.8.4 Alcohol specific The below shows that Hywel Dda UHB seems to be maintaining a downward trend, unlike the Welsh average, suggesting that Hywel Dda is significantly lower than the Welsh rates during Figure 53: Alcohol-specific mortality, 3 year rolling EASR per 100,000, persons, all ages, Hywel Dda UHB and Wales, to The below shows all Wales Health Boards, both Powys and Hywel Dda are significantly lower than the welsh average. Figure 54: Alcohol-specific mortality, EASR rate per 100,000, persons, all ages, Wales health boards, Page 66 of 264

67 Figure 55: Alcohol-specific mortality, persons all ages, Hywel Dda UHB, The light shades on the above map suggests lower alcohol specific mortality and the darker shades suggest higher rates of alcohol mortality. The area with the highest rate of alochol mortality is located within Carmarthenshire. Page 67 of 264

68 Figure Alcohol-specific 56: Alcohol-specific mortality, mortality, European persons age-standardised all ages, Hywel rate per Dda 100,000*, UHB, persons, all ages, Wales local authorities, Produced by Public Health Wales Observatory, using ADDE & MYE (ONS) 95% confidence interval Wales = 13 Isle of Anglesey 13 Gwynedd 15 Conwy 14 Denbighshire 17 Flintshire 10 Wrexham 12 Powys 9 Ceredigion 8 Pembrokeshire 11 Carmarthenshire 11 Swansea 14 Neath Port Talbot 12 Bridgend 16 The Vale of Glamorgan 13 Cardiff 16 Rhondda Cynon Taf 17 Merthyr Tydfil 18 Caerphilly 11 Blaenau Gwent 18 Torfaen 12 Monmouthshire 8 Newport 12 *Adjusted for ICD-10 coding changes and using the 2013 European Standard Population The above demonstrates all Wales local authority scores for alcohol specific mortality. Ceredigion is statistically significantly lower than the Welsh score of 13. Page 68 of 264

69 1.8.5 Chronic liver disease and cirrhosis The below shows the decline in mortality from chronic liver and cirrhosis within Hywel Dda UHB. Hywel Dda UHB is also significantly lower than the Welsh average. Figure 57: Mortality from chronic liver and cirrhosis, 3 year rolling EASR per 100,000*, persons, all ages, Hywel Dda UHB and Wales, and Hywel Dda UHB and Powys THB were both significantly lower than the Wales score of 14. Figure 58: Morality from Chronic liver disease and cirrhosis, EASR per 100,000*, Mortality persons from chronic all ages, liver disease and cirrhosis, European agestandardised rate per 100,000*, persons, all ages, Produced by Public Health Wales Observatory, using ADDE & MYE (ONS) 95% confidence interval Wales = 14 Betsi Cadwaladr UHB Powys thb Hywel Dda UHB ABM UHB Cardiff & Vale UHB Cwm Taf UHB Aneurin Bevan UHB *Adjusted for ICD-10 coding changes and using the 2013 European Standard Population Page 69 of 264

70 1.8.6 Stroke Figure 59: Mortality from cerebrovascular disease (stroke), EASR rate per 100,000 persons, , Wales local authorities. Ceredigion is statistically lower than the Welsh average score, however, Carmarthenshire is significantly higher than the Welsh average score. Pembrokeshire has no significant difference. Figure 60: Mortality from cerebrovascular disease (Stroke), EASR per 100,000 persons, , Wales local authorities. Page 70 of 264

71 1.8.7 Respiratory disease Figure 61: Respiratory disease mortality*, average annual deaths, crude rate Respiratory disease mortality*, average annual deaths, crude and EASR per 100,000, persons aged under 75, Wales local authorities, rate and European age-standardised rate (EASR) per 100,000, persons aged under 75, Wales local authorities, Isle of Anglesey ( ) Gwynedd ( ) Conwy ( ) Denbighshire ( ) Flintshire ( ) Wrexham ( ) Powys ( ) Ceredigion ( ) Pembrokeshire ( ) Carmarthenshire ( ) Swansea ( ) Neath Port Talbot ( ) Bridgend ( ) Vale of Glamorgan ( ) Cardiff ( ) Rhondda Cynon Taf ( ) Merthyr Tydfil ( ) Caerphilly ( ) Blaenau Gwent ( ) Torfaen ( ) Monmouthshire ( ) Newport ( ) Wales 1, ( ) Produced by Public Health Wales Observatory, using PHM & MYE (ONS) *ICD-10 codes J00-J99 Average annual deaths Crude rate EASR per 100,000 (95% confidence interval) Ceredigion had the lowest average annual deaths of 17, followed by Pembrokeshire 42 then Carmarthenshire 62. Page 71 of 264

72 Figure 62: Respiratory disease mortality*, EASR per 100,000 persons aged under 75, Wales local authorities, Ceredigion is significantly lower than the Wales score of 39. Page 72 of 264

73 Respiratory disease mortality*, average annual deaths, crude rate Figure 63: respiratory disease mortality*, average deaths, crude rate and EASR and European age-standardised rate (EASR) per 100,000, persons per 100,000, persons aged under 75, Wales health boards, aged under 75, Wales health boards, Betsi Cadwaladr UHB ( ) Powys thb ( ) Hywel Dda UHB ( ) Abertawe Bro Morgannwg UHB ( ) Cardiff and Vale UHB ( ) Cwm Taf UHB ( ) Aneurin Bevan UHB ( ) Wales 1, ( ) Produced by Public Health Wales Observatory, using PHM & MYE (ONS) *ICD-10 codes J00-J99 Average annual deaths Crude rate EASR per 100,000 (95% confidence interval) Both Powys THB and Hywel Dda UHB were significantly lower than the Wales scores. Figure 64: respiratory disease mortality*, EASR per 100,000, persons aged under 75, Wales health boards, Page 73 of 264

74 1.8.8 Asthma Asthma mortality*, average annual deaths, crude rate and Figure 65: European Asthma age-standardised mortality*, average rate annual (EASR) deaths, per 100,000, crude persons rate and EASR per 100,000 persons aged under 75, Wales health boards, aged under 75, Wales health boards, Betsi Cadwaladr UHB ( ) Powys thb** <1 0.2 Hywel Dda UHB ( ) Abertawe Bro Morgannwg UHB ( ) Cardiff and Vale UHB ( ) Cwm Taf UHB ( ) Aneurin Bevan UHB ( ) Wales ( ) Produced by Public Health Wales Observatory, using PHM & MYE (ONS) *ICD-10 codes J45-J46 Average annual deaths Crude rate EASR per 100,000 (95% confidence interval) **The EASR for Powys thb has been suppressed due to the small number of events. There is no statistical difference between Hywel Dda UHB and the Wales average. Figure 66: Asthma mortality*, average annual deaths, crude rate and EASR per 100,000, persons under 75, Wales health boards, Page 74 of 264

75 1.8.9 Chronic obstructive pulmonary disease Chronic obstructive pulmonary disease mortality*, average annual Figure deaths, 67: Chronic crude rate obstructive and European pulmonary age-standardised disease rate mortality*, (EASR) per EASR per 100,000, persons aged under 75, Wales local authorities, ,000, persons aged under 75, Wales local authorities, Isle of Anglesey ( ) Gwynedd ( ) Conwy ( ) Denbighshire ( ) Flintshire ( ) Wrexham ( ) Powys ( ) Ceredigion ( ) Pembrokeshire ( ) Carmarthenshire ( ) Swansea ( ) Neath Port Talbot ( ) Bridgend ( ) Vale of Glamorgan ( ) Cardiff ( ) Rhondda Cynon Taf ( ) Merthyr Tydfil ( ) Caerphilly ( ) Blaenau Gwent ( ) Torfaen ( ) Monmouthshire ( ) Newport ( ) Wales ( ) Produced by Public Health Wales Observatory, using PHM & MYE (ONS) *ICD-10 codes J40-J44 Average annual deaths Crude rate EASR per 100,000 (95% confidence interval) The average annual deaths from chronic obstructive pulmonary disease mortality varied from 9 in Ceredigion, 27 in Pembrokeshire and 37 in Carmarthenshire. Page 75 of 264

76 Figure 68 Chronic pulmonary disease mortality*, EASR per 100,000, persons aged under 75, Wales local authorities, Powys, Ceredigion and Monmouth were statistically lower than the Welsh average score. Pembrokeshire and Carmarthenshire showed no statistical difference. Page 76 of 264

77 Figure 69: Chronic obstructive pulmonary disease mortality*, average annual Chronic obstructive pulmonary disease mortality*, average annual deaths, deaths, crude crude rate and rate and EASR European per 100,000, age standardised persons aged rate (EASR) under per 75, Wales health boards, ,000, persons aged under 75, Wales health boards, Betsi Cadwaladr UHB ( ) Powys thb ( ) Hywel Dda UHB ( ) Abertawe Bro Morgannwg UHB ( ) Cardiff and Vale UHB ( ) Cwm Taf UHB ( ) Aneurin Bevan UHB ( ) Wales ( ) Produced by Public Health Wales Observatory, using PHM & MYE (ONS) *ICD-10 codes J40-J44 Average annual deaths Crude rate EASR per 100,000 (95% confidence interval) Hywel Dda UHB showed no statistical difference to the Welsh average score. Figure 70: Chronic obstructive pulmonary disease mortality*, EASR per 100,000, persons aged under 75 y, Wales health boards, Page 77 of 264

78 Interstitial lung disease Figure 71: Interstitial lung disease mortality*, average annual deaths, crude Interstitial lung disease mortality*, average annual deaths, crude rate and EASR per 100,000, persons aged under 75, Wales local authorities, rate and European age-standardised rate (EASR) per 100,000, persons aged under 75, Wales local authorities, Average annual deaths Isle of Anglesey ( ) Gwynedd ( ) Conwy ( ) Denbighshire ( ) Flintshire ( ) Wrexham ( ) Powys ( ) Ceredigion ( ) Pembrokeshire ( ) Carmarthenshire ( ) Swansea ( ) Neath Port Talbot ( ) Bridgend ( ) Vale of Glamorgan ( ) Cardiff ( ) Rhondda Cynon Taf ( ) Merthyr Tydfil ( ) Caerphilly ( ) Blaenau Gwent ( ) Torfaen ( ) Monmouthshire ( ) Newport ( ) Wales ( ) Produced by Public Health Wales Observatory, using PHM & MYE (ONS) *ICD-10 codes J60-J70; J80-J84; D86.0 Crude rate EASR per 100,000 (95% confidence interval) Ceredigion had the lowest average annual deaths of 3, followed by 6 in Pembrokeshire and 7 in Carmarthenshire. Page 78 of 264

79 Interstitial lung disease mortality*, average annual deaths, crude Figure 72: Interstitial lung disease mortality*, average deaths, crude rate and rate and European age-standardised rate (EASR) per 100,000, EASR per 100,000, persons aged under 75, Wales health boards, persons aged under 75, Wales health boards, Betsi Cadwaladr UHB ( ) Powys thb ( ) Hywel Dda UHB ( ) Abertawe Bro Morgannwg UHB ( ) Cardiff and Vale UHB ( ) Cwm Taf UHB ( ) Aneurin Bevan UHB ( ) Wales ( ) Produced by Public Health Wales Observatory, using PHM & MYE (ONS) *ICD-10 codes J60-J70; J80-J84; D86.0 Average annual deaths Crude rate EASR per 100,000 (95% confidence interval) Hywel Dda UHB had 16 average annual deaths, in comparison to the all Wales average of 140. This was statistically lower, as outlined below: Figure 73: Interstitial disease mortality*, EASR per 100,000, persons aged under 75, Wales health boards, Page 79 of 264

80 Cancer The general trend in cancer mortality rate is coming down, once changes in population age structure are taken into account. By 2012, mortality was around 174 per 100,000 people 11% less than ten years before. Figure 74: Trends in mortality (EASR) for cancers (excluding non-malignant melanomas), Wales, all ages, Cancer mortality (EASR) rate in Wales, all ages males Wales females Wales Welsh Cancer Intelligence and Surveillance Unit s Cancer Registry Mortality is increasing in the oldest age group. Overall, there has been a 3% increase in deaths for all ages, but the number of cancer deaths has increased by 31% in people aged 85 and over. Figure 75: Trends in mortality for cancers (excluding non-malignant melanomas), annual number of cancer deaths by age group, Wales, all persons, , aged 50+. Annual number of cancer deaths by age group. Wales, all persons, , age Page 80 of 264

81 Welsh Cancer Intelligence and Surveillance Unit s Cancer Registry Figure 76: Trends in mortality for cancers (excluding non-malignant melanomas), EASR of cancer deaths by sex, Wales and Hywel Dda, all ages, Cancer mortality (EASR) rate in Wales and Hywel Dda all ages males Wales males Hywel Dda females Wales females Hywel Dda Welsh Cancer Intelligence and Surveillance Unit s Cancer Registry Page 81 of 264

82 Chronic liver disease including cirrhosis Figure 77: Mortality for chronic liver disease including cirrhosis is identified when ICD-10 codes K70, K73 or K74 appear as the underlying cause of death. Aged The above shows the disease rates for Welsh health boards for persons aged between 20 and 74. Page 82 of 264

83 Figure 78: Mortality from chronic liver disease including cirrhosis*, crude rate, all persons aged 75+, Wales health boards, and The above shows the scores for all health boards in Wales for persons aged 75 plus. Page 83 of 264

84 Figure 79: Mortality from chronic liver disease including cirrhosis*, 3 year rolling rate (EASR), all persons, all ages, Wales health boards, and Mortality from chronic liver disease including cirrhosis is identified when ICD-10 codes K70, K73 or K74 appear as the underlying cause of death. Page 84 of 264

85 Figure 80: Mortality from chronic liver disease including cirrhosis*, annual average deaths by age group, all persons aged 20 and over, Wales death boards, to Mortality from chronic liver disease including cirrhosis is identified when ICD-10 codes K70, K73 or K74 appear as the underlying cause of death. Page 85 of 264

86 Figure 81: Mortality from all liver disease*, AESR per 100,000, males, females and persons aged 75, Wales health boards, Mortality from all liver disease is identified when ICD-10 codes B15-B19, C22, I81, I85, K70-K77 or T86.4 appear as the underlying cause of death. Page 86 of 264

87 Figure 82: Mortality from liver cancer*, EASR per 100,000, all persons aged under 75, Wales health boards, Mortality from liver cancer is identified when ICD-10 code C22 appears as the underlying cause of death. Page 87 of 264

88 Page 88 of 264

89 CHAPTER 2: CHRONIC CONDITIONS 2.1 Cardiovascular disease Cardiovascular disease (CVD*) is a major cause of ill-health and death in Wales. It is caused by disorders of the heart and blood vessels, and includes coronary heart disease (heart attacks), cerebrovascular disease (stroke), raised blood pressure (hypertension), and heart failure. CVD has a substantial impact on the health service. Over 7% of all inpatient hospital admissions in Wales are for CVD*. There were nearly 33,000 emergency admissions for CVD in 2011/12, around 9% of all emergency admissions. Figure 81 shows the number of emergency admissions by primary condition. Around a third of these admissions for CVD are for coronary heart disease (CHD) and another third for other forms of heart disease Figure 83: Emergency admissions for cardiovascular disease by primary condition (ICD-10 I00-I99), persons, all ages, Wales, 2011/12. Page 89 of 264

90 Figure 84: Cardiovascular disease emergency hospital admissions, EASR per 100,000, persons, all ages, Wales local authorities, financial year Both Ceredigion and Pembrokeshire were statistically lower than the Welsh average, Carmarthenshire however showed no statistical difference. Page 90 of 264

91 Figure 85: Cardiovascular disease emergency hospital admissions, EASR per 100,000, persons, all ages, Wales health boards, financial year Hywel Dda UHB is statistically lower than the Welsh average. Figure 86: Patients on GP practice registers with coronary heart disease, age aged standardised percentage, Wales health boards, Again, Hywel Dda UHB is statistically lower than the Welsh average. Page 91 of 264

92 2.2 Stroke Figure 87: Emergency hospital admissions with primary diagnosis of cerebrovascular disease (stroke), EASR per 100,000 persons, , Hywel Dda UHB, local authorities and Wales. Ceredigion had the lowest average annual deaths of 120, followed by 288 in Pembrokeshire and 403 in Carmarthenshire. Ceredigion was considered statistically lower than the Welsh average, whereas there was no statistical difference with Pembrokeshire and Carmarthenshire. Figure 88: Emergency hospital admissions with primary diagnosis of cerebrovascular disease (stroke) EASR per 100,000 persons, , Wales local authorities. Page 92 of 264

93 2.3 Diabetes Within Hywel Dda University Health Board we are aware that there are significant differences in the prevalence of diabetes. This is reflected in our hospital data that shows we have approximately 20% of in-patients in Llanelli with diabetes whereas in Aberystwyth the figure is closer to 15%. This is likely to reflect the differences in overall health and levels of social deprivation of people in these areas. Figure 90 is a map provided by the Retinopathy Screening Service for Wales that gives a good indication of the high and low areas of diabetes within the Health Board. Clearly we aim to tailor our services within diabetes to reflect these areas of demand. Figure 89: Retinopathy screening map indicating high and low areas of diabetes prevalence. Figure 90: Diabetes prevalence rate, QOF disease registers. National Paediatric Diabetes Audit (NPDA) Page 93 of 264

94 In the financial year of the prevalence of diabetes in Hywel Dda UHB was 5.8 % (n = 22,877), in comparison to Wales, which was 5.6% (n = 177,212). Figure 91: Age and gender of patients with Type 1 diabetes, Hywel Dda UHB. National Paediatric Diabetes Audit (NPDA) The previous graph identifies that Type 1 Diabetes is more prevalent in the male population of Hywel Dda UHB. Figure 92: Age and gender of patients with Type 2 diabetes, Hywel Dda UHB. National Paediatric Diabetes Audit (NPDA) The above graph identifies that Type 2 Diabetes is also more prevalent in males in Hywel Dda UHB. Page 94 of 264

95 Figure 93: Percentage of population with Type 2 diabetes in Hywel Dda UHB compared to England and Wales. National Paediatric Diabetes Audit (NPDA) The above identifies that 5.5% of Hywel Dda UHB s population has Type 2 Diabetes compared to England and Wales which is 4.7%. This merits further action in diabetes risk reduction Variations in incidences of complications of diabetes Figure 94: Complications - Stroke , additional risk of complication among people with diabetes. National Paediatric Diabetes Audit (NPDA) The proportion of individuals within Hywel Dda with diabetes who develop a stroke is 0.48%. Page 95 of 264

96 Figure 95: Complication - Myocardial infarction , additional risk of complication among people with diabetes. National Paediatric Diabetes Audit (NPDA) Within Hywel Dda UHB financial year 2011/2012 just under 0.3% of the diabetic population suffered a Myocardial Infarction compared to a Welsh average of over 0.45%. Figure 96: Complication - Angina, additional risk of complication among people with diabetes. National Paediatric Diabetes Audit (NPDA) Within Hywel Dda UHB financial year 2011/2012 just under 0.9% of people with diabetes had angina compared to the Welsh average of just under 7% Page 96 of 264

97 Figure 97: Complication Heart failure, additional risk of complication among people with diabetes. National Paediatric Diabetes Audit (NPDA) Within Hywel Dda UHB financial year 2011/12 just over 0.7% of people with diabetes suffered Heart Failure compared to the Welsh average of 0.6% Hospital admission for diabetes Figure 98: Hywel Dda UHB emergency admissions for diabetes. National Paediatric Diabetes Audit (NPDA) In Hywel Dda UHB the emergency admission for diabetes decreased from 401 in 2010 down to 317 in Page 97 of 264

98 Figure 99: Readmission within 30 days of previous discharge for diabetes. National Paediatric Diabetes Audit (NPDA) In Hywel Dda UHB the readmission within 30 days of previous discharge for diabetes decreased from 55 in 2010 down to 20 in Figure 100: Average length of stay. National Paediatric Diabetes Audit (NPDA) In Hywel Dda UHB the Length of stay for diabetes admissions had decreased from 8.4 in 2010 down to 7.3 in Page 98 of 264

99 2.3.3 HbA1c Target Figure 101: Hywel Dda UHB percentage target HbA1c <7.5. National Paediatric Diabetes Audit (NPDA) Within Hywel Dda UHB there appears to be variability in achieving the paediatric target for HbA1c < 7.5. In Bronglais achieved 20%, West Wales General achieved 23.2% and Withybush General achieved 17.39%, in comparison to the Wales score of 18.4%. Figure 102: Hywel Dda UHB paediatric percentage target for HbA1c >=7.5 <9.5. National Paediatric Diabetes Audit (NPDA) In Bronglais achieved achieved 63.9% West Wales General achieved 65.2% and Withybush General achieved 56.5%, in comparison to the Wales score of 57.7%. Page 99 of 264

100 Figure 103: Hywel Dda UHB paediatric percentage target HbA1c >9.5. National Paediatric Diabetes Audit (NPDA) Figure 104: Percentage patients recieving eigth care processes (excluding eye screening). National Paediatric Diabetes Audit (NPDA) The eight care processes include: HbA1c, Cholesterol, Serum Creatinine, Urine Albumin, Foot Surveillance, BMI and Smoking. Hywel Dda UHB reached 65.2% of its diabetes patients, in comparison 61.9% for Wales. Page 100 of 264

101 Figure 105: Percentage patients meeting all treatment targets. National Paediatric Diabetes Audit (NPDA) In % of patients in Hywel Dda UHB met all treatment targets, in comparison to 37.4% in Wales. Figure 106: Percentage patients offered or attended structured education. National Paediatric Diabetes Audit (NPDA) Page 101 of 264

102 Figure 107: Percentage with a record of retinal screening examination the preceding 15 months. National Paediatric Diabetes Audit (NPDA) Figure 108: Percentage patients with a record of a foot examination and risk classification within the preceding 15 months. National Paediatric Diabetes Audit (NPDA) Page 102 of 264

103 2.4 Respiratory disease Person-based hospital admissions: Chronic obstructive pulmonary disease (COPD) People admitted to hospital with a primary diagnosis of chronic Figure 109: People admitted to hospital with a primary diagnosis of chronic obstructive pulmonary disease*, count, crude and European obstructive pulmonary disease*, count, crude and EASR per 100,000, persons age-standardised rate (EASR) per 100,000, persons aged 35+, aged 35+, Wales local authorities, financial year Wales local authorities, financial year 2013/14 Count Crude rate Isle of Anglesey ( ) Gwynedd ( ) Conwy ( ) Denbighshire ( ) Flintshire ( ) Wrexham ( ) Powys ( ) Ceredigion ( ) Pembrokeshire ( ) Carmarthenshire ( ) Swansea ( ) Neath Port Talbot ( ) Bridgend ( ) Vale of Glamorgan ( ) Cardiff ( ) Rhondda Cynon Taf ( ) Merthyr Tydfil ( ) Caerphilly ( ) Blaenau Gwent ( ) Torfaen ( ) Monmouthshire ( ) Newport ( ) Wales 5, ( ) *IC D-10 codes J40-J44 EASR per 100,000 (95% confidence interval) Produced by Public Health Wales Observatory, using PEDW (NWIS) & MYE (ONS) Ceredigion was the lowest count at 85, Pembrokeshire was 207 and Carmarthenshire was 292 Page 103 of 264

104 Figure People 110: People admitted admitted to hospital to hospital with a primary with a primary diagnosis diagnosis of chronic of chronic obstructive obstructive pulmonary pulmonary disease*, disease*, count crude count, and crude EASR and European per 100,000, agestandardised rate (EASR) per 100,000, persons aged 35+, Wales persons aged 35+, Wales health boards, financial year health boards, financial year 2013/14 Count Crude rate Betsi Cadwaladr UHB 1, ( ) Powys thb ( ) Hywel Dda UHB ( ) Abertawe Bro Morgannwg UHB ( ) Cardiff and Vale UHB ( ) Cwm Taf UHB ( ) Aneurin Bevan UHB 1, ( ) Wales 5, ( ) Produced by Public Health Wales Observatory, using PEDW (NWIS) & MYE (ONS) *IC D-10 codes J40-J44 EASR per 100,000 (95% confidence interval) Hywel Dda UHB was statistically lower than the EASR per 100,000 for Wales. Page 104 of 264

105 Figure 111: Person based hospital admissions with a primary diagnosis of chronic obstructive pulmonary disease*, EASR per 100,000, persons aged 35+, Wales local authorities, financial year Each of the 3 counties within Hywel Dda UHB were statistically lower than the Welsh average score for hospital admissions with a primary diagnosis of chronic obstructive pulmonary disease. Page 105 of 264

106 Figure 112: Person based hospital admissions with a primary diagnosis of chronic obstructive pulmonary disease*, EASR per 100,000, persons aged 35+, Wales health boards, financial year Hywel Dda UHB was statistically lower than the Welsh score of 314 Figure 113: Person based hospital admissions with a primary diagnosis of chronic obstructive pulmonary disease*, EASR per 100,000, persons aged 35+, Wales by deprivation fifth, financial year This analysis counts the number of individuals admitted to hospital where the primary diagnosis in the admitting episode was an ICD-10 code between J40-J44. Individuals were only counted once regardless of the number of times they were admitted with a primary diagnosis between J40-J44 during the same financial year. Page 106 of 264

107 2.4.2 Emergency hospital admissions: Asthma Figure 114: Emergency hospital admissions with a primary diagnosis of asthma*, EASR per 100,000, persons aged 18+, Wales local authorities, financial year The confidence intervals suggest that Ceredigion was significantly lower than the Welsh score, whereas there was no statistical difference with Pembrokeshire and Carmarthenshire. Page 107 of 264

108 Figure 115: Emergency hospital admissions with a primary diagnosis of asthma*,easr per 100,000, persons aged 18+, Wales health boards, financial year There was no statistical difference between Hywel Dda UHB and the average Welsh score. Figure 116: Emergency hospital admissions with a primary diagnosis of asthma*, EASR per 100,000, persons aged 18+, Wales by deprivation fifths, financial year Asthma admissions were counted where the primary diagnosis was an ICD-10 code between J45-J46 and the admission method was an emergency (admission method between 21 and 28). This analysis is spell based meaning multiple spells are counted when an individual is admitted more than once during the financial year. Page 108 of 264

109 2.4.3 Emergency hospital admissions: Chronic obstructive pulmonary disease Figure 117: Emergency hospital admissions with a primary diagnosis of chronic obstructive pulmonary disease*, count, crude and EASR per 100,000, persons aged 18+, Wales local authorities, financial year Figure 118: Emergency hospital admissions with a primary diagnosis of chronic obstructive pulmonary disease*, count, crude and EASR per 100,000, persons aged 18+, Wales health boards, financial year Page 109 of 264

110 Emergency hospital admissions with a primary diagnosis of Figure 119: Emergency hospital admissions with a primary diagnosis of chronic obstructive pulmonary disease*, count, crude and chronic obstructive pulmonary disease*, count, crude and EASR per 100,000, European age-standardised rate (EASR) per 100,000, persons persons aged 18+, Wales by deprivation fifth, financial year aged 18+, Wales by deprivation fifth, financial year 2013/14 Number of admissions Crude rate Least deprived ( ) Next least deprived 1, ( ) Middle 1, ( ) Next most deprived 1, ( ) Most deprived 2, ( ) Wales 7, ( ) Produced by Public Health Wales Observatory, using PEDW (NWIS), MYE (ONS) & WIMD 2014 (WG) *IC D-10 codes J40-J44 EASR per 100,000 (95% confidence interval) Figure 120: Emergency hospital admissions with a primary diagnosis of chronic obstructive pulmonary disease*, EASR per 100,000, persons aged 18+, Wales local authorities, financial year All three counties within Hywel Dda UHB were statistically lower than the Welsh average. Page 110 of 264

111 Figure 121: Emergency hospital admissions with a primary diagnosis of chronic obstructive pulmonary disease*, EASR per 100,000, persons aged 18+, Wales health boards, financial year Hywel Dda UHB is statistically lower than the Welsh score GP practice registers Figure 122: Patients on GP practice registers with asthma, EASR per 100,000, Wales health boards, Hywel Dda is not statistically different to the all Wales score of 6.8. Page 111 of 264

112 Figure 123; Patients on GP practice registers with COPD, EASR per 100,000, Wales health boards, Cancer Non-surgical oncology treatment modalities include radiotherapy and systemic therapies. Radiotherapy includes conventional external beam and electron radiotherapy, proton radiotherapy, brachytherapy, and molecular radiotherapy (unsealed source therapy). Systemic therapies include chemotherapy, endocrine therapy and targeted biological therapies (such as antibodies, small molecules including tyrosine kinase inhibitors and immunotherapy). (Ref: Joint Collegiate Council for Oncology) Incidence of cancer There were 1389 new cancers registered in Hywel Dda male residents in 2012, and 1226 in females. Figure 122 shows the crude registered incidence for cancers in Figure 124: Incidence of all malignant cancers (excluding non-melanoma skin cancer), Hywel Dda UHB. Page 112 of 264

113 Allowing for different age structures across the population, the European Aged Standardised Rate per 100,000 population in 2012 across Hywel Dda was for males (Lower 95% CI: 437.8; Upper 95% CI 489.8) and for females (Lower 95% CI: 372.6; Upper 95% CI 422.2) The tables below show the EASR for males, and the EASR for females, Across Wales, the rate of cancer in men is about 18% more than in women around 70 extra cases for every 100,000 men compared to the rate in women. Cancer is more common in men, although the incidence is declining, but increasing in women. Figure 125: EASR per 100,000 for all malignant cancer incidences excluding non-melanoma skin cancer) by county: Males. Figure 126: EASR for all malignant cancer incidence (excluding non-melanoma skin cancer) by county: females. Page 113 of 264

114 2.5.2 Incidence of cancer, and trend, by age In 2012, two thirds of all cancer cases were diagnosed in people aged 65 and over. The number of cases in 2012 was higher than ten years previously for age groups from 60 years and over, except for to years group which was marginally lower. The largest rise (34%) was in the age group. Figure 127: Trends in annual numbers of cancer by age groups (40 years and over) Incidence of cancer by site The incidence of cancer varies by the cancer site (in the body) affected. The five most common types of cancer diagnosed in Hywel Dda are: bowel, prostate, lung, female breast, melanoma. Figure 128: EASR per 100,000 population for site specific cancer in Hywel Dda UHB and Wales, Welsh Cancer Intelligence and Surveillance Unit (WCISU), April 2014 Page 114 of 264

115 2.5.4 Proportion of cancer incidence by site and sex Figure 129: Proportion of cancers by site in men 2012 in Hywel Dda UHB. Other 35.3% Prostate 30.7% Colorectal 13.5% Urinary Tract exc Bladder 4.3% Head & Neck 4.8% Lung 11.5% Welsh Cancer Intelligence and Surveillance Unit (WCISU), April 2014 Figure 130: Proportion of cancers by site in women in 2012 in Hywel Dda UHB. Other 35.8% Breast 28.1% Colorectal 13.5% Ovary 4.3% Uterus 5.5% Lung 12.8% Welsh Cancer Intelligence and Surveillance Unit (WCISU), April 2014 Page 115 of 264

116 2.5.5 Survival from cancer Figure 131: One year relative survival from Cancer in Wales, all persons all ages. Period of diagnosis One year relative survival % Welsh Cancer Intelligence and Surveillance Unit s Cancer Registry Survival from cancer has improved over time. One year relative survival for Welsh residents for the years was 69.9% Figure 132: Five year relative survival from cancer in Wales, all persons all ages. Period of diagnosis One year relative survival % Welsh Cancer Intelligence and Surveillance Unit s Cancer Registry Survival from cancer by sex Figure 133: relative cancer survival in men and women in Wales, all persons all ages. Five year relative survival ( ) One year survival ( ) Men 50.0% 68.5% Women 55.0% 71.5% Welsh Cancer Intelligence and Surveillance Unit s Cancer Registry Page 116 of 264

117 Women have higher cancer survival rates than men. Even though cancer is much more common in men, one year survival is four per cent higher in women than men. Five year survival has a wider gap, being ten per cent higher in women than men Survival by cancer site Figure 134: One year survival rates (percentage) by cancer site, males. All malignancies ¹ Testis Prostate Melanoma Hodgkins Thyroid & Endocrine Larynx Rectum Head & Neck Colorectal Bladder ² Non-Hodgkins Lymphoma Colon Urinary Tract exc Bladder Leukaemia Oesophagus Stomach Brain & CNS Liver Lung Pancreas Hywel Dda University Wales Relative Survival % Welsh Cancer Intelligence and Surveillance Unit s Cancer Registry [note: missing values denote numbers too small to calculate; 1: all malignancies excluding non malignant melanoma] Page 117 of 264

118 Figure 135: One year relative rates (percentage) by cancer site, , females. All malignancies ¹ Melanoma Breast Uterus Thyroid & Endocrine Hodgkins Larynx Cervix Head & Neck Non-Hodgkins Lymphoma Rectum Colorectal Colon Urinary Tract exc Bladder Ovary Leukaemia Bladder ² Brain & CNS Oesophagus Stomach Lung Liver Pancreas Hywel Dda University Wales Relative Survival % Welsh Cancer Intelligence and Surveillance Unit s Cancer Registry [note: missing values denote numbers too small to calculate; 1: all malignancies excluding non malignant melanoma] Figure 136: Five year relative rates (percentage by cancer site , males. All malignancies ¹ Testis Prostate Melanoma Hodgkins Thyroid & Endocrine Larynx Rectum Head & Neck Colorectal Bladder ² Non-Hodgkins Lymphoma Colon Urinary Tract exc Bladder Leukaemia Oesophagus Stomach Brain & CNS Liver Lung Pancreas Hywel Dda University Wales Relative Survival % Welsh Cancer Intelligence and Surveillance Unit s Cancer Registry [note: missing values denote numbers too small to calculate; 1: all malignancies excluding non malignant melanoma] Page 118 of 264

119 Figure 137: Five year relative rates (percentage) by cancer site, , females. All malignancies ¹ Melanoma Breast Uterus Thyroid & Endocrine Hodgkins Larynx Cervix Head & Neck Non-Hodgkins Lymphoma Rectum Colorectal Colon Urinary Tract exc Bladder Ovary Leukaemia Bladder ² Brain & CNS Oesophagus Stomach Lung Liver Pancreas Hywel Dda University Wales Relative Survival % Welsh Cancer Intelligence and Surveillance Unit s Cancer Registry [note: missing values denote numbers too small to calculate; 1: all malignancies excluding non malignant melanoma] Projected future need In order to provide some measure of prediction for health service need to care for those that will have a cancer diagnosis in the future, the following modelling was carried out by the Public Health Wales Observatory. Utilising current levels of hospital activity carried out in support of diagnoses of malignant neoplasm (excluding non-melanoma skin cancer) and population projections to 2036 some indication of future health service need is offered. Note: This modelling is an expression of the projected change in population only and not on any projected change in incidence, survival or mortality or changes in hospital activity. Page 119 of 264

120 Figure 138: Current level of hospital activity, primary diagnosis of malignant neoplasm excluding non-melanoma skin cancer on discharge, Hywel Dda UHB resident population, all ages, Application of current activity to population projections provides some measure of future NHS need. The projected trend will also be affected in changes to incidence, survival and development of new treatments. This may affect the trend in a positive or negative direction. New preventative vaccine programmes for cancers or improved screening to enable earlier intervention may reduce the need for hospital care while, conversely, improved survival may require increased care and treatment for further cancer incidence. Figure 139: Application of current level of hospital activity to population projections up to 2036, primary diagnosis of malignant neoplasm excluding non- skin cancer (ICD10 C00-C97 excl C44) on discharge, Hywel Dda UHB resident population, all persons. Page 120 of 264

121 2.5.9 Projected future need by cancer site Hospital activity linked to particular cancers is predicted to be influenced by the projected change in population. This is in addition to any predicted effect of, for example, an increasingly obese population and the influence of smoking patterns on lung cancer incidence (still upward for women, staring to fall for men). Figure 140: Application of current level of hospital activity to population projection up to 2036, primary diagnosis of lung cancer (ICD10 C33-C34) on discharge,, Hywel Dda UHB resident population, all persons. Figure 141: application of current level of hospital activity to population projections up to 2036, primary diagnosis of bowel cancer (ICD 10 C18-20)) on discharge, Hywel Dda UHB residents population, all persons. Page 121 of 264

122 Number of discharges Figure 142: Application of current level of hospital activity to population projections up to 2036, primary diagnosis of breath cancer (ICD 10 C50), o on discharge, Hywel Dda UHB resident population, all females. Figure 143: Application of current level of hospital activity to population projections up to 2036, primary diagnosis of prostate cancer (ICD 10 C61) on Application of current level of hospital activity to projections up to 2036, primary diagnosis discharge, Hywel Dda UHB resident population, all males. of prostate cancer (ICD 10 C61) on discharge, Hywel Dda resident population, all males Produced by the Public Health Wales Observatory using data from Welsh Government, NWIS (PEDW) and ONS (MYE) 1,400 1,200 1, Baseline (average of ) Admissions There were 8,113 admissions to HDUHB hospitals in 2013/14. This included elective inpatient, emergency inpatient, day case and regular day admissions. 7,938 admissions were to the four General Hospitals. Admissions were for 1,310 individual patients, giving an average of 6 admissions per patient through the year. Page 122 of 264

123 Figure 144: Hospital admissions for cancer patients. Hospital Emergency admissions Elective admissions Daycase admissions Regular Day admission Bronglais Glangwili Prince Philip Withybush Regular day admissions Individuals requiring Regular Day Admission within non-surgical oncology services are admitted to the four general hospitals in Hywel Dda University Health Board, and for a small number of Palliative Medicine episodes, to Ty Bryn Gwyn. Although this report is primarily concerned with the delivery of Medical Oncology, the following figures show Medical, Clinical and Palliative Medicine Regular Day Admissions between 2007/08 and 2013/14. Figure 145: Number of regular day admissions, Bronglais General Hospital. 2,500 Bronglais General Hospital 2,000 1,500 1, / / / / / / /14 Palliative Medicine Medical Oncology 952 1,228 1,187 1,121 1,515 1,926 2,397 Clinical Oncology Hywel Dda UHB Information Service Informatics Department Page 123 of 264

124 Figure 146: Number of regular day admissions, Glangwilli General Hospital. 2,500 Glangwili General Hospital 2,000 1,500 1, / / / / / / /14 Palliative Medicine Medical Oncology 1,244 1,368 1, ,204 1,347 1,453 Clinical Oncology HDUHB Information Service Informatics Department Figure 147: Number of regular day admissions, Prince Philip General Hospital. 2,500 Prince Philip General Hospital 2,000 1,500 1, / / / / / / /14 Palliative Medicine Medical Oncology ,040 Clinical Oncology HDUHB Information Service Informatics Department Figure 148: Number of regular day admissions, Withybush General Hospital. 2,500 Withybush General Hospital 2,000 1,500 1, / / / / / / /14 Palliative Medicine Medical Oncology ,087 2,494 2,290 Clinical Oncology , Note: A change took place in 2010 in classification following implementation of the Myrddin system in Pembrokeshire Page 124 of 264

125 Day case admissions Figure 149: Day case admissions for non surgical oncology care, Hywel Dda UHB 2013/14. Hospital Day case admissions: Medical Oncology Day case admissions: Palliative Medicine Bronglais Glangwili 2 60 Prince Philip 0 0 Withybush 0 6 Ty Bryn Gwyn 0 10 HDUHB Information Service Informatics Department Elective inpatient admissions Individuals requiring elective inpatient care within non-surgical oncology services are admitted to three general hospitals in Hywel Dda University Health Board. Also, oncology services for residents of Carmarthenshire, Ceredigion and Pembrokeshire are provided through Abertawe Bro Morgannwg University Health Board services, particularly for Clinical Oncology. That activity is outside the scope of this report. Figure 150: Number of elective admissions, Bronglaiis General Hospital. 400 Bronglais General Hospital / / / / / / /14 Palliative Medicine Medical Oncology Clinical Oncology HDUHB Information Service Informatics Department Page 125 of 264

126 Figure 151: Number of elective admissions, Glangwilli General Hospital. 400 Glangwili General Hospital / / / / / / /14 Palliative Medicine Medical Oncology Clinical Oncology HDUHB Information Service Informatics Department Prince Philip General Hospital Prince Philip does not admit elective inpatients under the specialties. Withybush General Hospital There were an average 2 elective inpatient admissions a month in 2013/14 to Withybush, all under Medical Oncology. Figure 152: Number of elective admissions, Withybush General Hospital. 400 Withybush General Hospital / / / / / / /14 Palliative Medicine Medical Oncology Clinical Oncology HDUHB Information Service Informatics Department Ty Bryngwyn Mawr In previous years some admissions were recorded to Ty Bryngwyn Mawr, but none during 2013/14. Page 126 of 264

127 Emergency inpatient admissions Emergency admissions are recorded at the four General Hospitals within HDUHB. Although the following figures show Medical, Clinical and Palliative Medicine elective admissions between 2007/08 and 2013/14, no Clinical Oncology emergency admissions have been recorded in the last two years. Since Withybush Hospital changed its classification upon the implementation of the Myrddin system in Pembrokeshire in 2010, no Clinical Oncology emergency admissions have been recorded at any HDUHB hospital Figure 153: Number of emergency admissions, Bronglais General Hospital. 250 Bronglais General Hospital / / / / / / /14 Palliative Medicine Medical Oncology Clinical Oncology HDUHB Information Service Informatics Department Figure 154: Number of emergency admisions, Glangwilli General Hospital. 250 Glangwili General Hospital / / / / / / /14 Palliative Medicine Medical Oncology Clinical Oncology HDUHB Information Service Informatics Department Page 127 of 264

128 Figure 155: Number of emergency admissions, Prince Philip General Hospital. 250 Prince Philip General Hospital / / / / / / /14 Palliative Medicine Medical Oncology Clinical Oncology HDUHB Information Service Informatics Department Figure 156: Number of emergency admissions, Withybush General Hospital. 250 Withybush General Hospital / / / / / / /14 Palliative Medicine Medical Oncology Clinical Oncology HDUHB Information Service Informatics Department Note: change in classification following implementation of the Myrddin system in Pembrokeshire in Palliative care emergency admissions to other locations within HDUHB Figure 157: Number of palliative care admissions out with general hospitals, 2013/2014. Hospital Ty Bryngwyn Mawr 119 Amman Valley Hospital 19 Tregaron Hospital 3 HDUHB Information Service Informatics Department Patients admissions Page 128 of 264

129 Outpatients There were 3,720 outpatients attendances in HDUHB hospitals in 2013/14. This included 1,180 new and 2,540 follow up attendances and involved 1,624 individual patients Figure 158: Outpatient activity, by hospital, Page 129 of 264

130 2.6 Liver disease Non-alcoholic fatty liver disease (NAFLD) NAFLD admissions are identified when ICD-10 code K76.0 appears as the principal diagnosis on the admitting episode. Excludes admissions from regular day/night attendees. Figure 159: Hospital admissions due to non-alcoholic fatty liver disease* EASR per 100,000, all persons all ages, Wales health boards 2009/2010 to 2013/ Alcoholic liver disease Alcoholic liver disease admissions are identified when ICD-10 code K70 appears as the principal diagnosis on the admitting episode. Excludes admissions from regular day/night attendees. Figure 160: Hospital admissions due to alcohol liver disease*, EASR per 100,000, all persons, all ages, Wales health boards, 2011/12 to 2013/14. Page 130 of 264

131 2.6.3 Liver transplants procedures Liver transplant procedures are identified when there is any mention of OPCS code J01 in a patient s record. This indicator counts occurrences of procedures, rather than the number of spells or episodes where at least procedure was carried out. Some spells may have more than one recorded procedure. Figure 161: Liver transplant procedures*, EASR per 100,000, persons all ages, Wales health boards, 2004/05 to 2013/ Endoscopic retrograde cholangiopancreatography (ERC) procedures ERC procedures are identified when there is any mention of OPCS code J43 in a patients record. This indicator counts occurrences of procedures, rather than the number of spells or episodes where at least one procedure was carried out. Some spells may have more than one recorded procedure. All patient classes have been included for this indicator. Page 131 of 264

132 Figure 162: Endoscopic retrograde cholangionpan creatography (ERC) procedures*, EASR per 100,000, persons all ages, Wales health boards, 2013/ Paracetamol overdose hospital admissions Paracetamol overdose hospital admissions are identified when ICD-10 codes T39.1 and either X40 (accidental poisoning) or X60 (intentional poisoning) occur on the admitting episode of care, in any diagnosis position. Figure 163: Hospital admissions due to paracetamol overdose*, EASR per 100,000, all persons all ages, Wales health boards, 2013/ Liver disease hospital admissions Liver disease hospital admissions are identified when ICD-10 codes B15-B19, C22, I81, I85, K70-K77 or T86.4 appear as the principal diagnosis on the admitting episode. Excludes admissions from regular day/night attendees. Page 132 of 264

133 Figure 164: Hospital admissions due to liver disease*, EASR per 100,000, all persons all ages, Wales health boards, 2013/ Hepatitis B related end-stage liver disease/ hepatocellular carcinoma hospital admissions Hepatitis B related end-stage liver disease/hepatocellular carcinoma hospital admissions are identified when ICD-10 codes B18.0-B18.1 or B16 appear as the principal diagnosis on the admitting episode. Excludes admissions from regular day/night attendees. Rates for some health boards have been suppressed due to the low number of events. Figure 165: Hospital admissions due to hepatitis B related end stage liver disease/ hepatocellular carcinoma*, EASR per 100,000, all persons all ages, Wales health boards, 2004/05 to 3013/14. Page 133 of 264

134 2.6.8 Hepatitis C related end-stage liver disease/ hepatocellular carcinoma hospital admissions Hepatitis C related end-stage liver disease/hepatocellular carcinoma hospital admissions are identified when ICD-10 codes B18.2 or B17.1 appear as the principal diagnosis on the admitting episode. Excludes admissions from regular day/night attendees. Figure 166: Hospital admission due to hepatitis C related end stage liver disease/hepatocellular carcinoma* EASR per 100,000, all persons all ages, Wales health boards, 2004/05 to 2013/ Pancreatic cancer Mortality from pancreatic cancer is identified when ICD-10 code C25 appears as the underlying cause of death. Figure 167: Pancreatic cancer mortality*, EASR per 100,000, all persons aged under 75, Wales health boards, Page 134 of 264

135 Paracetamol poisoning Mortality from paracetamol poisoning is identified when ICD-10 codes T39.1 and either X40 (accidental poisoning) or X60 (intentional poisoning) appear in any cause position. Figure 168: Paracetamol overdose mortality*, EASR age-per 100,000, alls all ages, Wales health boards, Page 135 of 264

136 Chronic liver disease including cirrhosis, all ages Mortality from chronic liver disease including cirrhosis is identified when ICD-10 codes K70, K73 or K74 appear as the underlying cause of death. Figure 169: Mortality from chronic liver disease including cirrhosis*, EASR per 100,000 and persons all ages, Wales health boards, Page 136 of 264

137 Chronic liver disease including cirrhosis, aged under 75 years Mortality from chronic liver disease including cirrhosis is identified when ICD-10 codes K70, K73 or K74 appear as the underlying cause of death. Figure 170: Mortality from chronic liver disease including cirrhosis*, EASR per 100,000 all persons aged under 75, Wales health boards, Page 137 of 264

138 2.7 Neurology Hywel Dda University Health Board identifies the delivery of effective neurological services as a core feature in improving the health of the population. However, the geography of the Health Board s catchment area, as shown above, identifies a significant challenge with access to specialist neurological inpatient and day services and neuro-rehabilitation being hosted within ABMU. The map below demonstrates the drive-time boundaries for the majority of the population and highlights the challenge for people who may access a specialist service from a hospital in ABMU. Figure 171: Travel time to specialist neurology services. Page 138 of 264

139 2.7.1 Estimated need within population Figure 172: estimated prevalence of Alzheimer's disease in population. Estimated prevalence of Alzheimer's disease in the population Health Board Estimated number in population (Rocca)* Estimated number in population (Neurological Alliance)* Betsi Cadwaladr 6,200 6,800 Powys 1,400 1,300 Hywel Dda 3,600 3,700 Abertawe Bro Morgannwg 4,300 5,000 Cardiff and Vale 3,300 4,700 Cwm Taf 2,300 2,900 Aneurin Bevan 4,500 5,600 Wales 25,600 30,100 Produced by Public Health Wales, using data from Amar (2000), Neurological Alliance (2003) & MYE (ONS) *Estimated prevalence rounded to the nearest 100 Within Hywel Dda UHB there are approximately in excess 3,600 to 3,700 individuals with Alzheimer s disease. Figure 173: Estimated prevalence and incidence of Parkinson's disease in the population. Estimated prevalence and incidence of Parkinson's disease in the population Health Board Estimated number in population* Estimated new cases per year in population** Betsi Cadwaladr 1, Powys Hywel Dda Abertawe Bro Morgannwg Cardiff and Vale Cwm Taf Aneurin Bevan Wales 5, Produced by Public Health Wales, using data from Wickremaratchi et al (2009) & MYE (ONS) *Estimated prevalence rounded to the nearest 100 **Estimated new cases rounded to the nearest 10 Within Hywel Dda UHB there are around 700 individuals with Parkinson s disease, with approximately 60 new cases a year. Page 139 of 264

140 Figure Patients 174: on the Patients primary care on epilepsy the primary register and care estimated epilepsy prevalence register and and incidence estimated prevalence and incidence of epilepsy in the population. of epilepsy in the population Health Board Number on QOF epilepsy register 2009/10 Estimated number in population (Forsgren)* Estimated new cases per year in population (Forsgren)** Betsi Cadwaladr 5,020 4, Powys Hywel Dda 2,912 2, Abertawe Bro Morgannwg 4,101 3, Cardiff and Vale 3,004 2, Cwm Taf 2,548 1, Aneurin Bevan 4,365 3, Wales 22,885 17,900 1,580 Produced by Public Health Wales, using data from QOF (WG), Forsgren et al (2005) & MYE (ONS) *Estimated prevalence rounded to the nearest 100 **Estimated new cases rounded to the nearest 10 Within Hywel Dda UHB there is in excess of 2,912 individuals suffering with eplilepsy, with approximately 200 new cases per year. Figure 175: Estimated prevalence and incidence of multiple sclerosis in the population. Estimated prevalence and incidence of Multiple sclerosis in the population Health Board Estimated number in population (Hirst)* Estimated new cases per year in population (Hirst)** Betsi Cadwaladr 1, Powys Hywel Dda Abertawe Bro Morgannwg Cardiff and Vale Cwm Taf Aneurin Bevan Wales 4, Produced by Public Health Wales, using data from Hirst et al (2009) & MYE (ONS) *Estimated prevalence rounded to the nearest 100 **Estimated new cases rounded to the nearest 10 Within Hywel Dda UHB there is approximately 600 individuals suffering with Multiple sclerosis, with approximately 40 new cases each year. Page 140 of 264

141 Figure 176: Estimated prevalence of cerebral palsy in the population. Estimated prevalence of Cerebral palsy in the population Health Board Estimated number in population* Betsi Cadwaladr 1,260 Powys 240 Hywel Dda 700 Abertawe Bro Morgannwg 940 Cardiff and Vale 870 Cwm Taf 540 Aneurin Bevan 1,040 Wales 5,590 Produced by Public Health Wales, using data from Neurological Alliance (2003) & MYE (ONS) *Estimated prevalence rounded to the nearest 10 Within Hywel Dda UHB the estimated prevalence of cerebral palsy is approximately Service utilisation Figure 177: District general hospital inpatient admissions with a primary District general hospital inpatient admissions with a primary diagnosis of: diagnosis of all diseases of the nervous system (G00-G99). All diseases of the nervous system (G00-G99) Health Board Hospital 2005/ / / / /10 Total Betsi Cadwaladr Ysbyty Glan Clwyd Ysbyty Gwynedd Wrexham Maelor Hospital Hywel Dda Prince Philip Hospital Withybush General Hospital West Wales General Hospital Bronglais General Hospital Abertawe Bro Morriston Hospital Morgannwg Singleton Hospital Princess of Wales Hospital Neath Port Talbot Hospital Cardiff and Vale University Hospital of Wales Llandough Hospital Cwm Taf The Royal Glamorgan Hospital Prince Charles Hospital Aneurin Bevan Royal Gwent Hospital Nevill Hall Hospital Produced by Public Health Wales, using PEDW (NWIS) Page 141 of 264

142 Figure 178: District general hospital inpatient admissions with a primary District general hospital inpatient admissions with a primary diagnosis of: diagnosis of cerebral palsy and other paralytic syndromes (G80-G83). Cerebral palsy and other paralytic syndromes (G80-G83) Health Board Hospital 2005/ / / / /10 Total Betsi Cadwaladr Ysbyty Gwynedd Ysbyty Glan Clwyd Wrexham Maelor Hospital Hywel Dda Withybush General Hospital West Wales General Hospital <5 <66 Bronglais General Hospital 12 < <5 <63 Prince Philip Hospital Abertawe Bro Morriston Hospital Morgannwg Singleton Hospital Princess of Wales Hospital <5 10 <73 Neath Port Talbot Hospital Cardiff and Vale University Hospital of Wales Llandough Hospital Cwm Taf The Royal Glamorgan Hospital Prince Charles Hospital Aneurin Bevan Royal Gwent Hospital Nevill Hall Hospital Produced by Public Health Wales, using PEDW (NWIS) Figure 179: District general hospital inpatient admissions with a primary District general hospital inpatient admissions with a primary diagnosis of: diagnosis of Epilepsy (G40-G41). Epilepsy (G40-G41) Health Board Hospital 2005/ / / / /10 Total Betsi Cadwaladr Ysbyty Glan Clwyd Ysbyty Gwynedd Wrexham Maelor Hospital Hywel Dda Prince Philip Hospital Withybush General Hospital West Wales General Hospital Bronglais General Hospital Abertawe Bro Morriston Hospital Morgannwg Princess of Wales Hospital Singleton Hospital Neath Port Talbot Hospital Cardiff and Vale University Hospital of Wales Llandough Hospital Cwm Taf Prince Charles Hospital The Royal Glamorgan Hospital Aneurin Bevan Royal Gwent Hospital Nevill Hall Hospital Produced by Public Health Wales, using PEDW (NWIS) Page 142 of 264

143 Figure 180: district general hospital inpatient admissions with a primary District general hospital inpatient admissions with a primary diagnosis of: diagnosis of Parkinson s disease (G20). Parkinson's disease (G20) Health Board Hospital 2005/ / / / /10 Total Betsi Cadwaladr Ysbyty Glan Clwyd Ysbyty Gwynedd Wrexham Maelor Hospital Hywel Dda West Wales General Hospital Withybush General Hospital Prince Philip Hospital <5 12 <43 Bronglais General Hospital 5 6 <5 <5 7 <28 Abertawe Bro Morriston Hospital Morgannwg Princess of Wales Hospital Singleton Hospital < <45 Neath Port Talbot Hospital Cardiff and Vale Llandough Hospital University Hospital of Wales Cwm Taf The Royal Glamorgan Hospital Prince Charles Hospital Aneurin Bevan Nevill Hall Hospital Royal Gwent Hospital Produced by Public Health Wales, using PEDW (NWIS) Figure District general 181: hospital District inpatient general admissions hospital with a primary inpatient diagnosis admissions of: with a primary diagnosis Alzheimer's disease of Alzheimer s (G30) disease (G30). Health Board Hospital 2005/ / / / /10 Total Betsi Cadwaladr Ysbyty Glan Clwyd Wrexham Maelor Hospital Ysbyty Gwynedd Hywel Dda West Wales General Hospital 11 <5 <5 5 <5 <31 Withybush General Hospital <5 <5 7 <5 <5 <27 Prince Philip Hospital <5 <5 <5 6 <5 <26 Bronglais General Hospital <5 <5 <5 <5 <5 <25 Abertawe Bro Neath Port Talbot Hospital Morgannwg Singleton Hospital Princess of Wales Hospital 12 <5 <5 <5 8 <35 Morriston Hospital <5 7 <28 Cardiff and Vale Llandough Hospital University Hospital of Wales Cwm Taf The Royal Glamorgan Hospital Prince Charles Hospital <5 6 <36 Aneurin Bevan Nevill Hall Hospital Royal Gwent Hospital Produced by Public Health Wales, using PEDW (NWIS) Page 143 of 264

144 Figure District general 182: hospital District inpatient general admissions hospital with a primary inpatient diagnosis admissions of: with a primary diagnosis Multiple sclerosis of Multiple (G35) sclerosis (G35). Health Board Hospital 2005/ / / / /10 Total Betsi Cadwaladr Ysbyty Glan Clwyd Ysbyty Gwynedd Wrexham Maelor Hospital Hywel Dda Withybush General Hospital Prince Philip Hospital <5 6 <5 <5 9 <30 West Wales General Hospital 6 < <28 Bronglais General Hospital 5 <5 <5 <5 <5 <25 Abertawe Bro Morriston Hospital Morgannwg Princess of Wales Hospital 11 < <35 Singleton Hospital 6 <5 <5 <5 <5 <26 Neath Port Talbot Hospital 6 <5 <5 <5 <5 <26 Cardiff and Vale University Hospital of Wales Llandough Hospital <5 9 <5 <42 Cwm Taf The Royal Glamorgan Hospital Prince Charles Hospital 6 < <47 Aneurin Bevan Nevill Hall Hospital Royal Gwent Hospital Produced by Public Health Wales, using PEDW (NWIS) Figure 183: Districts general hospital inpatient admissions with a primary District general hospital inpatient admissions with a primary diagnosis of: diagnosis of Cerebral palsy. Cerebral palsy (G80) Health Board Hospital 2005/ / / / /10 Total Betsi Cadwaladr Wrexham Maelor Hospital 8 <5 6 <5 <5 <29 Ysbyty Glan Clwyd <5 5 <5 <5 <5 <25 Ysbyty Gwynedd <5 <5 <5 <5 <5 <25 Hywel Dda Withybush General Hospital Bronglais General Hospital <5 <5 <5 <5 <5 <25 West Wales General Hospital <5 <5 <5 <5 <5 <25 Prince Philip Hospital <5 <5 <5 <5 <5 <25 Abertawe Bro Morriston Hospital Morgannwg Singleton Hospital <5 <34 Neath Port Talbot Hospital <5 <5 <5 <5 <5 <25 Princess of Wales Hospital <5 <5 <5 <5 <5 <25 Cardiff and Vale University Hospital of Wales Llandough Hospital <5 <5 <5 <5 <5 <25 Cwm Taf The Royal Glamorgan Hospital 11 < <50 Prince Charles Hospital <5 <5 <5 <5 <5 <25 Aneurin Bevan Nevill Hall Hospital Royal Gwent Hospital 6 <5 <5 5 8 <29 Produced by Public Health Wales, using PEDW (NWIS) Page 144 of 264

145 Page 145 of 264

146 CHAPTER 3: WIDER DETERMINANTS Health is affected, positively and negatively by many factors. At an individual level there are fixed biological factors, such as age, sex and genetic (or inherited) makeup and potentially modifiable lifestyle factors, such as smoking, diet and exercise. The society within which individuals live can influence their health, with involvement in social and community networks, including friendships, contact with relatives and supportive community interaction, playing an important role in maintaining health. Then, at higher level again, are the wider determinants of health, or the causes of the causes, the environment, income and housing all influence health both directly and indirectly. Many of these wider determinants of health are both inter-related and beyond the direct control of individuals. For example, an individual with few qualifications is more likely to be unemployed or to have a low income, which in turn limits their housing choice. Similarly, there is evidence of a link between unemployment and health whereby ill health may be caused by, or result from unemployment 3. All of these circumstances may act to influence what is often wrongly perceived as solely a personal lifestyle choice. For example, whilst smoking may appear to be an individual s lifestyle choice, it is possible that their decision to smoke is pushed by the effects of the context of their lives and is in effect a response to those stresses 4. It follows then that any attempt to tackle poor health must address the wider contextual factors, rather than simply looking to influence individuals and their specific behaviours in isolation. As such, building health into all policies and all policies into health is rightly the first of seven action areas of Fairer Health Outcomes for All, the Welsh Government s strategic action plan to reduce inequalities in health Income Low income and poor health are strongly associated with low income leading to poor health, and poor health leading to low income. A low income is likely to reduce the household s ability to access or maintain key aspects such as healthy food and warm accommodation. Low income is also likely to reduce societal participation and limit 3 Bambra C et al. Tackling the wider social determinants of health and health inequalities: evidence from systematic reviews. J Epidemiol Community Health 2010; 64: Layte R, Whelan C. Explaining social class differentials in smoking: the role of education. Working paper No.12. Dublin: Economic and Social Research Institute, University College Dublin; Welsh Assembly Government. Fairer health outcomes for all: reducing inequalities in health strategic action plan. Cardiff: Welsh Assembly Government; 2011 Page 146 of 264

147 access to enabling resources and choices. Those on low incomes are more likely to engage in health damaging behaviours such as smoking and eating high calorie foods, as coping mechanisms or short term fixes. Whilst it must be remembered that these are model based estimates, across the health board there was almost a twofold difference in the proportion of households estimated to be living in poverty from 18.5% (Ceredigion MSOA 004) to 32.8% (Pembrokeshire MSOA 013). Estimates at local authority level were not available but the median MSOA percentages suggest Pembrokeshire to be slightly higher than the rest and Carmarthenshire to be slightly lower. It can be seen from the map that four of the five highest percentages occurred in Pembrokeshire around the towns of Pembroke, Pembroke Dock, Milford Haven and Haverfordwest. The remaining highest percentage occurred in Carmarthenshire around the town of Llanelli. Figure 184: Percentage of households living in poverty, 2007/08. Page 147 of 264

148 3.2 Housing The percentage of people living in households with no central heating was markedly higher than the Welsh average in two of the three local authorities within Hywel Dda. This was to such an extent that all 26 MSOAs in Ceredigion and Pembrokeshire we above the Welsh average. Across Wales as a whole the highest percentages were seen in the more rural areas, in the areas that were without access to mains gas. Within the health board, there was substaintial variation at the MSOA level, ranging from just 1% in Swiss Valley / Llangennech (Carmarthenshire MSOA 019) to 20% in parts of Milford Haven (Pembrokeshire MSOA 012). The below map shows a very clear difference between the north and south with the majority of the lower percentages occurring in the southern most part of the health board. Figure 185: Percentage of all people living in households with no central heating, Page 148 of 264

149 3.3 Economic activity Unemployment puts health at risk and has been shown to increase effects on mental health and self-reported ill health 6. Financial problems, distress, anxiety and depression and poor health behaviours such as smoking and excessive drinking are all related to unemployment 7. This indicator utilises the National Statistics Socio-Economic Classification (NS- SEC) which is an indication of socio-economic position based on occupation and is an ONS standard classification. In order to allocate a person of working age (16 to 74 years old) to an NS-SEC category their occupation title is combined with information about their employment status, whether they are employed or selfemployed and whether or not they supervise other employees. Full-time students are recorded in the' full-time students' category regardless of whether they are economically active or not. A person is defined as long-term unemployed at the time of the 2011 Census if they were unemployed on the 27th March 2011 and the year they last worked was 2009 or earlier. The 2011 Census in England and Wales found that 5.6% of working age residents in England and Wales have never worked or are long-term unemployed. In the regions of England and in Wales, the highest proportion of residents who have never worked or are long term unemployed is in London at 8.3%. Just over 5% of working age residents in Wales have never worked or are long-term unemployed and this is slightly under the England and Wales average. 6 Commission on Social Determinants of Health. Closing the gap in a generation: health equity through action on the social determinants of health. Final Report of the Commission on Social Determinants of Health. Geneva, World Health Organization, Available at: [Accessed 20th March 2013] 7 Marmot M. Fair society, healthy lives: The Marmot Review. London: University College London; Available at: [Accessed 20th March 2013] Page 149 of 264

150 Figure 186: Percentage of all residents aged 16 to 74 who have never worked or are long-term unemployed, Wales, England and English regions, March In Wales 5.4% of the working age population have never worked or are long-term unemployed. In Hywel Dda Health Board all three constituent local authorities are below the Welsh average. In Welsh local authorities Blaenau Gwent had the highest proportion of the population who have never worked or are long-term unemployed at 8.7% compared to Ceredigion which had the lowest percentage at 3.1%. Figure 187: Percentage of all Welsh residents aged 16 to 74 who have never worked or are long term unemployed, Wales and local authorities, March At the LSOA level the percentage of residents who have never worked or are longterm unemployed range from 0.85% in the Faenor area of Ceredigion (Ceredigion Page 150 of 264

151 LSOA 011A) to 14.1% in the Tyisha area of Carmarthenshire (Carmarthenshire LSOA 026E). It is important to note that these are crude percentages only and do not take into account the age structure of the population. The areas with the highest percentages are found in the Llwynhendy and Tyisha areas of Carmarthenshire and in the Pembroke: Monkton and Pembroke Dock: Llanion areas of Pembrokeshire. Figure 188: Residents aged 16 to 74 who have never worked or are long term unemployed, March There was considerable variation at the MSOA level from just 6.9% in parts of Aberystwyth (Ceredigion MSOA 002) to 27.6% in parts of Llanelli (Carmarthenshire MSOA 026). Eight of the nine highest percentages occurred in Carmarthenshire. The other particularly high percentage was in Pembroke Dock (MSOA 013). Ceredigion had a particularly high percentage in the Cardigan / Aberporth area (Ceredigion MSOA 009). Employment related benefits, unsurprisingly, show a similar pattern to that of poverty, being generally highest in the coastal and larger towns. Page 151 of 264

152 Figure 189; Percentage of working-age population claiming employment related benefits, November Page 152 of 264

153 3.4 Education Educational outcomes affect physical and mental health, as well as income, employment and quality of life. The relationship between socioeconomic position and qualifications has implications for other social determinants such as income and living standards which have an impact on health. This indicator measures all usual residents aged 16 and over and under 74 years who have no academic or professional qualification. No academic or professional qualification is derived from the question asking people to indicate all types of qualifications held. The 2011 Census in England and Wales found that over one-fifth (22.7%) of working age residents in England and Wales have no academic or professional qualifications. In the regions of England and in Wales, the highest proportions of residents who have no academic and professional qualifications are contained in the West Midlands at 26.6%, followed by Wales at 25.9%. London has the lowest proportion of people having no qualifications at 17.6%. Figure 190: Percentage of all residents aged 16 to 74 who have academic or professional qualifications, Wales, England and English regions, March In Welsh local authorities the proportion of working age residents with no academic or professional qualifications ranged from 1 in 3 people in Blaenau Gwent and Merthyr Tydfil to just under 1 in 5 people in Ceredigion, the Vale of Glamorgan, Cardiff and Monmouthshire. Two local authorities in Hywel Dda Health Board were below the Welsh average, Ceredigion and Pembrokeshire, while Carmarthenshire was above the Welsh average at 26.8%. Blaenau Gwent had the highest proportion Page 153 of 264

154 of people with no qualifications at 36% compared to Ceredigion which had the lowest at 19.8%. Figure 191: Percentage of all Welsh residents aged 16 to 74 who have no academic or professional qualifications, Wales and local authorities, March There is considerable variation at the LSOA level within this health board. However these are crude percentages only and do not take into account the age structure of the population. The proportion of residents who have no academic or professional qualifications ranged from 5.3% in the Aberystwyth Bronglais area of Ceredigion (Ceredigion LSOA 002A) to 42.2% in the Tyisha area of Carmarthenshire (Carmarthenshire LSOA 026E). The areas with the highest percentages are found in the Tyisha and Bigyn areas of Carmarthenshire and the Pembroke Dock: Llanion area of Pembrokeshire. Page 154 of 264

155 Figure 192: residents aged years who have no academic or professional qualifications, March Page 155 of 264

156 Page 156 of 264

157 CHAPTER 4: HEALTHY LIFE STAGES AND LIFE STYLE 4.1 Early years, children and young people Childhood health surveillance The childhood health surveillance focuses on the health of children. It comprises of a suite of childhood indicators, presented at local authority level, as highlighted in figure 33, 34 and 35. Figure 193: Childhood health surveillance for Ceredigion, Page 157 of 264

158 Figure 194: Childhood health surveillance for Carmarthenshire, Page 158 of 264

159 Figure 195: Childhood health surveillance for Pembrokeshire, Low birth rates The below table provides an outline of the percentage of low birth rates for Hywel Dda in comparison to other Health Board and Local Authority areas: Page 159 of 264

160 Figure 196: Singleton live births, low birth weight (less than 2500g), percentage, Hywel Dda UHB and Wales, In 2014 there were 165 (4.7%) cases of live births / low birth rates for Hywel Dda UHB. There is no statistical difference between Hywel Dda UHB and Wales. Page 160 of 264

161 4.1.3 Breast fed at birth Figure 197: Percentage of babies breast fed at birth, % of babies breastfed at birth, 2011 Produced by Public Health Wales Observatory, using NCCHD (NWIS) Betsi Cadwaladr Powys Hywel Dda ABM Cardiff & Vale Cwm Taf Aneurin Bevan Wales = 55.5% Isle of Anglesey Gwynedd Conwy Denbighshire Flintshire Wrexham Powys Ceredigion Pembrokeshire Carm arthenshire Swansea Neath Port Talbot Bridgend Vale of Glamorgan Cardiff Rhondda Cynon Taf Merthyr Tydfil Caerphilly Blaenau Gwent Torfaen Monmouthshire Newport Ceredigion, Pembrokeshire and Carmarthenshire are all above the Wales average percentage score of 55.5% for percentage of babies breast fed at birth. Page 161 of 264

162 4.1.4 Uptake rate for primary MMR vaccine at age two Figure 198: Uptake rate for primary MMR vaccine at age two, to The MMR coverage rate in Pembrokeshire has increased 2.1 percentage points since to a rate of 95.5 per cent in , which is below the Welsh average. Figure 199: Uptake rate for primary MMR vaccine at age two, to The MMR coverage rate in Ceredigion has increased 3.3 percentage points since to a rate of 97.2 per cent in , which is above the Welsh average. Page 162 of 264

163 Figure 200: Uptake rate for primary MMR vaccine at age two, to The MMR coverage rate in Carmarthenshire has increased 3.4 percentage points since to a rate of 97.2 per cent in , which is above the Welsh average Uptake of routine immunisations by 4 years of age Figure 201: Percentage of children up to date with routine immunisations by 4 years of age, % of children up to date with routine immunisations by 4 years of age, 2012 Produced by Public Health Wales Observatory, using CDSC and VPDP (PHW) Betsi Cadwaladr Powys Hywel Dda ABM Cardiff & Vale Cwm Taf Aneurin Bevan Isle of Anglesey Gwynedd Conwy Denbighshire Flintshire Wrexham Powys Ceredigion Pem brokeshire Carm arthenshire Swansea Neath Port Talbot Bridgend Vale of Glamorgan Cardiff Rhondda Cynon Taf Merthyr Tydfil Caerphilly Blaenau Gwent Torfaen Monm outhshire Newport Wales=82.4% Page 163 of 264

164 In Hywel Dda UHB the number of children up to date with routine immunisations was 3124, in Ceredigion the 513, Pembrokeshire 998 and Carmarthenshire 1613 Figure 202: Percentage of children up to date with immunisations by 4 years of age, Wales MSOA's, The above map shows the areas, where the greatest uptake of immunisations for 4 year olds. Page 164 of 264

165 4.1.6 Healthy eating Figure 203: Percentage of persons aged 11-16* who reported who reported eating at least one piece of fruit, daily, 2009/10. % of persons aged 11-16* who reported eating at least one piece of fruit, daily, 2009/10 Produced by Public Health Wales Observatory, using HBSC (WG) Males Fem ales Greenland (lowest) Denmark(highest) HBSC average Scotland Ireland England Wales Betsi Cadwaladr Powys Hywel Dda ABM Cardiff & Vale Cwm Taf Aneurin Bevan *Country level data only includes ages 11, 13 and 15. There were more females (38%) than males (28%) aged years, in Hywel Dda UHB who reported eating at least one piece of fruit daily. Page 165 of 264

166 Figure 204: Percentage of persons aged 11-16* who reported eating at least one piece of fruit, daily, There were more girls (36%) than boys (30%) aged years, in Hywel Dda UHB who reported eating at least one piece of fruit daily. Figure 205: Percentage of persons aged 11-16*, who reported eating vegetables every day, There were more girls (49%) than boys (36%) aged years, in Hywel Dda UHB who reported eating vegetables every day Page 166 of 264

167 Figure 206: Persons aged who reported breakfast five days a week, There were more boys (70%) than girls (56%) aged years in Hywel Dda UHB who reported eating breakfast five days a week Physical activity Figure 207: Percentage of children aged years who reported undertaking physical activity for an hour or more every day, % of children aged years reported undertaking phyical activity for an hour or more everday within Hywel Dda UHB. Boys (21%) were more active than girls (11%). Page 167 of 264

168 4.1.8 Overweigh and obesity Figure 208: Proportion of children aged 4 to 5 years, who are a healthy weight or underweight, Child Measurement Programme, Wales and local authorities, 2012/13. The above show the information at local authority and health board level for children with a BMI classified as healthy weight or underweight. Figure 209: Proportion of children aged 4 to 5 who are overweight or obese, Wales and local authorities, Child measurement Programme 2012/ % of children measured in 2012/13 in Wales were either overweight or obese. This proportion varies by local authority health board. The prevalence for overweight or obesity was lower in Ceredigion, than in Pembrokeshire or Carmarthenshire. Page 168 of 264

169 Figure 210: Percentage of year olds who were reported as being overweight / obese, % of year olds were classified as overweight / obese. The boys were reported higher at 26% in comparison to the girls at 14%. Figure 211: Percentage of persons aged who are overweight or obese, stratified % by of Family persons Affluence aged Scale who are (FAS), overweight Wales*, or obese, 2009/10. stratified by Family Affluence Scale (FAS), Wales*, 2009/10 Produced by Public Health Wales Observatory, using HBSC (WG) FAS 1 (low) FAS 2 (med) FAS 3 (high) Year 7 Year 8 Year 9 Year 10 Year 11 Males Females Persons *Approximately half of data missing for Wales Page 169 of 264

170 4.1.9 Smoking Figure 212: Percentage of persons aged who reported smoking at least once a % week, of persons stratified aged by Family who Affluence reported smoking Scale (FAS), at least Wales, once a 2009/10. week, stratified by Family Affluence Scale (FAS), Wales, 2009/10 Produced by Public Health Wales Observatory, using HBSC (WG) Males Females Persons FAS 1 (low) FAS 2 (med) FAS 3 (high) Year 7 Year 8 Year 9 Year 10 Year <0.5 < Figure 213: Percentage aged who reported currently being a smoker (daily or occasionally), Percent (n=11,600) of young people aged in Hywel Dda UHB reported as being current smokers. There is no statistical difference between Hywel Dda UHB and Wales. Page 170 of 264

171 Figure 214: Percentage of year olds who reported they smoke at least once a week, % of years olds within Hywel Dda reported they smoked at least once a week. Figure 215: Percentage of persons aged year olds who have tried e-cigar on a few occasions/ regularly, % of persons aged have tried an e-cigarette on a few occasions / regularly, which is much lower than the Welsh average of 12%. Page 171 of 264

172 Alcohol Figure 216: Percentage of persons aged 11-16* years who reported being drunk the last 30 days, More girls (9%) than boys (8%) aged years reported being drunk in the last 30 days. Figure 217: Percentage of persons aged years old who reported drinking alcohol at least once a week, Page 172 of 264

173 Figure 218: Percentage of persons aged who reported drinking alcohol at least once a week, stratified by Family Affluence Scale (FAS), Wales, % of persons aged who reported drinking alcohol at least once 2009/10. a week, stratified by Family Affluence Scale (FAS), Wales, 2009/10 Produced by Public Health Wales Observatory, using HBSC (WG) Males Females Persons FAS 1 (low) FAS 2 (med) FAS 3 (high) Year 7 Year 8 Year 9 Year 10 Year Figure 219: Persons aged who reported drinking above the recommended guidelines on at least one day in the previous week, % (n= 20,600) of persons aged years reported drinking above the recommended guidelines on at least one day in the previous week, withinin Hywel Dda UHB. Page 173 of 264

174 Substance misuse Figure 220: Percentage of persons aged who reported using any illicit drug (even if only once), % boys and 7% girls from Hywel Dda UHB reported using any illicit drug. Hywel Dda reported similar score to the all Wales percentage Figure 221: Percentage of persons aged years who have taken cannabis, Hywel Dda UHB scored (6%), which is lower than the Welsh average score of 7%. Page 174 of 264

175 2008/ / / /12 Figure 222: Percentage of persons aged who reported using any illicit drug in the last year, stratified by Family Affluence Scale (FAS), Wales, 2009/10. % of persons aged who reported using any illicit drug in the last year, stratified by family affluence scale (FAS), Wales, 2009/10 Produced by Public Health Wales Observatory, using HBSC (WG) Males Females Persons FAS 1 (low) FAS 2 (med) FAS 3 (high) Year 7 Year 8 Year 9 Year 10 Year Figure 223: Number of referrals for substance misuse, persons aged 0-24, Wales, 2008/ /12. Number of referrals for substance misuse, persons aged 0-24, Wales, 2008/ /12 Produced by Public Health Wales Observatory, using WNDSM (NWIS) Under 15 males Under 15 males males males males males Under 15 females Under 15 females females females females females 1,500 Drugs Alcohol 1,250 1,000 1,500 1,500 1,250 1,250 1, , Drugs Drugs 2008/ / / / / / / /12 The above shows the All Wales trend in referals by age for substance misuse, in persons aged 0-24 from , in both male and females. Page 175 of 264

176 Figure 224: Referrals for substance misuse, persons aged 0-24, incidence rate per 1000,000, 2011/12. Referrals for substance misuse, persons aged 0-24, incidence rate per 100,000, 2011/12 Produced by Public Health Wales Observatory, using WNDSM (NWIS) Betsi Cadwaladr Powys Hywel Dda ABM Cardiff & Vale Cwm Taf Aneurin Bevan Drugs Wales = 68 Alcohol Wales = 41 Isle of Anglesey Gwynedd Conwy Denbighshire Flintshire Wrexham Powys Ceredigion Pembrokeshire Carmarthenshire Swansea Neath Port Talbot Bridgend Vale of Glamorgan Cardiff Rhondda Cynon Taf Merthyr Tydfil Caerphilly Blaenau Gwent Torfaen Monmouthshire Newport Hywel Dda UHB was the highest Health Board in Wales for referring or alcohol misuse and second highest in Wales for Drug misuse. Figure 225: Alcohol-specific hospital admissions (person-based), 3-year rolling crude Alcohol-specific rate per 100,000, hospital admissions persons aged (person-based), under 18, 3-year Hywel rolling Dda crude UHB rate and per Wales, financial 100,000, years persons 2003/ /13. aged under 18, Hywel Dda UHB and Wales, financial years 2003/ /13 Produced by Public Health Wales Observatory, using PEDW (NWIS) & MYE (ONS) 95% confidence interval Hywel Dda UHB Wales / / / / / / / / / / / / / / / /13 Page 176 of 264

177 Figure 226: Alcohol-specific hospital admissions (person-based), crude rate per Alcohol-specific 100,000, persons hospital aged admissions under (person-based), 18, Wales health crude rate boards, per 100,000, financial years 2010/ /13. persons aged under 18, Wales health boards, financial years 2010/ /13 Produced by Public Health Wales Observatory, using PEDW (NWIS) & MYE (ONS) 95% confidence interval Wales = 65 Betsi Cadwaladr UHB Powys thb Hywel Dda UHB ABM UHB Cardiff & Vale UHB Cwm Taf UHB Aneurin Bevan UHB Page 177 of 264

178 Sexual health Figure 227: Conception in females aged under 18, Hywel Dda UHB, The above map highlights the key areas, within each of the Health Board counties with the highest conception rates. Page 178 of 264

179 Figure 228: Conception rate per 1,000 female aged under 18*, local authorities within Hywel Dda UHB, The above figure shows the change in conception rates from Carmarthen seems to have a steady decline, whereas Pembrokeshire and Ceredigion seem to have an increase in 2011, followed by a decline in Figure 229: Conception rates per 1,000 female under 18*, health boards within Wales, Page 179 of 264

180 Figure 230: Conception rates per 1,000 females aged under 18*, Wales Local Authorities Ceredigion was statistically lower than the Wales average for conception rates in females under 18. Page 180 of 264

181 Figure 231: Teenage conception rates per 1,000 female, Teenage conceptions, rate per 1,000 females, 2011 Produced by Public Health Wales Observatory, using conceptions data (ONS) England North East North West Yorkshire and The Humber East Midlands West Midlands East of England London South East South West Under 16 Under 16 Under 18 rate Wales = 6.1 rate Under 18 Wales = 34.2 Betsi Cadwaladr Powys Hywel Dda* ABM Cardiff & Vale Cwm Taf Aneurin Bevan* Isle of Anglesey Gwynedd Conwy Denbighshire Flintshire Wrexham Powys Ceredigion* Pembrokeshire Carmarthenshire Swansea Neath Port Talbot Bridgend Vale of Glamorgan Cardiff Rhondda Cynon Taf Merthyr Tydfil Caerphilly Blaenau Gwent Torfaen Monmouthshire* Newport Rates for females under 16 are per 1,000 females aged 13-15; rates for females under 18 are per 1,000 females aged *Rates based on counts of less than 5 have been suppressed; secondary suppression has been applied where necessary Page 181 of 264

182 Figure 232: Teenage conception, females aged under 18, Wales, The above map shows the areas where teenage conception is more promenant, the darker areas indicates the highest rates. Page 182 of 264

183 Figure Conceptions 233: Conception in females in females aged aged under under 16 years 16 years by fifth by fifth of of deprivation, Wales, deprivation, rate per 10,000 Wales, population rate per aged 1, , population aged 13-15, Produced by Public Health Wales Observatory, using conceptions data (ONS) & WIMD 2011 (WG) Least deprived Next least deprived Middle Next most deprived Most deprived Wales = 8.1 Figure 234: Abortion rate per 1,000 females aged under 18*, Wales local authorities, Although Ceredigion (11.3), Pembrokeshire (12.6) and Carmarthenshire (10.3) are below the Welsh score of 12.6, they are not statistically lower. Page 183 of 264

184 Rate per 1,000 Figure 235: Legal abortions, females, crude rate per 1,000, Legal abortions, females, crude rate per 1,000, 2011 Produced by Public Health Wales Observatory, using Department of Health data & MYE (ONS) Under 18* Betsi Cadwaladr Powys Hywel Dda ABM Cardiff & Vale Cwm Taf Aneurin Bevan Wales = Wales = Wales = 26.2 *Rate per 1,000 females aged The above shows the rates of abortion between under 18 s, and year olds in Hywel Dda. Although Hywel Dda is lower than the welsh rates, it is not statistically lower. Figure 236: Legal abortions, females, crude rate per 1,000, Legal abortions, females, crude rate per 1,000, Produced by Public Health Wales Observatory, using Department of Health data England Wales Under 18 years years years Page 184 of 264

185 Figure 237: tests for gonorrhoea and Chlamydia in persons aged y by area of residence, rate per 1,000 population. Tests for gonorrhoea and chlamydia in persons aged by area of residence, rate per 1,000 population Produced by Public Health Wales Observatory, using SWS data provided by CDSC (PHW) & MYE (ONS) Betsi Cadwaladr Powys Hywel Dda* ABM Cardiff & Vale Cwm Taf Aneurin Bevan Isle of Anglesey Gwynedd Conwy Denbighshire Flintshire Wrexham Powys Ceredigion Pembrokeshire* Carmarthenshire* Swansea Neath Port Talbot Bridgend Vale of Glamorgan Cardiff Rhondda Cynon Taf Merthyr Tydfil Caerphilly Blaenau Gwent Torfaen Monmouthshire Newport Gonorrhoea (annual Positive test (%) average ) Gonorrhoea Chlamydia Wales* = Chlamydia (2011) Wales* = 31.4 * Data from clinics in Carmarthenshire and Pembrokeshire are not 1.4 currently 14.0 available via SWS so the figures presented represent only residents who have visited clinics elsewhere. Please note that completeness on reporting of area of residence and coding of diagnosis is variable across clinics and so res ults should be interpreted with caution Although there are some queries about the data for Carmartehsnhire and Pembrokeshire, Hywel Dda UHB has the lowest tests in Wales. Page 185 of 264

186 Immunisations Figure 238: % of children up to date with routine immunisations by 4 years of % of children up to date with routine immunisations by 4 age, years of age, 2012 Produced by Public Health Wales Observatory, using CDSC and VPDP (PHW) Betsi Cadwaladr Powys Hywel Dda ABM Cardiff & Vale Cwm Taf Aneurin Bevan Isle of Anglesey Gwynedd Conwy Denbighshire Flintshire Wrexham Powys Ceredigion Pem brokeshire Carm arthenshire Swansea Neath Port Talbot Bridgend Vale of Glamorgan Cardiff Rhondda Cynon Taf Merthyr Tydfil Caerphilly Blaenau Gwent Torfaen Monm outhshire Newport Wales=82.4% In Hywel Dda UHB the number of children up to date with routine immunisations was 3124, in Ceredigion the 513, Pembrokeshire 998 and Carmarthenshire 1613 Page 186 of 264

187 Figure 239: Percentage of children up to date with immunisations by 4 years of age, Wales MSOA's, The above map shows the areas, where the greatest uptake of immunisations for 4 year olds. Page 187 of 264

188 % of children who are up to date with their routine Figure 240: Percentage of children who are up to date with their routine immunisations at 4 years of age by deprivation fifth, Wales, immunisations at 4 years of age by deprivation fifths, Wales, Produced by Public Health Wales Observatory, using, using CDSC & VPDP (PHW); WIMD 2011 (WG) Wales = 82.4% Least deprived Next least deprived Middle Next m ost deprived Most deprived Number of children receving 2 dose course of the MMR in Hywel Dda UHB 3280, Ceredigion 545, Pembrokeshire 1095 and Carmarthenshire 1640 Figure 241: Percentage of persons aged 16 who have completed a dose course of the MMR vaccine, % of persons aged 16 who have completed a 2 dose course of the MMR vaccine, 2012 Produced by Public Health Wales Observatory, using CDSC and VPDP (PHW) Wales=83.1% Betsi Cadwaladr Powys Hywel Dda ABM Cardiff & Vale Cwm Taf Aneurin Bevan Isle of Anglesey Gwynedd Conwy Denbighshire Flintshire Wrexham Powys Ceredigion Pem brokeshire Carm arthenshire Swansea Neath Port Talbot Bridgend Vale of Glamorgan Cardiff Rhondda Cynon Taf Merthyr Tydfil Caerphilly Blaenau Gwent Torfaen Monm outhshire Newport Page 188 of 264

189 Figure 242: Percentage of girls completing a 3 dose course of HPV vaccine, school year 9, % of girls completing a 3 dose course of the HPV vaccine, school year 9, 2012/13 Produced by Public Health Wales Observatory, using CDSC and VPDP (PHW) Betsi Cadwaladr Powys Hywel Dda ABM Cardiff & Vale Cwm Taf Aneurin Bevan Isle of Anglesey Gwynedd Conwy Denbighshire Flintshire Wrexham Powys Ceredigion Pem brokeshire Carm arthenshire Swansea Neath Port Talbot Bridgend Vale of Glamorgan Cardiff Rhondda Cynon Taf Merthyr Tydfil Caerphilly Blaenau Gwent Torfaen Monm outhshire Newport Wales = 86.6% The number of girls completing a 3 dose course of the HPV vaccine was Hywel Dda UHB 1617 (85.5%), Ceredigion 251 (83.1%), Pembrokeshire 531 (81.7%) and Carmarthenshire 835 (88.8%). Page 189 of 264

190 General health & well being Figure 243: Percentage of persons aged had a long-term illness, disability or medical condition (such as, diabetes, arthritis, allergy or cerebral palsy) that had been diagnosed by a doctor Hywel Dda UHB reported similar score to the all Wales percentage. Figure 244: Percentage of persons aged years who rated their health as fair / poor, % of bys and 22% of girls reported their health as being fair / poor within Hywel Dda UHB. Page 190 of 264

191 . Figure 245: Percentage of persons aged who reported having 2 or more health complaints more than once a week, % of girls living within Hywel Dda UHB scored higher than the Welsh average at 31% for reporting 2 or more health concerns a week. Figure 246: Percentage of persons aged scoring 6 or higher on self-rated life satisfaction, % of boys and 79% of girls scored 6 or higher on self-rated life satisfaction. Page 191 of 264

192 Rate per 100,000 Figure 247: Percentage of persons aged years who have reported being bullied at least a couple of times in the past month, % of persons aged years living within Hywel Dda UHB have reported being bullied at least a couple of times int he past month. This i s lower than the Welsh average of 37% Use of services Figure 248: Persons aged admitted to hospital with a primary diagnosis of Persons eating aged disorder, Wales, admitted to hospital with a primary diagnosis of eating disorder, Wales, Produced by Public Health Wales Observatory, using PEDW (NWIS) & MYE (ONS) The rates for hospital admission with primary diagnosis of eating disorder in Wales have gone up since 2002, peaking at 2010 with a slight decline in Page 192 of 264

193 Figure 249: Persons aged admitted to hospital with a primary diagnosis of eating disorder, Wales, Figure 250: Estimated number of children and young people aged 5-16 with any mental health disorder, Page 193 of 264

194 Figure 251: Estimated number of children and young people aged 5-16 with any mental health disorder, Figure 252: Emergency admissions*, persons aged 0-24, EASR per 1,000, Emergency admissions*, persons aged 0-24, EASR per 1,000, 2011 Produced by Public Health Wales Observatory, using PEDW (NWIS) & MYE (ONS) Wales = Betsi Cadwaladr Powys Hywel Dda ABM Cardiff & Vale Cwm Taf Aneurin Bevan Isle of Anglesey Gwynedd Conwy Denbighshire Flintshire Wrexham Powys Ceredigion Pem brokeshire Carm arthenshire Swansea Neath Port Talbot Bridgend Vale of Glamorgan Cardiff Rhondda Cynon Taf Merthyr Tydfil Caerphilly Blaenau Gwent Torfaen Monm outhshire Newport *Patients are counted more than once if they had multiple admissions during 2011 The above suggests that Hywel Dda UHB has statistically lower rates of emergency admissionsfor persosn aged Both Ceredigion and Pembrokeshire slightly higher than than the welsh rate of 100.4, at 102.6, however, this is not statistically greater. Page 194 of 264

195 Figure 253: Emergency admissions for persons aged 0-24, The above map shows the demographic spread of admissionsfor persons aged 0-24 years across Hywel Dda UHB. Page 195 of 264

196 Figure 254: Emergency admissions* by main cause for persons aged 0-24 years, Wales Emergency admissions* by main cause for persons aged 0-24, Wales, 2011 Produced by Public Health Wales Observatory, using PEDW (NWIS) 0-4 year olds 5-11 year olds Respiratory system 12,523 Injury/poisoning 2,488 Infectious and parasitic 7,977 Abnormal findings and ill-defined causes 2,331 Abnormal findings and ill-defined causes 5,283 Respiratory system 2,033 Injury/poisoning 3,420 Infectious and parasitic 1,206 Disgestive system 2,684 Disgestive system 1,150 Perinatal conditions Genitourinary system 2, Genitourinary system Musculoskeletal system/connective system Skin and subcutaneous tissue 734 Nervous system 342 Factors influencing health and contact with health services Congenital malformations Skin and subcutaneous tissue Blood, blood forming organs and immune mechanism year olds year olds Injury/poisoning 3,042 Injury/poisoning 4,152 Abnormal findings and ill-defined causes 2,797 Abnormal findings and ill-defined causes 4,110 Disgestive system 999 Pregnancy, childbirth and the puerperium 3,821 Respiratory system 916 Disgestive system 1,830 Genitourinary system 680 Genitourinary system 1,635 Infectious and parasitic 394 Respiratory system 1,097 Mental and behavioural disorders 382 Mental and behavioural disorders 735 Pregnancy, childbirth and the puerperium 344 Skin and subcutaneous tissue 593 Nervous system 330 Musculoskeletal system/connective system 427 Endocrine, nutritional and metabolic 329 Nervous system 426 *Patients are counted more than once if they had multiple admissions during 2011 Page 196 of 264

197 Figure 255: Admissions for pedestrian injuries by fifth of deprivation, children aged 5-14, Wales, rate per 100, Admission rates in the most deprived and next most deprived categories were significantly greater than the Wales score of 31.7 Figure 256: Admissions for pedestrian injuries by fifth of deprivation, children aged 5-14, Wales, rate per 100,000, Admissions for pedestrian injuries by fifth of deprivation, children aged 5-14, Wales, rate per 100,000, Produced by Public Health Wales Observatory, using PEDW (NWIS), MYE (ONS) & WIMD 2011 (WG) Wales = 31.7 Least deprived 15.1 Next least deprived 20.9 Middle 28.8 Next m ost deprived 38.8 Most deprived 51.0 Page 197 of 264

198 Number of casualties Figure 257: Number of road traffic casualties, persons aged 0-24, Wales, Number of road traffic casualties, persons aged 0-24, Wales, Produced by Public Health Wales Observatory, using Road accidents and safety data (STATS19) 0-4 males 5-11 males females females females sles males females females females females Males 2,000 Males 2,000 1,800 1,800 1,600 1,600 1,400 1,4001,200 1,000 1, , Females The most amount of road traffic casualties occur in persons aged between years, with males being higher than females. Figure 258: Number of road traffic casualties, persons aged 0-24, Wales, Page 198 of 264

199 Number of casualties Figure 259: Number of road traffic causalities by casualty type, persons aged 25 Number and under, of road Wales, traffic casualties by casualty type, persons aged 25 and under, Wales, Produced by Public Health Wales Observatory, using Road accidents and safety data (STATS19) Male driver or rider Male passenger Male pedestrian Female driver or rider Female passenger Female pedestrian 1,800 1,600 1,400 1,200 1, Males Females The above suggests most the common type of road traffic accident amongst males is either with a male driver or rider and for females it s due to being a passenger. Figure 260: Number of road traffic casualties by casualty type, persons aged 25 and under, Wales, Page 199 of 264

200 Cancer Figure 261: Percentage of patients on primary care chronic conditions register with % of asthma, patients persons primary aged care under chronic 25, conditions register with asthma, persons % patients agedon under chronic 25, conditions February % patients 2012 register on with chronic asthma, conditions males register with asthma, Produced aged under by Public 25 years, Health Wales February Observatory, 2012 using Audit+ (NWIS) females aged under 25 years, February 2012 Produced by Public Health Males Wales Observatory, Produced using by Public Audit+ Health (NWIS) Females Wales Observatory, using Audit+ (NWIS) Betsi Cadwaladr Powys Hywel Dda ABM Cardiff & Vale Cwm Taf Aneurin Bevan Wales = 5.7 Betsi Cadwaladr Powys Hywel Dda ABM Cardiff & Vale Cwm Taf Aneurin Bevan Wales = 4.9 Isle of Anglesey Gwynedd Conwy Denbighshire Flintshire Wrexham Powys Ceredigion Pem brokeshire Carm arthenshire Swansea Neath Port Talbot Bridgend Vale of Glamorgan Cardiff Rhondda Cynon Taf Merthyr Tydfil Caerphilly Blaenau Gwent Torfaen Monm outhshire Newport Isle of Anglesey Gwynedd Conwy Denbighshire Flintshire Wrexham Powys Ceredigion Pem brokeshire Carm arthenshire Swansea Neath Port Talbot Bridgend Vale of Glamorgan Cardiff Rhondda Cynon Taf Merthyr Tydfil Caerphilly Blaenau Gwent Torfaen Monm outhshire Newport Ceredigion is statistically lower and Pemrbokeshire is statistically higher than the wales rates in Males. Page 200 of 264

201 Rate per 1 million population Figure 262: Incidence of cancer*, persons aged 0-24, EASR per 100,000 population, In Hywel Dda UHB there is on average 18 new cases of cancer per year. Figure 263: Cancer registration rates by cancer site for persons aged 0-24, Wales, Cancer registration rates by cancer site for persons aged 0-24, Wales, Produced by Public Health Wales Observatory, using MYE (ONS) & cancer registrations (WCISU) 60 Testis (males only)* Brain & central nervous system Thyroid & endocrine Hodgkin's lymphoma Non-Hodgkin's lymphoma Leukaemia 0 *Denominator for cancer of testis is males aged 0-24 years Page 201 of 264

202 Rate per 1 million population Figure 264: Cancer registration rates by cancer site for persons aged 0-24, Wales Figure 265: Cancer registration rates by age and sex, Wales, Cancer registration rates by age and sex, Wales, Produced by Public Health Wales Observatory, using MYE (ONS) & cancer registrations (WCISU) Males Females years 5-11 years years years Page 202 of 264

203 Figure 266: Cancer registration rates by age and sex, Wales, Figure 267: Cases of congenital anomalies EUROCAT definition, Page 203 of 264

204 Oral heath Figure 268: Average decay, missing and filled teeth (dmft) for 5 year olds, Welsh local health boards, 2007/08 compared with 2011/12. Hywel Dda, Betsi Cadwaladr and Abertawe Bro Morgannwg University health boards experienced statistically significant reductions. The 2011/12 Hywel Dda average was statistically lower when compared with the Welsh average for the same year. Figure 269: Average dmft for 5 year olds, in unitary authorities within Hywel Dda UHB, 2007/08 compared with 2011/12. During 2007/08 average dmft values for all 3 Hywel Dda unitary authorities were within the average range when compared with the Welsh average for that same year. For Carmarthenshire UA there was a statistically significant reduction in average dmft between 2007/08 and 2011/12, from 2.2 to 1.0. There were reductions in the average dmft for Ceredigion (2007/08: /12: 1.2) and Pembrokeshire (2007/08: /12: 1.6) between the survey years. But, neither of these changes were statistically significant. Page 204 of 264

205 Figure 270: Percentage of 5 year olds with caries experience 9%dmft>0), Welsh health boards, 2007/098 compared with 2011/12. Although there appears to be a general tendency (except in Cwm Taf) for a reduction in the proportion of children with decay experience, the changes only reach statistical significance in Aneurin Bevan and Hywel Dda LHB areas. Figure 271: Percentage of 5 year olds with caries experience (%dmft>0) in unitary authorities within Hywel Dda UHB, 2007/08 compared with 2011/12. The %dmft>0 for Carmarthenshire fell by over 20% between 2007/08 and 2011/12, from 53.2% (95%CI: 48.2%-58.1%) to 30.6% (95%CI: 25.5%-35.6). This was a statistically significant change. The %dmft>0 for Ceredigion for both surveys was statistically lower than the Welsh percentage at the corresponding time points. The %dmft>0 for the UA fell between 2007/08 and 2011/12 from 35.7% (95%CI: 28.1% %) to 28.7% (95%CI: 22.5%-35.0%) but this was not a statistically significant change. The %dmft>0 for Pembrokeshire for both surveys was within average range when compared with the Welsh percentage. The %dmft>0 for the UA fell between 2007/08 and 2011/12 from 44.9% (95%CI: 38.8% -51.1%) to 38.8% (95%CI: 33.0%- 44.6%) but this was not statistically significant. Page 205 of 264

206 Figure 272: Average dmft of those with caries experience for 5 year olds, Welsh health boards, 2007/08 compared with 2011/12. The above table shows the average number of decayed, missing and filled teeth among the children with at least one decayed/missing/filled tooth. There is a general tendency for a reduction in the mean scores; the only change shown which reaches statistical significance is in ABMU where the averages for 2007/08 and 2011/12 were 4.4 (95%CI: ) and 3.7 (95%CI: ) respectively. Figure 273: Average dmft of those with caries expereince for 5 year olds, in unitary authorities within Hywel Dda UHB, 2007/08 compared with 2011/12. In Carmarthenshire there was a significant reduction in the average dmft of those with dmft between 2007/08 (4.2, 95%CI: ) and 2011/12 (3.2, 95%CI: ). Also, the average dmft of those with dmft for the UA in 2011/12 was statistically lower than the Welsh average for the same year. There were small reductions in the average dmft of those with dmft for Ceredigion (2007/08: /12: 4.3) and Pembrokeshire (2007/08: /12: 4.0) between the survey years. But, neither of these changes were statistically significant. Page 206 of 264

207 The decayed teeth (dt) component of total experience of decay (dmft) measures active decay. This puts the child at risk of pain, infection and suggests risk of decay of permanent successor teeth. In the past it has been called untreated disease. Figure 274: Average dt for 5 years olds, Welsh health boards, 2007/07 compared with 201/12. The above graph shows that only Betsi Cadwaladr and Hywel Dda showed statistically significant reductions in average dt scores between 2007/08 and 2011/12. Hywel Dda experienced a reduction in average dt representing over 2/3rds of a tooth, falling from 1.5 (95%CI: ) in 2007/08 to 0.8 (95%CI: ) in 2011/12. In 2011/12 average dt ranged from 0.8 in Hywel Dda to 1.5 in Aneurin Bevan LHB. Figure 275: Average dt for 5 year olds, in unitary authorities within Hywel Dda UHB, 2007/08 compared with 2011/12. There were small reductions in the average dt for Ceredigion (2007/08: /12: 0.9) and Pembrokeshire (2007/08: /12: 1.1) between the survey years; neither of these changes were statistically significant. Furthermore, the Page 207 of 264

208 average dt for these two unitary authorities were with average range when compared with Wales at both time points Figure 276: Average dt of those with any experience of caries (dmft) for 5 year olds, Welsh health boards, 2007/08 compared with 2011/12. The above graph shows changes in average dt for those children with decay experience between the 2 survey years by health board. Only Hywel Dda and Betsi Cadwaladr experienced a statistically significant reduction. Hywel Dda experienced a reduction in average dt for those children with decay representing over 2/3rds of a tooth, falling from 3.3 (95%CI: ) in 2007/08 to 2.5 (95%CI: ) in 2011/12. In 2011/12 the averages ranged from 2.2 in Cwm Taf to 3.1 in Aneurin Bevan. Figure 277: Average dt of those with any experience of caries (dmft) for 5 year olds, in unitary authorities within Hywel Dda UHB, 2001/08 compared with 2011/12. Page 208 of 264

209 For Carmarthenshire UA there was a statistically significant reduction in average dt of those with dmft between 2007/08 and 2011/12, from 3.2 to 1.9. There were reductions in the average dt of those with dmft for Ceredigion (2007/08: /12: 3.0) and Pembrokeshire (2007/08: /12: 2.9) between the survey years. But, neither of these changes were statistically significant. Figure 278: Average number of decayed, missing or filled teeth, children aged 5 years, 2011/12. Page 209 of 264

210 Figure 279: Percentage of persons p aged years who reported brushing their teeth more than once a day, Page 210 of 264

211 Percent 4.2 Adult and older populations Smoking Figure 280: Smoking prevalence in Hywel Dda UHB (20083/ Smoking Prevalence in Hywel Dda University Health Board (2003/4-2013/14). Source: Welsh Health Survey % Target (2016) 15 16% Target (2020) 10 5 Ceredigion Pembrokeshire Carmarthenshire Hywel Dda Wales /04 & 2004/ /05 & 2005/ / & & & & & & &14 Smoking prevalence in the area covered by Hywel Dda University Health Board (HDUHB) continues to decline and is currently in line with the 2016 Tobacco Control Action Plan target (20% smoking prevalence by 2016). Figure 281: Percentage of adults reporting to be current smoker, aged standardised percentage, persons, Hywel Dda UHB and Wales, 2003/ Page 211 of 264

212 Figure 282: Percentage of adults reporting to be a current smoker, agestandardised percentage, persons, Hywel Dda UHB and Wales, 2003/ The below map shows that smoking prevalence by Upper Super Output Area varies considerably across Hywel Dda. Darker shading represents areas with a higher proportion of people who currently smoke. Smoking prevalence in the most deprived areas is higher than in the least deprived areas, with the highest level seen in the Llanelli area of Carmarthenshire (26.3%-28.3%) and Pembroke Dock in Pembrokeshire (24.1%-26.3%). Figure 283: Percentage currently smoking, Hywel Dda UHB Page 212 of 264

213 Figure 284: Percentage of smoking-attributable admissions by disease, Wales and Hywel Dda UHB, Percent of smoking-attributable admissions by disease, Wales and Hywel Dda, 2010 Diseases Wales Hywel Dda Wales Hywel Dda All admissions All cancers All circulatory disease All respiratory disease All diseases of the digestive system Percent of smoking-attributable deaths by disease, Wales and Hywel Dda, 2010 Diseases Males Males Females Females Wales Hywel Dda Wales Hywel Dda All admissions All cancers All circulatory disease All respiratory disease All diseases of the digestive system 4.3 n/a 3.8 n/a Source: Public Health Wales Observatory, Tobacco and Health in Wales: Supporting Data (2012) The above table shows the smoking-attributable admissions by disease, with respiratory disease being the most common disease in both males and females. Page 213 of 264

214 Figure 285: (Experimental) Smoking prevalence estimated by General Practice, (Experimental) smoking prevalence estimates by General Practice Produced by Public Health Wales Observatory using Honeyford K, Baker R, Bankart MJG, et al. Estimating smoking prevalence in general practice using data from the Quality and Outcomes Framework (QOF). BMJ Open 2014;4:e doi: /bmjopen North Ceredigion (17.1) W92056, 15.8 W92054, 15.9 W92025, 16.4 W92024, 16.6 W92022, 17.1 W92053, 17.6 W92014, 17.7 W92006, 20.6 Hywel Dda UHB (19.4) Taf \ Teifi \ Twyi (17.5) W92063, 11.8 W92009, 15.5 W92023, 15.7 W92055, 16.3 W92016, 18.1 W92007, 18.6 W92616, 21.3 W92050, 21.8 Wales (21.1) Cluster (see label) South Ceredigion (19.0) W92019, 15.2 W92034, 17.7 W92018, 18.7 W92005, 18.8 W92039, 19.1 W92065, 19.2 W92044, 21.8 W92045, 22.2 Amman / Gwendraeth (19.9) W92051, 16.8 W92046, 17.2 W92035, 17.3 W92013, 18.9 W92036, 19.2 W92003, 19.8 W92040, 22.7 W92610, 24.5 South Pem brokeshire (20.1) W92060, 13.0 W92038, 14.9 W92033, 15.7 W92027, 20.0 W00067, 23.3 W92440, 24.1 North Pem brokeshire (20.8) W92059, 14.9 W92058, 16.0 W92015, 17.0 W92064, 17.8 W92061, 20.0 W92042, 20.7 W92002, 21.0 W92041, 22.9 W92008, 27.1 Llanelli (21.3) W92048, 19.2 W92037, 19.6 W92021, 20.2 W92030, 20.3 W92031, 20.3 W92436, 22.3 W92052, 23.6 W92614, Page 214 of 264

215 4.2.2 Physical activity Figure 286: Average number of days of 30 minutes moderate or vigorous physical activity (capped) reported by adults, aged-standardised, Wales local authorities, All three of the local authorities within Hywel Dda UHB are significantly higher than the all Wales average. Page 215 of 264

216 Figure 287: Percentage of adults reporting to be physically active on no days in the past week, age-standardised percentage, persons, Hywel Dda UHB and Wales, 2009/ Adults reporting in Hywel Dda are more active on 5+ days in the past week than the percentage reporting for all Wales. There is a statistical difference as highlighted in the table below: Figure 288: Percentage of adults reporting to be physically active on 5+ days in the past week, age-standardised percentage, persons, Hywel Dda UHB and Wales, 2003/ Page 216 of 264

217 Figure 289: Average number of days of physical activity (capped) reported by adults in the past week, age-standardised, persons, Hywel Dda UHB and Wales, 2003/ The average number of days of physical activity reported by adults within Hywel Dda UHB is statistically greater than the average number of days for Wales. Page 217 of 264

218 4.2.3 Blood pressure Figure 290: QOF Public Health Domain Summary - Blood Pressure (BP), Hypertension Figure 291: QOF Clinical Summary - Blood pressure (Hypertension), Page 218 of 264

219 4.2.5 Obesity Figure 292: Number of survey respondents (weighted) and observed percentage with a BMI of 30 and over or 35 and over, persons aged over 16, Wales health boards, Hywel Dda UHB had 887 reposndants reporting with a BMI 30+ and 273 with a BMI of 35+. Figure 293: QOF public health domain summary obesity, Page 219 of 264

220 Figure 294: Number of survey respondents (weighted) and observed percentage with a BMI of 30 and over 35 and over, persons aged over 16, Wales health boards, Within Hywel Dda UHB 740 respondents reported a BMI of 30+ and 223 reported a BMI of 35+. Figure 295: Number of survey respondents (weighted) and observed percentage with a BMI of 40 and over and 50 and over, persons aged over 16, Wales health boards, Page 220 of 264

221 2003/ / / / / Figure 296: Age-standardised percentage percentage of adults of reporting adults reporting to be obese to be obese (BMI 30+), persons (BMI aged 30+), 16 persons and over, aged Welsh 16 and health over, Wales boards, health boards, Produced by Public Health Wales Observatory, using WHS (WG) 95% confidence interval Wales = 23 Betsi Cadwaladr UHB 21 Powys thb 20 Hywel Dda UHB 23 ABM UHB 23 Cardiff and Vale UHB 20 Cwm Taf UHB 26 Aneurin Bevan UHB 26 Hywel Dda UHB score the same as the Wales percentage for age-standardised adults reporting to be obese (BMI 30+). Figure 297: Age-standardised percentage of adults reporting to be overweight or obese Age-standardised (BMI 25+): Males percentage in Hywel of adults Dda reporting UHB. to be obese, males, Hywel Dda UHB and Wales Produced by Public Health Wales Observatory, using Welsh Health Survey (WG) 95% confidence interval Hywel Dda UHB Wales Both graphs show the difference in BMI 25+ between males and females in Hywel Dda UHB. Page 221 of 264

222 2003/ / / / / / / / / / Figure 298: Age-standardised percentage of adults reporting to be overweight Age-standardised percentage of adults reporting to be obese, females, Hywel or obese (BMI 25+): Females in Hywel Dda UHB. Dda UHB and Wales Produced by Public Health Wales Observatory, using Welsh Health Survey (WG) 95% confidence interval Hywel Dda UHB Wales Figure 299: Age-standardised percentage of adults reporting to be overweight Age-standardised percentage of adults reporting to be overweight or obese, or obese, males, Ceredigion and Wales. males, Ceredigion and Wales Produced by Public Health Wales Observatory, using Welsh Health Survey (WG) 95% confidence interval Ceredigion Wales Both graphs show the difference in BMI 25+ Ceredigion. between males and females in Page 222 of 264

223 2003/ / / / / / / / / / Figure 300: Age-standardised percentage of adults reporting to be overweight or obese, Age-standardised females, Ceredigion percentage and of adults Wales. reporting to be overweight or obese, females, Ceredigion and Wales Produced by Public Health Wales Observatory, using Welsh Health Survey (WG) 95% confidence interval Ceredigion Wales Figure 301: Age-standardised percentage of adults reporting to be overweight Age-standardised percentage of adults reporting to be overweight or obese, or obese, males, Pembrokeshire and Wales. males, Pembrokeshire and Wales Produced by Public Health Wales Observatory, using Welsh Health Survey (WG) 95% confidence interval Pembrokeshire Wales Page 223 of 264

224 2003/ / / / / / / / / / Figure 302: Age-standardised percentage of adults reporting to be overweight Age-standardised percentage of adults reporting to be overweight or obese, or obese, females, Pembrokeshire and Wales. females, Pembrokeshire and Wales Produced by Public Health Wales Observatory, using Welsh Health Survey (WG) 70 95% confidence interval Pembrokeshire Wales Figure 303: Age-standardised percentage of adults reporting to be overweight or Age-standardised obese, males, Carmarthenshire percentage of adults and reporting Wales. to be overweight or obese, males, Carmarthenshire and Wales Produced by Public Health Wales Observatory, using Welsh Health Survey (WG) 95% confidence interval Carmarthenshire Wales Page 224 of 264

225 2003/ / / / / / / / / / Figure 304: Age-standardised percentage of adults reporting to be overweight Age-standardised percentage of adults reporting to be overweight or obese, or obese, Carmarthenshire and Wales. females, Carmarthenshire and Wales Produced by Public Health Wales Observatory, using Welsh Health Survey (WG) 70 95% confidence interval Carmarthenshire Wales Figure 305: Age-standardised percentage of adults reporting to be obese (BMI 30+), males, Age-standardised Hywel Dda percentage UHB and of Wales. adults reporting to be obese, males, Hywel Dda UHB and Wales Produced by Public Health Wales Observatory, using Welsh Health Survey (WG) 95% confidence interval Hywel Dda UHB Wales Page 225 of 264

226 2003/ / / / / / / / / / Figure 306: Age-standardised percentage of adults reporting to be obese (BMI 30+), females, Age-standardised Hywel Dda percentage UHB and of adults Wales. reporting to be obese, females, Hywel Dda UHB and Wales Produced by Public Health Wales Observatory, using Welsh Health Survey (WG) 95% confidence interval Hywel Dda UHB Wales Figure 307: Age-standardised percentage of adults reporting to be obese (BMI 30+), males, Age-standardised Ceredigion percentage and Wales. of adults reporting to be obese, males, Ceredigion and Wales Produced by Public Health Wales Observatory, using Welsh Health Survey (WG) 95% confidence interval Ceredigion Wales Page 226 of 264

227 2003/ / / / / / / / / / Figure 308: Age-standardised percentage of adults reporting to be obese, (BMI 30+) females, Age-standardised Ceredigion percentage and Wales. of adults reporting to be obese, females, Ceredigion and Wales Produced by Public Health Wales Observatory, using Welsh Health Survey (WG) 95% confidence interval Ceredigion Wales Figure 309: Age-standardised percentage of adults reporting to be obese(bmi Age-standardised percentage of adults reporting to be obese, males, 30+), males, Pembrokeshire and Wales. Pembrokeshire and Wales Produced by Public Health Wales Observatory, using Welsh Health Survey (WG) 95% confidence interval Pembrokeshire Wales Page 227 of 264

228 2003/ / / / / / / / / / Figure 310: Age-standardised percentage of adults reporting to be obese (BMI Age-standardised percentage of adults reporting to be obese, females, 30+), females, Pembrokeshire and Wales. Pembrokeshire and Wales Produced by Public Health Wales Observatory, using Welsh Health Survey (WG) 95% confidence interval Pembrokeshire Wales Figure 311: Age-standardised percentage of adults reporting to be obese (BMI 30+), males, Age-standardised Carmarthenshire percentage and of adults Wales. reporting to be obese, males, Carmarthenshire and Wales Produced by Public Health Wales Observatory, using Welsh Health Survey (WG) 95% confidence interval Carmarthenshire Wales Page 228 of 264

229 Wales Hywel Dda UHB 2003/ / / / / Figure 312: Age-standardised percentage of adults reporting to be obese (BMI 30+), females, Age-standardised Carmarthenshire percentage of and adults Wales. reporting to be obese, females, Carmarthenshire and Wales Produced by Public Health Wales Observatory, using Welsh Health Survey (WG) 95% confidence interval Carmarthenshire Wales Figure 313: Percentage of adults reporting to be overweight or obese, age Percentage of adults reporting to be overweight or obese, by broad group, all persons, Hywel Dda UHB and Wales. age group, all persons, Hywel Dda UHB and Wales Produced by Public Health Wales Observatory, using Welsh Health Survey (WG) 95% confidence interval 2004/ Page 229 of 264

230 Wales Ceredigion Wales Hywel Dda UHB Figure 314: Percentage of adults reporting to be obese, age group, all persons, Percentage of adults reporting to be obese, by broad age group, all Hywel Dda UHB and Wales. persons, Hywel Dda UHB and Wales Produced by Public Health Wales Observatory, using Welsh Health Survey (WG) 95% confidence interval 2004/ Figure 315: Percentage of adults reporting to be overweight or obese, by Percentage of adults reporting to be overweight or obese, by broad board, age group, all persons, Ceredigion and Wales. age group, all persons, Ceredigion and Wales Produced by Public Health Wales Observatory, using Welsh Health Survey (WG) 95% confidence interval 2004/ Page 230 of 264

231 Wales Pembrokeshire Wales Ceredigion Figure 316: Percentage of adults reporting to be obese, by broad age group, all Percentage of adults reporting to be obese, by broad age group, all persons, Ceredigion. persons, Ceredigion and Wales Produced by Public Health Wales Observatory, using Welsh Health Survey (WG) 95% confidence interval 2004/ Figure 317: percentage of adults reporting to be overweight or obese, by broad age group, Percentage all persons, of adults Pembrokeshire reporting to be and overweight Wales. or obese, by broad age group, all persons, Pembrokeshire and Wales Produced by Public Health Wales Observatory, using Welsh Health Survey (WG) 95% confidence interval 2004/ Page 231 of 264

232 Wales Carmarthenshire Wales Pembrokeshire Figure 318: Percentage of adults to be obese, by broad age group, all persons, Pembrokeshire and Wales. Percentage of adults reporting to be obese, by broad age group, all persons, Pembrokeshire and Wales Produced by Public Health Wales Observatory, using Welsh Health Survey (WG) 95% confidence interval 2004/ Figure 319: Percentage of adults reporting to be overweight or obese, age group, all persons, Percentage Carmarthenshire of adults reporting and to be overweight Wales. or obese, by broad age group, all persons, Carmarthenshire and Wales Produced by Public Health Wales Observatory, using Welsh Health Survey (WG) 95% confidence interval 2004/ Page 232 of 264

233 Wales Carmarthenshire Figure 320: Percentage of adults reporting to be obese, by broad age group, all persons, Carmarthenshire and Wales. Percentage of adults reporting to be obese, by broad age group, all persons, Carmarthenshire and Wales Produced by Public Health Wales Observatory, using Welsh Health Survey (WG) 95% confidence interval 2004/ Figure 321: Percentage of adults reporting to be overweight or obese, by Percentage of adults reporting to be overweight or obese, by deprivation fifth, all persons, Hywel Dda UHB. deprivation fifth, all persons, Hywel Dda UHB Produced by Public Health Wales Observatory, using Welsh Health Survey (WG) 95% confidence interval 2004/ Most deprived Next most deprived Middle Next least deprived Least deprived Page 233 of 264

234 Figure 322: Percentage of adults reporting to be obese, by deprived fifth, all Percentage of adults reporting to be obese, by deprivation fifth, all persons, Hywel Dda UHB. persons, Hywel Dda UHB Produced by Public Health Wales Observatory, using Welsh Health Survey (WG) 95% confidence interval 2004/ Most deprived Next most deprived Middle Next least deprived Least deprived Page 234 of 264

235 Females Males Alcohol Figure 323: Percentage of adults reporting drinking above guidelines (males over 4 units, females over 3 units) on the heaviest drinking day in the past week, aged-standardised percentage*, persons, Wales health boards, Percentage of adults reporting drinking above guidelines (males over 4 units, females over 3 units) on the heaviest drinking day in the past week, age-standardised percentage*, persons, Wales health boards, Produced by Public Health Wales Observatory, using Welsh Health Survey (WG) 95% confidence interval Wales = 42.7 Betsi Cadwaladr UHB Powys thb Hywel Dda UHB ABM UHB Cardiff & Vale UHB Cwm Taf UHB Aneurin Bevan UHB * Using aggregated weightings from the 2013 European Standard Population Hywel Dda UHB is significantly lower (38.7%) than the all Wales score of 42.7%. Figure 324: Percentage of adults reporting drinking above guidelines (males over Percentage 4 units, of adults females reporting over drinking 3 units) above on the guidelines heaviest (males day over in the 4 units, past week, age, Hywel females Dda over UHB 3 units) on the heaviest drinking day in the past week, Hywel Dda UHB, Produced by Public Health Wales Observatory, using Welsh Health Survey (WG) 95% confidence interval The highest rates reported for drinking above guidelines was greatest in males males between the ages of years and females aged years. Page 235 of 264

236 Figure 325: Percentage of adults reporting drinking above guidelines (males over 4 units, females over 3 units) on the heaviest drinking day in the past week, Hywel Dda UHB, Figure 326: Percentage of adults reporting heavy (Binge) drinking (males over 8 Percentage units, females of adults over reporting 6 units) heavy on (binge) the heaviest drinking (males day in over the 8 past units, week, agestandardised percentage*, persons, Wales health boards, females over 6 units) on the heaviest drinking day in the past week, age standardised percentage*, persons, Wales health boards, Produced by Public Health Wales Observatory, using Welsh Health Survey (WG) 95% confidence interval Wales = 26.6 Betsi Cadwaladr UHB Powys thb Hywel Dda UHB ABM UHB Cardiff & Vale UHB Cwm Taf UHB Aneurin Bevan UHB * Using aggregated weightings from the 2013 European Standard Population Hywel Dda UHB was statistically lower (23.3) than the all Wales score of Page 236 of 264

237 Females Males Figure 327: Percentage of adults reporting heavy (binge) drinking (males over 8 units, females Percentage over of adults 6 units) reporting on heavy the heaviest (binge) drinking drinking (males day over in 8 units, the past week, age-standardised females over percentage*, 6 units) on the persons, heaviest drinking Wales day local in the authorities, past week, age standardised percentage*, persons, Wales local authorities, Produced by Public Health Wales Observatory, using Welsh Health Survey (WG) 95% confidence interval Wales = 26.6 Isle of Anglesey 23.4 Gwynedd 26.9 Conwy 27.7 Denbighshire 21.8 Flintshire 28.2 Wrexham 25.5 Powys 22.9 Ceredigion 25.2 Pembrokeshire 22.1 Carmarthenshire 22.9 Swansea 27.9 Neath Port Talbot 28.2 Bridgend 29.3 The Vale of Glamorgan 27.5 Cardiff 25.5 Rhondda Cynon Taf 31.2 Merthyr Tydfil 27.2 Caerphilly 28.6 Blaenau Gwent 27.9 Torfaen 26.1 Monmouthshire 27.0 Newport 26.8 * Using aggregated weightings from the 2013 European Standard Population Both Ceredigion and Pembrokeshire showed statistically significant difeerence lower than the all Wales score, whereas Carmarthenshire showed no statistical difference. Figure 328: Percentage of adults reporting heavy (binge) drinking (males over 8 units, females Percentage over of adults 6 units) reporting on heavy the (binge) heaviest drinking (males drinking over 8 units, day in the past week, Hywel Dda females UHB, over units) on the heaviest drinking day in the past week, Hywel Dda UHB, Produced by Public Health Wales Observatory, using Welsh Health Survey (WG) 95% confidence interval Males tend to heavier (binge) drinkers than females within Hywel dda UHB. Page 237 of 264

238 Figure 329: Percentage of adults reporting heavy (binge) drinking (males over 8 units, females over 6 units) on the heaviest drinking day in the past week, Hywel Dda UHB, Page 238 of 264

239 Figure Percentage 330: Percentage of adults of reporting adults very reporting heavy drinking very heavy (males drinking over 12 units, (males over 12 units, females over 9 9 units), on the heaviest drinking day in the past week, agestandardised percentage*, persons, Wales health boards, Produced by Public Health Wales Observatory, using Welsh Health Survey (WG) 95% confidence interval Wales = 14.9 Betsi Cadwaladr UHB Powys thb Hywel Dda UHB ABM UHB Cardiff & Vale UHB Cwm Taf UHB Aneurin Bevan UHB * Using aggregated weightings from the 2013 European Standard Population Hywel Dda UHB was statically lower (13.3%) than the all wales score of 14.9%. Page 239 of 264

240 Figure 331: Percentage of adults reporting very heavy drinking (males over 12 units, Percentage females of adults over 9 reporting units) on very the heavy heaviest drinking drinking (males day over in 12 the units, past week, agestandardised percentages*, persons, Wales local authorities, females over 9 units) on the heaviest drinking day in the past week, age standardised percentage*, persons, Wales local authorities, Produced by Public Health Wales Observatory, using Welsh Health Survey (WG) 95% confidence interval Wales = 14.9 Isle of Anglesey 12.9 Gwynedd 14.1 Conwy 16.1 Denbighshire 12.8 Flintshire 15.9 Wrexham 14.2 Powys 12.6 Ceredigion 13.6 Pembrokeshire 11.9 Carmarthenshire 13.7 Swansea 15.4 Neath Port Talbot 14.0 Bridgend 16.6 The Vale of Glamorgan 16.5 Cardiff 13.7 Rhondda Cynon Taf 18.0 Merthyr Tydfil 16.1 Caerphilly 16.9 Blaenau Gwent 18.0 Torfaen 16.0 Monmouthshire 15.1 Newport 13.9 * Using aggregated weightings from the 2013 European Standard Population Although it may appear that all 3 localities within Hywel Dda UHB are reporting lower than the welsh average for very heavy drinking, only Pembrokeshire is statistically significant. Page 240 of 264

241 Fem ales Males Figure 332: Percentage of adults reporting very heavy drinking (males over 12 units, Percentage females of adults over reporting 9 units) very on heavy the heaviest drinking (males drinking over day 12 units, in the females past week, Hywel over 9 Dda units) UHB, on the heaviest drinking day in the past week, Hywel Dda UHB, Produced by Public Health Wales Observatory, using Welsh Health Survey (WG) 95% confidence interval Overall the percentage of males reporting very heavy drinking was much greater than females within Hywel Dda UHB. Page 241 of 264

242 Figure 333: Percentage of adults reporting very heavy drinking (males over 12 units, females over 9 units) on the heaviest drinking day in the past week, Hywel Dda UHB, Page 242 of 264

243 Figure 334: Alcohol -specific hospital admissions (person-based), EASR per 100,000*, Alcohol-specific persons, hospital all admissions ages, Hywel (person-based), Dda UHB European and Wales, age-standardised Financial rate years 2003/04 per 100,000*, /13. persons, all ages, Hywel Dda UHB and Wales, financial years 2003/ /13 Produced by Public Health Wales Observatory, using PEDW (NWIS) & MYE (ONS) 95% confidence interval Hywel Dda UHB Wales / / / / / / / / / /13 * Using the 2013 European Standard Population Figure Alcohol-specific 335: Alcohol-specific hospital admissions (person-based), EASR European per 100,000*, agestandardised persons, all ages, Wales health rate per boards, 100,000*, financial persons, year all ages, 2012/13. Wales health boards, financial year 2012/13 Produced by Public Health Wales Observatory, using PEDW (NWIS) & MYE (ONS) 95% confidence interval Wales = 339 Betsi Cadwaladr UHB Powys thb Hywel Dda UHB ABM UHB Cardiff & Vale UHB Cwm Taf UHB Aneurin Bevan UHB * Using the 2013 European Standard Population Hywel Dda UHB was statistically lower than the Welsh average for alcohol specific hospital admissions. Page 243 of 264

244 Figure Alcohol-specific 336: alcohol-specific hospital admissions hospital (person-based), admissions European (person-based), agestandardised EASR per 100,000, persons, rate per all ages, 100,000*, Wales persons, local all authorities, ages, Wales financial local authorities, year 2012/13. financial year 2012/13 Produced by Public Health Wales Observatory, using PEDW (NWIS) & MYE (ONS) 95% confidence interval Wales = 339 Isle of Anglesey 388 Gwynedd 397 Conwy 381 Denbighshire 370 Flintshire 311 Wrexham 334 Powys 242 Ceredigion 238 Pembrokeshire 421 Carmarthenshire 257 Swansea 340 Neath Port Talbot 340 Bridgend 285 The Vale of Glamorgan 343 Cardiff 324 Rhondda Cynon Taf 368 Merthyr Tydfil 383 Caerphilly 381 Blaenau Gwent 456 Torfaen 354 Monmouthshire 250 Newport 428 * Using the 2013 European Standard Population Pembrokeshire had the 3 rd highest score across the local authorities in Wales for alcohol specifi hopital admissions. Both Ceredigion and Carmarthesnshire were statistically lower than the Welsh average. Page 244 of 264

245 Figure 337: Alcohol-specific hospital admissions (person-based), persons, all ages, Hywel Dda UHB, financial years 2010/ /13. Page 245 of 264

246 Figure 338: Months of life lost due to alcohol, males aged under 75, Wales Months of life lost due to alcohol, males aged under 75, Wales health boards, health boards, Produced by Public Health Wales Observatory, using ADDE, Life Tables for Wales & MYE (ONS) Wales = 13.5 Betsi Cadwaladr UHB 13.1 Powys thb 11.7 Hywel Dda UHB 11.7 ABM UHB 15.3 Cardiff & Vale UHB 13.2 Cwm Taf UHB 18.1 Aneurin Bevan UHB 12.4 Within Hywel dda UHB 11.7 months of life are lost due to alcohol amongst males and 5.9 months of life are lost due to alcohol amongst females. Figure 339: Months of life lost due to alcohol, females aged under 75, Wales health Months boards, of life lost due to alcohol, females aged under 75, Wales health boards, Produced by Public Health Wales Observatory, using ADDE, Life Tables for Wales & MYE (ONS) Wales = 6.5 Betsi Cadwaladr UHB 6.9 Powys thb 6.1 Hywel Dda UHB 5.9 ABM UHB 6.7 Cardiff & Vale UHB 6.0 Cwm Taf UHB 8.1 Aneurin Bevan UHB 5.8 Page 246 of 264

247 4.2.7 Substance misuse Figure 340: Estimated incidence rates by region (year: ). All referrals for alcohol misuse number (.) Individuals referred for alcohol misuse number Estimated incidence rate alcohol misuse (*) All referrals for drug misuse number (.) Individuals referred for drug misuse number Estimated incidence rate drug misuse (*) Carmarthenshire 1, Ceredigion Pembrokeshire Wales 13,447 8, ,767 6, (.) These include multiple referrals for some clients) ) or any indicative sinage. (*) Rates are per 100,000 population ) Page 247 of 264

248 4.2.8 Suicide and self harm Figure 341: Suicides, ranked local authorities, EASR per 100,000, persons aged Suicides, 15+, ranked local authorities, European age-standardised rate per 100,000, persons aged 15+, Produced by Public Health Wales Observatory, using ADDE & MYE (ONS) Local Authority Wales 95% confidence interval Conwy Neath Port Talbot Denbighshire Carmarthenshire Bridgend Merthyr Tydfil Swansea Isle of Anglesey Cardiff Flintshire Rhondda Cynon Taf Wrexham Ceredigion Powys Torfaen Caerphilly Gwynedd Pembrokeshire The Vale of Glamorgan Blaenau Gwent Monmouthshire Newport Wales rate 12.6 Ceredigion was ranked the 4 th highest in local authorities across Wales for suicide and self harm rates, followed by Ceredigion at 13 and Pembrokeshire at 18. Page 248 of 264

249 EASR Crude rate per 100,000 Figure 342: Individual patients having an emergency hospital admission with any Individual mention patients of self having harm an emergency in the admitting hospital admission episode*, with rate any per 100,000 of males mention of self harm in the admitting episode*, rate per 100,000 of males and females, aged 10+, Wales residents, & females, aged 10+, Wales residents, Produced by Public Health Wales Observatory, using PEDW (NWIS) and MYE (ONS) Males 600 Females Females aged between were reported as the highest rate for being admitted to hospital with any mention of self harm in the admitting episode. Figure 343: Suicides, 3 year rolling trends, EASR per 100,000, males and Suicides, 3-year rolling trends, European age-standardised rate per females, Wales, ,000 (EASR), males and females, Wales, Produced by Public Health Wales Observatory, using ADDE & MYE 30 Males Females Page 249 of 264

250 4.2.9 Emotional and mental well being Figure 344: QOF clinical summary - learning disabilities, Figure 345: Percentage of adults free from a common mental disorder (as measured by a Mental Health Inventory 5 score > 60), age-standardised, Wales local authorities, Page 250 of 264

251 4.3 OLDER PEOPLE Emergency admissions and hip fractures Figure 346: Emergency hospital admissions with a primary diagnosis of hip fracture. EASR per 100,000, persons aged 65 and over, Hywel Dda UHB, local authorities and Wales, financial years 2003/ /13. Figure 347: Emergency hospital admissions with a primary diagnosis of hip fracture, EASR per 100,000, persons aged 65 and over, Hywel Dda UHB, local authorities and Wales, financial years 2003/ /13. Page 251 of 264

252 Figure 348: Emergency hospital admissions with a primary diagnosis of hip fracture, EASR per 100,000, persons aged 65 and over, Wales health boards, local authorities, financial year 2012/13. Carmarthenshire had statistically greater rates of emergency hopital admission swith a primary diagnois of hip fracture, whereas Pembrokeshire was statistically lower than the welsh average score. Page 252 of 264

253 Figure 349: Emergency hospital admissions with a primary diagnosis of hip fracture, EASR per 100,000, persons aged 65 and over, Wales health boards, local authorities, financial years 2012/13. Page 253 of 264

254 Figure 350: Emergency hospital admissions with a primary diagnosis of hip fracture, EASR per 100,000, persons aged 65 and over, Hywel Dda UHB, local authorities and Wales, financial years 2003/ /13. Figure 351: Emergency hospital admissions with a primary diagnosis of hip fracture, EASR per 100,000, persons aged 65 and over, Hywel Dda UHB, local authorities and Wales, financial years 2003/ /13. Page 254 of 264

255 European age-standardised rate per 100,000 persons Figure 352: Emergency hospital admissions with a diagnosis of fractured neck of Emergency femur, EASR hospital per admissions 100,000 with persons, a diagnosis Hywel of fractured Dda UHB, neck of Local femur, European authorities age-anstandardised Wales, persons rate aged per 100, and persons, over, Hywel 2003 Dda to Health Board, local authorities and Wales, 1000 persons aged 65 & over, 2003 to 2010 Produced by Public Health Wales Observatory, using PEDW (NWIS) & MYE (ONS) Health board / local authority Hywel Dda Wales Ceredigion 95% confidence interval Pembrokeshire Carmarthenshire Palliative care Figure 353: QOF clinical summary - palliative care, Page 255 of 264

256 4.3.3 Quality of life indicators Figure 354: Welsh Health Survey results (observed) from selected quality of life indicators, Hywel Dda he UHB residents by local authority, health board and Wales, persons aged 65 and over, Selected chronic conditions Figure 355: Welsh health Survey results (observed) for selected conditions, Hywel Dda UHB residents by local authority, health board and Wales, persons aged 65 and over, Page 256 of 264

257 4.3.4 Uptake of bowel screening programme Figure 356: Uptake of bowel screening programme*, local authorities, health boards and Wales, persons aged year old, Hywel Dda UHB scored slighly higher than the Welsh score at 55% for uptake of bowel screening amongst persons aged years Uptake of breast screening programme Figure 357: Uptake of breast screening programme*, local authorities, health boards and Wales, females aged 50 to 70 years, Hywel Dda UHB scored slighly higher than the Welsh score at 77% for uptake of breast screening. Although ceredigion was slighly lower than Pemrbokeshire and Ceredigion at 69%. Page 257 of 264

258 4.3.6 Cervical screening coverage Figure 358: Coverage of cervical screening programme*, local authorities, health boards and Wales, females aged 50 to 64 years, Hywel Dda UHB reported the same coverage of cervical screening as that in Wales, 78%.Although, Ceredigion was slighly higher at 79% Excess winter deaths Figure 359: Excess winter deaths (EWD) index, Wales health boards, residents aged 65 and over, Hywel dda UHB scoare 22.7, which was slighly greater than the Welsh average of 21 for Excess Winter deaths amongst residents aged 65 and over. Page 258 of 264

259 Figure 360: Excess winter deaths (EWD) index, Wales health boards, residents aged 65 and over, Figure 361: Excess winter deaths (EWD) index, Hywel Dda UHB and Wales, residents aged 65 and over, Page 259 of 264

260 Figure 362: Excess winter deaths (EWD) index, Hywel Dda UHB and Wales, residents aged 65 and over, rolling 3 years periods Page 260 of 264

261 Page 261 of 264

262 CHAPTER 5: LINKS TO SINGLE INTEGRATED PLANS The Single Integrated Plans commit all partners within the Local Service Board to a new way of working, which replaces previous plans and strategies. The websites with each Local Authority (listed below) provide full details about how each locality plan to address the wider determinants agenda, acknowledging the challenges of inequalities and deprivation. 5.1 Carmarthenshire The Integrated Community for Carmarthenshire The Integrated Community Strategy focuses on five strategic outcomes, which all contribute to the overarching vision for the County: People in Carmarthenshire are healthier People in Carmarthenshire fulfil their learning potential People who love, work and visit Carmarthenshire are safe and feel safer. Carmarthenshire s communities and environment are sustainable Carmarthenshire has a stronger and more prosperous economy For further details please refer to: %20Strategy% pdf Page 262 of 264

263 5.2 Ceredigion Ceredigion for All Ceredigion Local Service Board s Single Integrated Plan This Plan has selected 3 outcomes to concentrate on in the coming years: Supporting families Economy and place Independent living For further details please refer to: langtoken=eng 5.3 Pembrokeshire Pembrokeshire Single Integrated Plan Six outcomes have been agreed in Pembrokeshire: Children, young people and families have the opportunity to fulfil their learning potential and to live healthy and happy lives Pembrokeshire has a competitive, productive and sustainable economy People in Pembrokeshire enjoy an attractive, sustainable and diverse environment People in Pembrokeshire are healthier Children and adults are safeguarded Communities in Pembrokeshire feel safe Page 263 of 264

264 For further details please refer to: id=646&textonly=true Page 264 of 264