Cancer Incidence and Mortality by Upper Super Output Area in Wales Welsh Cancer Intelligence and Surveillance Unit December 2009
Table of Contents 1 Introduction...... 1 2 Definitions of statistical terms. 3 3 Executive Summary. 4 4 Results 6 4.1 All Malignancies excluding Non Melanoma Skin Cancer.. 6 4.2 Prostate Cancer.. 8 4.3 Female Breast Cancer... 9 4.4 Lung Cancer.... 10 4.5 Colorectal Cancer... 12
1 Introduction Upper Super Output Areas (USOAs) in Wales were developed in 2008 by the Local Government Data Unit (LGDU) in association with the Welsh Local Government Association (WLGA). There are 94 USOAs in Wales with a mean population of around 32,000. The Welsh Cancer Intelligence and Surveillance Unit have examined cancer incidence and cancer mortality by these new USOAs in Wales to determine patterns of incidence and mortality that would not otherwise have been observed using Local Health Boards due to these covering a large area of Wales. Middle Super Output Areas are also available but cover much smaller areas in Wales. For incidence and mortality data, the five year period 2003-2007 was examined. Mortality data for Wales is sourced from the Office for National Statistics (ONS) 1. Each case was allocated a USOA. Figure 1 shows these USOAs in Wales. European Age Standardised Rates (EASR) per 100,000 population were calculated for both incidence and mortality. Maps of the EASRs are produced in this report showing regional variations for those with low rates (yellow) to those with high rates (red). The breaks used are called Natural Breaks and use a method whereby class breaks that best group similar values are used and maximize the differences between classes this aims at idenitifying spatial patterns, if any are present in the data. The cancers examined were all malignancies excluding non melanoma skin cancer (ICD 10 codes C00-C96 excluding C44), prostate cancer (C61), female breast cancer (C50), lung cancer (C33-C34) and colorectal cancer (C18-C20). 1 http://www.statistics.gov.uk W e l s h C a n c e r I n t e l l i g e n c e a n d S u r v e i l l a n c e U n i t Page 1
Figure 1: Upper Super Output Areas in Wales W e l s h C a n c e r I n t e l l i g e n c e a n d S u r v e i l l a n c e U n i t Page 2
2 Definitions of statistical terms Incidence is defined as the number of new registrations of cancer made in a particular time period. Mortality is defined as the number of deaths that occurred in a particular time period. The European Age Standardised Rate (EASR) per 100,000 population is calculated by applying age specific rates (the total number of cases in a specific five year age band as a proportion of the total population in that specific five year age band) in Wales to the relevant standard European population. These are then summed across all age groups to obtain the overall EASR. The age structure of the Welsh population differs from that of the European standard population, and as such the standardised rate for Wales, for any particular type of cancer will differ from the crude rate (the total number of cases per year as a proportion of the total population). In general, because the Welsh population is slightly older than the European standard, the effect will be to lower the crude rate. W e l s h C a n c e r I n t e l l i g e n c e a n d S u r v e i l l a n c e U n i t Page 3
3 Executive Summary For all malignancies excluding non melanoma skin cancer, the overall EASRs in Wales were 464.73 per 100,000 population and 377.54 per 100,000 population for male and female incidence respectively. For male incidence, the highest rates are found in the Cardiff and Vale Local Health Board but other high rates are located in the South Wales valleys and the lowest rates are located in Powys with the lowest rate located in Ceredigion. For female incidence, the lowest rates were scattered throughout Wales with the three lowest rates of all located in the Cardiff and Vale Local Health Board. The highest rate was found in Rhondda Cynon Taff. The EASRs for mortality in Wales were 225.62 per 100,000 population for males and 160.34 per 100,000 population for females. For male mortality, the two lowest rates were located in Powys with generally low rates in Mid Wales and the highest rates located in Cardiff and Vale Local Health Board with North East Wales also tending to have higher rates. For female mortality, the lowest rates were scattered throughout Wales with the lowest in Cardiff and Vale Local Health Board and the highest rates tending to be in the South Wales valleys. For prostate cancer, the EASRs for Wales as a whole was 114.24 per 100,000 population for incidence and 26.61 per 100,000 population for mortality. For incidence, the lowest rate was located in Ceredigion with a large area of Mid Wales having low rates. Parts of Abertawe Bro Morgannwg Local Health Board also had low rates. The highest rates were located in Cardiff and Vale Local Health Board with Aneurin Bevan also showing some high rates. For mortality, there appears to be large areas in Wales with high rates this is due to the more populated areas being smaller in size and having the lower rates. However, three of the four highest rates were located in Pembrokeshire. For female breast cancer, the EASRs in Wales as a whole was 122.91 per 100,000 population for incidence and 28.46 per 100,000 population for mortality. For incidence, the lowest rates were found in South Wales, the lowest being in Rhondda Cynon Taff but a large number of the lowest rates were also located in Abertawe Bro Morgannwg Local Health Board. The highest rates were located in Carmarthenshire but generally higher rates were found in North and Mid Wales. For mortality, a similar spatial pattern as for incidence was found. W e l s h C a n c e r I n t e l l i g e n c e a n d S u r v e i l l a n c e U n i t Page 4
For lung cancer, the all Wales EASR were 66.69 per 100,000 population for male incidence and 39.31 per 100,000 population for female incidence. For males, a large area of the map has low rates located in Powys and Mid Wales with the higher rates found in parts of South Wales. For females, the lowest rates were located in Mid and West Wales with generally lower rates in North West Wales also. The highest rates were located Merthyr Tydfil and Caerphilly. The all Wales rates for mortality were 54.51 per 100,000 population for males and 30.92 per 100,000 population for females. Very similar spatial patterns are seen for mortality as was seen for incidence with the highest rates in South Wales and the lowest rates in Mid Wales. For colorectal cancer, the EASRs in Wales as a whole were 60.09 per 100,000 population for male incidence and 36.41 per 100,000 population for female incidence. For males, the lowest rates tended to be found in South Wales with the higher rates being found in North West Wales. For females, a similar pattern was seen as for males with the lowest rates located in South East Wales and the highest rates located in North West Wales with the two highest rates being located in Anglesey and Gwynedd. The EASRs in Wales for mortality were 25.99 per 100,000 population for males and 14.61 per 100,000 population for females. The lowest rates were found in North East Wales for males and the highest rates were found in West Wales and South Wales, the highest rate being in Caerphilly. For females, the lowest rates were found in Caerphilly with the highest rates being located in parts of South Wales. In summary, the EASRs at USOA level in this report enable analysis to be at a lower level than Local Health Board where a high or low rate in a particular area of the Local Health Board would not have been found unless for this level. However, for some site specific cancers, caution is advised in that some USOAs had very small numbers of observed cases and an increase of just one or two cases would dramatically affect the corresponding USOA. W e l s h C a n c e r I n t e l l i g e n c e a n d S u r v e i l l a n c e U n i t Page 5
4 Results - All Malignancies excluding Non Melanoma Skin Cancer Figure 1: EASR per 100,000 population by USOA in Wales, Males, Incidence. Figure 2: EASR per 100,000 population by USOA in Wales, Females, Incidence. W e l s h C a n c e r I n t e l l i g e n c e a n d S u r v e i l l a n c e U n i t Page 6
Figure 3: EASR per 100,000 population by USOA in Wales, Males, Mortality. Figure 4: EASR per 100,000 population by USOA in Wales, Females, Mortality. W e l s h C a n c e r I n t e l l i g e n c e a n d S u r v e i l l a n c e U n i t Page 7
Prostate Cancer Figure 5: EASR per 100,000 population by USOA in Wales, Incidence. Figure 6: EASR per 100,000 population by USOA in Wales, Mortality. W e l s h C a n c e r I n t e l l i g e n c e a n d S u r v e i l l a n c e U n i t Page 8
Female Breast Cancer Figure 7: EASR per 100,000 population by USOA in Wales, Incidence. Figure 8: EASR per 100,000 population by USOA in Wales, Mortality. W e l s h C a n c e r I n t e l l i g e n c e a n d S u r v e i l l a n c e U n i t Page 9
Lung Cancer Figure 9: EASR per 100,000 population by USOA in Wales, Males, Incidence. Figure 10: EASR per 100,000 population by USOA in Wales, Females, Incidence. W e l s h C a n c e r I n t e l l i g e n c e a n d S u r v e i l l a n c e U n i t Page 10
Figure 11: EASR per 100,000 population by USOA in Wales, Males, Mortality. Figure 12: EASR per 100,000 population by USOA in Wales, Females, Mortality. W e l s h C a n c e r I n t e l l i g e n c e a n d S u r v e i l l a n c e U n i t Page 11
Colorectal Cancer Figure 13: EASR per 100,000 population by USOA in Wales, Males, Incidence. Figure 14: EASR per 100,000 population by USOA in Wales, Females, Incidence. W e l s h C a n c e r I n t e l l i g e n c e a n d S u r v e i l l a n c e U n i t Page 12
Figure 15: EASR per 100,000 population by USOA in Wales, Males, Mortality. Figure 16: EASR per 100,000 population by USOA in Wales, Females, Mortality. W e l s h C a n c e r I n t e l l i g e n c e a n d S u r v e i l l a n c e U n i t Page 13