Investigation Response Team: Descriptive Health Data

1. Investigation Response Team: Descriptive Health Data 9 December 2010 Dr C Humphreys and Dr R Salmon Dr C Humphreys and Dr R Salmon

2. Overview • Background • Aims • What we did • What we found • Summary Dr C Humphreys and Dr R Salmon

3. Background • Health concerns raised by communities • Variety of conditions • Variety of areas • Amount of ill health compared to normal • Premature illness & mortality • Infant illness & mortality Dr C Humphreys and Dr R Salmon

4. Aims • Describe health in vicinity of cement works using routinely available data • Put in context of N Wales & Wales • Focus on initial concerns: • General health or ill health • Levels of cancer • Levels of respiratory disease • Illness or death at a younger age • NOT ‘cause and effect’ Dr C Humphreys and Dr R Salmon

5. What we did • Select a geography • Small area to show detail • Large enough population for robust, reliable results Dr C Humphreys and Dr R Salmon

6. Focus on seven MSOAs Dr C Humphreys and Dr R Salmon

7. Health information • 21 indicators • Used • Births & deaths data • Health service hospital admissions • Registry data • Not used • Primary care • Survey data • Infant mortality • 2008: 147 in Wales; 7 in Flintshire Dr C Humphreys and Dr R Salmon

8. Statistics • Rate • The number of (e.g. deaths) per 100,000 people • Age standardised • Allow for differences in age structure • Confidence intervals • How much rate is influenced by random factors • Statistical significance • Rate unlikely to be as different from all-Wales rate due to chance alone • False positives & false negatives Dr C Humphreys and Dr R Salmon

9. Alcohol Health care Work environment Tobacco Physical activity Illicit drugs Factors affecting health & health measures General Socio economic, Cultural and environmental conditions Living & working conditions Traffic Education Family & community networks Agriculture & food Lifestyle Housing Eatinghabits Employ- ment Social support Age, sex, heredity Social network Based on Dahlgren & Whitehead, Lancet, 1991; & Beth Hammarström Dr C Humphreys and Dr R Salmon

10. Cancer 1 in 3 lifetime risk 28% of deaths Different cancers have different risk factors Tobacco; diet; infectious agents Association with deprivation variable Respiratory illness 14% of deaths Chronic obstructive pulmonary disease Association with tobacco smoke exposure Asthma Causes less certain Allergen exposure Deaths are rare About cancer & respiratory illness Dr C Humphreys and Dr R Salmon

11. What we found • Deprivation analyses • Some examples of indicators • Summary Dr C Humphreys and Dr R Salmon

12. Deprivation Dr C Humphreys and Dr R Salmon

13. All cause mortality <75 years Dr C Humphreys and Dr R Salmon

14. The same information, a different way All cause mortality < 75 years Dr C Humphreys and Dr R Salmon

15. Emergency admissions for COPD, < 75 years Dr C Humphreys and Dr R Salmon

16. This information in a different way Emergency COPD admissions < 75 years Dr C Humphreys and Dr R Salmon

17. Emergency admissions for asthma, <75 years Dr C Humphreys and Dr R Salmon

18. This information in a different way Emergency asthma admissions < 75 years Dr C Humphreys and Dr R Salmon

19. All cancer incidence, all ages Dr C Humphreys and Dr R Salmon

20. This information in a different way All cancer incidence, all ages Dr C Humphreys and Dr R Salmon

21. All cancer mortality, all ages Dr C Humphreys and Dr R Salmon

22. This information in a different way All cancer mortality, all ages Dr C Humphreys and Dr R Salmon

23. Dr C Humphreys and Dr R Salmon

24. Some context • Expect some ‘better’ & some ‘worse’ in any community because: • One in 20 analyses expected green/red due to chance AND • 147 analyses were undertaken • Some indicators are ‘better’ • Cancer • Incidence is worse in one area (MSOA Flintshire 020) BUT • Includes diverse cancer types that have many different risk factors • All cancer mortality pattern different • Two MSOAs around plant have lower than typical for Wales • Further work on cancer incidence ongoing Dr C Humphreys and Dr R Salmon

25. Summary • Routine information suggests, compared to Wales, in the areas around the plant • Health is generally as good or better • Incidence & mortality from cancer is generally similar • Respiratory disease (hospital admissions & mortality) is generally as good or better • One indicator, all cause cancer incidence, is statistically significantly high in one area BUT all cause cancer mortality is not • The factors that contribute to the levels of health measured are complex • Deprivation is likely to contribute to the levels of health seen Dr C Humphreys and Dr R Salmon