Age, Sex & Biological Factors

Age, Sex & Biological Factors

• In 2011, the population of Betsi Cadwaladr University Health Board (BCU HB) was estimated to be 687,800.
• BCU HB has higher proportions of people aged 55 years and over and lower proportions of the population aged between 15 and 34 years, compared to Wales.
• The proportion of the population aged under 18 years in BCU HB is 20.7%; lower than 21% in Wales as a whole.
• The proportion of people aged over 75 years in BCU HB is higher than the average for Wales, 9.3% compared to 8.6%. There is variation across UAs, MSOAs and localities.
• The proportion of the population aged 85 years and over in BCU HB is just above the average across Wales, 2.7% compared to 2.5%. There is again variation.
• Five of the six counties in BCU HB are in the top 10 most sparsely populated counties in Wales.
• The percentage of the population in BCU HB aged 65 years and over has increased from 18.3% of the population in 2001 to 20.2% of the population in 2010, reflecting the aging of the population. This is a 10.4% growth in this population.
• The 65 year old and over population in BCU HB is predicted to increase by 60% between 2008 and 2033.
• There are large populations of temporary residents and tourists in North Wales which impact on the provision of health services.
• The General Fertility Rate (GFR) for BCU HB is above the average for Wales, 65.4 per 1,000 compared to 63.3 per 1,000.
• The proportion of low birth weight babies in BCU HB is lower than the average across Wales, 5.5% compared to 5.8%. There is considerable variation across MSOAs in BCU HB. MSOA Denbighshire 006 (Rhyl South West) has the highest proportion of low birth weight babies, 8.2%. MSOA Conwy 003 (LlandrilloynRhos, Penrhyn) has the lowest proportion, 2.9%.
• Teenage conception rates (15 to 17 year olds) across BCU HB are highest in Wrexham (42.8 per 1,000) which is higher than the average for Wales (37.7 per 1,000).
• The abortion rates in Unitary Authorities across BCU HB, with the exception of Gwynedd, are higher than the average for Wales.
• The Black and Ethnic Minority population in BCU HB is lower than the average for Wales, 2.4% compared to 4.4%.
• Overseas migration data are based on National Insurance Registrations, although this is deemed to be an underestimation of the true figure. Data show that Wrexham has had the highest number of registrations since 2002/03.
• The percentage of people, aged over three years, able to speak Welsh in BCU HB ranges from 12.9% in Wrexham to 65.4% in Gwynedd. All UAs in BCU HB have experienced a decline in the proportion of Welsh speakers between the 2001 and 2011 Census.
• There are 88,600 people of working age in BCU HB with a disability.

1.Demography

North Wales is a geographical area of approximately 2,500 square miles. There are six unitary authorities (UA) within this region – Isle of Anglesey, Gwynedd, Conwy, Denbighshire, Flintshire and Wrexham, and one Health Board (HB) – Betsi Cadwaladr University Health Board (BCU HB).

Table 1 shows that in 2011, the approximate population of BCU HB was 687,800. Flintshire in the North East has the largest population of 152,500 and Anglesey in the North West has the smallest population, 69,700.

Table 1: Population numbers, Wales, Betsi Cadwaladr University Health Board & unitary authorities, 2011

Table 2 below shows that 705,715 individuals are registered with a GP in the BCU HB area; a further 8,160 BCU residents are registered with a GP in England and 1,607 with GP elsewhere in Wales. 8,064 individuals who are registered in BCU GP practices reside outside the BCU area.The registered population is higher than the resident population, this could be partly explained by practice inflation, which occurs when people move to a new practice but do not notify their old practice of the move1. It may also be due to people accessing services outside their immediate local area. There are around 697,650 individuals registered with a GP in BCU HB and residing in the region.

Table 2: Registered GP population, Betsi Cadwaladr University Health Board, December 2012

Figure 1 and Table 3shows that BCU HB has a larger proportion of the population aged 55 years and over compared to Wales and a smaller proportion of the population in the younger age groups, particularly the mid teens to early 30s age groups. The proportions of each age band, over 55, over 65, over 75 and over 85 are all individually higher than the average for Wales as a whole. This is important as need for healthcare varies according to age, and in particular, the young and elderly, whose populations are not evenly distributed across the country2.

Increases in healthcare costs are strongly associated with increasing age and it is widely projected that the healthcare of the very elderly will account for an increasing proportion of health budgets in the future3.

Figure 1:

Table 3: Proportion and number of population by age and sex, Wales and Betsi Cadwaladr University Health Board, 2010

1.1Proportion of the population aged under 18 years

In BCU HB, 20.7% of the population is under the age of 18 years, compared with 21.0% in Wales as a whole. Figures 2 and 3 show how this varies across BCU HB, with the highest proportion of under 18s in Flintshire UA (21.4%) and MSOA Wrexham 010 (Cartrefle, Queensway, Wynnstay) at 29.4%, and the lowest proportion of under 18s residing in Conwy UA at 20.0% and MSOA Gwynedd 001 at 10.2% (Deiniol, Hirael, Marchog, Menai-Bangor). Locality boundaries are also given. Figure 4 shows the variation by UA across Wales.

Figure 2: Percentage of population aged under 18 in Betsi Cadwaladr University Health Board area, 2009

Produced by the Public Health Wales Observatory using data from ONS (MYE)

Figure 3: Percentage of the population aged under 18 years, Betsi Cadwaladr University Health Board, locality areas, 2009

Figure 4:

1.2Proportion of the population aged 75 years and over

In BCU HB, the proportion of the population aged 75 years and over is 9.3%, which is higher than the proportion in Wales as a whole, at 8.6%. Again, there are variations across BCU HB. Figures 5 and 6 show that the highest proportion of the 75s and over reside in Conwy UA at 11.9% and MSOA Conwy 004 (LlandrilloynRhos) at 20.4%, and the lowest proportion in Flintshire UA (7.5%) and MSOA Denbighshire 006 (Rhyl South West) at 5.3%. Locality boundaries are also given. Figure 7 shows the variation by UA across Wales.

Figure 5: Percentage of population aged 75 and over in Betsi Cadwaladr University Health Board area, 2009

Produced by Public Health Wales Observatory, using data from ONS (MYE)

Figure 6: Percentage of the population aged 75 years and over, Betsi Cadwaladr University Health Board, locality areas, 2009

Figure 7:

1.3Proportion of the population aged 85 years and over

In BCU HB, 2.7% of the population are aged 85 years and over, which is slightly higher than the average of 2.5% across Wales. Figures 8 and 9 show that the highest proportion of 85 year olds and over reside in Conwy UA, 3.5% and MSOA Conwy 004 (LlandrilloynRhos), 6.8%. The lowest proportions live in Flintshire UA 2.1% and MSOA Wrexham 013 (Minera, Penycae, PenycaeRuabon South), 1.2%. Locality boundaries are also given.

Figure 8: Percentage of population aged 85 and over in Betsi Cadwaladr University Health Board area, 2009

Produced by Public Health Wales Observatory, using data from ONS (MYE)

Figure 9:Percentage of the population aged 85 years and over, Betsi Cadwaladr University Health Board, locality areas, 2009

©Crown Copyright Licence Number 100022432 Produced by Public Health Wales Observatory, adapted by Claire Jones, March 2013

2.Population Density

Population density provides a measure of the concentration of people living in an area. It is calculated by dividing the population by the geographical area in square kilometres.

Population density varies across Wales. The chart below shows that five out of the six North Wales counties – Gwynedd, Anglesey, Conwy, Denbighshire and Wrexham – are in the top 10 most sparsely populated counties in Wales. This is important as the cost of providing healthcare may be higher in remote rural areas because of diseconomies of scale.

Figure 10: Population density, Wales & unitary authorities, 2011

Source: Office for National Statistics, Census 2011

North Wales has62 areas which are classed as ‘urban’ (that is, an area with a minimum population of 1,500). 40 of these areas have populations of less than 5,000 people and 14 areas have populations of 10,000 people or more (Table 4).

It should be noted that this data is now 10 years old and we are awaiting analyses of data from the 2011 Census.

Table 4: Main urban areas in North Wales, 2001census

Source: Census 2001

3.Population Change

Table 5 shows that here has been a 3.5% increase in the population of BCU HB between 2001 and 2011, with Wrexham experiencing the largest percentage increase.

Table 5: Population change, Wales, Betsi Cadwaladr University Health Board & unitary authorities, 2001-2011

To look at the percentage chance in specific age-bands, we need to look at mid-year population estimates, as this specific data is not yet available from the 2011 Census. The percentage of the population in BCU HB aged 65 years and over has increased from 18.3% of the population in 2001 to 20.2% of the population in 2010, reflecting the aging of the population. This is a 10.4% growth in this population.

There has been a 6.8% increase in the population aged 75+ in the same period. The population aged 85+ has grown by 12.5%. This is important as it is widely projected that the healthcare of the very elderly will account for an increasing proportion of health budgets in the future3; this is shown in Figure 11 and Table 6.

Figure 11:

Table 6:

4.Projected changes in total population from 2008 to 2033

Figure 12shows that the 65 year old and over age group in BCU HB is predicted to increase by 60% between 2008 and 2033. The proportion aged 75 years and over (Figure 13) is projected to increase around 7% and 8% per cent in Flintshire and Wrexham to around 15% and 14% respectively during this period. In Conwy, the proportion is projected to rise from around 12% to 18%. The percentage aged 85 years and over (Figure 14) is projected to double from around 2% to 3.5% to around 5.5% to 7% by 20334.

It is important to note that population projections provide estimates of the size of the future population, and are based on assumptions about births, deaths and migration. The assumptions are based on past trends. Projections only indicate what may happen should the recent trends continue. Projections done in this way do not make allowances for the effects of local or central government policies on future population levels, distribution and change1.

Figure 13:

Figure 14:

* Y-axis is truncated

Figure 15:

* Y-axis is truncated

• Public Health Observatory Wales: Population estimates and projection resources

5. Transient Populations

5.1 Temporary Residents

There is a high concentration of caravan sites on the coastal strip of North Wales, predominantly around Kinmel Bay and Towyn.

There are likely to be substantial numbers of long-term caravan residents in North Wales who access local health services. However, research from Lincolnshire5 has found that the Census of Population, the electoral register and Council Tax register all seriously under-record this population. The omissions from the Census of Population are particularly important because Census data (and the mid-year population estimates built upon Census data) plays a central role in public sector funding formulas.

Key findings on demography of the surveyed caravan population in Lincolnshire found5:

• nearly three-quarters are over 55, and more than 40 per cent over 65
• over 60 per cent describe themselves as ‘retired’
• fewer than a quarter have a job – and this low figure includes a number of site
• workers for whom the caravan came with the job

The households surveyed spend a large proportion of the year living in a caravan:

• 85 per cent live on site for at least three months of the year
• over 40 per cent live on site at least nine months of the year
• 43 per cent don’t return to another home elsewhere for part of the year
• 39 per cent consider their caravan or chalet to be their main home
• 39 per cent are permanently registered with a GP at the caravan’s address.

These findings could also be applicable to North Wales.

5.2 Tourists

North Wales is a prime tourist destination, predominantly for visitors from the North West of England/ Merseyside (Liverpool and Manchester), who stay in coastal resorts such as Llandudno, Rhyl and Prestatyn.

The large increase in the number of visitors, especially in the summer months, may lead to increased pressure on health care resources.

In 2011, there were almost 3.5 million overnight visits to North Wales. Overall, there was a 15% increase in overnight visits to North Wales between 2009 and 2011.

Table 7: Overnight tourism by GB visitors to North Wales, 2009-2011

These figures do not include day visits, which are covered in the GB Day Visits Survey (GBDVS). This was undertaken for the first time in its present form in 2011, so comparative or trend data is not yet available. Day visits are very significant, however, and GBDVS tells us that in 2011, some 26 million day trips from home were made to destinations in North Wales. Overseas tourists are covered separately in the International Passenger Survey. Data for 2011 are not yet available, but in comparison with GB, the volume is relatively small, around 300,000 trips annually to North Wales.

A review conducted by the National Public Health Service (NPHS) for Wales on the impact of tourism on health found the following6:

• There is little research done on the health impacts of tourism in the UK
• Holidaymakers have different patterns of consulting in primary care than the resident population, consulting more often for respiratory, Gastrointestinal, minor infections and skin complaints
• Workload for GP’s in popular holiday resorts can increase in summer months.
• Holidaymakers are often ill prepared for their trip, forgetting vital medications and travelling after major illnesses and surgery. Comprehensive pre-trip counselling by health professionals in the ‘donor’ areas, especially for those with chronic conditions, could reduce burden on health services in the ‘host’ areas.
• Local residents are more likely to present at A&E for illnesses, and tourists are more likely to present at A&E for accidents in one Australian seaside resort.
• Tourists often have little local knowledge of conditions, putting them at increased risk of accidents, especially in relation to the natural environment.
• Comprehensive data collection on tourist health episodes and good communication and information sharing between Health Services, Tourist Industry and Local Government can aid planning for the health impacts of tourism.
• Risky behaviour in terms of alcohol use, drug use and sexual behaviour increase when people are on holiday.
• The hedonistic, ‘carnavalised’, transient atmosphere of UK seaside resorts, together with easy access to alcohol can contribute to risk taking in the sexual behaviour of young people. Young people are often drawn into the leisure and entertainment industry geared towards adults which can leave them open to exploitation.
• Transport problems and issues with visibility and confidentiality can prevent young people from accessing sexual health services in the rural areas surrounding seaside resorts. Schools can be successful in directing young people to appropriate services.
• According to the Single Issue Panel report, Primary Care Trusts in England may not currently be reimbursed under the Out of Area Treatment scheme, for temporary residents attending A&E, minor injuries units and outpatient clinics. This may be particularly important in areas with high levels of tourism where the allocation of health service resources are not currently reflecting the burden of tourist health encounters on some services.

6.General Fertility Rate

The general fertility rate (GFR) is defined as the total number of live births born to females who are of childbearing age in a population, i.e. those aged between 15 and 44 years. This rate provides a useful indicator when studying population growth and change.

Across Wales and the UK, the GFR fell between 1998 and 2001/2002. Figure 15 shows it has been slowly rising since 2001/2002. It has been postulated that this upturn has been largely driven by increasing birth rates among older women. In 2010, the BCU HB GFR was higher than the Wales rate (65.4 per 1,000 compared to 63.3 per 1,000), but closely reflects the Welsh pattern.

Figure 15:

• Public Health Wales Observatory: UA level trend data

Figures 16 and 17 show that the GFR for 2006-8 is highest in Wrexham UA (64 per 1,000) and MSOA Wrexham 010 (Cartrefle, Queensway, Wynnstay) at 93 per 1,000 and lowest in Gwynedd UA (58 per 1,000) and MSOA Gwynedd 001 (Deiniol, Marchog, Hirael, Menai [Bangor]), 21 per 1,000; rates are particularly low in parts of Bangor where there is a large student population. Figure 16 also shows locality boundaries. Figure 18 shows how GFR varies in UAs across Wales.

Figure 16: General fertility rate per 1,000 in Betsi Cadwaladr University Health Board area, females aged 15-44, 2006-08