The Health of the Grampian Population:

A Review of Current and Future Health Challenges

Original report prepared by Dr Lesley Wilkie and

Dr Catriona Hughes October 2009

Updated by Dr Emmanuel Okpo 2010

Contents

Foreward 8

Childhood 9

Children in Grampian 9

Births 10

Health of newborns and young children 11

Life expectancy at birth 15

Ill health in childhood 17

Preventing illness in childhood 21

Immunisation 21

Dental health 23

Lifestyle issues in later childhood 24

Mortality in infants and childhood 29

Working age population 31

Mortality 31

Morbidity 34

Behavioural risk factors 36

Screening in adults 39

Infectious diseases 41

Elderly population 43

Mortality 45

Morbidity 45

Preventing ill health 48

Diseases of significant concern 51

Cancer 51

Coronary Heart Disease (CHD) 52

Stroke 56

Chronic Obstructive Pulmonary Disease (COPD) 59

Chronic Kidney Disease (CKD) 60

Diabetes 61

Mental health 61

Protecting the health of the population 63

Outbreaks of gastrointestinal infections 65

Immunisation and vaccine preventable diseases 65

Description of the UK immunisation programme 66

Vaccine update results - overview of 2009/2010 66

Primary immunisation uptake rate by deprivation 67

Uptake of HPV vaccine 68

Tuberculosis (TB) 71

Pandemic influenza 71

References 72


List of Figures and Tables

Figure 1: percentage of children aged between 0-14 years in Grampian by local council area (based on mid 2008 population estimates) 9

Figure 2: Projected percentage change in population aged 0-15 (2006 based), by Grampian Council Areas 2006-2031 10

Figure 3: Number of live births per year by council area4 11

Figure 4: Smoking at Booking Grampian 2000-2006 12

Figure 5: Trends in percentage of women smoking during pregnancy in Grampian 1995-2008 12

Figure 6: Percentage of mothers smoking during pregnancy by CHP 1995-2008 13

Table 1: Proportion of mothers in Grampian breastfeeding at 6 weeks 2006/2007. 13

Table 2: Percentage low weight live births weight Babies in Grampian & CHPs (Singleton Births) 3 year averages 2005/06–2007/08. 14

Figure 7: Average BMI by gender and year15 14

Figure 8: Life expectancy in Grampian compared to Scotland (1981-2007) 16

Figure 9: Life expectancy at birth for Aberdeen City, Aberdeenshire and Moray (1981-2007) 16

Table 3: Life expectancy at birth (2005-2007)10 17

Figure 10: Causes of elective admissions in children in Grampian 2007/087. 18

Figure 11: Causes of emergency admission in children in Grampian 2007/087 19

Table 4: Rates of unintentional injuries in the home, 3 year average crude rate 2004-200617 19

Table 5: Emergency hospital admissions as a result of an unintentional injury in Children aged under 15 in Grampian NHS Community Health Partnership, and Scotland year ending 31 March 2009 20

Table 6: Unintentional injury in children, 2007/087 20

Table 7: Uptake rates-Percentage completing primary course by 24 months of age (1 April 2009 to 31 Marcn 2010) in Grampian, Grampian CHP areas and Scotland 21

Table 8: Percentage completing primary course by 5 years of age (1 April 2009 to 31 March 2010) in Grampian, Grampian CHP areas and Scotland 22

Figure 12: Percentage of Primary 1 children with no decay. 23

Figure 13: Percentage of school-aged children who have ever had a proper alcoholic drink in Grampian 2006 compared with 2002 24

Figure 14: Percentage of school-aged children who are regular smokers in Grampian 2006 compared with 2002 25

Figure 15: Percentage of school-aged children who have used drugs in the month prior to the survey 26

Figure 16: Teenage Pregnancy rates per 1000 women in Grampian and Scotland 1994-2007 27

Figure 17: Teenage pregnancy in Grampian by age group and deprivation quintile, 2007 27

Table 9: Stillbirth and infant mortality rates per 1000 live births 3 year averages 2006-20085 29

Figure 18: Deaths in children under 15 years of age by SIMD14 30

Table 10: Projected percentage changes in population (2006-based), by council areas and Grampian selected years 31

Figure 19: Main causes of death in all age groups in Grampian, 2008. 32

Table 11: Most frequent causes of death in Scotland by age group 33

Figure 20: Main causes of premature death in Grampian, 2008. 33

Table 12: Percentage of population reporting limiting long-term illness, 2001 census17 34

Table 13: Incidence rates of long term condition discharges from hospital per 100,000 Population, Grampian and Scotland 2008/2009 34

Table 14: Incidences rates of main diagnosis discharges from hospital per 100,000 population by Financial Year in Grampian (all ages) 35

Table 15: QOF prevalence data per 100 registered patients31 36

Figure 21: Percentage of population smoking by SIMD quintile, Scotland 200734. 37

Table 16: Estimated percentage of smokers in the adult population by age and sex, 2003/0433 37

Figure 22: Estimated levels of harmful drinking in the adult Scottish population by type of harmful drinking36. 38

Figure 23: Percentage of selected Grampian population groups taking the recommended level of physical activity per week. 39

Figure 24: Persons in Grampian reported to be hepatitis C antibody positive 1999 to 31 March 200943 41

Figure 25: HIV incidence rate by year, Grampian and Scotland44 42

Figure 26: Elderly population of the North east hospital region (1959-2008) 43

Table 17: Projected population aged 65 and over (persons) 2006-2031 in thousands 44

Figure 27: Population projections for the 75 and over age group in Grampian2 44

Figure 28: Self-perception of health by age group46 45

Figure 29: Trend of Admission Rates per 100,000 Population of All Emergency Admissions for Patients Aged 65+ by Financial Year, Scotland, Grampian and CHP 46

Figure 30: Admission Rates per 100,000 Population of All Emergency Admissions for Patients Aged 65+ by 5 year age group Grampian 2008/2009 47

Table 18: NHS Grampian Staphylococcus aureus bacteraemia rates January 2006-June 2009 48

Table 19: Numbers of cases and rates of CDAD in patients 65 years and older 51 49

Figure 31: Deaths associated with CDAD in Grampian by year52 49

Table 20: Projected number of cases of cancer in Grampian54 51

Figure 32: Projected cases per 5 year period by ICD code for Grampian54 51

Figure 33: European age-standardised incidence (2001-2005) and mortality (2003-2007) rates for cancer in Scotland, by SIMD 2006 deprivation quintile57. 52

Figure 34: CHD mortality rates among under 75 year olds in the most deprived 15% areas (SIMD 2006); rate per 100,000 European age-standardised (EASR) 3 year rolling averages 1998-2008 53

Figure 35: Incidence of CHD (from first hospital admission) 54

Figure 36: Trend, Age-sex standardised incidence rate from CHD (Standard European population) per 100, 000 population. CHP, Grampian and Scotland 2000-2009 (all age groups) 54

Figure 37: Trend, Age-Sex standardised mortality rate from CHD (Standard European Population) per 100, 000 population. CHP, Grampian and Scotland 1999-2008 (all age groups) 55

Figure 38: Trend, Age-Sex Standardised Incidence rate of cerebrovascular disease (by first hospital admission) Grampian, CHP area and Scotland 2000-2009 66 56

Figure 39: Trend, Age-sex standardised mortality rates from stroke per 100,000 population (Grampian, CHP, Scotland) 2000-2009. 57

Figure 40: Standardised rates (%) of patients surviving for 30 days after an emergency admission for Stroke in NHS Grampian Hospitals 1998-200765 58

Figure 41: Age-sex standardised mortality rates (under 75) from stroke per 100,000 population in Grampian 2000-2009: Progress against targets 58

Table 21: QOF Prevalence Estimates of COPD in Grampian and CHP 59

Table 22 : Episodes of Care as a Consequence of COPD & Bronchiectasis Grampian Residents 60

Figure 42: Rates of neurotic disorder by subcategory71 62

Table 23: Admissions to mental illness specialities in Grampian hospitals by type of admission 2007/2008 62

Figure 43: E Coli o157 2005 to 2010 63

Table 24: Number of cases of reported and notified communicable disease in Grampian in 2005-2009 64

Table 25: Number of outbreaks of gastrointestinal infection by date reported to Health Protection Scotland 2005-2009 65

Table 26: Location of outbreaks of Norovirus infection reported by NHS Grampian 65

Table 27: Uptake of Diphtheria, Tetanus, Pertussis, Polio and Hib by 12 months of age in Grampian 1 April 2009 to 31 March 2010 66

Table 28: Uptake of Diphtheria, Tetanus, Pertussis, Polio and Hib by 24 months of age in Grampian by CHP area, 1 April 2009 to 31 March 2010 67

Table 29: Uptake of Diphtheria, Tetanus, Pertussis, Polio and Hib by 5 years of age in Grampian by CHP area, 1 April 2009 to 31 March 2010 67

Figure 44: Uptake of immunisation by deprivation 68

Figure 45: Uptake of HPV Immunisation for Girls in S2 in Grampian by CHP Year 1 (2008/2009) 69

Table 30: Uptake of HPV Immunisation in Girls eligible for catch-up vaccination in Grampian (year 1) 69

Figure 46: Uptake of HPV Immunisation in Girls eligible for the catch-up vaccination in year 1 (2008/09) in Grampian by CHP area 70

Figure 47: Uptake of HPV Immunisation for Girls in S2 in Grampian by CHP Year 2 (2009/2010) 71


Foreword

The Health of the Grampian Population brings together a range of information regarding the health status of the population and was produced to inform the NHS Grampian Health Plan. A life course approach has been taken in order to highlight the range of needs which require to be addressed across the population, an approach which appears particularly appropriate given the changes in the population structure which are predicted in the coming years. Whilst topics have been placed within this structure it is acknowledged that many aspects of health and disease are of importance throughout the life course, and that health and disease do not necessarily follow the traditional boundaries of young, middle and “old" age.

The majority of information presented in this report is routinely available and has largely been sourced from the websites of Information Services Division (ISD), General Register Office for Scotland (GROS) and Scottish Public Health Observatory (ScotPHO). Local data that is not available from these sources has been provided by Fred Nimmo, Health Intelligence at NHS Grampian or from documents produced for NHS Grampian.


Childhood

Children in Grampian

Improving the health outcome for children and young people is a key priority for NHS Grampian and its partners. The Children’s Services (Scotland) Bill 2006; ‘Getting it right for every child’, gives clear authority and responsibility to agencies, professionals, children, families and local communities, to work together in a way that brings practicality and reality to the vision for Scotland's children. Fundamental to the transition from childhood to adulthood is good health, and NHS Grampian has made it clear that raising the health status of children and young people in Grampian is one of its main challenges.

The most recent data about the population of Grampian is the mid -2008 population estimates. It is estimated that there are around 88,466 children aged between 0-14 years of age in Grampian. This accounts for around 18% of the Grampian population1. Out of which 48.7% are in Aberdeenshire, 34.9% in Aberdeen city and 16.4% in Moray (figure 1).

Figure 1 below shows the percentage of children aged between 0-14 years in each of the local council area in Grampian based on the 2008 population estimates.

Figure 1: percentage of children aged between 0-14 years in Grampian by local council area (based on mid 2008 population estimates)

Source: GROS, 2008

It is predicted that this population would decrease from levels estimated in 2006 by approximately 12% by the year 20312.

This predicted change in population would vary within Grampian. However, Aberdeenshire would see a small increase in the number of children aged 15 years and under by approximately 0.1%2. In contrast, it is projected that this population

would fall by about 20% and 25% respectively in Moray and Aberdeen City2 (figure 2).

Figure 2: Projected percentage change in population aged 0-15 (2006 based), by Grampian Council Areas 2006-2031

Source: GRO 2008

Births

In recent years the number of births registered in Scotland each year has been steadily increasing since 2002, with 2008 seeing the highest number of births since 19953. The number of births in Grampian follows a similar trend as can be seen in figure 3 below. In 2008, there were 6,060 live births in Grampian compared to 5,027 live births in 2002. This figure excludes deliveries at home and births at non-NHS hospitals.

General fertility rates across each council area have risen in keeping with this. In 2008, Moray had a live birth rate of 63 per 1000 women aged 15-44 years compared to Aberdeenshire (61.9 per 1000) and Aberdeen City (56 per 1000). These rates are higher than the Scottish average of 57.2 per 1000 except for Aberdeen City where the rate is lower than the Scottish average4.

Figure 3: Number of live births per year by council area4

Source: GRO 2008

The proportion of live births to mothers of UK origin has decreased in recent years in Grampian. Births to mothers of UK origin accounted for 85% of all births in 2006-2008 compared with 92% of all births in 2001-2003. The proportion of births to mothers of European origin, excluding the UK and Ireland, has increased from 2% to 6% during this period, with births to mothers from all other countries increasing by about 2% to an average of 9%4.

This increase in the proportion of births to mothers of non UK origin has significant implications for healthcare provision in Grampian especially in the way that a wide range of services e.g. maternity and child health services are provided.

Health of newborns and young children

There are a number of specific factors including lifestyle and health behaviour during pregnancy which can influence the health and wellbeing of newborns and children.

Smoking in pregnancy

Smoking in pregnancy is a serious health hazard for both the mother and the unborn child. The effect of smoking in pregnancy continues to affect the infant even long after birth. There is conclusive evidence that a pregnant women who smokes is more likely to have a baby with a low or very low birth weight.

In Grampian the number of women who currently smoke at their first antenatal booking visit is comparable with that of other mainland boards. In 2007, 20.3% of women in Grampian were current smokers at their first antenatal booking visit compared to 24.2% in 2003. Average figures for all of Scotland during the same period were 20.8% and 25.3% respectively.

Figure 4: Smoking at Booking Grampian 2000-2006

Source: ISD 2009

In Scotland, rates of smoking in the most deprived groups are much higher despite improvements in rates across all deprivation quintiles. Similar trends are seen in Grampian and across the three local council areas. In 2007/08 only 10% of Grampian mothers in the most affluent quintile smoked during pregnancy whilst 42% of mothers in the most deprived quintile were recorded as smoking (figure 5)7

Figure 5: Trends in percentage of women smoking during pregnancy in Grampian 1995-2008


Similar trend are seen across the 3 CHPs in Grampian (figure 6).

Figure 6: Percentage of mothers smoking during pregnancy by CHP 1995-2008

Breastfeeding19