Measuring Long-Term Conditions in Scotland - A summary report Introduction This summary report provides insight into: What are the most common long-term conditions in Scotland? What is the population prevalence of these conditions? These questions have been tackled by developing an understanding of a range of routine data sources, and combining these with other information, to find out what are the most common long-term conditions and to estimate the prevalence of various individual long-term conditions. This has provided knowledge of what these databases tell us about long-term conditions, and so gives a basis for future analysis. It is often difficult to separate long-term from acute conditions, and to assess the burden of disease (on individuals and health/other services) and need for care created by a condition or combination of conditions. Multiple databases can be used in combination to help achieve this, however. For example, Practice Team Information (PTI) gives an insight into the proportion of people who consult over a given time period for back pain, but the Scottish Health Survey (SHS) estimates how many people believe they have back pain which constitutes a long-term illness, and how many feel this limits their lifestyle. Using this knowledge of the databases and information produced so far regarding population prevalence, combinations of long-term conditions can be assessed, as well as how prevalence varies between age, gender and deprivation groups. Further information on the methodology and in-depth analysis on the prevalence of each condition is available in the full report Measuring Long-Term Conditions in Scotland (http://www.isdscotland.org/isd/.html ).
Key Findings 1) There are numerous definitions of what constitutes a long-term condition. Conditions which require ongoing medical care, limit what a person can do for a year or more and have a clear diagnosis are generally included (e.g. coronary heart disease, diabetes), but this definition also includes many conditions which, although long-term and life-limiting in some cases, can also be acute or easily managed in others (e.g. back pain, skin disorders). All analysis of long-term conditions should be interpreted according to the definition used. 2) Estimates of the prevalence of long-term conditions can be derived from a number of sources. The richest sources of information are the primary care data collected for the Quality and Outcomes Framework (QOF) and Practice Team Information (PTI). The Scottish Health Survey (SHS) asks respondents about any long-term conditions they have, and so offers some insight into people s perceptions of which conditions are long-standing and what impact these have on their lives. ) Using these data sources, the most common long-term conditions are asthma, depression and hypertension, each affecting over % of the population. The following conditions affect 2-% of the population: coronary heart disease (CHD), diabetes mellitus, hypothyroidism, and stroke. Chronic obstructive pulmonary disease (COPD) affects just under 2%. Skin and musculoskeletal disorders (particularly osteoarthritis and back pain) are also very common conditions, but it is difficult to ascertain the prevalence of those that constitute a long-term illness at a population level (see Figure 2). ) Estimates for the number of people with a long-term condition vary widely depending on the definitions and data sources used. According to PTI, approximately % of the population (% of those aged 1 and over) consult a member of the GP practice team for a potential long-term condition in a 1-year period, but this includes many individuals who are able to manage their conditions so they do not affect the person s quality of life. In the SHS, around % of the population reported some form of long-term illness, health problem or disability, and % said that they have a condition that limits their day to day activities (see Table 1). ) Data from QOF show one-fifth of the population registered with a GP have one or more of the following conditions: asthma; COPD; CHD; stroke; diabetes; hypertension (see Figure ). ) Prevalence of long-term conditions increases with age. For example, the SHS shows that % of the over s reported some form of long-term illness, health problem or disability, with % reporting two or more conditions. In the over s these rise to % and % respectively. ) Over 2% of people with CHD, diabetes mellitus, osteoarthritis or stroke also have hypertension. Other common combinations include COPD and asthma, although this could be a coding artefact (see Figure ).
Further Application The methodology developed here can be adapted to the needs of the user, since any analysis of long-term conditions depends on the models of care being developed. These methods and data may help to address issues such as: The prevalence of a particular long-term condition, or combination of conditions, in specific age, gender and deprivation groups. The proportion of people with a specific condition who also have one or more other long-term conditions, and what the most common other conditions are. The proportion of individuals with a specific condition/combination of conditions who are admitted to hospital, consult a GP (and how often), or have other health care needs. The Kaiser Permanente pyramid has proved to be a very useful method for conceptualising risk stratified groups of patients with long term conditions. The pyramid models long-term conditions by splitting the population into those who can care for themselves, individuals who need help to manage their diseases, and people who require more intensive case management. Putting the population into these groups is complex due to limited information, people moving between levels of the pyramid, and the way different models of care may influence our assessment of an individual s needs (and therefore where they are in the pyramid). The data contained in this report could be regarded as a first step toward populating a Kaiser Permanente pyramid for Scotland, both at nationwide and CHP level. Figure 1) Patients with long-term conditions: self-care and management
Figure 2) Estimate of the number of people living with long term conditions in Scotland (Rate per 1,000 population) Estimate of the number of people living with long term conditions in Scotland (Rate per 1,000 population) Condition Depression CHD Cancer COPD Atrial fibrillation Dementia Heart failure Epilepsy Rheumatoid Arthritis Schizophrenia Inflammatory Bowel Disease CFS/ME Multiple Sclerosis Parkinson's disease Back Pain Chronic Kidney Disease 1 20 1 1 1. 2.1 1. 1. 2.-1 2 12 1- - 0 20 0 0 0 0 120 10 10 200 Rate per 00 Interpretation: It is estimated that the number of people living with diabetes in Scotland is per 1,000 population. Source: Long Term Conditions Programme, ISD Scotland. Based on QOF, PTI, SHS 200 and scientific literature
Table 1) People with Long Term Conditions 1 or more condition 2 or more conditions All ages age 1+ age + age + All ages age 1+ age + age + GP consultations 1 Percentage of population consulting in one year Conditions lasting >1 year 2 2 2 0 Conditions which may also be acute 21 2 1 Scottish Health Survey Percentage reporting long term conditions Some form of long term illness, health problem or disability 1 1 Conditions limiting day-to-day activities (% of total population) 1 2 2 n/a n/a n/a n/a Conditions limiting day-to-day activities (As a % of those with 1 or 2 or more conditions) 1 0 1 N otes 1. Data from Practice Team Information (PTI), year ending 1 March 200 2. See Appendix 1 for list of conditions. See Appendix 2 for list of conditions. Data from Scottish Health Survey 200
Figure ) Number of co-existing conditions This condition only This condition plus 1 other This condition plus 2 or more others CHD 2 1 2 0 COPD 1 2 1 2 2 2 Condition Joint disorders 2 0 2 2 2 2 Depression 1 2 Back pain 0 2 2 2 Skin disorders 2 2 0% % 20% 0% 0% 0% 0% 0% 0% 0% 0% % of people Interpretation: Of all people listed as having CHD, % have only CHD, 2% have CHD plus one other condition and % have CHD plus 2 or more other conditions. Source: Practice Team Information (PTI), year ending 1 March 200, using conditions lasting > 1 year (see Appendix 1 for list of conditions)
Figure ) Common combinations of conditions % of people with this condition......who also have this condition. -1 0 1 2 12 1 1 12 CHD COPD Back Pain Depression Joint Disorders 2 Skin Disorders 1 1 1 1 12 2 1 1 2 2 2 2 0 1 CHD COPD 2 2 1 1 2 2 2 1 1 1 12 0 1 1 Back Pain 1 22 0 1 1 Depression Joint Disorders Skin Disorders Other 1 2 Interpretation: % of people with also have diabetes. % of people who have suffered a stroke also have hypertension Source: Practice Team Information (PTI), year ending 1 March 200, using conditions lasting > 1 year (see Appendix 1 for list of conditions)
Appendix 1) PTI list of conditions lasting >1 year Alcoholic liver Bronchiectasis CHD Chromosome incl downs Chronic sinusitis COPD Endometriosis Female infertility Heart failure Inflammatory bowel disease Multiple sclerosis Osteoporosis + bone mets Pneumoconiosis Rheumatic heart disease Skin incl eczema, psoriasis Cerebral palsy CHD monitoring Chronic kidney disease Congenital malformations Dementia Diverticular disease Epilepsy Glaucoma Hiv Learning disability Parkinson's disease Psychosis/bipolar Rheumatoid arthritis Spina bifida Thyrotoxicosis
Appendix 1) PTI list of conditions which may also be acute Alcoholic Liver Anaemia Back Pain Blood Vessels Cancer Chd Chromosome Incl Downs Chronic Kidney Disease Chronic Tonsil Disease Copd Depression Digestive Including Coeliac Dizziness Endocrine Epilepsy Female Infertility General Heart Diseases Haemorrhoids Heart Failure Hiv Inflammatory Bowel Disease Learning Disability Menstrual Disorders Nervous System Obesity Osteomyelitis Other Arthroplasties Other Bowel Other Kidney Other Respiratory Parkinson's Disease Psychosis/Bipolar Rheumatoid Arthritis Spina Bifida Thyrotoxicosis Urinary Incontinence Visual Impairment Allergies Arrhythmia Atrial Fibrillation Blood Diseases Bronchiectasis Cerebral Palsy Chd Monitoring Chronic Fatigue Syndrome Chronic Sinusitis Congenital Malformations Dementia Diverticular Disease Drug And Alcohol Misuse Endometriosis Female Genital Prolapse General Ear Diseases Glaucoma Hearing Loss Hepatitis Hyperplasia Of Prostate Joint Disorders Malnutrition Multiple Sclerosis Neurosis Osteoporosis + Bone Mets Other Bone Other Circulatory Other Liver Pancreas Pneumoconiosis Rheumatic Heart Disease Skin Incl Eczema, Psoriasis Ulcer Varicose Veins Warfarin