Introduction to Primary Data Sources Stuart Harris Public Health Intelligence Analyst Course – Day 2

2 In this session… Primary data sources Differences between record-level and aggregate data Some examples of primary data (births, deaths, HES) Simple sources of pre-calculated data (Compendium, NeSS) Confidentiality Codes and lookups More specialist data sources (reference and links) Introduction to primary data sources

3 Data through our lives Census; local authority data; deprivation indices; surveys PH mortality file; vital statistics; compendium PH births file; vital statistics; compendium Inpatient data (SUS; HES); GP data; community information systems; screening uptake (IC) Healthcare + immunisations uptake; maternity data; HV needs assessment Introduction to primary data sources

4 Some data sources for public health Data types 1. Person-based 2. Aggregate 3. More complex tools - Health Profiles, Slope Index, etc, 4. Codes and lookups Introduction to primary data sources

5 Person-based data Only available under confidentiality agreements to appropriate organisations Individual records. E.g. - Births - Mortality - HES - A&E attendances May be anonymised Record linkage increasingly difficult May or may not have NHS number Confidentiality issues Introduction to primary data sources

6 Common characteristics Each line is one patient/episode of care Usually includes: relevant dates eg birth, death, admission geographical data eg postcode, LA appropriate details of event e.g. COD, underlying cause of death, place of death, diagnosis, procedure Some socioeconomic data may be inferred Introduction to primary data sources

7 ONS mortality file – some fields Date of BirthDate of registration Date of DeathSex AgeCauses of death (15 occurrences) Age Unit (1=years, 2=months, 3=weeks, 4=days) Underlying cause of death (non- neonatal) Postcode of residenceSecondary cause of death Communal Establishment Code (H=Home, E=Elsewhere Neonatal indicator Establishment where death occurredCountry of place of birth Place of residence (LA, Ward, Region) Standard Occupation Classification LA place of deathPlace of death Introduction to primary data sources

8 HES has many more fields Refer to data dictionary for full list: Introduction to primary data sources

9 Aggregate data For example: HSCIC Indicator Portal Neighbourhood Statistics (NeSS) ONS births/deaths statistics These do not include individual data Rates already calculated Quick for standard queries More examples in complex tools session later… Introduction to primary data sources

10 HSCIC Indicator Portal Contains a variety of indicator sets, including; Clinical Commissioning Group Indicators Compendium of Population Health Indicators Local Basket of Inequalities Indicators GP Practice Data Social Care Indicators NHS Outcome Framework Indicators Collections of Excel spreadsheets Introduction to primary data sources

11 HSCIC Indicator Portal or (NHS version) Contains hundreds of Excel spreadsheets Compendium is best collection of data on health and disease (including mortality rates) LBOI indicators cover wider determinants Introduction to primary data sources

12 HSCIC Indicator Portal Introduction to primary data sources

13 Neighbourhood Statistics (NeSS) NeSS established in 2001 ( Contains over 300 datasets, covering Health, Housing, Education, Deprivation, Age, Ethnicity and Census data Around 1 billion counts of information, to neighbourhood level On-line guidance available to help users through the site Can search by postcode or area of interest, down to small area geographies Introduction to primary data sources

14 Neighbourhood Statistics site Introduction to primary data sources

15Introduction to primary data sources

16 NOMIS NOMIS website presents official labour market statistics ( Can obtain profiles by local authority and ward Alternatively, can construct more detailed queries Good source for benefits (job seekers, Incapacity Benefit, Employment and Support Allowance) Also good source from which to extract Census data Introduction to primary data sources

17Introduction to primary data sources

18 Confidentiality ONS releases data under one of two acts: National Health Service Act 1977 (Section 124A as amended by the Health Act 1999) Census Act 1920 (Section 5) Data supplied under confidentiality declarations No statistics may be published which will reveal personal information In practice this means no numbers under 5 (including 0’s) Avoid indirect disclosure (disclosure by differencing) e.g. subtracting males from a total will reveal that the count for females is under 5 Introduction to primary data sources

19 Confidentiality Methods that can be used to protect tables: Table re-design Grouping categories within a table Aggregating across a number of time periods Using a higher level of geography Suppression Suppression of rows and/or columns Suppression of cells In both row and cell suppression, some secondary suppression is usually necessary Introduction to primary data sources

20 Codes and lookups Gridlink (NHS Postcode Directory) Index of Multiple Deprivation ICD-10 OPCS 4 Ward History Database (ONS) UK Statistical Geographies database (ONS) Introduction to primary data sources

21 Gridlink postcode file Background information - hs_postcode_directory.asp?shownav=1 Download – N3 connection required Fields include: Postcode (8 character) Easting and Northing (for mapping) County / District / Ward / Region / SHA / PCT OA / LSOA / MSOA Urban/rural indicator Cancer registry / cancer network Introduction to primary data sources

22 Index of Multiple Deprivation 2010 Distinct dimensions of deprivation which can be recognised and measured separately. These are experienced by individuals living in an area. People may be counted in one or more of the domains, depending on the number of types of deprivation that they experience. Introduction to primary data sources

23 Domains of Index of Multiple Deprivation 2010 Introduction to primary data sources

24 Extract from IMD Introduction to primary data sources

25 IMD 2010 For every indicator: Figures derived at LSOA level Rank 1 is the most deprived LSOA in England Updated set using 2011 LSOAs available for some domains Ward scores and ranks are calculated (unofficially) Local Authority summaries calculated (officially) Introduction to primary data sources

26Introduction to primary data sources

27 ICD 10; chapter headings Introduction to primary data sources

28 C33-C34 Lung cancer C43 Skin cancer C91-C95 Leukaemia E10-E14 Diabetes G30 Alzheimer’s disease I20-I25 Ischaemic heart diseases I60-I69 Stroke J12-J18 Pneumonia W58 Bitten or struck by crocodile or alligator ICD 10; some common categories Introduction to primary data sources

29 OPCS4 – Classification of surgical operations and procedures Used to describe procedures in HES Different versions available (4.7 is current) E-version available from HSCIC (need to register); Introduction to primary data sources

30 OPCS4 – Classification of surgical operations and procedures A - Nervous System B - Endocrine System and Breast C - Eye D - Ear E - Respiratory Tract F - Mouth G - Upper Digestive Tract H - Lower Digestive Tract J - Other Abdominal Organs - principally digestive K - Heart L - Arteries and Veins M - Urinary Introduction to primary data sources

31 Other disease classifications Read (primary care) SNOMED (Systematic Nomenclature of Medicine) ICF (International Classification of Functioning, Disability and Health) Introduction to primary data sources

32 Elementary record linkage If you have a common field in two sets of records you can link records eg NHS number (link HES and mortality records) – with permission! Postcode (link mortality to Gridlink to IMD for Super Output Area (LSOA) deprivation scores) Introduction to primary data sources

33 Principles of record linkage Admissions numbers Quintile Quintile Quintile Quintile Quintile population Rate 000 HES record ID procedure postcode XX1 2XX Gridlink Postcode SOA XX1 2XX YYYYYYY IMD SOA IMD score quintile YYYYYY ZZZZZ 5 / = Introduction to primary data sources

34 Other useful data sources There are many sources of special data (which we can’t cover here) including: Infectious diseases ( Cancer- your local cancer registry ( Sexual health ( and Child and maternity health ( Obesity ( Introduction to primary data sources

35 What we have covered Differences between record-level and aggregate data Some examples of primary data (births, deaths, HES) Simple sources of pre-calculated data (HSCIC, NeSS, NOMIS) Confidentiality Codes and lookups Specialist data sources (reference and links) Introduction to primary data sources