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

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

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

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

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

Focus on seven MSOAs Dr C Humphreys and Dr R Salmon

Health information 21 indicators Used Not 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

Statistics Rate Age standardised Confidence intervals 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

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

About cancer & respiratory illness 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 Dr C Humphreys and Dr R Salmon

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

Deprivation Dr C Humphreys and Dr R Salmon

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

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

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

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

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

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

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

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

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

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

Dr C Humphreys and Dr R Salmon

Some context Dr C Humphreys and Dr R Salmon 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

Summary Dr C Humphreys and Dr R Salmon 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