1. 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

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 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

8. 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

9. 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

10. 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

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 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

25. 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