director of public health annual report: chart book · director of public health annual report:...

Director of Public Health Annual Report: Chart Book

Director of Public Health

Annual Report: Chart Book

Published July 2011


Contents

1 INTRODUCTION ...................................................................... 1

2 DEMOGRAPHY ......................................................................... 2 2.1 Demography: key points .................................................... 2 2.2 Population ........................................................................ 4

2.2.1 Population by age and sex ............................................... 4 2.2.2 Population aged under 18 ................................................ 5 2.2.3 Population aged 75 and over ............................................ 8 2.2.4 Population aged 85 and over .......................................... 11

2.3 Population projections ...................................................... 13 2.3.1 Population projections by age group................................ 13 2.3.2 Population projections, persons aged 75 and over ............. 14 2.3.3 Population projections, persons aged 85 and over ............. 15

2.4 Births ............................................................................ 16 2.4.1 General fertility rate ..................................................... 16

2.5 Deaths ........................................................................... 19 2.5.1 All-cause mortality ....................................................... 19 2.5.2 All-cause mortality, aged under 75 ................................. 22

3 DETERMINANTS OF HEALTH .................................................. 26 3.1 Determinants of health: key points .................................... 26 3.2 Wider determinants of health ............................................ 27

3.2.1 Deprivation in relation to Wales ...................................... 27 3.2.2 Deprivation within the health board ................................ 29 3.2.3 Inequality in all-cause mortality ..................................... 30

3.3 Lifestyle factors............................................................... 31 3.3.1 Smoking as reported by adults ....................................... 31 3.3.2 Binge drinking as reported by adults ............................... 32 3.3.3 Five or more fruit or vegetables a day as reported by adults33 3.3.4 Physical activity as reported by adults ............................. 34 3.3.5 Overweight and obesity, adults based on self reported data 35

4 USE OF SERVICES .................................................................. 36 4.1 Use of services: key points ............................................... 36 4.2 Prevention services: vaccination uptake ............................. 38

4.2.1 Childhood immunisations ............................................... 38 4.2.2 Seasonal influenza vaccination ....................................... 44

4.3 Population Based National Screening Programmes in Wales ... 46 4.3.1 Uptake of national screening programmes in Wales ........... 46

4.4 Primary care services ....................................................... 47 4.4.1 Use of primary care as reported by adults ........................ 47

4.5 Use of secondary and tertiary care ..................................... 48 4.5.1 Hospital admissions: individuals aged under 75 ................ 48 4.5.2 Emergency hospital admissions: individuals aged under 75 51 4.5.3 Elective hospital admissions: individuals aged under 75 ..... 54

5 HEALTH STATUS .................................................................... 57


5.1 Health status: key points .................................................. 57 5.2 Physical and mental health ............................................... 59

5.2.1 Low birth weight .......................................................... 59 5.2.2 Physical health as reported by adults* ............................. 62 5.2.3 Mental health as reported by adults* .............................. 63 5.2.4 Limiting long term illness as reported by adults ................ 64 5.2.5 Mental illness as reported by adult .................................. 65

5.3 Mortality from specific conditions ....................................... 66 5.3.1 Mortality from circulatory disease, all ages ....................... 66 5.3.2 Mortality from circulatory disease, under 75s ................... 69 5.3.3 Mortality from coronary heart disease ............................. 72 5.3.4 Mortality from cancer .................................................... 75 5.3.5 Mortality from respiratory disease ................................... 78 5.3.6 Cancer survival ............................................................ 81

APPENDIX A: ORIGINAL SOURCE REPORTS AND FURTHER INFORMATION ...................................................................... 84

APPENDIX B: GLOSSARY ............................................................. 85

APPENDIX C: MAPS SHOWING MIDDLE SUPER OUTPUT AREAS IN THE ANEURIN BEVAN HEALTH BOARD AREA ......................... 86

© 2011 Public Health Wales NHS Trust.

Material contained in this document may be reproduced without prior permission provided it is done so accurately and is not used in a misleading context.

Acknowledgement to Public Health Wales NHS Trust to be stated.

Copyright in the typographical arrangement, design and layout belongs to Public Health Wales NHS Trust.


1

1 Introduction This Aneurin Bevan Health Board chart book has been produced by the Public Health Wales Observatory as an appendix to the Director of Public Health Annual Report. It updates and adds to the chart book produced by the Director of Public Health for Abertawe Bro Morgannwg University Health Board (UHB) for his Interim Annual Report. A decision was made by the Wales Directors of Public Health to use these indicators to inform their annual reports. The Abertawe Bro Morgannwg UHB chart book indicators originated from a number of sources:

• Public Health Wales Observatory • Vaccine Preventable Disease Programme (Public Health Wales) • Public Health Wales Screening Services • Welsh Cancer Intelligence and Surveillance Unit (Public Health Wales)

This updated chart book draws together information from the above resources and adds new information sourced from:

The Public Health Wales Observatory:

• Director of Public Health Annual Report: supporting indicators, 2011 • Demography Profile, 2009 • Lifestyle Profile, 2010 • Inequalities in mortality in Aneurin Bevan Health Board: interim release to support

Directors of Public Health annual reports From other sources: • Welsh Health Survey, Welsh Assembly Government (repackaged by the Public Health

Wales Observatory) • Public Health Wales, Vaccine Preventable Disease Programme • Screening Division (Public Health Wales) • Welsh Cancer Surveillance and Intelligence Unit (Public Health Wales)

The indicators have been presented under the following chapter headings: demography; determinants of health; use of services and health status. A summary of key points is included at the beginning of each chapter.

Maps included in this document show data by fifths of equal range within the health board area.

Included in Appendix A are web links for the original source reports and further information to support the used in this chart book.

A glossary of some of the terms used in this chart book is included in Appendix B.

Appendix C comprises of a series of local authority area maps showing the MSOA boundaries for the health board area.


2

2 Demography

2.1 Demography: key points

Population structure

The population of Aneurin Bevan Health Board is estimated to have been 560 thousand in 2009. Around 30 per cent of the Aneurin Bevan Health Board population live in the Caerphilly local authority area and 25 per cent live in the Newport local authority area.

The age structure of the population is similar to Wales but with slightly higher proportions of persons aged under 15 and in their forties and lower proportions of persons in their twenties.

At middle super output area (MSOA) level, higher proportions of persons aged under 18 are found in Greenmeadow; Thornhill and West Pontnewydd in Torfaen, as well as Tredegar Park; Duffryn; Ringland; Pillgwenlly; Alway; Liswerry and Uskmouth in Newport. The areas with the lowest proportions are in Monmouthshire in the areas north of Abergavenny including Pandy; Grosmont; Crucorney; Mardy and Priory.

Among the older age groups the proportion aged 75 and over is about the same as Wales. Within the health board, Monmouthshire has a higher proportion and Caerphilly has a lower proportion whereas Blaenau Gwent, Newport and Torfaen are similar to Wales and the health board average. At the MSOA level, the highest proportions are found in Stow Park and Gaer in Newport, Croesyceiliog and Llanyrafon North in Torfaen as well as in Monmouthshire the areas north of Abergavenny including Pandy; Grosmont; Crucorney; Mardy and Priory. The pattern is very similar in those aged 85 and over.

Population projections

The latest projections indicate that if current trends continue, the number of persons aged 65 and over resident in Aneurin Bevan Health Board area will increase by almost 60 per cent between 2008 and 2033. The proportion aged 75 and over is projected to increase from around seven to ten per cent at local authority level to around 11 to 19 per cent over this period, the sharpest increases being in Monmouthshire and Torfaen. At local authority level, the percentage aged 85 and over is projected to double from between two and three percent to between five and eight per cent by 2033, with the exception of Monmouthshire where a sharper increase is projected with the proportion set to treble in size.

The increase in the number of older people is likely to be associated with a rise in chronic conditions whose prevalence is strongly age-related such as circulatory and respiratory diseases and cancers. Meeting the needs of these individuals will be a key challenge for the health board. 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.


3

Birth rate

The General Fertility Rate (GFR) for Aneurin Bevan Health Board is almost identical to the rate for Wales. At the local authority level, Caerphilly and Newport are seen to have rates higher than that for Wales. At the MSOA level, there is considerable variation with Newport having by far the highest and lowest rates i.e. rates are highest in Pillgwenlly and lowest in Caerleon.

All-cause mortality

The European age-standardised all-cause mortality rate takes into account the age structure of the population, allowing valid comparisons to be made between areas. The rate for Aneurin Bevan Health Board is comparable to Wales. Within the health board, rates are higher in Blaenau Gwent and Caerphilly, and lower in Monmouthshire. At the MSOA level, variation is considerable with rates ranging from 393 to 961 per 100,000 population. The lowest rates are found in the Mill, Rogiet, The Elms, Llanfihangel and Magor areas of Monmouthshire. The highest rates are seen in the Pillgwenlly area of Newport. Among persons aged under 75 years the pattern is similar. The health board exhibits a decreasing trend in mortality in persons under 75 years from 2000 to 2009 which is generally in line with the all Wales pattern.


4

2.2 Population

2.2.1 Population by age and sex

Wales and Aneurin Bevan Health Board

12 10 8 6 4 2 0 2 4 6 8 10 12

00-0405-0910-1415-1920-2425-2930-3435-3940-4445-4950-5455-5960-6465-6970-7475-7980-84

85+

Proportion (%) of population

Proportion of population by age and sex Aneurin Bevan Health Board: 2009

Aneurin Bevan females Aneurin Bevan males Wales females Wales males

Produced by the Public Health Wales Observatoryusing data from 2009 mid year population estimates, Office for National Statistics


5

2.2.2 Population aged under 18

Middle super output areas


6

Percentage of population aged under 18 in Aneurin Bevan Health Board area, 2009 Produced by Public Health Wales Observatory, using data from ONS (MYE)

19.220.621.021.021.121.421.621.721.821.821.822.022.222.422.422.622.822.923.023.324.724.925.425.5

017015010013005016007020023001003014024004011022008006002019009012021018

MS

OA

Caerphilly

% under 18

Caerphilly % = 22.4

20.320.720.820.921.121.521.721.723.4

004006001008003002009007005

MS

OA

Blaenau Gwent

% under 18

Blaenau % = 21.4

18.519.219.520.020.420.721.721.822.923.023.124.9

27.8

008005013004006010001007002011012003009

MS

OA

Torfaen

% under 18

Torfaen % = 22.0

18.618.718.920.522.022.122.222.322.422.422.723.223.423.924.424.7

26.526.826.828.5

017001014012016004007008002005006009011003013020015018010019

MS

OA

Newport

% under 18

Newport % = 23.2

17.118.218.418.7

21.021.121.622.023.324.125.7

001006005003010009007008002004011

MS

OA

Monmouthshire

% under 18

Monmouthshire % = 21.1

MSOA Health Board (22.2%) Wales (21.0%) Local Authority


7

Local authorities

Percentage of population aged under 18 by local authority, 2009 Produced by Public Health Wales Observatory, using data from ONS (MYE)

20

.6%

20

.2%

19

.9%

20

.6%

21

.4%

21

.2%

20

.2%

17

.6% 21

.5%

20

.7%

19

.6%

20

.8%

21

.4%

22

.3%

20

.3%

21

.5%

22

.2%

22

.4%

21

.4%

21

.8%

21

.1%

23

.2%

Isle

of Angle

sey

Gw

yned

d

Con

wy

Den

big

hsh

ire

Flin

tshire

Wre

xham

Pow

ys

Cer

edig

ion

Pem

bro

kesh

ire

Car

mar

then

shire

Sw

anse

a

Nea

th P

ort

Talb

ot

Bridgen

d

The

Val

e of

Gla

mor

gan

Car

diff

Rhon

dda

Cyn

on T

aff

Mer

thyr

Tyd

fil

Cae

rphill

y

Bla

enau

Gw

ent

Torf

aen

Mon

mou

thsh

ire

New

por

t

Wales = 21.0%

Areas ordered geographically from north west to south east


8

2.2.3 Population aged 75 and over



9

Percentage of population aged 75 and over in Aneurin Bevan Health Board area, 2009 Produced by Public Health Wales Observatory, using data from ONS (MYE)

5.05.35.35.95.96.36.56.77.07.37.47.57.67.77.77.88.18.18.48.89.09.89.810.8

018019021008022012016006014024009001007002005004023013003011020017015010

MS

OA

Caerphilly

% 75 and over

Caerphilly % = 7.4

6.77.57.98.08.18.28.99.110.4

005007009001003004008006002

MS

OA

Blaenau Gwent

% 75 and over

Blaenau % = 8.2

5.05.86.66.7

8.08.28.5

9.79.99.910.7

12.7

13.9

012009011003004002001006005007010013008

MS

OA

Torfaen

% 75 and over

Torfaen % = 8.8

4.84.95.15.36.26.66.97.17.37.37.68.58.78.79.29.710.811.1

12.3

14.2

013003020019018011015007006004014016009002010001005008012017

MS

OA

Newport

% 75 and over

Newport % = 7.9

6.07.98.28.99.310.010.010.411.211.913.1

011009008007002006010005004003001

MS

OA

Monmouthshire

% 75 and over




10

Local authorities

Percentage of population aged 75 and over by local authority, 2009 Produced by Public Health Wales Observatory, using data from ONS ( MYE)

9.6

%

9.7

% 11

.9%

10

.2%

7.5

%

7.9

% 10

.6%

10

.0%

9.8

%

9.7

%

8.9

%

8.9

%

8.1

%

8.5

%

6.7

%

7.9

%

7.7

%

7.4

%

8.2

%

8.8

%

9.7

%

7.9

%

Isle

of Angle

sey

Gw

yned

d

Con

wy

Den

big

hsh

ire

Flin

tshire

Wre

xham

Pow

ys

Cer

edig

ion

Pem

bro

kesh

ire

Car

mar

then

shire

Sw

anse

a

Nea

th P

ort

Talb

ot

Bridgen

d

The

Val

e of

Gla

mor

gan

Car

diff

Rhon

dda

Cyn

on T

aff

Mer

thyr

Tyd

fil

Cae

rphill

y

Bla

enau

Gw

ent

Torf

aen

Mon

mou

thsh

ire

New

por

t

Wales = 8.6%



11

2.2.4 Population aged 85 and over



12

Percentage of population aged 85 and over in Aneurin Bevan Health Board area, 2009 Produced by Public Health Wales Observatory, using data from ONS (MYE)

0.91.01.31.31.41.51.71.71.81.92.12.12.22.22.22.22.32.32.42.62.72.83.1

3.3

019021022008018014016012006009013024005003002023001007004015020011017010

MS

OA

Caerphilly

% 85 and over

Caerphilly % = 2

1.62.02.22.22.22.22.3

3.03.8

005001006007003009004008002

MS

OA

Blaenau Gwent

% 85 and over

Blaenau % = 2.3

0.81.4

1.81.92.22.52.62.62.62.93.03.2

4.0

012009011003002007001005004010008006013

MS

OA

Torfaen

% 85 and over

Torfaen % = 2.4

0.91.2

1.51.61.61.61.71.7

2.22.32.32.42.62.93.03.23.3

3.83.8

5.4

013003020015004011010019006018007016002009008014001012005017

MS

OA

Newport

% 85 and over

Newport % = 2.4

1.42.02.2

2.62.62.62.62.6

3.13.7

4.4

011009008010002006003007005004001

MS

OA

Monmouthshire

% 85 and over




13

2.3 Population projections

2.3.1 Population projections by age group

Aneurin Bevan Health Board

-30

-20

-10

0

10

20

30

40

50

60

70

2008

2009

2010

2011

2012

2013

2014

2015

2016

2017

2018

2019

2020

2021

2022

2023

2024

2025

2026

2027

2028

2029

2030

2031

2032

2033

Perc

en

tage c

han

ge fro

m 2

00

8

0-15 16-24 25-44 45-64 65+

Produced by the Public Health Wales Observatory, using data from the Welsh Assembly Government

2008-based population projections for Aneurin Bevan Health Board, persons: 2008 to 2033


14

2.3.2 Population projections, persons aged 75 and over

Local authorities within Aneurin Bevan Health Board*

* Y-axis is truncated

6

8

10

12

14

16

18

20

2008

2009

2010

2011

2012

2013

2014

2015

2016

2017

2018

2019

2020

2021

2022

2023

2024

2025

2026

2027

2028

2029

2030

2031

2032

2033

%

Projected population, 2008-2033, % aged 75 and overProduced by Public Health Wales Observatory, using data from the Welsh Assembly Government

Caerphilly Blaenau Gwent Torfaen

Monmouthshire Newport Wales


15

2.3.3 Population projections, persons aged 85 and over

Local authorities within Aneurin Bevan Health Board*

* Y-axis is truncated

2

3

4

5

6

7

8

2008

2009

2010

2011

2012

2013

2014

2015

2016

2017

2018

2019

2020

2021

2022

2023

2024

2025

2026

2027

2028

2029

2030

2031

2032

2033

%

Projected population, 2008-2033, % aged 85 and overProduced by Public Health Wales Observatory, using data from the Welsh Assembly Government

Caerphilly Blaenau Gwent Torfaen

Monmouthshire Newport Wales


16

2.4 Births

2.4.1 General fertility rate


Numbers on map indicate MSOAs with a rate statistically significantly higher than the all Wales rate.


17

General fertility rate per 1,000 in Aneurin Bevan Health Board area, females aged 15-44, 2006-08 Produced by Public Health Wales Observatory, using data from ONS (ADBE, MYE)

4656575757575758585960616162636464676771717274

82

017005023007020013001009016015010008019006014003011012004024018022002021

MS

OA

Caerphilly

GFR

Caerphilly GFR = 63

445353

6060616161

75

004001003006005008009007002

MS

OA

Blaenau Gwent

GFR

Blaenau GFR = 58

47485151555662646567677274

005013011008012007006002004003010009001

MS

OA

Torfaen

GFR

Torfaen GFR = 60

374954555858595960616464656667686974

87

112

001016004008002007003005009017006011015012020019014010013018

MS

OA

Newport

GFR

Newport GFR = 64

4153535354546062636468

006009003005011001010008002007004

MS

OA

Monmouthshire

GFR

Monmouthshire GFR = 58

MSOA Health Board (GFR = 61) Wales (GFR = 60) Local AuthorityMSOA GFR with 95% confidence interval


18

Local authorities

62

.8

58

.5

62

.0

61

.0

59

.8

64

.2

59

.8

41

.3

62

.3

60

.3

57

.9

59

.4

61

.5

60

.2

56

.9

59

.9 66

.0

62

.8

58

.2

60

.4

57

.5 64

.3

Isle

of A

ngle

sey

Gw

ynedd

Conw

y

Denbig

hsh

ire

Flin

tshire

Wre

xham

Pow

ys

Cere

dig

ion

Pem

bro

kesh

ire

Car

mar

thensh

ire

Sw

anse

a

Neat

h P

ort

Tal

bot

Bridgend

The V

ale o

f G

lam

org

an

Car

diff

Rhondda

Cyn

on T

aff

Mert

hyr

Tyd

fil

Cae

rphill

y

Bla

enau

Gw

ent

Torf

aen

Monm

outh

shire

New

port

General fertility rate per 1,000, by local authority, 2006-08Produced by Public Health Wales Observatory, using data from ONS (ADBE, MYE)

Wales = 59.7


95% confidence interval


19

2.5 Deaths

2.5.1 All-cause mortality




20

All-cause mortality in Aneurin Bevan Health Board area, all persons, 2004-08, European age-standardised rates per 100,000 Produced by Public Health Wales Observatory, using data from ONS (ADDE, MYE)

497516

587604630631648651665672686691691699741757759765766767801821824874

024016021005011019008009014022020013007023010018006017004003012002015001

MS

OA

Caerphilly

EASR per 100,000

Caerphilly EASR = 698

691699702718726765793848865

004008009005003007006001002

MS

OA

Blaenau Gwent

EASR per 100,000

Blaenau EASR = 752

520526548572592606644678682707714757790

005012008011002013006004007003001009010

MS

OA

Torfaen

EASR per 100,000

Torfaen EASR = 637

459472501540541582585590621644655662666713728739760761815

961

004009016007001012015002005020006017008019011013003010014018

MS

OA

Newport

EASR per 100,000

Newport EASR = 635

393450464491506551579580604605631

011005009006004007003008001010002

MS

OA

Monmouthshire

EASR per 100,000

Monmouthshire EASR = 533

MSOA Health Board (EASR = 650) Wales (EASR = 635) Local AuthorityMSOA EASR with 95% confidence interval


21

Local authorities

59

7.0

61

1.8

62

0.0

61

1.3

61

9.7

64

4.7

55

0.3

51

6.6 61

8.5

65

1.7

63

6.2

66

6.7

68

4.2

59

5.6

63

6.1

70

8.5

74

1.7

69

7.9

75

1.9

63

6.6

53

3.2 63

5.3

Isle

of A

ngle

sey

Gw

ynedd

Conw

y

Denbig

hsh

ire

Flin

tshire

Wre

xham

Pow

ys

Cere

dig

ion

Pem

bro

kesh

ire

Car

mar

thensh

ire

Sw

anse

a

Neat

h P

ort

Tal

bot

Bridgend

The V

ale o

f G

lam

org

an

Car

diff

Rhondda

Cyn

on T

aff

Mert

hyr

Tyd

fil

Cae

rphill

y

Bla

enau

Gw

ent

Torf

aen

Monm

outh

shire

New

port

All cause mortality by local authority, all persons, 2004-08, European age-standardised rates per 100,000 Produced by Public Health Wales Observatory, using data from ONS (ADDE, MYE)

Wales = 635.1




22

2.5.2 All-cause mortality, aged under 75



23

All-cause mortality in Aneurin Bevan Health Board area, persons aged under 75 years, 2004-08, European age-standardised rates per 100,000 Produced by Public Health Wales Observatory, using data from ONS (ADDE, MYE)

214295314316319326341348350357360381391393402403406406415418441444446485

024021009005016019011014013006008020018007023017004022010015002003012001

MS

OA

Caerphilly

EASR per 100,000


369394403415420422435443461

004003008002006005009007001

MS

OA

Blaenau Gwent

EASR per 100,000

Blaenau EASR = 416

228245263275275281

341361374393406421463

012011005002008013006007004003009001010

MS

OA

Torfaen

EASR per 100,000

Torfaen EASR = 331

188216239267276285290297335339344381391400418418427439477

650

009004012001016020007002015008005017006019011003014013010018

MS

OA

Newport

EASR per 100,000

Newport EASR = 342

174208218221239270292306320333333

011009005007006004003001010002008

MS

OA

Monmouthshire

EASR per 100,000




24

Local authorities

31

0

31

9

33

2

31

8

31

2

33

0

26

9

26

2 31

7

32

7

33

1

34

9

35

2

29

6 34

6 38

0

40

4

37

3 41

6

33

1

26

3

34

2

Isle

of A

ngle

sey

Gw

ynedd

Conw

y

Denbig

hsh

ire

Flin

tshire

Wre

xham

Pow

ys

Cere

dig

ion

Pem

bro

kesh

ire

Car

mar

thensh

ire

Sw

anse

a

Neat

h P

ort

Tal

bot

Bridgend

The V

ale o

f G

lam

org

an

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diff

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Cyn

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aff

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fil

Cae

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y

Bla

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Gw

ent

Torf

aen

Monm

outh

shire

New

port

All cause mortality by local authority, persons aged under 75 years, 2004-08, European age-standardised rates per 100,000 Produced by Public Health Wales Observatory, using data from ONS (ADDE, MYE)

Wales = 331




25

Wales and Aneurin Bevan Health Board trend

0

100

200

300

400

500

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

EA

SR

per

10

0,0

00

popu

lati

on

Aneurin Bevan Health Board Wales

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

All-cause mortality rate trend for Aneurin Bevan Health Board, persons aged under 75: 2000 to 2009


26

3 Determinants of health

3.1 Determinants of health: key points

Pattern of deprivation

The pattern of deprivation as described by the Welsh Index of Multiple Deprivation shows that the most deprived areas are located primarily in the west of the Aneurin Bevan Health Board area i.e. Tredegar; Rhymney; Blackwood and Cwmbran. The least deprived areas are in Monmouthshire in places like Devauden, Raglan, to the west of Chepstow and north of Monmouth.

Analysis of the association between deprivation and poor health

The association between socioeconomic deprivation and poor health outcomes is well-established. The Public Health Wales Observatory will be publishing a profile examining the relationship over time between deprivation and mortality later this year. This chart book contains some preliminary analysis released for inclusion in Director of Public Health Annual Reports. The analysis shows that the European age-standardised all-cause mortality rate in the most deprived fifth of areas within Aneurin Bevan Health Board is approximately twice the rate in the least deprived fifth. This gap is slightly higher in males than females. The charts also show the gap is not narrowing.

Lifestyle data

The Welsh Health Survey is a rich source of information on lifestyle. It is a self-reported survey randomly sampling around 15 thousand adults (aged 16+) per year in Wales. The sample is constructed to allow reporting at local authority level.

Lifestyle indicators in the Aneurin Bevan Health Board area are generally worse than, or similar to, the Wales average. Almost one in four people smoke, leading to around 1,000 deaths per year within the health board area.

Nearly half the population of the health board area drinks more alcohol than the recommended limits and more than a quarter binge drink on at least one day a week. Hospital admissions due to alcohol are more common than in Wales as a whole, with particularly high levels found in Blaenau Gwent. In total, more than 10,000 hospital admissions and 180 deaths are caused by alcohol each year.

Overall, only around a third of people eat the recommended amount of fruit and vegetables. The picture is even worse for physical activity. Improving diet and physical activity are essential to reducing the high proportions of people who are overweight or obese. Nearly 60 per cent of adults in the health board area are either overweight or obese.


27

3.2 Wider determinants of health

3.2.1 Deprivation in relation to Wales

The Welsh Index of Multiple Deprivation (2008) is produced at a small area level called lower super output area, and is derived from a broad range of factors including income, employment, health, education, skills and training, community safety, housing, physical environment and access to services. It is a geographically based deprivation measure which can be used to show inequalities in health and suggest areas likely to most need measures to improve health and manage ill-health.

This map shows the level of deprivation in the health board in comparison to the rest of Wales.


28

0 5 10

miles

Newport

Abergavenny

Caerphilly

Risca

Cwmbran

Blackwood

Rhymney

Ebbw ValeTredegar

Pontypool

Chepstow

Monmouth

Overall Welsh Index of Multiple Deprivation 2008Fifths of deprivation, Low er Super Output Areas, Data source: WAG

Most deprived (88)Next most deprived (93)Median (54)Next least deprived (62)Least deprived (72)

A roads

Motorway

Local authority boundary

This map is reproduced from Ordnance Survey material with the permission of Ordnance Survey on behalf of the Controller of Her Majesty's Stationery Office © Crown copyright. Unauthorised reproduction infringes Crown copyright and may lead to prosecution or civil proceedings. Wales Centre for Health. Licence Number: 100044810. 2009


29

3.2.2 Deprivation within the health board

This map shows the most and least deprived fifths within the health board. It is this grouping that is used to demonstrate inequalities in mortality in the next section.


30

3.2.3 Inequality in all-cause mortality

These graphs compare mortality in the most deprived fifth of the health board population with the least deprived fifth of health board population.

1.9 2.0 2.1 2.3 2.4 2.3 2.10

100

200

300

400

500

600

700

800

2001-03 2002-04 2003-05 2004-06 2005-07 2006-08 2007-09

Most deprived within Aneurin Bevan (95% CI) Wales EASR

Least deprived within Aneurin Bevan Aneurin Bevan overall

Produced by Public Health Wales Observatory, using ADDE/MYE (ONS), WIMD 2008 (WAG)

All-cause mortality, under 75, males, European age-standardised rate (EASR) per 100,000, Aneurin Bevan HB and Wales, 2001-09

Rate Ratio - most deprived divided by least deprived

1.9 1.9 2.2 2.2 2.2 2.1 2.00

50

100

150

200

250

300

350

400

450

500

2001-03 2002-04 2003-05 2004-06 2005-07 2006-08 2007-09

Most deprived within Aneurin Bevan (95% CI) Wales EASR

Least deprived within Aneurin Bevan Aneurin Bevan overall

Produced by Public Health Wales Observatory, using ADDE/MYE (ONS), WIMD 2008 (WAG)

All-cause mortality, under 75, females, European age-standardised rate (EASR) per 100,000, Aneurin Bevan HB and Wales, 2001-09

Rate Ratio - most deprived divided by least deprived


31

3.3 Lifestyle factors

3.3.1 Smoking as reported by adults

24 2225

2225

2226

22 22 23 22 22 24 24 23 25 23 23 23 24 25 24

30

24 2427 26

20

26

Bets

i Cad

wal

adr

Isle

of A

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sey

Gw

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Conw

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Denbig

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ire

Flin

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Wre

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Pow

ys

Pow

ys

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Pem

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Car

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ire

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Bridgend

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diff

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ity

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an

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Mert

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Aneurin B

eva

n

Cae

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y

Bla

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Gw

ent

Torf

aen

Monm

outh

shire

New

port

Adults who reported being a current smoker by local authority and health board, age standardised percentage, 2008-2009Produced by Public Health Wales Observatory using data from the Welsh Health Survey, 2008 and 2009

Wales = 24



32

3.3.2 Binge drinking as reported by adults

27 27 2926 28 27 27 25 25 23 23 22 23

31 30 32 30 29 29 28 29 29 3128 28 29 28 27 29

Bets

i Cad

wal

adr

Isle

of A

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sey

Gw

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Conw

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Denbig

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ire

Flin

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Wre

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Pow

ys

Pow

ys

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da

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Pem

bro

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ire

Car

mar

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Abert

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org

annw

g

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Neat

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Bridgend

Car

diff

& V

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The V

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an

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Mert

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Aneurin B

eva

n

Cae

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Bla

enau

Gw

ent

Torf

aen

Monm

outh

shire

New

port

Adults who reported binge drinking on at least one day in the past week by local authority and health board, age standardised percentage, 2008-2009Produced by Public Health Wales Observatory using data from the Welsh Health Survey, 2008 and 2009

Wales = 28



33

3.3.3 Five or more fruit or vegetables a day as reported by adults

37 3942

37 37 3731

39 39 39 41 39 3834

3733

29

3935

40

29 2832 33 33

2932

3833

Bets

i Cad

wal

adr

Isle

of A

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sey

Gw

ynedd

Conw

y

Denbig

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Flin

tshire

Wre

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Pow

ys

Pow

ys

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da

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Pem

bro

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Car

mar

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Abert

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Sw

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Neat

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ort

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Bridgend

Car

diff

& V

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The V

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an

Car

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af

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Cyn

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Mert

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eva

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Cae

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Bla

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Gw

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Torf

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Monm

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shire

New

port

Adults who reported eating five/more portions fruit/veg the previous day by local authority/health board, age standardised percentage, 2008-2009Produced by Public Health Wales Observatory using data from the Welsh Health Survey, 2008 and 2009

Wales = 36



34

3.3.4 Physical activity as reported by adults

31 3034 33 33

30 28

39 3933 34 36

30 28 27 28 3026

3025 27 27 29 28 28 26 28

3126

Bets

i Cad

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adr

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Gw

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Conw

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Denbig

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Flin

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Wre

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Pow

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Car

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Cyn

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eva

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Cae

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Bla

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Gw

ent

Torf

aen

Monm

outh

shire

New

port

Adults who reported meeting physical activity guidelines in the past week by local authority/health board, age standardised percentage, 2008-2009Produced by Public Health Wales Observatory using data from the Welsh Health Survey, 2008 and 2009

Wales = 29



35

3.3.5 Overweight and obesity, adults based on self reported data

54 56 5752 53 55 52 56 56 59

5462 60 59 57 60 61

55 53 5560 60 60 59 61 63 60

55 58

Bets

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adr

Isle

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Gw

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Conw

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Denbig

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Flin

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Wre

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Pow

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Car

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Abert

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an

Car

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Cw

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af

Rhondda

Cyn

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Mert

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Aneurin B

eva

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Cae

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Bla

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Gw

ent

Torf

aen

Monm

outh

shire

New

port

Adults who were overweight or obese by local authority and health board, age standardised percentage, 2008-2009Produced by Public Health Wales Observatory using data from the Welsh Health Survey, 2008 and 2009

Wales = 57



36

4 Use of services

4.1 Use of services: key points

Childhood immunisations

Childhood immunisation uptake rates show positive long term trends, although remain below target rates in a number of key areas. Immunisations in children under one year of age reach the 95% target. All immunisations scheduled for children in their second year of life do not reach the 95% target, and coverage of immunisations in five year olds and sixteen year olds are also below target; in particular, uptake of the three-in-one booster by sixteen years which is at less than 20 per cent; there have, however, been recent programmatic changes in the delivery of this vaccine in Aneurin Bevan Health Board and coverage, measured through the quarterly COVER report, is expected to increase substantially. MMR vaccine uptake is a particular concern given a large outbreak of measles in Wales in 2009, and ongoing outbreaks in Europe in 2011. Uptakes of one dose of MMR in two year olds and two doses in five year olds have improved since 2005, but a 95% uptake of two doses is needed to eliminate measles in line with WHO goals. Improving uptake of pre-school and teenage immunisation will reduce risk of outbreaks of vaccine preventable diseases in future.

Seasonal influenza vaccination

In Wales, free seasonal influenza immunisation is offered to all people aged 65 years and over, and people between 6 months and 65 years in clinical risk groups (currently chronic respiratory disease, chronic heart disease, chronic renal disease, chronic liver disease, chronic neurological conditions, diabetes mellitus, and immunosuppression), residents of long-stay care homes and those who were the main carer for an elderly or disabled person whose welfare may be at risk if the carer fell ill. For 2009/10 WAG set a target immunisation uptake rate of 70% for people aged 65 years and over. For the 2010/11 seasonal influenza immunisation campaign the national uptake target was raised to the WHO target of 75% uptake in recommended groups. This target was also put in place for those younger than 65 years in ‘at-risk’ groups. During the 2010/11 campaign influenza immunisation was also offered to pregnant women who were not an existing clinical risk group.

Uptake of seasonal influenza immunisation for Aneurin Bevan Health Board in persons aged 65 years and over during 2010/11 was 9% under the target level. In persons aged under 65 years in the at risk groups, uptake during 2010/11 was 25% below the target level.

Population Based National Screening Programmes in Wales

Uptake/coverage rates in Aneurin Bevan Health Board for the national screening programmes for bowel, breast and cervical cancer and newborn hearing screening are generally on a par with or slightly higher than Wales overall. However only rates for cervical screening for ages 25-64 and newborn hearing screening achieve the UK target rates, the other programmes fall slightly short of the targets. Rates in Newport for bowel screening, and Blaenau Gwent and Torfaen for breast cancer screening are noticeably lower than for Wales and the other local authorities within Aneurin Bevan.


37

Primary care services

The latest Welsh Health Survey data show that age-standardised percentages of primary care service use by adults in Aneurin Bevan Health Board are broadly on a par with those for Wales as a whole.

Use of secondary and tertiary care

Age-standardised overall hospital admission rates in persons aged under 75 years for 2009 in Aneurin Bevan Health Board show that overall rates are higher than Wales. For local authority areas within the health board the rate is highest in Blaenau Gwent and lowest in Monmouthshire. Drilling down to the MSOA level there is considerable variation. Rates are lowest in the Devauden; St. Kingsmark; Trellech; Llanishen and Newchurch areas of Monmouthshire, and highest in the Pillgwenlly area of Newport.

Looking at emergency admissions in this age group, the health board rate is above that of Wales and is highest in Blaenau Gwent and Torfaen. At the MSOA level the rate varies greatly (more than for all admissions) with the lowest rates again found the Devauden; St. Kingsmark; Trellech; Llanishen and Newchurch areas of Monmouthshire, and highest in the Pillgwenlly area of Newport. High rates of emergency hospital admission may be indicative of inadequate self-care and primary care services.

The health board elective admission rate is slightly higher that for Wales. The rate is again highest in Blaenau Gwent. At the MSOA level rates are highest in Badminton and Ebbw Vale North areas of Blaenau Gwent. The rates are lowest in the Devauden; St. Kingsmark; Trellech; Llanishen and Newchurch areas of Monmouthshire.


38

4.2 Prevention services: vaccination uptake

Note: Y-axes in the graphs of this section are truncated

4.2.1 Childhood immunisations Routine childhood immunisation Aneurin Bevan Health Board area, trends 2004-2011 Produced by Public Health Wales Vaccine Preventable Disease Programme, from the Public Health Wales COVER reports

Routine childhood immunisation Aneurin Bevan Health Board area, 2011 quarter 1 Produced by Public Health Wales Vaccine Preventable Disease Programme, from the Public Health Wales COVER reports

60

70

80

90

100

2004

120

04 2

2004

320

04 4

2005

120

05 2

2005

320

05 4

2006

120

06 2

2006

320

06 4

2007

120

07 2

2007

320

07 4

2008

120

08 2

2008

320

08 4

2009

120

09 2

2009

320

09 4

2010

120

10 2

2010

320

10 4

2011

1

% u

ptak

e

Cover quarter

5 in 1 at 1yr MMR 1 at 2yrs

MMR2 at 5yrs 4 in 1 at 5 yrs

Men C at 1 yr 95% target

96.6%96.5%96.8%

92.3%92.5%93.9%

87.4%90.1%89.0%

80.2%17.1%

5 in 1 primary by age 1y (3 doses)MenC primary by age 1y (2 doses)PCV primary by age 1y (2 doses)

MMR by age 2y (1st dose)PCV by age 2y (final (3rd) dose)

Hib/MenC booster by age 2yMMR by age 5y (2nd dose)

4 in 1 pre‐school booster by age 5yMMR coverage (1 dose) by age 16yMMR coverage (2 doses) by age 16y3 in 1 Teenage booster by age 16y

Aneurin Bevan HB Summary ‐ COVER98


39

Routine childhood immunisation Blaenau Gwent local authority area, trends 2004-2011 Produced by Public Health Wales Vaccine Preventable Disease Programme, from the Public Health Wales COVER reports

60

70

80

90

10020

04 1

2004

220

04 3

2004

420

05 1

2005

220

05 3

2005

420

06 1

2006

220

06 3

2006

420

07 1

2007

220

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420

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08 3

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420

09 1

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420

10 1

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220

10 3

2010

420

11 1

% u

ptak

e

Blaenau Gwent

5 in 1 at 1yr Men C at 1 yrMMR 1 at 2yrs MMR2 at 5yrs4 in 1 at 5 yrs 95% target


40

Routine childhood immunisation Caerphilly local authority area, trends 2004-2011 Produced by Public Health Wales Vaccine Preventable Disease Programme, from the Public Health Wales COVER reports

60

70

80

90

10020

04 1

2004

220

04 3

2004

420

05 1

2005

220

05 3

2005

420

06 1

2006

220

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2006

420

07 1

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420

08 1

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420

09 1

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09 3

2009

420

10 1

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220

10 3

2010

420

11 1

% u

ptak

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Caerphilly



41

Routine childhood immunisation Monmouthshire local authority area, trends 2004-2011 Produced by Public Health Wales Vaccine Preventable Disease Programme, from the Public Health Wales COVER reports

60

70

80

90

10020

04 1

2004

220

04 3

2004

420

05 1

2005

220

05 3

2005

420

06 1

2006

220

06 3

2006

420

07 1

2007

220

07 3

2007

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08 1

2008

220

08 3

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420

09 1

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220

09 3

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420

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420

11 1

% u

ptak

e

Monmouthshire

5 in 1 at 1yr Men C at 1 yr

MMR 1 at 2yrs MMR2 at 5yrs

4 in 1 at 5 yrs 95% target


42

Routine childhood immunisation Newport local authority area, trends 2004-2011 Produced by Public Health Wales Vaccine Preventable Disease Programme, from the Public Health Wales COVER reports

60

70

80

90

10020

04 1

2004

220

04 3

2004

420

05 1

2005

220

05 3

2005

420

06 1

2006

220

06 3

2006

420

07 1

2007

220

07 3

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08 1

2008

220

08 3

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09 1

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420

10 1

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220

10 3

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420

11 1

% u

ptak

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Newport



43

Routine childhood immunisation Torfaen local authority area, trends 2004-2011 Produced by Public Health Wales Vaccine Preventable Disease Programme, from the Public Health Wales COVER reports

60

70

80

90

10020

04 1

2004

220

04 3

2004

420

05 1

2005

220

05 3

2005

420

06 1

2006

220

06 3

2006

420

07 1

2007

220

07 3

2007

420

08 1

2008

220

08 3

2008

420

09 1

2009

220

09 3

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420

10 1

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220

10 3

2010

420

11 1

% u

ptak

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Torfaen



44

4.2.2 Seasonal influenza vaccination Uptake of seasonal influenza immunisation in Aneurin Bevan Health Board area, 2010/2011 Produced by Public Health Wales Vaccine Preventable Disease Programme, data source: Audit +

Distribution of practice level seasonal influenza immunisation uptake rates (patients aged 65 years and over), Aneurin Bevan Health Board area, 2010/2011 Produced by Public Health Wales Vaccine Preventable Disease Programme, data source: Audit +

Total patients

Patients immunised Uptake (%)

Total patients

Patients immunised Uptake (%)

Blaenau Gwent 13,042 8,246 63.2 8,273 4,180 50.5

Caerphilly 26,709 17,226 64.5 17,740 8,801 49.6

Monmouthshire 14,378 10,299 71.6 6,345 3,542 55.8

Newport 23,946 16,182 67.6 14,812 7,518 50.8

Torfaen 16,542 10,926 66.1 10,352 4,984 48.1

Health Board total 94,617 62,879 66.5 57,522 29,025 50.5

Patients aged 65y and over Patients aged under 65y at risk

30 40 50 60 70 80 90 100Uptake% (65y and over)

TorfaenNewport

MonmouthshireCaerphilly

Blaenau Gwent

Produced by Public Health Wales Vaccine Preventable Disease ProgrammeData source: Audit Plus Data Quality System


45

Distribution of practice level seasonal influenza immunisation uptake rates (patients aged under 65 years at risk), Aneurin Bevan Health Board area, 2010/2011 Produced by Public Health Wales Vaccine Preventable Disease Programme, data source: Audit +

The line inside the shaded box represents the median practice uptake rate (half of the local authority practices have an uptake higher than the median value and half have an uptake lower than the median value). The shaded box represents the spread in uptake rates of the central 50% of practices, this is called the interquartile range. The whiskers extending above and below the shaded box represent the spread in practice uptake rates for the majority of practices within the local authority. Any practices with uptake rates that are very different from the majority of practices within the local authority are termed ‘outliers’ and appear as dots outside the whiskers.

30 40 50 60 70 80 90 100Uptake% (under 65y at risk)

TorfaenNewport

MonmouthshireCaerphilly

Blaenau Gwent

Produced by Public Health Wales Vaccine Preventable Disease ProgrammeData source: Audit Plus Data Quality System


46

4.3 Population Based National Screening Programmes in Wales Screening is a process of identifying apparently healthy people who may be at increased risk of a disease or condition. They can then be offered information, further tests and appropriate treatment to reduce their risk and/or any complications arising from the disease or condition. In the context of screening programmes: Uptake is the proportion of people routinely invited for screening for who a screening test result is recorded within the same invitation episode. Uptake is an important measure of the acceptability of a screening programme. There are minimum uptake standards and targets set for each of the programmes.

Coverage is the proportion of people resident and eligible at a particular point in time who have been screened at least once in a defined time period (dependent on the screening interval of the different programmes).

4.3.1 Uptake of national screening programmes in Wales Uptake of breast, bowel, cervical and newborn screening programme statistics for Aneurin Bevan Health Board area, period 1 April 2009-31 March 2010 compared to all Wales Produced by Screening Division, Public Health Wales

Screening programme

Age range / Test frequency in Wales

UK target rate

Wales rate

Aneurin Bevan

Blaenau Gwent Caerphilly

Monmouth shire Newport Torfaen

Bowel Screening1Currently 60-69 years / every 2 years

Uptake: 60% 55.3% 54.8% 54.7% 55.6% 58.0% 51.1% 54.9%

Breast Screening2 50-70 years / every 3 years

Uptake: Minimum 70%, Target 80%

76.2% 76.3% 70.4% 77.3% 82.8% 74.9% 70.8%

Cervical Screening3

(aged 20-64)20-64 years / every 3 years

Coverage: 80% at 5 years (aged 25-64)

76.2% 78.4% 78.5% 78.0% 80.8% 76.9% 78.9%

Cervical Screening4

(aged 25-64)20-64 years / every 3 years

Coverage: 80% at 5 years (aged 25-64)

79.5% 80.6% 80.4% 80.2% 83.0% 79.6% 81.1%

Newborn Hearing Screening5

Newborn babies / within first month of birth

Uptake: 95% 99.7% 99.8% 99.9% 99.5% 99.6% 99.9% 100.0%

Notes1 Bowel: Uptake of people invited April 2009 to end of March 20102 Breast: uptake stated (of those routinely invited, number screened)3 Cervical (aged 20-64): coverage stated, tested within 5 years4 Cervical (aged 25-64): coverage stated, tested within 5 years - the 25-64 age range allows direct comparison with England5 Newborn: uptake stated (of babies born, number tested)


47

4.4 Primary care services

4.4.1 Use of primary care as reported by adults

Aneurin Bevan Health Board adults who reported particular service use, Welsh Health Survey 2008 & 2009.

Observed per cent

Age-standardised

percentWales

per cent

18 18 18

5 4 5

71 71 7067 67 7050 50 49

6,011 6,011 29,331

(i) Bases vary: those shown are for the whole sample.Age standardised rate is standardised to the Wales population.

Source: Welsh Health Survey 2008 + 2009

Health service useFamily doctor (GP) in the past two weeks

In the past three months: Accident, injury or poisoning needing hospital treatment or a visit to casualty

In the past twelve months: PharmacistDentistOptician

Unweighted base (i)All aged 16+


48

4.5 Use of secondary and tertiary care

4.5.1 Hospital admissions: individuals aged under 75



49

Hospital admissions in Aneurin Bevan Health Board area, persons aged under 75, 2009, European age-standardised rates per 1,000 Produced by Public Health Wales Observatory, using data from NWIS (PEDW), ONS (MYE)

133134140144148148149151151151152154156156157157158162162170173173177180

024020021018006004017023005009013016015022012014019010008007011002001003

MS

OA

Caerphilly

EASR per 1,000


157160163164166173174174177

006002007009008001005003004

MS

OA

Blaenau Gwent

EASR per 1,000

Blaenau EASR = 168

137140142144149149160164

178181183190190

008005013006011012007010009004002001003

MS

OA

Torfaen

EASR per 1,000

Torfaen EASR = 163

128133133135141143149150154161163163168171172174176179188

225

001004012020002009007016006005011008014003017019010015013018

MS

OA

Newport

EASR per 1,000

Newport EASR = 159

113117130132133138138

161161167

186

007009008011004005006010003001002

MS

OA

Monmouthshire

EASR per 1,000


MSOA EASR with 95% confidence interval

Health Board (EASR = 157) Wales (EASR = 145) Local Authority


50

Local authorities

Hospital admissions by local authority, persons aged under 75, 2009, European age-standardised rates per 1,000 Produced by Public Health Wales Observatory, using data from NWIS (PEDW), ONS (M YE)

15

6.8

14

1.4

14

5.8

14

1.0

13

7.1

12

8.0

13

7.6

12

5.7

14

7.5

14

5.0

14

4.8

15

0.0

14

5.5

14

8.2

13

8.7

15

2.0

17

5.5

15

5.2

16

7.7

16

2.5

14

1.9

15

9.2

Isle

of Angle

sey

Gw

yned

d

Con

wy

Den

big

hsh

ire

Flin

tshire

Wre

xham

Pow

ys

Cer

edig

ion

Pem

bro

kesh

ire

Car

mar

then

shire

Sw

anse

a

Nea

th P

ort

Talb

ot

Bridgen

d

The

Val

e of

Gla

mor

gan

Car

diff

Rhon

dda

Cyn

on T

aff

Mer

thyr

Tyd

fil

Cae

rphill

y

Bla

enau

Gw

ent

Torf

aen

Mon

mou

thsh

ire

New

por

t

Wales = 145.1




51

4.5.2 Emergency hospital admissions: individuals aged under 75



52

Emergency hospital admissions in Aneurin Bevan Health Board area, persons aged under 75, 2009, European age-standardised rates per 1,000 Produced by Public Health Wales Observatory, using data from NWIS (PEDW), ONS (MYE)

555959

67686869717273737374767777788182838993100101

024020021023018016006019004022017013015009005010012008014007011003001002

MS

OA

Caerphilly

EASR per 1,000


828384848588899091

006009002008007003001005004

MS

OA

Blaenau Gwent

EASR per 1,000

Blaenau EASR = 86

676767707177788592100102107

116

006008013005012011007010009004002003001

MS

OA

Torfaen

EASR per 1,000

Torfaen EASR = 85

6263636566696973798185878893969798100105

138

020001012004009002016007017006008011005003019014010015013018

MS

OA

Newport

EASR per 1,000

Newport EASR = 83

50535961636367

828388

101

007009008011004005006010003001002

MS

OA

Monmouthshire

EASR per 1,000




53

Local authorities

Emergency hospital admissions by local authority, persons aged under 75, 2009, European age-standardised rates per 1,000 Produced by Public Health Wales Observatory, using data from NWIS (PEDW), ONS (M YE)

70

.9

63

.4

67

.2

68

.1

63

.5

61

.1

55

.3

53

.8

59

.6

62

.3 76

.0

71

.2

65

.2

66

.8

60

.5

76

.9

97

.8

75

.4 86

.4

85

.0

68

.8 83

.4

Isle

of Angle

sey

Gw

yned

d

Con

wy

Den

big

hsh

ire

Flin

tshire

Wre

xham

Pow

ys

Cer

edig

ion

Pem

bro

kesh

ire

Car

mar

then

shire

Sw

anse

a

Nea

th P

ort

Talb

ot

Bridgen

d

The

Val

e of

Gla

mor

gan

Car

diff

Rhon

dda

Cyn

on T

aff

Mer

thyr

Tyd

fil

Cae

rphill

y

Bla

enau

Gw

ent

Torf

aen

Mon

mou

thsh

ire

New

por

t

Wales = 68.5




54

4.5.3 Elective hospital admissions: individuals aged under 75



55

Elective hospital admissions in Aneurin Bevan Health Board area, persons aged under 75, 2009, European age-standardised rates per 1,000 Produced by Public Health Wales Observatory, using data from NWIS (PEDW), ONS (MYE)

727576767777777878808181828384848485868787888892

020021024004017018002009014013005006012015016023001011022010019008007003

MS

OA

Caerphilly

EASR per 1,000


778383838590909194

002008007006009003005001004

MS

OA

Blaenau Gwent

EASR per 1,000

Blaenau EASR = 87

70747777798182838787878891

008011005013012006007010004001002009003

MS

OA

Torfaen

EASR per 1,000

Torfaen EASR = 82

6366687273747575767980808081818284849092

004012001020002007011014009003016006010005019013008015018017

MS

OA

Newport

EASR per 1,000

Newport EASR = 77

56596671727477818183

92

007009011008004006005010003001002

MS

OA

Monmouthshire

EASR per 1,000


Health Board (EASR = 80) Wales (EASR = 77) Local AuthorityMSOA EASR with 95% confidence interval


56

Local authorities

Elective hospital admissions by local authority, persons aged under 75, 2009, European age-standardised rates per 1,000 Produced by Public Health Wales Observatory, using data from NWIS (PEDW), ONS (M YE)

86

.0

77

.9

77

.2

71

.7

72

.2

63

.9 77

.8

68

.6 83

.7

82

.8

71

.6 79

.5

79

.2

79

.9

77

.4

77

.4 84

.4

81

.5

86

.6

81

.6

73

.2

76

.9

Isle

of Angle

sey

Gw

yned

d

Con

wy

Den

big

hsh

ire

Flin

tshire

Wre

xham

Pow

ys

Cer

edig

ion

Pem

bro

kesh

ire

Car

mar

then

shire

Sw

anse

a

Nea

th P

ort

Talb

ot

Bridgen

d

The

Val

e of

Gla

mor

gan

Car

diff

Rhon

dda

Cyn

on T

aff

Mer

thyr

Tyd

fil

Cae

rphill

y

Bla

enau

Gw

ent

Torf

aen

Mon

mou

thsh

ire

New

por

t

Wales = 76.9




57

5 Health status

5.1 Health status: key points

There are consistent general patterns exhibited across the various indices of health status. The east of Aneurin Bevan Health Board has generally poorer levels of health whereas the west of the area has better levels of health than Wales as a whole.

Low birth weight

Low birth weight is associated with poor maternal health and lifestyle and there is increasing evidence to show an association with adverse effects later in life. The percentage of singleton live born babies weighing under 2500g in Aneurin Bevan Health Board is higher than that for Wales. At the MSOA level, the highest percentage by far is found in the Pillgwenlly area of Newport whereas the lowest percentages are seen in Graig; Bassleg and Rogerstone in Newport, Devauden; St. Kingsmark; Trellech; Llanishen and Newchurch areas of Monmouthshire, and the north east (New Inn) area of Pontypool in Torfaen.

Self-reported health status

The Welsh Health Survey contains a number of questions on health status, including the SF36 questionnaire which can be summarised into overall physical and mental health scores. The latest results show that self reported physical and mental health scores are worse in Aneurin Bevan Health Board than in Wales as a whole. At the local authority level, self reported physical and mental health scores are worse in Blaenau Gwent whereas Monmouthshire has scores well above those for Wales. The data also show that Aneurin Bevan Health Board has a higher age-standardised rate of persons reporting a limiting long term illness (which includes problems related to old age) than Wales. At the local authority level, Blaenau Gwent again exhibits the highest self reported rate and Monmouthshire the lowest self reported rate within the health board area. Looking at persons reporting current treatment for a mental health condition, the health board rate is above that for Wales, with Blaenau Gwent and Torfaen having the highest rates of the 22 local authority areas across Wales.

Mortality from specific conditions

Circulatory disease includes heart disease and stroke and is the most common underlying cause of death in Wales. Lifestyle factors such as diet, exercise, alcohol consumption and especially smoking are known to be implicated in circulatory disease. The European age-standardised mortality rate for Aneurin Bevan Health Board is similar to Wales. At the local authority level rates are higher in Blaenau Gwent and Caerphilly and lower in Monmouthshire. At the MSOA level the rate more than doubles between the lowest and highest areas. The lowest rates are found in the Caerwent, Caldicot, Portskewett, Shirenewton and Gaerllwyd areas of Monmouthshire. Conversely the highest rates are seen in the Llechrhyd, Rhymney, Moriah, Pontlottyn and Twyn Carno areas of Caerphilly.


58

Coronary heart disease is a sub-category within circulatory disease and includes heart attacks. Smoking is a major cause of coronary heart disease. The European age-standardised mortality rate for Aneurin Bevan Health Board is slightly higher than Wales. At the local authority level rates are higher in Blaenau Gwent and Caerphilly and lower in Monmouthshire. At MSOA level, once again, variation is high. The pattern is very similar to that for circulatory disease with the lowest rates in the Caerwent; Caldicot; Portskewett; Shirenewton and Gaerllwyd areas of Monmouthshire, and the highest rates seen in the Llechrhyd; Rhymney; Moriah; Pontlottyn and Twyn Carno areas of Caerphilly.

Cancer is the second most common cause of death in Wales. Causes of cancer are multifactorial, varying depending on the site but smoking and other lifestyle factors are important risk factors. The European age-standardised mortality rate for Aneurin Bevan Health Board is similar to Wales. Across the local authorities in the health board area, the highest rate is seen in Blaenau Gwent and the lowest in Monmouthshire. At MSOA level there is significant variation. The lowest rates are located in the Llanover; Llantilio Crossney; Mitchel Troy and Raglan areas of Monmouthshire, and the highest rates in the Pillgwenlly area of Newport.

Respiratory disease is a very common cause of death. Once again, smoking is a major risk factor for respiratory disease. The European age-standardised mortality rate for Aneurin Bevan Health Board is almost identical to Wales, again with the highest rate across the local authority areas being in Blaenau Gwent and the lowest in Monmouthshire. At the MSOA level there is considerable variation with the rate more than trebling between lowest and highest areas. The wider confidence intervals on the caterpillar charts are indicative of the fact that there are fewer respiratory disease deaths than for cancer or circulatory disease. The lowest rates are found in the Mill, Rogiet, The Elms, Llanfihangel and Magor areas of Monmouthshire. The highest rates are in the Llechrhyd, Rhymney, Moriah, Pontlottyn and Twyn Carno areas of Caerphilly.

Cancer survival

Relative survival is the most widely used method in population studies. It is the ratio of the survival observed in the group of cancer patients to the survival that would be expected if they were subject to the same overall mortality rates by age, sex and calendar period as the general population. The expected probabilities are obtained from life tables for Wales that provide the life expectancy of persons for a given year by age and sex. The problems arising with crude survival are therefore overcome. It enables one to measure variations in cancer survival (or its complement, mortality) independently of variations in expected (background) mortality associated with various factors (age and sex in these analyses).The regional data for Wales indicate a steady improvement in one year relative survival for both males and females.

The site-specific one and five year relative survival figures indicate that there is little difference between Aneurin Bevan Health Board and Wales as a whole for the majority of cancer sites. However, there are some exceptions i.e. prostate cancer where the one and five year survival is statistically significantly lower for men and all malignancies (excluding non melanoma skin cancer) where the one and five year survival for men and the one year survival for women are statistically significantly lower.


59

5.2 Physical and mental health

5.2.1 Low birth weight




60

Low birth weight in Aneurin Bevan Health Board area, percentage of singleton live births, 1998-2007 Produced by Public Health Wales Observatory, using data from ONS (ADBE, MYE)

3.74.55.05.15.25.25.35.46.16.26.36.36.36.46.56.56.66.76.97.07.17.37.98.0

024013011014012019010008023005020015009017003021018007002006022004001016

MS

OA

Caerphilly

% low birthweight

Caerphilly %LBW = 6.1

6.37.27.47.97.98.08.18.38.8

002004001003007005009008006

MS

OA

Blaenau Gwent

% low birth weight

Blaenau %LBW = 7.8

5.65.95.96.06.36.97.27.68.0

5.34.5

4.0

3.3005008012004003011007013006002001009010

MS

OA

Torfaen

% low birth weight

Torfaen %LBW = 6.0

4.44.54.64.95.0

5.76.26.36.46.66.66.87.07.1

8.38.48.58.6

3.2

9.7

016007012009020004001006005002017008010015019003014013011018

MS

OA

Newport

% low birth weight

Newport %LBW = 6.8

5.55.86.3

7.7

4.74.6

4.14.1

4.0

3.93.3007

011001009006004003008005010002

MS

OA

Monmouthshire

% low birthweight

Monmouthshire %LBW = 4.9

MSOA Health Board (6.3%) Wales (5.8%) Local AuthorityMSOA % with 95% confidence interval


61

Local authorities

5.4

%

5.0

% 6.0

%

6.0

%

5.3

%

5.4

%

5.0

%

4.4

% 5.5

%

5.6

%

5.5

%

5.7

%

5.7

%

5.5

%

6.2

%

6.5

% 7.6

%

6.1

%

7.8

%

6.0

%

4.9

%

6.8

%

Isle

of A

ngle

sey

Gw

ynedd

Conw

y

Denbig

hsh

ire

Flin

tshire

Wre

xham

Pow

ys

Cere

dig

ion

Pem

bro

kesh

ire

Car

mar

thensh

ire

Sw

anse

a

Neat

h P

ort

Tal

bot

Bridgend

The V

ale o

f G

lam

org

an

Car

diff

Rhondda

Cyn

on T

aff

Mert

hyr

Tyd

fil

Cae

rphill

y

Bla

enau

Gw

ent

Torf

aen

Monm

outh

shire

New

port

Low birth weight by local authority, percentatge of singleton live births, 1998-2007Produced by Public Health Wales Observatory, using data from ONS (ADBE, MYE)

Wales = 5.8%




62

5.2.2 Physical health as reported by adults*

* Y-axis truncated to 45

49.7

49.3

49.2 49

.949

.6 50.3

49.5 49.7

49.7

49.0 49

.749

.848

.148

.1 48.6

47.4 48

.149

.1 49.3

49.0

48.0 48.2

47.5 48

.247

.747

.0 47.7

50.2

48.4

Bets

i Cad

wal

adr

Isle

of A

ngle

sey

Gw

ynedd

Conw

y

Denbig

hsh

ire

Flin

tshire

Wre

xham

Pow

ys

Pow

ys

Hyw

el D

da

Cere

dig

ion

Pem

bro

kesh

ire

Car

mar

thensh

ire

Abert

awe B

ro M

org

annw

g

Sw

anse

a

Neat

h P

ort

Tal

bot

Bridgend

Car

diff

& V

ale U

niv

ers

ity

The V

ale o

f G

lam

org

an

Car

diff

Cw

m T

af

Rhondda

Cyn

on T

af

Mert

hyr

Tyd

fil

Aneurin B

eva

n

Cae

rphill

y

Bla

enau

Gw

ent

Torf

aen

Monm

outh

shire

New

port

Mean SF-36 Physical component summary score by local authority and health board, age standardised rate, 2008-2009Produced by Public Health Wales Observatory using data from the Welsh Health Survey, 2008 and 2009

Wales = 48.8



63

5.2.3 Mental health as reported by adults*

* Y-axis truncated to 45

50.7 51.0

50.7 51.0

50.1

51.2

50.2

51.6

51.6

50.3 51

.351

.349

.349

.549

.749

.1 49.7

49.8 50

.249

.648

.548

.747

.749

.248

.648

.0 48.9

51.0

49.4

Bets

i Cad

wal

adr

Isle

of A

ngle

sey

Gw

ynedd

Conw

y

Denbig

hsh

ire

Flin

tshire

Wre

xham

Pow

ys

Pow

ys

Hyw

el D

da

Cere

dig

ion

Pem

bro

kesh

ire

Car

mar

thensh

ire

Abert

awe B

ro M

org

annw

g

Sw

anse

a

Neat

h P

ort

Tal

bot

Bridgend

Car

diff

& V

ale U

niv

ers

ity

The V

ale o

f G

lam

org

an

Car

diff

Cw

m T

af

Rhondda

Cyn

on T

af

Mert

hyr

Tyd

fil

Aneurin B

eva

n

Cae

rphill

y

Bla

enau

Gw

ent

Torf

aen

Monm

outh

shire

New

port

Mean SF-36 Mental component summary score by local authority and health board, age standardised rate, 2008-2009Produced by Public Health Wales Observatory using data from the Welsh Health Survey, 2008 and 2009

Wales = 49.9



64

5.2.4 Limiting long term illness as reported by adults

25 2724 23 25 24 24 26 26 28

24 2630 30 28

3330

26 26 2629 29 31 29 31 32 31

2529

Bets

i Cad

wal

adr

Isle

of A

ngle

sey

Gw

ynedd

Conw

y

Denbig

hsh

ire

Flin

tshire

Wre

xham

Pow

ys

Pow

ys

Hyw

el D

da

Cere

dig

ion

Pem

bro

kesh

ire

Car

mar

thensh

ire

Abert

awe B

ro M

org

annw

g

Sw

anse

a

Neat

h P

ort

Tal

bot

Bridgend

Car

diff

& V

ale U

niv

ers

ity

The V

ale o

f G

lam

org

an

Car

diff

Cw

m T

af

Rhondda

Cyn

on T

af

Mert

hyr

Tyd

fil

Aneurin B

eva

n

Cae

rphill

y

Bla

enau

Gw

ent

Torf

aen

Monm

outh

shire

New

port

Adults who reported having a limiting long-term illness by local authority and health board, age standardised percentage, 2008-2009Produced by Public Health Wales Observatory using data from the Welsh Health Survey, 2008 and 2009

Wales = 27



65

5.2.5 Mental illness as reported by adult

8 86

89 9

10

7 79

78

10 108

1112

10 10 10

13 13 1311 11

1514

810

Bets

i Cad

wal

adr

Isle

of A

ngle

sey

Gw

ynedd

Conw

y

Denbig

hsh

ire

Flin

tshire

Wre

xham

Pow

ys

Pow

ys

Hyw

el D

da

Cere

dig

ion

Pem

bro

kesh

ire

Car

mar

thensh

ire

Abert

awe B

ro M

org

annw

g

Sw

anse

a

Neat

h P

ort

Tal

bot

Bridgend

Car

diff

& V

ale U

niv

ers

ity

The V

ale o

f G

lam

org

an

Car

diff

Cw

m T

af

Rhondda

Cyn

on T

af

Mert

hyr

Tyd

fil

Aneurin B

eva

n

Cae

rphill

y

Bla

enau

Gw

ent

Torf

aen

Monm

outh

shire

New

port

Adults who reported currently being treated for a mental illness by local authority and health board, age standardised percentage, 2008-2009Produced by Public Health Wales Observatory using data from the Welsh Health Survey, 2008 and 2009

Wales = 10



66

5.3 Mortality from specific conditions

5.3.1 Mortality from circulatory disease, all ages




67

Mortality from circulatory disease in Aneurin Bevan Health Board area, all persons, 2004-08, European age-standardised rates per 100,000 Produced by Public Health Wales Observatory, using data from ONS (ADDE, MYE)

160189193207214215216232232234234237239239240246251253267274285289298311

024016005021020022009013014007008019010023011017006012018002003004015001

MS

OA

Caerphilly

EASR per 100,000


221222226239242268287289290

007009008005004002003001006

MS

OA

Blaenau Gwent

EASR per 100,000

Blaenau EASR = 251

170181182185186187203224224229232237243

005012013006011008004002009010007003001

MS

OA

Torfaen

EASR per 100,000

Torfaen EASR = 204

145145165168174185185190197209216219230241251253255262

289296

016004007009015001006020012002019005008017011013010003018014

MS

OA

Newport

EASR per 100,000

Newport EASR = 210

130148155156163186191202203211216

009006011005004007001010008002003

MS

OA

Monmouthshire

EASR per 100,000




68

Local authorities

19

4.1

20

7.1

21

0.4

21

2.3

21

5.5

21

5.6

18

9.9

17

6.3 21

3.0

23

4.5

21

5.9

21

8.9

22

5.9

19

1.1

19

7.9 23

8.8

25

9.6

23

9.4

25

1.0

20

3.8

17

7.5

21

0.0

Isle

of A

ngle

sey

Gw

ynedd

Conw

y

Denbig

hsh

ire

Flin

tshire

Wre

xham

Pow

ys

Cere

dig

ion

Pem

bro

kesh

ire

Car

mar

thensh

ire

Sw

anse

a

Neat

h P

ort

Tal

bot

Bridgend

The V

ale o

f G

lam

org

an

Car

diff

Rhondda

Cyn

on T

aff

Mert

hyr

Tyd

fil

Cae

rphill

y

Bla

enau

Gw

ent

Torf

aen

Monm

outh

shire

New

port

Mortality from circulatory disease by local authority, all persons, 2004-08, European age-standardised rates per 100,000 Produced by Public Health Wales Observatory, using data from ONS (ADDE, MYE)

Wales = 213.9




69

5.3.2 Mortality from circulatory disease, under 75s




70

Mortality from circulatory disease in Aneurin Bevan Health Board area, all persons aged under 75, 2004-08, European age-standardised rates per 100,000 Produced by Public Health Wales Observatory, using data from ONS (ADDE, MYE)

597578879598100100103103103111116118120121121122126137138141151173

024005009019020014013021008011016006017007018022023010004015012002003001

MS

OA

Caerphilly

EASR per 100,000


108115115117119126136138145

007008005004002009001003006

MS

OA

Blaenau Gwent

EASR per 100,000

Blaenau EASR = 123

73747879858791100116124127

5761

013012011008006005004009002007003010001

MS

OA

Torfaen

EASR per 100,000

Torfaen EASR = 88

677172738291939798109122122127130131140

5443

164

60

009004016012007001020006015008002019005011017014010013003018

MS

OA

Newport

EASR per 100,000

Newport EASR = 94

7682849396102

6158515036009

011006005007004001010002003008

MS

OA

Monmouthshire

EASR per 100,000




71

Local authorities

77

.5

78

.7

81

.8

81

.4

85

.1

86

.7

72

.1

66

.5 87

.1

91

.4

89

.9

96

.0

91

.5

72

.9 87

.0 11

2.3

11

6.9

11

2.2

12

3.3

87

.6

71

.0

94

.5

Isle

of A

ngle

sey

Gw

ynedd

Conw

y

Denbig

hsh

ire

Flin

tshire

Wre

xham

Pow

ys

Cere

dig

ion

Pem

bro

kesh

ire

Car

mar

thensh

ire

Sw

anse

a

Neat

h P

ort

Tal

bot

Bridgend

The V

ale o

f G

lam

org

an

Car

diff

Rhondda

Cyn

on T

aff

Mert

hyr

Tyd

fil

Cae

rphill

y

Bla

enau

Gw

ent

Torf

aen

Monm

outh

shire

New

port

Mortality from circulatory disease by local authority, all persons aged under 75, 2004-08, European age-standardised rates per 100,000 Produced by Public Health Wales Observatory, using data from ONS (ADDE, MYE)

Wales = 89.5




72

5.3.3 Mortality from coronary heart disease




73

Mortality from coronary heart disease in Aneurin Bevan Health Board area, all persons, 2004-08, European age-standardised rates per 100,000 Produced by Public Health Wales Observatory, using data from ONS (ADDE, MYE)

819298105109114117118119125125127129132134137138139139143145145

162187

024021016005019008020012010017022023007013009014003002018011004006015001

MS

OA

Caerphilly

EASR per 100,000


110121123123131138

155164166

008002007005004009003006001

MS

OA

Blaenau Gwent

EASR per 100,000

Blaenau EASR = 135

748290939799113116123126127133135

012005013006011008004009003007002001010

MS

OA

Torfaen

EASR per 100,000

Torfaen EASR = 107

75767883849193949597110112118118129129137139141

161

016004007020009005015012001006002008011019013017010003014018

MS

OA

Newport

EASR per 100,000

Newport EASR = 106

77787878868897110115119

48009011006005004001010007008002003

MS

OA

Monmouthshire

EASR per 100,000




74

Local authorities

93

.5

97

.4

10

1.9

10

5.5

11

5.7

11

8.9

93

.7

86

.8

97

.7

11

1.7

11

1.3

11

7.9

11

2.9

92

.0

94

.6

13

0.1

14

2.1

12

8.7

13

4.6

10

6.7

87

.7 10

6.3

Isle

of A

ngle

sey

Gw

ynedd

Conw

y

Denbig

hsh

ire

Flin

tshire

Wre

xham

Pow

ys

Cere

dig

ion

Pem

bro

kesh

ire

Car

mar

thensh

ire

Sw

anse

a

Neat

h P

ort

Tal

bot

Bridgend

The V

ale o

f G

lam

org

an

Car

diff

Rhondda

Cyn

on T

aff

Mert

hyr

Tyd

fil

Cae

rphill

y

Bla

enau

Gw

ent

Torf

aen

Monm

outh

shire

New

port

Mortality from coronary heart disease by local authority, all persons, 2004-08, European age-standardised rates per 100,000 Produced by Public Health Wales Observatory, using data from ONS (ADDE, MYE)

Wales = 108.4




75

5.3.4 Mortality from cancer




76

Mortality from all cancers in Aneurin Bevan Health Board area, all persons, 2004-08, European age-standardised rates per 100,000 Produced by Public Health Wales Observatory, using data from ONS (ADDE, MYE)

147167167168170177183184188189193194195203204204206212212218218226231246

024007005009011004016020021023019008013018015017012006010014022002003001

MS

OA

Caerphilly

EASR per 100,000


169189192199201208209223235

006002009008003005004001007

MS

OA

Blaenau Gwent

EASR per 100,000

Blaenau EASR = 203

146150164173180181190191192203203206

230

011002005008006001003012013007004009010

MS

OA

Torfaen

EASR per 100,000

Torfaen EASR = 184

133150153159161177181191194195196196208208214229243254257

288

004009012002016007001014011017015005020008013010003006019018

MS

OA

Newport

EASR per 100,000

Newport EASR = 193

114130145151153164174181183183

209

005011003007009004001010008006002

MS

OA

Monmouthshire

EASR per 100,000




77

Local authorities

18

9.6

18

7.2

18

6.3

18

4.3

18

9.2

19

1.2

15

7.4

15

4.2 18

6.4

17

6.9

18

4.1

19

2.2

19

3.2

17

4.4

19

3.6

19

5.5

21

5.4

19

5.0

20

2.8

18

4.5

16

2.2 19

3.4

Isle

of A

ngle

sey

Gw

ynedd

Conw

y

Denbig

hsh

ire

Flin

tshire

Wre

xham

Pow

ys

Cere

dig

ion

Pem

bro

kesh

ire

Car

mar

thensh

ire

Sw

anse

a

Neat

h P

ort

Tal

bot

Bridgend

The V

ale o

f G

lam

org

an

Car

diff

Rhondda

Cyn

on T

aff

Mert

hyr

Tyd

fil

Cae

rphill

y

Bla

enau

Gw

ent

Torf

aen

Monm

outh

shire

New

port

Mortality from all cancers by local authority, all persons, 2004-08, European age-standardised rates per 100,000 Produced by Public Health Wales Observatory, using data from ONS (ADDE, MYE)

Wales = 185.5




78

5.3.5 Mortality from respiratory disease




79

Mortality from respiratory disease in Aneurin Bevan Health Board area, all persons, 2004-08, European age-standardised rates per 100,000 Produced by Public Health Wales Observatory, using data from ONS (ADDE, MYE)

6167687172748285858888909495979899101108111112

136127

43016011024014019022008005023013021004007003009020006012010018017015002001

MS

OA

Caerphilly

EASR per 100,000


7780848791

105110112

123

008003004009005002006007001

MS

OA

Blaenau Gwent

EASR per 100,000

Blaenau EASR = 95

49

58727378798183919798107

55008012011005007002003013004009006001010

MS

OA

Torfaen

EASR per 100,000

Torfaen EASR = 78

48495050

61666770717576788085858888888898

001004009016007015020002005008017019014010003012006013011018

MS

OA

Newport

EASR per 100,000

Newport EASR = 71

485859637278

34

474443

41011005004009008006010001002007003

MS

OA

Monmouthshire

EASR per 100,000




80

Local authorities

71

.1

64

.8

62

.9 72

.9

79

.5 93

.5

64

.0

55

.1

58

.7

81

.7

77

.5 85

.5

85

.1

76

.7

74

.3

97

.7

99

.1

89

.8

94

.9

77

.7

54

.2 71

.4

Isle

of A

ngle

sey

Gw

ynedd

Conw

y

Denbig

hsh

ire

Flin

tshire

Wre

xham

Pow

ys

Cere

dig

ion

Pem

bro

kesh

ire

Car

mar

thensh

ire

Sw

anse

a

Neat

h P

ort

Tal

bot

Bridgend

The V

ale o

f G

lam

org

an

Car

diff

Rhondda

Cyn

on T

aff

Mert

hyr

Tyd

fil

Cae

rphill

y

Bla

enau

Gw

ent

Torf

aen

Monm

outh

shire

New

port

Mortality from respiratory disease by local authority, all persons, 2004-08, European age-standardised rates per 100,000 Produced by Public Health Wales Observatory, using data from ONS (ADDE, MYE)

Wales = 77.0




81

5.3.6 Cancer survival One year relative survival, all cancer (excluding non melanoma skin cancer), males, Wales regions, all persons, 1994/6-2006/8 Produced by the Welsh Cancer Intelligence and Surveillance Unit

1994‐1996 1997‐1999 2000‐2002 2003‐2005 2006‐2008

Wales 53.07 56.24 60.98 64.45 66.93

North Wales 54.26 56.20 62.52 65.26 68.74

South Wales 52.69 56.26 60.46 64.19 66.34

50

55

60

65

70

75

80

85

90

95

100

One

year relative

survival (%

)


82

One year relative survival, all cancer (excluding non melanoma skin cancer), females, Wales regions, all persons, 1994/6-2006/8 Produced by the Welsh Cancer Intelligence and Surveillance Unit

1994‐1996 1997‐1999 2000‐2002 2003‐2005 2006‐2008

Wales 62.00 64.20 66.21 68.65 70.18

North Wales 62.01 64.06 64.97 68.36 71.61

South Wales 61.99 64.25 66.61 68.74 69.71

50

55

60

65

70

75

80

85

90

95

100

One

year relative

survival (%

)


83

One year and five year relative survival, by cancer site Aneurin Bevan Health Board area, males and females, 2000-2004 (95% confidence intervals) Produced by the Welsh Cancer Intelligence and Surveillance Unit Male

1 year relative survival Cancer Site Aneurin Bevan All Wales Prostate 84.39 (81.92, 86.55) 88.80 (87.95, 89.59) Lung 20.67 (18.23, 23.22) 22.84 (21.71, 24.00) Colorectal 67.98 (64.57, 71.14) 71.51 (70.12, 72.85) Bladder 88.42 (84.67, 91.30) 86.10 (84.51, 87.53) All malignancies (excl NMSC) 58.70 (57.40, 59.98) 62.11 (61.57, 62.63)

5 year relative survival Cancer Site Aneurin Bevan All Wales Prostate 72.05 (68.49, 75.28) 77.17 (75.83, 78.45) Lung 4.92 (3.62, 6.50) 5.36 (4.73, 6.04) Colorectal 44.29 (40.40, 48.09) 48.59 (46.91, 50.24) Bladder 73.75 (68.11, 78.56) 72.34 (70.04, 74.50) All malignancies (excl NMSC) 41.79 (40.37, 43.21) 45.39 (44.79, 45.99)

Female 1 year relative survival

Cancer Site Aneurin Bevan All Wales Breast 93.39 (91.94, 94.59) 93.41 (92.83, 93.94) Lung 26.21 (23.00, 29.53) 25.53 (24.09, 26.99) Colorectal 66.49 (62.42, 70.24) 68.80 (67.19, 70.36) Ovary 58.66 (52.86, 63.99) 63.92 (61.50, 66.24) Corpus Uteri 87.63 (82.18, 91.50) 89.83 (87.90, 91.46) All malignancies (excl NMSC) 65.41 (64.14, 66.65) 67.24 (66.71, 67.76)

5 year relative survival Cancer Site Aneurin Bevan All Wales Breast 82.09 (79.87, 84.10) 82.06 (81.14, 82.94) Lung 5.91 (4.28, 7.90) 6.85 (6.00, 7.76) Colorectal 47.21 (42.67, 51.60) 49.18 (47.31, 51.01) Ovary 35.20 (29.67, 40.76) 39.29 (36.78, 41.80) Corpus Uteri 74.74 (67.75, 80.44) 77.77 (75.02, 80.25) All malignancies (excl NMSC) 50.81 (49.39, 52.20) 52.76 (52.17, 53.36)

Excl NSCM: Excluding non melanoma skin cancer


84

Appendix A: Original source reports and further information

The original reports for the data included in this chart book, together with further information and, in some cases, methodological information and other guides to interpretation can be found through the producers of the charts, tables or data included:

Demography Public Health Wales Observatory www.publichealthwalesobservatory.wales.nhs.uk

Determinants of health

Public Health Wales Observatory www.publichealthwalesobservatory.wales.nhs.uk

Use of prevention services: vaccination uptake

Vaccine Preventable Disease Programme

http://www.wales.nhs.uk/sitesplus/888/page/43510

Use of prevention services: screening

Public Health Wales Screening Services

http://www.screeningservices.org.uk/

Use of primary care by adults

Welsh Assembly Government, Welsh Health Survey

http://new.wales.gov.uk/

Use of secondary and tertiary care

Public Health Wales Observatory www.publichealthwalesobservatory.wales.nhs.uk

Health status Public Health Wales Observatory www.publichealthwalesobservatory.wales.nhs.uk

Cancer survival Welsh Cancer Surveillance and Intelligence Unit

http://www.wales.nhs.uk/sites3/home.cfm?OrgID=242


85

Appendix B: Glossary

Middle Super Output Areas

Middle super output areas (MSOAs) were released by the Office for National Statistics (ONS) in 2004. In contrast with administrative boundaries such as electoral divisions (wards), super output areas were created for the purpose of showing statistical data.

MSOAs have a mean population of 7,500 and a minimum of 5,000. There are 413 MSOAs in Wales and 77 MSOAs in the Aneurin Bevan Health Board area. These are shown on the maps in Appendix 2.

The ONS have stated that super output area geographies will be fixed for at least 10 years. The advantage of using these statistical geographies is stability and homogeneity. However, the main drawback is that they do not conform to known administrative boundaries such as electoral divisions (wards); this makes them less amenable to the public and local government.

Age-standardised rate

Age-standardisation allows comparison of rates across different populations while taking account of the different age structures of those populations.

This chart book uses the direct standardisation method, which produces the rate you would get if the population had the same age-structure as a particular ‘standard’ population.

The Wales standard population has been used for the Welsh Health Survey indicators and the theoretical European standard population (ESP) has been used for all other age-standardised indicators included in this chart book.

An age-standardised rate only allows for comparison between the rates which have been standardised to the same standard population.

Confidence intervals

Confidence intervals are indications of the random variation that would be expected around a rate. Confidence intervals must be considered when assessing or interpreting a rate. The 95% confidence interval represents a range which has a 95% probability of including the underlying population rate.

The range of the confidence interval is dependent on the size of the population from which the events came. Rates based on small populations are likely to have wider confidence intervals and rates based on large populations are likely to have narrower confidence intervals.

Statistical significance

A result may be deemed statistically significant if it is considered unlikely to have occurred by chance alone. The basis for such judgements is a predetermined and arbitrary cut-off, usually taken as 5% or 0.05. A result may be clinically significant whilst not being statistically significant and vice versa.


86

Appendix C: Maps showing Middle Super Output Areas in the Aneurin Bevan Health Board area

The Public Health Wales Observatory has also produced a web-based interactive map showing MSOA boundaries, with the added facility of background Ordnance Survey mapping. Follow this link: http://www2.nphs.wales.nhs.uk/InstantAtlas/GeographyTool/atlas.html Caerphilly

A Caerphilly 001 G Caerphilly 007 M Caerphilly 013 S Caerphilly 019B Caerphilly 002 H Caerphilly 008 N Caerphilly 014 T Caerphilly 020C Caerphilly 003 I Caerphilly 009 O Caerphilly 015 U Caerphilly 021D Caerphilly 004 J Caerphilly 010 P Caerphilly 016 V Caerphilly 022E Caerphilly 005 K Caerphilly 011 Q Caerphilly 017 W Caerphilly 023F Caerphilly 006 L Caerphilly 012 R Caerphilly 018 X Caerphilly 024


87

Blaenau Gwent

A Blaenau Gwent 001B Blaenau Gwent 002C Blaenau Gwent 003D Blaenau Gwent 004E Blaenau Gwent 005F Blaenau Gwent 006G Blaenau Gwent 007H Blaenau Gwent 008I Blaenau Gwent 009


88

Torfaen

A Torfaen 001 H Torfaen 008B Torfaen 002 I Torfaen 009C Torfaen 003 J Torfaen 010D Torfaen 004 K Torfaen 011E Torfaen 005 L Torfaen 012F Torfaen 006 M Torfaen 013G Torfaen 007


89

Monmouthshire

A Monmouthshire 001 G Monmouthshire 007B Monmouthshire 002 H Monmouthshire 008C Monmouthshire 003 I Monmouthshire 009D Monmouthshire 004 J Monmouthshire 010E Monmouthshire 005 K Monmouthshire 011F Monmouthshire 006


90

Newport

A Newport 001 K Newport 011B Newport 002 L Newport 012C Newport 003 M Newport 013D Newport 004 N Newport 014E Newport 005 O Newport 015F Newport 006 P Newport 016G Newport 007 Q Newport 017H Newport 008 R Newport 018I Newport 009 S Newport 019J Newport 010 T Newport 020

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