South West Public Health Observatory The work of the South West Public Health Observatory on End of Life care SEPHIG January 2011 Andy Pring

South West Public Health Observatory My plan.... Some background Some history Recent patterns in –Cause of death –Place of death –Deprivation –Hospital statistics

South West Public Health Observatory End of Life Care Strategy (DH 2008) Raising the profile Strategic commissioning Identify people in need of EOLC Care planning Coordination of care Rapid access to care Delivery of high quality services Last days of life & care after death Involving and supporting carers Education and training Measurement and research Funding

South West Public Health Observatory National end of life care Intelligence Network

South West Public Health Observatory Work so far End Of Life Profiles (interactive maps) Compendium of data resources Place of Death Deaths from Neurological disease Deaths of Dementia, Alzheimers Disease and Senility Deaths from Renal Disease Deaths in Older Adults Together with some previous work including End of Life Care for Cancer Patients in the South West: Trends in hospital care, place and cause of death summary

South West Public Health Observatory End Of Life Care Profiles

South West Public Health Observatory “Death in old age is inevitable, but death before old age is not” Richard Doll

South West Public Health Observatory Some History...

South West Public Health Observatory Longer life Source : A Century of Change: House of Commons research paper 99/111 (1999)

South West Public Health Observatory Projected population of people aged 75 and over by age group, England, 2008– based National Population Projections Source: South West Public Health Observatory from Office for National Statistics data

South West Public Health Observatory Source : A Century of Change: House of Commons research paper 99/111 (1999) Changing numbers of births and deaths

South West Public Health Observatory Deaths in England and Wales Source : Gomes and Higginson; Where people die (1974–2030): past trends, future projections and implications for care., Palliative Medicine 2008; 22: 33–41

South West Public Health Observatory Source : A Century of Change: House of Commons research paper 99/111 (1999) Changing causes of death

South West Public Health Observatory Cause of Death

South West Public Health Observatory Trend in cause of death, England Source: South West Public Health Observatory from Office for National Statistics data

South West Public Health Observatory Trend in cause of death, England Male Female Source: South West Public Health Observatory from Office for National Statistics data

South West Public Health Observatory Cause of death by age England : Source SWPHO from ONS

South West Public Health Observatory External causes of death – important for younger people

South West Public Health Observatory Deaths, non-cancer, by age - England Source: South West Public Health Observatory from Office for National Statistics data

South West Public Health Observatory Deaths, cancer,by age - England Source: South West Public Health Observatory from Office for National Statistics data

South West Public Health Observatory Place of death

South West Public Health Observatory Place of death trend - Counts

South West Public Health Observatory Place of death trend – Percentages

South West Public Health Observatory Place of death trend – Combine home, care home and nursing home

South West Public Health Observatory Measure for proportion of deaths in hospital Crude Age standardised proportion – using ESP Age standardised – using recent national age profile of deaths Ratio of “ASR”s : ASRH / ASRA ASRH : numerators: Number hospital deaths denominators : Living population ASRA : numerators: Total deaths denominators : Living population both using ESP as weights

South West Public Health Observatory Place of death, , England

South West Public Health Observatory Place of death; non-cancer causes

South West Public Health Observatory Place of death – cancer

South West Public Health Observatory Deprivation Deaths in England,

South West Public Health Observatory Deprivation and place of death Hospice deaths

South West Public Health Observatory Deprivation and deaths in hospital, by LA

South West Public Health Observatory Deprivation, cause of death

South West Public Health Observatory Deprivation, cause of death

South West Public Health Observatory Deprivation, cause of death

South West Public Health Observatory Hospital episode statistics

South West Public Health Observatory Number and proportion of deaths in hospital with a <3 day admission before death by disease group and type of admission, Source : SWPHO from Hospital Episode Statistics

South West Public Health Observatory Cancer patients - Time spent in hospital in 6 months before end of life Source : Hospital Episode Statistics

South West Public Health Observatory Cancer patients on HES Source : Hospital Episode Statistics; South West England

South West Public Health Observatory Cancer patients on HES Source : Hospital Episode Statistics; South West England

South West Public Health Observatory To Conclude End of life care strategy Increasing number of deaths Greater proportion elderly at death More pressure on EOLC services

South West Public Health Observatory

Proportion of deaths from breast, colorectal, lung and prostate cancer by age in older adults, England 2007–09 Source: South West Public Health Observatory from Office for National Statistics data

South West Public Health Observatory Distribution of deaths by age (2008) All deaths Deaths from cancer

South West Public Health Observatory Deaths from breast, colorectal, lung and prostate cancer: average deaths per year, England 2007–09 Labels give proportions of all deaths. Source: South West Public Health Observatory from Office for National Statistics data

South West Public Health Observatory Deaths from breast, colorectal, lung and prostate cancer by sex: average deaths per year, England 2007–09 Labels give proportions of deaths in males and females. Source: South West Public Health Observatory from Office for National Statistics data

South West Public Health Observatory Deaths from breast, colorectal, lung and prostate cancer by age, average deaths per year England 2007–09 Source: South West Public Health Observatory from Office for National Statistics data

South West Public Health Observatory Underlying cause of death by age, England, 2005–07 Source: South West Public Health Observatory from Office for National Statistics data

South West Public Health Observatory Ten most common causes of death, England 2007–09 ICD-10 codeDescription Deaths per year % deaths I25Chronic ischaemic heart disease 43,4509.3% C34Malignant neoplasm of bronchus and lung 27,9656.0% I21Acute myocardial infarction 27,1625.8% J18Pneumonia, organism unspecified 25,8745.5% J44Other chronic obstructive pulmonary disease 21,1214.5% I64Stroke, not specified as haemorrhage or infarction 20,0684.3% F03Unspecified dementia 14,5063.1% I67Other cerebrovascular diseases 10,1432.2% C50Malignant neoplasm of breast 9,9982.1% C80Malignant neoplasm without specification of site 8,9341.9% All causes 468,574 Source: South West Public Health Observatory from Office for National Statistics data

South West Public Health Observatory Ten most common causes of death, people aged 75 and over, England 2006–08 Description Deaths per year% deaths I25: Chronic ischaemic heart disease31, % J18: Pneumonia, organism unspecified23,0857.4% I21: Acute myocardial infarction19,3446.2% I64: Stroke, not specified as haemorrhage or infarction18,8786.0% J44: Other chronic obstructive pulmonary disease14,7114.7% C34: Malignant neoplasm of bronchus and lung13,2784.2% F03: Unspecified dementia12,9554.1% I67: Other cerebrovascular diseases9,1542.9% R54: Senility8,8552.8% I50: Heart failure7,0492.2% Total (ten most common causes)158, % All causes313,942 Source: South West Public Health Observatory from Office for National Statistics data

South West Public Health Observatory Number of deaths per year, England 2005–07 As an underlying cause: 130,181 (27.4%) from cancer (malignant, benign and in- situ neoplasms) 150,034 (31.6%) from cardiovascular disease 128,649 (27.1%) from ‘other’ causes 65,854 (13.9%) from respiratory disease 33% of deaths had cancer mentioned on the death certificate

South West Public Health Observatory Proportion of deaths with a cancer cause England Source: South West Public Health Observatory from Office for National Statistics data

South West Public Health Observatory Proportion of deaths from breast, colorectal, lung and prostate cancer by age, England 2007–09 Source: South West Public Health Observatory from Office for National Statistics data

South West Public Health Observatory Ten most common causes of cancer death, England 2007–09 ICD-10 codeDescription Deaths per year % of all deaths C34Malignant neoplasm of bronchus and lung 27,9656.0% C50Malignant neoplasm of breast 9,9982.1% C80Malignant neoplasm without specification of site 8,9341.9% C61Malignant neoplasm of prostate 8,6991.9% C18Malignant neoplasm of colon 8,1961.7% C25Malignant neoplasm of pancreas 6,5311.4% C15Malignant neoplasm of oesophagus 6,1021.3% C16Malignant neoplasm of stomach 4,1750.9% C67Malignant neoplasm of bladder 4,1740.9% C56Malignant neoplasm of ovary 3,4790.7% All causes 468,574 Source: South West Public Health Observatory from Office for National Statistics data

South West Public Health Observatory Place of death by cause: average number of deaths per year, England 2005–07 Source: South West Public Health Observatory from Office for National Statistics

South West Public Health Observatory Place of death by cause: proportion of deaths in each place, England 2005–07 Source: South West Public Health Observatory from Office for National Statistics

South West Public Health Observatory Place of cancer death by Government Office Region: proportion of cancer deaths, England 2005–07 Source: South West Public Health Observatory from Office for National Statistics

South West Public Health Observatory Place of death for breast, colorectal, lung and prostate cancer: proportion of deaths in each place, England 2007–09 Source: South West Public Health Observatory from Office for National Statistics

South West Public Health Observatory Underlying cause of death in males and females, England 2005–07 Source: South West Public Health Observatory from Office for National Statistics data

South West Public Health Observatory Place of death from cancer by age: proportion of cancer deaths*, England 2007–09 *including benign and in situ Source: South West Public Health Observatory from Office for National Statistics

South West Public Health Observatory Cause of death by deprivation, England 2005–07 IMD 2007=Index of Multiple Deprivation 2007 Source: South West Public Health Observatory from Office for National Statistics and Communities and Local Government data

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South West Public Health Observatory Underlying cause of death by sex in older people: Average number of deaths per year by underlying cause and sex in people aged 75 and over, England 2006–08 Labels give proportions of deaths from each cause in males and females. Source: South West Public Health Observatory from Office for National Statistics data

South West Public Health Observatory Underlying cause of death by age, older people: Proportion of deaths in people aged 75 and over, England 2006–08 Source: South West Public Health Observatory from Office for National Statistics data

South West Public Health Observatory Underlying cause of death by age and sex: Proportion of deaths in age group by sex, England, 2005–07 Source: South West Public Health Observatory from Office for National Statistics data

South West Public Health Observatory Underlying cause of death by age and sex in older adults: Proportion of deaths in people aged 75 and over in England, 2006–08 Males Females

South West Public Health Observatory Deaths by age, all causes, England 2008 Source: South West Public Health Observatory from Office for National Statistics data

South West Public Health Observatory Cancer deaths by age, England 2008 Source: South West Public Health Observatory from Office for National Statistics data